Widening inequalities in smoking initiation and cessation patterns. A cohort and gender analysis in France

Aims This study investigates the evolution of educational inequalities in smoking initiation and cessation in France according to gender and birth cohort. Methods We used a 2005 nationwide survey comprising 25,239 subjects aged 18–75 years. Three cohort groups were defined (born 1930–1945, 1946–1965 or 1966–1987). We compared their smoking histories until age 40 years with time-discrete logistic regressions. Educational differences in initiation and cessation were quantified using odds ratios and relative indices of inequality (RII), and the gender gap using odds ratios (gender ratios). Results For smoking initiation, in the oldest cohorts, no educational gradient appeared in men, but there was a positive gradient in women (RII = 0.19); in the middle cohorts, a negative gradient emerged in men (RII = 1.55), while the positive gradient reduced in women (RII = 0.74); in the youngest cohorts, there was a strengthening of the negative gradient in men (RII = 2.72), and the emergence of a negative gradient for women (RII = 1.86). The gender ratio narrowed from the oldest cohorts (3.23) to the youngest (1.09), and diminished with increasing educational level within each cohort. For smoking cessation, the educational gradients were negative in both genders, with wider gaps in the youngest cohorts, and gender ratios below 1 reflecting more marked cessation dynamics in women. Conclusion Women are at an earlier stage in the tobacco epidemic than men for initiation and at a later stage for cessation and social inequalities are widening. We believe that they will not decrease unless gender and the psycho-social aspects of smoking are considered in prevention campaigns