TY - JOUR
T1 - 24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program
T2 - The case of Brazil
AU - Bandi, Priti
AU - Chang, Virginia W.
AU - Sherman, Scott E.
AU - Silver, Diana
N1 - Funding Information:
This study was supported by American Cancer Society Intramural Research (to Dr. Bandi) and the College of Global Public Health , NYU (doctoral student funding to Dr. Bandi). The authors did not receive any other funding for this work.
Funding Information:
We would like to thank Dr. Pricila Mullachery for Dr. James Macinko for input on earlier drafts of this manuscript. This study was supported by American Cancer Society Intramural Research (to Dr. Bandi) and the College of Global Public Health, NYU (doctoral student funding to Dr. Bandi). The authors did not receive any other funding for this work.
Publisher Copyright:
© 2019
PY - 2020/2
Y1 - 2020/2
N2 - Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.
AB - Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.
KW - Disparities
KW - Inequalities
KW - Low- and middle-income countries
KW - Population programs
KW - Socioeconomic status
KW - Tobacco control
KW - Tobacco smoking
UR - http://www.scopus.com/inward/record.url?scp=85076700437&partnerID=8YFLogxK
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U2 - 10.1016/j.ypmed.2019.105957
DO - 10.1016/j.ypmed.2019.105957
M3 - Article
C2 - 31857097
AN - SCOPUS:85076700437
VL - 131
JO - Preventive Medicine
JF - Preventive Medicine
SN - 0091-7435
M1 - 105957
ER -