The Impact of Tobacco Control Policies on Smoking Among Socioeconomic Groups in Nine European Countries, 1990-2007.
BACKGROUND
It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries during the past two decades. This paper aims to investigate the impact of price and non-price related population-wide tobacco control policies on smoking by socioeconomic group in nine European countries between 1990 and 2007.


METHODS
Individual-level education, occupation and smoking status were obtained from nationally representative surveys. Country-level price-related tobacco control policies were measured by the relative price of cheapest cigarettes and of cigarettes in the most popular price category. Country-level non-price policies were measured by a summary score covering four policy domains: smoking bans or restrictions in public places and workplaces, bans on advertising and promotion, health warning labels, and cessation services. The associations between policies and smoking were explored using logistic regressions, stratified by education and occupation, and adjusted for age, Gross Domestic Product, period and country fixed effects.


RESULTS
The price of popular cigarettes and non-price policies were negatively associated with smoking among men. The price of the cheapest cigarettes was negatively associated with smoking among women. While these favorable effects were generally in the same direction for all socioeconomic groups, they were larger and statistically significant in lower socioeconomic groups only.


CONCLUSIONS
Tobacco control policies as implemented in nine European countries, have probably helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors. Policies with larger effects on lower socioeconomic groups are needed to reverse this trend.


CONCLUSIONS
Socioeconomic inequalities in smoking widened between the 1990s and the 2000s in Europe. During the same period, there were intensified tobacco control policies in many European countries. It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries. This study shows that tobacco control policies as implemented in the available European countries have helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors.
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Yannan
Y
Hu
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Frank J
FJ
van Lenthe
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland.
Stephen
S
Platt
Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Jizzo R
JR
Bosdriesz
Department of Public Health, University of Helsinki, Helsinki, Finland.
Eero
E
Lahelma
Sorbonne Universités, Université Pierre et Marie Curie (Paris 6), INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France.
Gwenn
G
Menvielle
Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
Enrique
E
Regidor
Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal.
Paula
P
Santana
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Rianne
R
de Gelder
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Johan P
JP
Mackenbach
D000328:Adult; D000368:Aged; D003132:Commerce / Q000191:economics; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000191:economics; D012907:Smoking / Q000191:economics* / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods; D000074606:Smoking Prevention / Q000191:economics* / Q000331:legislation & jurisprudence* / Q000379:methods; D012923:Social Class; D012959:Socioeconomic Factors; D062789:Tobacco Products / Q000191:economics; D000073869:Tobacco Smoking / Q000191:economics / Q000628:therapy