Smoking initiation and cessation by gender and educational level in Catalonia, Spain

Background. The role of gender and socioeconomic status in smoking has been characterized in the United States and Northern European countries. Howeve r, there is scarce information of the dynamic of the tobacco epidemic in So uthern European countries. The aim of this study was to analyze smoking ini tiation and cessation according to level of education and gender in Catalon ia, Spain. Methods. Data from the Catalan Health Survey (1994), a cross-sectional stud y based in a representative sample of the noninstitutionalized population o f Catalonia, was used. The relative risks and 95% confidence interval of sm oking initiation were computed by means of Cox's regression. The odds ratio s and 95% confidence intervals of quitting smoking were derived from logist ic regression models. Direct responses from 4,370 men and 5,213 women ages 25 years or over were included for analysis. Results. Ever smoking was inversely related to level of education in men. M ales with the highest educational level tended to have a lower probability of being a smoker at a given age than those with less than primary school ( relative risk = 0.6; 95% confidence interval: 0.5-0.7). This pattern appear ed with small variation across age groups. In women, a reverse trend was pr esent: the higher the level of education the higher the relative risk of st arting smoking (relative risk = 4.6; 95% confidence interval: 3.1-6.7), Qui tting smoking was more likely among men and women with higher education as compared to men and women with less than primary school (men: odds ratio = 1.5; 95% confidence interval 1.1-2.1; women: odds ratio = 4.6; 95% confiden ce interval: 2.1-10.4). Conclusions. The differential effect of education according to gender may r eflect different phases of the smoking epidemic. In Catalonia, the transiti on of smoking from upper and lower socioeconomic groups occurred recently a mong men, and women have currently begun to experience this transition. (C) 2001 American Health Foundation and Academic Press.