Gender, economics and culture: diversity and the international evolution of smoking prevalence

How community-level social and economic developments have changed the patterns of substance use in a transition economy?

Most social changes take place at the community level before indirectly affecting individuals. Although the contextual effect is far-reaching, few studies have investigated the important questions of: how do community-level developments affect drinking and smoking, and how do they change the existing gender and income patterns of drinking and smoking, particularly in transition economies? In this study, I used a Chinese panel dataset between 1991 and 2011 to reveal the moderating effects of community developments. Through multilevel growth curve modeling that controls for age, period, and cohort effects, as well as individual- and community-level covariates, I found that community-level economic development and social development are negatively associated with drinking and smoking. Moreover, economic and social developments also moderate the important influences of income and gender: women start to drink more in communities with higher economic development; the traditionally positive association between income and smoking/drinking is also reversed, i.e. the rich start to smoke and drink less in communities with higher social development. This study concludes that the rapid changes in communal social and economic structures have created new health disparities based on the gender and socioeconomic hierarchy.

Chinese smokers' behavioral response toward cigarette price: individual and regional correlates

Background

Many studies have explored smokers’ behavioral response to cigarette prices at the individual level, but none have factored in regional variation and determinants. This study addresses these research gaps in the Chinese context.

Methods

A cross-sectional multistage sampling process was used to recruit participants in 21 cities in China. Individual-level information was collected using standardized questionnaires. City-level variables were retrieved from a nationall database. Multilevel logistic regression analysis was used to assess price sensitivity variation at both individual and city levels.

Results

Among 5660 current smokers, 5.9 % used non-self-paying cigarettes, 32.8 % purchased cigarettes in cartons, and 5.2 % decreased their smoking expenditure due to price. Multilevel analysis showed that individual demographic and smoking expenditure characteristics and regional smoking restrictions in work places, cigarette production, and media news coverage are associated with price sensitivity.

Conclusions

This study adds substantially to the understanding of Chinese smokers’ behavioral responses to cigarette prices. Increasing smoker sensitivity to cigarette prices will require stronger tobacco control and public education campaigns.

Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

BACKGROUND

In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world.

METHODS

We used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region.

RESULTS

In Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia.

CONCLUSIONS

A positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.