Patterns and trends of tobacco consumption in the Portuguese population: National Health Survey data 1987 - 2005

Background: Smoking is a significant risk factor for many diseases, particularly respiratory, cardiovascular and cancer. Describing smoking patterns in the Portuguese population is important for monitoring and planning preventative strategies for this public health problem. This study aims to contribute to the epidemiological survey of smoking in Portugal using data from the several National Health Surveys. Objectives: Estimate prevalence of smoking and its evolution from 1987 to 2005 according to socio-demographic characteristics. Methods: We used data collected in National Health Surveys 1987, 1995, 1998 and 2005. For each survey, gender specific smoking prevalences were computed for different age-groups. Also, age-standardized prevalences were estimated (direct method, standard European population), stratified by occupation, educational degree, professional category, marital status and region. Results: Smoking prevalences suggest cohort effects both in men and in women, with higher estimates moving from survey to survey to older age-groups. Removing the effect of the different age structures smoking prevalence in men is decreasing between periods, from 35.2% [95% Confidence Interval (95%CI): 34.2; 36.2] for 1987 to 28.8% (95%CI: 27.8; 29.9) in 2005/2006. Unemployed (from 40.6 in 2005 to 51.6 in 1995), divorced (range: 44.9% in 2005 to 58.4% in 1987), resident in Alentejo (range: 34.1% in 2005 to 46.8% in 1987), non-qualified workers (range: 35.8% in 1995 to 42.7% in 1987) had the highest smoking prevalences. No trends were observed by occupation, marital status, region and professional category. Similar analysis in women showed that smoking prevalence is increasing: 6.0% (95%CI: 5.6; 6.4) in 1987 to 11% (95%CI: 10.6; 11.9) in 2005/2006. Across the different surveys we observed that divorced (range: 19.3% in 1987 to 27.4% in 1995) and resident in Lisbon (range: 9.2 % in 1987 to 16.0% in 2005) women had the highest smoking prevalences. No trends were observed in marital status and region. In the educational level we observed a trend, where a higher prevalence was verified for the high education in 1987 (23.4%) and 1995 (18.2) switching for high school in more recent surveys (18.9% and 14.8% for 1998 and 2005, respectively). No patterns were identified for the remaining variables in either gender. Conclusions: Smoking trends have some differences in Portuguese men and women irrespective of age effects, with prevalence diminishing among men and rising among women. Smokers profiles also differ by gender, with highest tobacco consumption in men observed in more deprived socio-economical groups, while in women the pattern seems to affect more affluent groups