The European Journal of Public Health Advance Access published online on April 2, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm030
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Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia
Mall Leinsalu1,2, Mare Tekkel2 and Anton E. Kunst3
1 Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University College, Huddinge, Sweden
2 Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia, Estonian Centre of Excellence in Behavioral and Health Sciences, Tartu-Tallinn, Estonia
3 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
Correspondence: Mall Leinsalu, Stockholm Centre on Health of Societies in Transition, Södertörn University College, 14189 Huddinge, Sweden, tel: +46 8 608 4561; fax: +46 8 608 4030, e-mail: mall.leinsalu{at}sh.se
Received November 7, 2006 , accepted March 5, 2007
Background: To study the association of socioeconomic and demographic indicators with ever initiating regular smoking and quitting smoking among ever regular smokers in Estonia in order to identify target groups for equity-oriented tobacco control policies. Methods: Data for 4277 individuals in the 25–64 age group come from three cross-sectional studies conducted in 2000, 2002 and 2004. Age-standardized prevalence rates and odds ratios with 95% confidence intervals were calculated. Results: High rates of ever initiation were observed for lower educated men and women after controlling for other socioeconomic indicators. This association was not observed for women above age 50. Independent, although weaker associations were found among men who were unemployed or with a low occupational status. Low cessation rates were observed among men who were unemployed, who had a lower occupational position or who had a low income. These associations remained after controlling for other socioeconomic variables. The effect of income became stronger in the older age groups among men. Rates of ever initiation and cessation also varied strongly in relationship to some demographic variables. The highest initiation rates were found among divorced women and among women living in the capital city. The lowest cessation rates were found among divorced women, and among Russian men. Conclusions: While educational level was the strongest predictor of ever initiating regular smoking, smoking cessation was related more directly to aspects of social disadvantage originating in adult life. To be effective, tobacco control interventions should not only target lower educated, but also those in material disadvantage.
Keywords: Estonia, ever regular smoking, smoking cessation
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