Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

Abstract

BackgroundIn Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world.MethodsWe used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region.ResultsIn Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia.ConclusionsA positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries

“…These pro-poor disparities could be explained by increasing social acceptability of smoking among younger women, growing empowerment of women and economic independence of women in these regions 42. Bosdriesz et al 21 have also reported that strong negative gradients existed among men and women in South-east Asian countries which is similar to our results. Studies by Harper and McKinnon22 and Hosseinpoor et al 23 have reported that smoking inequalities were pro-rich in most countries while pro-poor in some European countries (among women), also similar to our results.…”

“…In our study, aggregate educational inequalities were highest in LICs and lowest among uMIC. However, Bosdriesz et al 21 argued that there was a positive educational gradient among older women and a negative gradient among younger women of Europe and Central Asian countries. These pro-poor disparities could be explained by increasing social acceptability of smoking among younger women, growing empowerment of women and economic independence of women in these regions 42.…”

Socioeconomic Inequalities in Tobacco Smoking in Women Aged 15-54 in Iran: A multilevel model

“…[9] Studies have shown that women who use tobacco are at higher risk of various types of cancers, chronic obstructive pulmonary diseases, and the birth of neonates with a genetic defect. [10] Studies have shown that people with a lower socioeconomic status and lower levels of education are more likely to smoke [11][12][13] , so that the prevalence of smoking in high socioeconomic groups is declining and this decline has led to inequality in the prevalence of tobacco smoking in various social economic classes. [14] There has been significant evidence of a reciprocal relationship between the economic situation and tobacco smoking, also international studies have shown that social and economic inequalities in tobacco smoking is stronger for women compared to men.…”

Evaluación de la dependencia física y psicológica al tabaco en fumadores mexicanos adultos, Encodat 2016

“…Este hallazgo es inesperado según lo que se conoce sobre consumo de tabaco y dependencia. 50,51 Finalmente, sólo en el análisis bivariado se encontró asociación entre violencia y dependencia psicológica en fumadores ocasionales. Estudios reportan que las mujeres que experimentaron violencia de pareja tienen más probabilidad de fumar antes del embarazo 52 y que la violencia de vecindario se relaciona con mayor intensidad del consumo de tabaco y menos intentos de abandono.…”