Understanding the relationship between socioeconomic status, smoking cessation services provided by the health system and smoking cessation behavior in Brazil

Szklo, André Salem; Thrasher, James F.; Perez, Consuelo M.; Figueiredo, Valeska Carvalho; Fong, Geoffrey T.; Almeida, Liz Maria de

doi:10.1590/s0102-311x2013000300007

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…However, differently from what we observed in Brazil, some of these studies found an increase over time in the proportion of highly dependent smokers among individuals that experience greater difficulties in accessing health services,6 10 24 that is, low-income and low-educational level smokers. These findings suggest that the broad set of legislative, healthcare, educational and economic interventions implemented in Brazil in the past years aimed at promoting smoking cessation/reducing initiation likely reached different population subgroups with the same level of effectiveness 4.…”

Section: Discussioncontrasting

confidence: 92%

“…Measures of nicotine dependence (ie, cigarette smoking prevalence, recent quitting attempts, proportion of daily smokers, proportion of recent daily smokers, years of daily smoking, proportion of heavy smokers, passive smoking among light smokers, passive smoking among heavy smokers, and cessation rate) were stratified by gender and educational level (or area of residence), as one would expect lower cessation rates among underprivileged smokers who tend to have less access to treatment and communication strategies 3 10 24. We also estimated measures of nicotine dependence stratified by gender and age-group, as the optimistic bias among younger people, compared to older smokers, may have produced a differential effect of stronger tobacco control implemented in Brazil 25–27.…”

Section: Methodsmentioning

confidence: 99%

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Smokers in Brazil: who are they?

Szklo¹,

Souza

Szklo

et al. 2015

Tob Control

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Section: Discussioncontrasting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Smokers in Brazil: who are they?

Szklo¹,

Souza

Szklo

et al. 2015

Tob Control

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“…Studies from Brazil and other countries found an increase in the rate of habitual and hazardous alcohol consumption in the last decade [31, 32], with a more dramatic increase in women [33]. Although alcohol consumption is increasing among females, the results of this study show that HED is 3 times higher in males, a finding that is consistent with the literature [32, 33].…”

Section: Discussionsupporting

confidence: 90%

“…Prevalence rates are still lower in the capitals of Brazilian states [27], totaling 11 % of the population aged 18-64 years. However, inequalities persist indicating the need to improve health services to support smoking cessation [31], especially for the population with low educational levels, precisely those assisted by the public health system.…”

Section: Discussionmentioning

confidence: 99%

Social inequalities in health behaviors among Brazilian adults: National Health Survey, 2013

Barros

Lima

Medina

et al. 2016

Int J Equity Health

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BackgroundConsidering the high socioeconomic inequalities prevailing in Brazil and lifestyle as a strong determinant of morbidity and premature mortality, our purpose was to evaluate the degree of socioeconomic disparities in the prevalence of health behaviors among Brazilian adult population using data from the 2013 Brazilian National Health Survey.MethodBased on a sample of 49,025 individuals aged 20 to 59 years, we estimated the prevalence of several health behaviors and a score of unhealthy behaviors according to gender, education, race/color and possession of private health insurance. The prevalence ratios adjusted by age and gender were estimated by means of multiple Poisson regression and the analyses took into account the sampling design.ResultsSignificant social inequalities were identified in the Brazilian adults. Higher prevalence of current smoking, leisure-time physical inactivity, sedentary lifestyle, whole milk consumption and low ingestion of greens, vegetables, and fruits were observed among the less educated, in the non-white population, and among those without private health insurance. Higher prevalence of heavy episodic drinking was found in the non-white population, but no difference in the consumption of fatty meat was found according to skin color. Score of unhealthy behavior higher than 6 was more frequent in lower educational strata (PR = 3.74) in the non-white population (PR = 1.39) and among those without private health insurance (PR = 1.78). Compared to women, men had higher prevalence rates of smoking, hazardous alcohol consumption, and fatty meat consumption and lower consumption of greens, vegetables and fruits.ConclusionThe results of the study emphasize the importance of monitoring social inequalities in health as part of national health policies and the urgent need to prioritize actions to promote healthy behaviors, especially among the most socially vulnerable segments of society.

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“…International Tobacco Control (ITC) survey data from Bangladesh, Brazil, Malaysia, and Thailand found no association between cessation and education or income [35–37]. However, the ITC Brazil survey did find greater likelihood of cessation attempts among high SES smokers who received physician advice to quit compared to low-SES smokers [36]. Similarly, successful quitting has been found to be associated with higher SES in Hong Kong [38], Vietnam [39], Indonesia [39], Malaysia and Thailand [40], China [41] and India [42].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

et al. 2019

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Introduction Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Methods Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008–2011) and the International Tobacco Control Surveys (2009–2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Results Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Conclusion Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

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Understanding the relationship between socioeconomic status, smoking cessation services provided by the health system and smoking cessation behavior in Brazil

Cited by 11 publications

References 15 publications

Smokers in Brazil: who are they?

Smokers in Brazil: who are they?

Social inequalities in health behaviors among Brazilian adults: National Health Survey, 2013

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

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