title: Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study.
abstract: BACKGROUND
  The Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES). Financial strain can affect smoking behaviour. This study examines socioeconomic inequalities in current smoking and smoking cessation in The Netherlands before and during the Global Financial Crisis (GFC).
  
  
  METHODS
  Participants were 66,960 Dutch adults (≥ 18 years) who took part in the annual national Health Survey (2004-2011). Period was dichotomised: 'pre-' and 'during-GFC'. SES measures used were income, education and neighbourhood deprivation. Outcomes were current smoking rates (smokers/total population) and smoking cessation ratios (former smokers/ever smokers). Multilevel logistic regression models controlled for individual characteristics and tested for interaction between period and SES.
  
  
  RESULTS
  In both periods, high SES respondents (in all indicators) had lower current smoking levels and higher cessation ratios than those of middle or low SES. Inequalities in current smoking increased significantly in poorly educated adults of 45-64 years of age (Odds Ratio (OR) low educational level compared with high: 2.00[1.79-2.23] compared to pre-GFC 1.67[1.50-1.86], p for interaction = 0.02). Smoking cessation inequalities by income in 18-30 year olds increased with borderline significance during the GFC (OR low income compared to high income: 0.73[0.58-0.91]) compared to pre-GFC (OR: 0.98[0.80-1.20]), p for interaction = 0.051).
  
  
  CONCLUSIONS
  Overall, socioeconomic inequalities in current smoking and smoking cessation were unchanged during the GFC. However, current smoking inequalities by education, and smoking cessation inequalities by income, increased in specific age groups. Increased financial strain caused by the crisis may disproportionately affect smoking behaviour in some disadvantaged groups.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. f.e.benson@amc.uva.nl.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Benson
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. m.a.kuipers@amc.uva.nl.
authors.forename: Mirte A G
authors.initials: MA
authors.lastname: Kuipers
authors.affiliation: Department of Public Health and First Line Medicine, LUMC, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. v.nierkens@lumc.nl.
authors.forename: Vera
authors.initials: V
authors.lastname: Nierkens
authors.affiliation: Statistics Netherlands, CBS-weg 11, 6412, EX, Heerlen, The Netherlands. jw.bruggink@cbs.nl.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Bruggink
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. k.stronks@amc.uva.nl.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. a.kunst@amc.uva.nl.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011203:Poverty; D012111:Residence Characteristics; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult