(online), with the title: Tracing the cigarette epidemic: An age-period-cohort study of education, gender and smoking using a pseudo-panel approach http://www.sciencedirect.com/science/article/pii/S0049089X14001033Tracing the cigarette epidemic: An age-period-cohort study of education, gender and smoking using a pseudopanel approach AbstractThis study examined if temporal variations in daily cigarette smoking and never-smoking among groups with different levels of education fit the pattern proposed by the theory of diffusion of innovations (TDI), while taking into account the separate effects of age, period and birth cohort (APC). Aggregated data from nationally representative interview surveys from Norway from 1976 to 2010 was used to calculate probabilities of smoking using an APC approach in which the period variable was normalized to pick up short term cyclical effects. Results showed that educational differences in smoking over time were more strongly determined by birth cohort membership than variations in smoking behavior across the life course. The probability of daily smoking decreased faster across cohorts among higher compared to lower educated. In contrast, the change in probability of never having smoked across cohorts was similar in the two education groups, but stronger among men compared to women. Moreover, educational differences in both daily and never-smoking increased among early cohorts and leveled off among late cohorts. The results emphasizes the importance of birth cohort for social change and are consistent with TDI, which posits that smoking behavior diffuse through the social structure over time.
Background: Most studies on perceived risks of smokeless tobacco products (SLT) have been conducted in the U.S., and the vast majority conclude that perceptions of the relative harmfulness of SLT versus cigarettes in the population are inconsistent with epidemiologically-based risk estimates, and typically conflated to that of cigarettes. We tested whether such inaccuracies also existed in Norway, where SLT-products are less toxic (Swedish snus) and SLT use is more prevalent than in the U.S. Methods: Over a 16 years period (2003–2018), 13,381 respondents (aged 16–79 years) answered questions about risk perceptions in Statistics Norway’s nationally representative survey of tobacco behavior. We applied an indirect measure of comparative harm where risk beliefs for eight nicotine products were assessed independently of other products and then compared the answers. The wording of the question was: “We will now mention a variety of nicotine products and ask you how harmful you think daily use of these are. Use a scale from 1 to 7, where 1 is slightly harmful and 7 is very harmful”. Mean scores with 95% confidence intervals were calculated. Results: The overall risk score for cigarettes was 6.48. The risk score for snus was 5.14–79.3% of the risk score of cigarettes. The relative risk scores for e-cigarettes (3.78) and NRT products (3.39) was 58.4% and 52.3% when compared to cigarettes. Perceptions of risk were stable over time. A strong association was observed between perceived risk of snus and having used snus in attempts to quit smoking. Conclusion: Perceptions of relative risk between snus and cigarettes is inconsistent with estimates from medical expert committees, which assess the overall health risk from use of Swedish snus to be minor when compared to the risk from smoking. Like the situation in the US, incorrect beliefs about SLT risks seem to be prevalent also in the snus-prevalent Norwegian setting. Accurate information on differential harms needs to be communicated. Future research should try to identify reasons why health authorities in the US and Scandinavia allow these well-documented misconceptions to persist.
AimsTo examine how the relative size of six groups of male ever snus users (current and former users of snus who were current, former or never cigarette smokers) varied over time in Norway, and how these groups differ with regard to important measures of tobacco behaviour.DesignRepeated cross‐sectional nationally representative surveys of tobacco use. The association between survey year and the six categories of ever snus use was examined using cross‐tabulation and multinomial logistic regression. Differences in tobacco behaviour across snus use categories were examined using logistic and ordinary least squares (OLS) regression.SettingNorway, 2003–15.ParticipantsA total of 2067 males aged 15–79 years.MeasurementsThe categories of ever snus use represented all six combinations of cigarette smoking (current, former or never) among current and former users of snus. The variables measuring tobacco behaviour were: order of product uptake (snus or cigarettes first), mean cigarette consumption, reduction from daily to occasional smoking, intention to quit cigarettes, future smoking identity and use of snus in latest quit attempt.FindingsDuring the period 2003–15, the relative share of current snus users who had never smoked, and current snus users who were former smokers, increased. The share of dual users, and smokers who were former snus users, decreased. Among men who reported life‐time experience with both products, a large majority had initiated their tobacco use with cigarettes. The average number of cigarettes smoked weekly was lower among dual users compared with current smokers who were former snus users or had never used snus.ConclusionsDuring the period 2003–15 in Norway, which has a mature snus market, even though smoking has declined and the relative size of the category of never‐smokers among male users of snus has increased, the majority of snus users are still former or current smokers.
Objectives. The aim was (1) to investigate the association between education and smoking status (current, former and never-smoking) among non-western immigrants in Norway and (2) examine if these associations fit the pattern predicted by the model of the cigarette epidemic.Design. Data came from the Oslo Health Study and the Oslo Immigrant Health study (2000–2002). The first included all Oslo citizens from seven selected birth cohorts. The second included all Oslo citizens born in Turkey, Iran, Pakistan, Vietnam and Sri Lanka. 14,768 respondents answered questions on smoking, education and relevant background variables (over-all response rate 43.3%). Two gender specific multinomial logistic regression models with smoking status [current, former or never-smoker (reference)] as dependent variable were computed and predicted probabilities of smoking status among groups with different levels of education were calculated.Results. Smoking prevalence among men ranged from 19% among Sri Lankans to 56% among Turks. Compared to the smoking prevalence among Norwegian men (27%), smoking was widespread among Iranians (42%) and Vietnamese (36%). Higher education was associated with lower probability of current smoking among all male immigrant groups except Sri Lankans. Never having smoked was positively associated with education among Pakistani and Norwegian men. Among women, < 5% smoked among Pakistanis, Vietnamese and Sri Lankans. Smoking prevalence among Turkish (28%) and Iranian (23%) women were comparable to Norwegian women (30%). The probability of smoking among Turkish and Iranian women with secondary education was higher than for other levels of education. The probability of being a never-smoker was high among Turkish and Iranian women with primary education.Conclusions. High smoking prevalence among Turkish and Iranian men highlights the importance of addressing smoking behaviour in subgroups of the general population. Smoking was almost non-existent among Pakistani, Vietnamese and Sri Lankan women and indicates strong persistent social norms against smoking.
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