title: Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision.
abstract: The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.
authors.affiliation: Institut national d'études démographiques (Ined), 133 boulevard Davout, Paris 75020, France. khlat@ined.fr.
authors.forename: Myriam
authors.initials: M
authors.lastname: Khlat
authors.affiliation: Population Program, University of Colorado, Boulder, CO 80302, USA. fred.pampel@colorado.edu.
authors.forename: Fred
authors.initials: F
authors.lastname: Pampel
authors.affiliation: Institut national d'études démographiques (Ined), 133 boulevard Davout, Paris 75020, France. bricard@irdes.fr.|Institut de recherche et documentation en économie de la santé (Irdes), 117 bis rue Manin, Paris 75019, France. bricard@irdes.fr.
authors.forename: Damien
authors.initials: D
authors.lastname: Bricard
authors.affiliation: Institut national de la statistique et des études économiques (Insee), 6 Rue Legrand, Malakoff 92240, France. stephane.legleye@insee.fr.|Centre de recherche en épidémiologie et santé des populations (CESP), Faculté de médecine-Université Paris-Sud, Faculté de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif 94805, France. stephane.legleye@insee.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legleye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D004522:Educational Status; D005260:Female; D005602:France / Q000453:epidemiology; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D012907:Smoking / Q000191:economics / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: addiction; cigarette smoking; inequalities; public policy; social behavior