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Widening educational inequalities in adolescent smoking following national tobacco control policies in the N etherlands in 2003: a time–series analysis
Author(s) -
Kuipers Mirte A. G.,
Nagelhout Gera E.,
Willemsen Marc C.,
Kunst Anton E.
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12637
Subject(s) - tobacco control , respondent , demography , confidence interval , logistic regression , monitoring the future , inequality , youth smoking , population , medicine , smoking prevalence , environmental health , public health , political science , substance abuse , sociology , mathematics , mathematical analysis , nursing , psychiatry , law
Background and Aims In 2003, the N etherlands introduced tobacco control policies, including bans on tobacco sales to minors, advertising and sponsoring and tobacco sales in government institutions. We examined the extent to which these policies were associated with a change in educational inequalities in adolescent smoking. Design Repeated cross‐sectional survey. Setting The N etherlands, 1992–2011. Participants A total of 43 527 14–19‐year‐old adolescents. Measurements Data were obtained from the national Y outh S moking M onitor. We used logistic regression analyses to model the immediate change in daily smoking prevalence in 2003, the trends and the changes in trends. Models included interactions between educational level (high versus low, based on the educational track of the respondent) and, respectively, period (after versus before 2003), time and time × period. Findings Before 2003 the smoking trend declined slightly, and the decline was comparable for students of both high and low educational levels. Immediately after tobacco policies were introduced, daily smoking prevalence dropped for the total population [regression coefficient (β) = −0.340, 95% confidence interval (CI) = −0.445; −0.236]. This drop was larger for high educational level compared to low educational level (β interaction = −0.400, 95% CI = −0.623; −0.176). After 2003, trends in educational inequalities in smoking stabilized. Conclusions Following the introduction of new tobacco control policies in the N etherlands in 2003, smoking prevalence rates decreased among adolescents of both higher and lower educational levels. However, socio‐economic inequalities in adolescent smoking increased.