Keywords
Inequality, tobacco smoking, socioeconomic status, women, Iran
Abstract
Significant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran. This study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants. The prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women. Inequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.
References
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[33] Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grötvedt L, Helmert U, et al. Educational differences in smoking: international comparison. Bmj 2000;320:1102-7.
[34] Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, et al. Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. Journal of Epidemiology & Community Health 2005;59:395-401.
[35] Kunst A. Describing socioeconomic inequalities in health in European countries: an overview of recent studies. Revue d'epidemiologie et de sante publique 2007;55:3-11.
[36] Pampel FC, Denney JT. Cross-national sources of health inequality: education and tobacco use in the World Health Survey. Demography 2011;48:653-74.
[37] Zhou J, Yang Y, Qiu X, Yang X, Pan H, Ban B, et al. Relationship between anxiety and burnout among Chinese physicians: a moderated mediation model. PloS one 2016;11:e0157013.
[38] Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN, Singh PK. Socioeconomic inequality in the prevalence of smoking and smokeless tobacco use in India. Asian Pacific Journal of Cancer Prevention 2013;14:6965-9.
[39] Hosseinpoor AR, Parker LA, d'Espaignet ET, Chatterji S. Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey. PloS one 2012;7:e42843.
[40] De Vries H. Socio-economic differences in smoking: Dutch adolescents' beliefs and behaviour. Social Science & Medicine 1995;41:419-24.
[41] Koivusilta LK, Rimpelä AH, Kautiainen SM. Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position? BMC Public health 2006;6:110.
[42] Fukuda Y, Nakamura K, Takano T. Socioeconomic pattern of smoking in Japan: income inequality and gender and age differences. Annals of epidemiology 2005;15:365-72.
[43] Johnson NW, Warnakulasuriya S, Gupta P, Dimba E, Chindia M, Otoh E, et al. Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Advances in dental research 2011;23:237-46.
[44] Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European Union: comparing education and income. Preventive medicine 2005;40:756-64.
[45] Sarkar BK, Arora M, Gupta VK, Reddy KS. Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India. Asian Pacific Journal of Cancer Prevention 2013;14:1931-5.
[46] Eek F, Östergren P-O, Diderichsen F, Rasmussen NK, Andersen I, Moussa K, et al. Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies. BMC Public Health 2010;10:9.
[47] Siahpush M, Borland R, Taylor J, Singh GK, Ansari Z, Serraglio A. The association of smoking with perception of income inequality, relative material well-being, and social capital. Social science & medicine 2006;63:2801-12.
[48] Corsi DJ, Subramanian S, Lear SA, Teo KK, Boyle MH, Raju PK, et al. Tobacco use, smoking quit rates, and socioeconomic patterning among men and women: a cross-sectional survey in rural Andhra Pradesh, India. European journal of preventive cardiology 2014;21:1308-18.
[49] Ding D, Gebel K, Oldenburg BF, Wan X, Zhong X, Novotny TE. An early-stage epidemic: a systematic review of correlates of smoking among Chinese women. International journal of behavioral medicine 2014;21:653-61.
[50] Yang G, Fan L, Tan J, Qi G, Zhang Y, Samet JM, et al. Smoking in China: findings of the 1996 national prevalence survey. Jama 1999;282:1247-53.
[51] Kunst A, Giskes K, Mackenbach J. Socio-economic inequalities in smoking in the european union: applying an equity lens to tobacco control policies: for the EU network on interventions to reduce socio-economic inequalities in health: Erasmus Medical Center Rotterdam; 2004.
[52] Van Bui T, Blizzard CL, Luong KN, Le Van Truong N, Tran BQ, Otahal P, et al. Physical activity in Vietnam: estimates and measurement issues. PloS one 2015;10:e0140941.
[2] Chen Z, Peto R, Zhou M, Iona A, Smith M, Yang L, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. The Lancet 2015;386:1447-56.
[3] Khazaei Z, Tosang MA, Zadeh SZM, Khazaei S, Goodarzi E, Asadi ZS. Prevalence of risky behaviors and related factors among students of Dezful University of Medical Sciences in 2014. Iranian Journal of Psychiatry 2017;12:188.
[4] Barik A, Rai RK, Gorain A, Majumdar S, Chowdhury A. Socio-economic disparities in tobacco consumption in rural India: evidence from a health and demographic surveillance system. Perspectives in Public Health 2016;136:278-87.
[5] Organization WH. WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship: World Health Organization; 2013.
[6] Pirdehghan A, Vakili M, Arab M, Aghakoochak A. Smoking frequency and modeling the underlying predicting factors of tobacco smoking among high school students in Yazd city, 2012. Journal of Shahrekord Uuniversity of Medical Sciences 2014;16.
[7] Naurath N, Jones J. Smoking Rates around the World-How Do Americans Compare. Gallup News Service 2007.
[8] Jafarabadi MA, Allahverdipour H, Bashirian S, Jannati A. Modeling the underlying predicting factors of tobacco smoking among adolescents. Iranian journal of public health 2012;41:46.
[9] Kulkarni N, Shilpa K, Naik VA, Mallapur M. Epidemiological correlates of tobacco consumption among women in reproductive age group-a community based cross sectional study in the rural area of Belgaum District, Karnataka, South India. International Journal Of Community Medicine And Public Health 2016;3:3161-5.
[10] Bosdriesz JR, Mehmedovic S, Witvliet MI, Kunst AE. Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women? International journal for equity in health 2014;13:14.
[11] Kiyohara C, Ohno Y. Sex differences in lung cancer susceptibility: a review. Gender medicine 2010;7:381-401.
[12] Schaefer DR, Haas SA, Bishop NJ. A dynamic model of US adolescents’ smoking and friendship networks. American Journal of Public Health 2012;102:e12-e8.
[13] Schnohr CW, Kreiner S, Rasmussen M, Due P, Diderichsen F. School-related mediators in social inequalities in smoking: a comparative cross-sectional study of 20,399 adolescents. International journal for equity in health 2009;8:17.
[14] Harper S, McKinnon B. Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the World Health Surveys. Cancer Causes & Control 2012;23:11-25.
[15] Doku D, Koivusilta L, Rainio S, Rimpelä A. Socioeconomic differences in smoking among Finnish adolescents from 1977 to 2007. Journal of Adolescent Health 2010;47:479-87.
[16] Moor I, Rathmann K, Lenzi M, Pförtner T-K, Nagelhout GE, de Looze M, et al. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. The European Journal of Public Health 2015;25:457-63.
[17] Palipudi KM, Gupta PC, Sinha DN, Andes LJ, Asma S, McAfee T, et al. Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey. PloS one 2012;7:e33466.
[18] Tchicaya A, Lorentz N, Demarest S. Socioeconomic inequalities in smoking and smoking cessation due to a smoking ban: general population-based cross-sectional study in Luxembourg. PloS one 2016;11:e0153966.
[19] Kuipers MA, Monshouwer K, van Laar M, Kunst AE. Tobacco control and socioeconomic inequalities in adolescent smoking in Europe. American journal of preventive medicine 2015;49:e64-e72.
[20] Friel S, Bell R, Houweling T, Marmot M. Calling all Don Quixotes and Sancho Panzas: achieving the dream of global health equity through practical action on the social determinants of health. Global health promotion 2009;16:09-13.
[21] Tabuchi T, Kondo N. Educational inequalities in smoking among Japanese adults aged 25–94 years: Nationally representative sex-and age-specific statistics. Journal of epidemiology 2017;27:186-92.
[22] Moser CA, Kalton G. Survey methods in social investigation: Routledge; 2017.
[23] Monteiro CA, Conde WL, Matsudo SM, Matsudo VR, Bonseñor IM, Lotufo PA. A descriptive epidemiology of leisure-time physical activity in Brazil, 1996-1997. Revista Panamericana de Salud Publica 2003;14:246-54.
[24] O'donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation: The World Bank; 2007.
[25] Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A. Decomposition of inequity determinants of healthcare utilization, Iran. Public health 2013;127:661-7.
[26] Moradi G, Mohammad K, Majdzadeh R, Ardakani HM, Naieni KH. Socioeconomic inequality of non-communicable risk factors among people living in Kurdistan Province, Islamic Republic of Iran. International journal of preventive medicine 2013;4:671.
[27] Hosseinpoor AR, Mohammad K, Majdzadeh R, Naghavi M, Abolhassani F, Sousa A, et al. Socioeconomic inequality in infant mortality in Iran and across its provinces. Bulletin of the World Health Organization 2005;83:837-44.
[28] Moradi G, Moinafshar A, Adabi H, Sharafi M, Mostafavi F, Bolbanabad AM. Socioeconomic inequalities in the oral health of people aged 15-40 years in Kurdistan, Iran in 2015: a cross-sectional study. Journal of Preventive Medicine and Public Health 2017;50:303.
[29] Moradi G, Majdzadeh R, Mohammad K, Malekafzali H, Jafari S, Holakouie-Naieni K. Is the status of diabetes socioeconomic inequality changing in Kurdistan province, west of Iran? A comparison of two surveys. Medical journal of the Islamic Republic of Iran 2016;30:375.
[30] Hox JJ, Moerbeek M, Van de Schoot R. Multilevel analysis: Techniques and applications: Routledge; 2017.
[31] Goldstein H. Multilevel statistical models: John Wiley & Sons; 2011.
[32] Hox J. Multilevel analysis: Techniques and applications. Routledge. New York 2010.
[33] Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grötvedt L, Helmert U, et al. Educational differences in smoking: international comparison. Bmj 2000;320:1102-7.
[34] Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, et al. Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. Journal of Epidemiology & Community Health 2005;59:395-401.
[35] Kunst A. Describing socioeconomic inequalities in health in European countries: an overview of recent studies. Revue d'epidemiologie et de sante publique 2007;55:3-11.
[36] Pampel FC, Denney JT. Cross-national sources of health inequality: education and tobacco use in the World Health Survey. Demography 2011;48:653-74.
[37] Zhou J, Yang Y, Qiu X, Yang X, Pan H, Ban B, et al. Relationship between anxiety and burnout among Chinese physicians: a moderated mediation model. PloS one 2016;11:e0157013.
[38] Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN, Singh PK. Socioeconomic inequality in the prevalence of smoking and smokeless tobacco use in India. Asian Pacific Journal of Cancer Prevention 2013;14:6965-9.
[39] Hosseinpoor AR, Parker LA, d'Espaignet ET, Chatterji S. Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey. PloS one 2012;7:e42843.
[40] De Vries H. Socio-economic differences in smoking: Dutch adolescents' beliefs and behaviour. Social Science & Medicine 1995;41:419-24.
[41] Koivusilta LK, Rimpelä AH, Kautiainen SM. Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position? BMC Public health 2006;6:110.
[42] Fukuda Y, Nakamura K, Takano T. Socioeconomic pattern of smoking in Japan: income inequality and gender and age differences. Annals of epidemiology 2005;15:365-72.
[43] Johnson NW, Warnakulasuriya S, Gupta P, Dimba E, Chindia M, Otoh E, et al. Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Advances in dental research 2011;23:237-46.
[44] Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European Union: comparing education and income. Preventive medicine 2005;40:756-64.
[45] Sarkar BK, Arora M, Gupta VK, Reddy KS. Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India. Asian Pacific Journal of Cancer Prevention 2013;14:1931-5.
[46] Eek F, Östergren P-O, Diderichsen F, Rasmussen NK, Andersen I, Moussa K, et al. Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies. BMC Public Health 2010;10:9.
[47] Siahpush M, Borland R, Taylor J, Singh GK, Ansari Z, Serraglio A. The association of smoking with perception of income inequality, relative material well-being, and social capital. Social science & medicine 2006;63:2801-12.
[48] Corsi DJ, Subramanian S, Lear SA, Teo KK, Boyle MH, Raju PK, et al. Tobacco use, smoking quit rates, and socioeconomic patterning among men and women: a cross-sectional survey in rural Andhra Pradesh, India. European journal of preventive cardiology 2014;21:1308-18.
[49] Ding D, Gebel K, Oldenburg BF, Wan X, Zhong X, Novotny TE. An early-stage epidemic: a systematic review of correlates of smoking among Chinese women. International journal of behavioral medicine 2014;21:653-61.
[50] Yang G, Fan L, Tan J, Qi G, Zhang Y, Samet JM, et al. Smoking in China: findings of the 1996 national prevalence survey. Jama 1999;282:1247-53.
[51] Kunst A, Giskes K, Mackenbach J. Socio-economic inequalities in smoking in the european union: applying an equity lens to tobacco control policies: for the EU network on interventions to reduce socio-economic inequalities in health: Erasmus Medical Center Rotterdam; 2004.
[52] Van Bui T, Blizzard CL, Luong KN, Le Van Truong N, Tran BQ, Otahal P, et al. Physical activity in Vietnam: estimates and measurement issues. PloS one 2015;10:e0140941.