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

Abstract

Background Significant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran.MethodThis study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants.ResultsThe prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women.ConclusionInequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.

Determinants of cigarette smoking and smoking frequency among women of reproductive age in Nigeria: evidence from a nationwide cross-sectional survey

“…We found that while age 25-34 increased the odds of female cigarette smoking, age 15-24 reduced their likelihood of smoking daily. The findings of the current study are consistent with the evidence from previous studies [ 5 , 18 , 19 , 27 ], but differ from one study in which younger ages were predisposed to smoking [ 26 ]. As explained in a prior study, low prevalence among young women might be related to the effect of the ban on advertising and the increase in tobacco taxes [ 18 ].…”

“…Our finding of a low prevalence rate of cigarette smoking among women of reproductive age is consistent with evidence from Kenya, and a study of 42 low-and middle-income countries (LMICs) [ 9 , 18 ]. In contrast, relatively higher prevalence rates were found in other African countries, Eastern Europe, Latin America, and Southeast Asia [ 5 , 19 – 24 ]. The differing prevalence is related to the stage of the epidemic in each country [ 9 ].…”

“…Smoking prevalence rates among women were low in Sub-Saharan Africa, Eastern Mediterranean and East Asia regions (<10%), and relatively high in Eastern Europe, Latin America, and Southeast Asia (15%-21%) [ 19 ]. The prevalence rates ranged from 2 to 3 per cent in Senegal, Congo, Thailand, and China [ 20 , 21 ]; 5 to 7 per cent in Iran, Kazakhstan, and Pakistan [ 5 , 19 ]; and 12 to19 per cent in Iran, Mexico, South Africa, India, Brazil, United States of America, and Viet Nam [ 5 , 6 , 14 , 19 , 22 – 25 ].…”

“…On the determinants of cigarette smoking among women, evidence indicates that familial and partner influences [ 20 ], low income [ 4 , 5 , 7 , 9 , 21 , 22 , 26 , 27 ], low education [ 4 , 7 , 9 , 18 , 21 , 22 , 28 , 29 ], greater education [ 30 , 31 ], urban areas [ 5 , 7 , 21 ], rural areas [ 10 ], older age [ 5 , 18 , 19 , 27 ], younger age [ 26 ], being married [ 5 ], being formerly married (divorced/separated/widowed) [ 18 , 27 ], female-headed household [ 29 ], being employed [ 7 ], unemployment [ 4 ], perceiving distance as a problem in seeking healthcare [ 7 ], religion [ 27 ], severely food insecure women [ 32 ], depression and stress [ 26 ], narcissistic and impulsive personality traits [ 28 ], region heterogeneity [ 7 , 21 ], multiparity [ 4 ], television viewing [ 23 ], and intimate partner sexual violence [ 33 ] increased the likelihood of cigarette smoking among women of reproductive age.…”

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants

“…There are multiple smoking-related factors associated with women, which differ from those associated with men. Compared with men, women’s smoking is more sensitive to social environmental factors 9 10. These factors include wealth, urbanisation and economic determinants,11–13 as well as smoking prevalence, its acceptance and empowerment 6 7 14 15.…”