title: Smoking in context - a multilevel approach to smoking among females in Helsinki.
abstract: BACKGROUND
  Smoking is associated with disadvantage. As people with lower social status reside in less privileged areas, the extent of contextual influences for smoking remains unclear. The aims were to examine the spatial patterning of daily smoking within the city of Helsinki, to analyse whether contextual variation can be observed and which spatial factors associate with current daily smoking in the employed female population.
  
  
  METHODS
  Data from a cross-sectional questionnaire were collected for municipal employees of Helsinki (aged 40-60 years). The response rate was 69%. As almost 4/5 of the employees are females, the analyses were restricted to women (n = 5028). Measures included smoking status, individual level socio-demographic characteristics (age, occupational social class, education, family type) and statistical data describing areas in terms of social structure (unemployment rate, proportion of manual workers) and social cohesion (proportions of single parents and single households). Logistic multilevel analysis was used to analyse data.
  
  
  RESULTS
  After adjusting for the individual-level composition, smoking was significantly more prevalent according to all social structural and social cohesion indicators apart from the proportion of manual workers. For example, high unemployment in the area of domicile increased the risk of smoking by almost a half. The largest observed area difference in smoking - 8 percentage points - was found according to the proportion of single households.
  
  
  CONCLUSIONS
  The large variation in smoking rates between areas appears mainly to result from variation in the characteristics of residents within areas. Yet, living in an area with a high level of unemployment appears to be an additional risk for smoking that cannot be fully accounted for by individual level characteristics even in a cohort of female municipal employees.
authors.affiliation: STAKES, National Research and Development Centre for Welfare and Health, Box 220, 00531 Helsinki, Finland. sakari.karvonen@stakes.fi
authors.forename: Sakari
authors.initials: S
authors.lastname: Karvonen
authors.forename: Petteri
authors.initials: P
authors.lastname: Sipilä
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen
authors.forename: Mikko
authors.initials: M
authors.lastname: Laaksonen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009790:Occupations; D015995:Prevalence; D012907:Smoking / Q000191:economics / Q000453:epidemiology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014478:Unemployment