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SMOKING AND SMOKING CESSATION IN A HEALTH EQUITY PERSPECTIVE IN SWEDEN – AN EPIDEMIOLOGICAL STUDY IN THE ADULT POPULATION

Moussa, Kontie LU (2009) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2009:105.
Abstract
The widening inequalities in smoking are one of the growing public health challenges in western countries, where smoking and smoking cessation patterns are unequally distributed among the populations. Inequalities in smoking and smoking cessation are closely associated with factors such as socioeconomic status, psychosocial and cultural factors. In Sweden, individuals with low socioeconomic status, low social capital, and immigrants have been reported to smoke more, to stop smoking to a lesser extent, and to have higher risks of exposure to environmental tobacco smoke (ETS) compared to their counterparts.



The overall aim of this thesis has been to assess the impact of socioeconomic and demographic factors on smoking and... (More)
The widening inequalities in smoking are one of the growing public health challenges in western countries, where smoking and smoking cessation patterns are unequally distributed among the populations. Inequalities in smoking and smoking cessation are closely associated with factors such as socioeconomic status, psychosocial and cultural factors. In Sweden, individuals with low socioeconomic status, low social capital, and immigrants have been reported to smoke more, to stop smoking to a lesser extent, and to have higher risks of exposure to environmental tobacco smoke (ETS) compared to their counterparts.



The overall aim of this thesis has been to assess the impact of socioeconomic and demographic factors on smoking and smoking cessation in order to fill knowledge gaps for future policy formulation and implementation of effective measures to decrease tobacco smoking at the population level, as well as to decrease the socially inequitable distribution of smoking.



The study populations of this thesis are based on data from the Medical Birth Registry (MBR) in Sweden (Studies I & II), the Scania Public Health Survey (SPHS) 2000, Study III), and the Scania Public Health Cohort (SPHC) 2000–2005 (Study IV). In Study I, registry data indicating educational level and smoking status at the first antenatal visit in all pregnancies from 1982 to 2001 was analysed to assess the impact of educational level on smoking during pregnancy. In Study II, immigrant pregnant women were selected from the same population as Study I in order to investigate whether smoking among pregnant immigrant women in Sweden follows the epidemic model in the women’s countries of origin. For both studies, prevalences, odds ratios based on prevalences and total attributable fractions were compared for five-year intervals. In Study III, vocationally active individuals between the ages of 18 and 65 were selected from SPHS 2000 to assess the association between sociodemographic factors and exposure to ETS. This association was measured by means of logistic regression analysis. Study IV followed up baseline smokers for five years to assess the impact of social capital on smoking cessation. Cox’s proportional hazard regression was used to measure this association.



Overall, smoking prevalence declined dramatically in absolute terms, but in relative terms inequalities in smoking increased between pregnant women with different educational attainment regardless of country of origin. Similarly, the exposure to environmental tobacco smoke has been shown to be concentrated among people with low socioeconomic status. Moreover, low education and low trust have been shown to act as independent factors influencing smoking cessation. Further, a low level of social participation acts synergistically with low education in preventing smoking cessation.



Total attributable fraction has been suggested as an appropriate measure of inequalities and preferably could be used in policy making. To tackle increasing inequalities in smoking, integrative policies in tobacco control ought to consider investing in low socioeconomic groups rather than cultural patterns, where there exists less likelihood of stopping smoking and a higher risk of ETS exposure. Including aspects of social capital in smoking cessation may also benefit the overall tobacco control policies. (Less)
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author
supervisor
opponent
  • Professor Gilljam, Hans, Karolinska institutet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Environmental tobacco smoke, Immigrant women, Smoking trends, Smoking and pregnancy, Inequalities in health, Attributable fraction, Educational inequality, Workplace exposure, Passive smoking, Smoking epidemic, Socioeconomic status, Sweden.
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2009:105
pages
138 pages
publisher
Department of Clinical Sciences, Lund University
defense location
OSCE-hallen, CRC, Entrance 72, Malmö
defense date
2009-10-23 09:00
ISSN
1652-8220
ISBN
978-91-86253-93-6
language
English
LU publication?
yes
id
b2267cda-07a6-4f31-a227-1c05c856c0ed (old id 1481064)
date added to LUP
2009-10-12 11:35:21
date last changed
2016-09-19 08:44:46
@phdthesis{b2267cda-07a6-4f31-a227-1c05c856c0ed,
  abstract     = {The widening inequalities in smoking are one of the growing public health challenges in western countries, where smoking and smoking cessation patterns are unequally distributed among the populations. Inequalities in smoking and smoking cessation are closely associated with factors such as socioeconomic status, psychosocial and cultural factors. In Sweden, individuals with low socioeconomic status, low social capital, and immigrants have been reported to smoke more, to stop smoking to a lesser extent, and to have higher risks of exposure to environmental tobacco smoke (ETS) compared to their counterparts. <br/><br>
<br/><br>
The overall aim of this thesis has been to assess the impact of socioeconomic and demographic factors on smoking and smoking cessation in order to fill knowledge gaps for future policy formulation and implementation of effective measures to decrease tobacco smoking at the population level, as well as to decrease the socially inequitable distribution of smoking. <br/><br>
<br/><br>
The study populations of this thesis are based on data from the Medical Birth Registry (MBR) in Sweden (Studies I &amp; II), the Scania Public Health Survey (SPHS) 2000, Study III), and the Scania Public Health Cohort (SPHC) 2000–2005 (Study IV). In Study I, registry data indicating educational level and smoking status at the first antenatal visit in all pregnancies from 1982 to 2001 was analysed to assess the impact of educational level on smoking during pregnancy. In Study II, immigrant pregnant women were selected from the same population as Study I in order to investigate whether smoking among pregnant immigrant women in Sweden follows the epidemic model in the women’s countries of origin. For both studies, prevalences, odds ratios based on prevalences and total attributable fractions were compared for five-year intervals. In Study III, vocationally active individuals between the ages of 18 and 65 were selected from SPHS 2000 to assess the association between sociodemographic factors and exposure to ETS. This association was measured by means of logistic regression analysis. Study IV followed up baseline smokers for five years to assess the impact of social capital on smoking cessation. Cox’s proportional hazard regression was used to measure this association.<br/><br>
<br/><br>
Overall, smoking prevalence declined dramatically in absolute terms, but in relative terms inequalities in smoking increased between pregnant women with different educational attainment regardless of country of origin. Similarly, the exposure to environmental tobacco smoke has been shown to be concentrated among people with low socioeconomic status. Moreover, low education and low trust have been shown to act as independent factors influencing smoking cessation. Further, a low level of social participation acts synergistically with low education in preventing smoking cessation. <br/><br>
<br/><br>
Total attributable fraction has been suggested as an appropriate measure of inequalities and preferably could be used in policy making. To tackle increasing inequalities in smoking, integrative policies in tobacco control ought to consider investing in low socioeconomic groups rather than cultural patterns, where there exists less likelihood of stopping smoking and a higher risk of ETS exposure. Including aspects of social capital in smoking cessation may also benefit the overall tobacco control policies.},
  author       = {Moussa, Kontie},
  isbn         = {978-91-86253-93-6},
  issn         = {1652-8220},
  keyword      = {Environmental tobacco smoke,Immigrant women,Smoking trends,Smoking and pregnancy,Inequalities in health,Attributable fraction,Educational inequality,Workplace exposure,Passive smoking,Smoking epidemic,Socioeconomic status,Sweden.},
  language     = {eng},
  pages        = {138},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {SMOKING AND SMOKING CESSATION IN A HEALTH EQUITY PERSPECTIVE IN SWEDEN – AN EPIDEMIOLOGICAL STUDY IN THE ADULT POPULATION},
  volume       = {2009:105},
  year         = {2009},
}