Cohort changes in educational disparities in smoking: France, Germany and the United States

Abstract

This study investigates the evolution of educational disparities in smoking uptake across cohorts for men and women in three countries. Nationally representative surveys of adults in France, Germany and the United States in 2009-2010 include retrospective measures of age of uptake that are compared for three cohorts (born 1946-1960, 1961-1975, and 1976-1992). Discrete logistic regressions and a relative measure of education are used to model smoking histories until age 34. The following patterns are found: a strengthening of educational disparities in the timing of uptake from older to younger cohorts; an earlier occurrence of the strengthening for men than women and for the United States than France or Germany; a faster pace of the epidemic in France than in the United States, and; a divide between the highest level of education and the others in the United States, as opposed to a gradient across categories in France. Those differences in smoking disparities across cohorts, genders and countries help identify the national and temporal circumstances that shape the size and direction of the relationship between education and health and the need for policies that target educational disparities.

Keywords: Cohort; Education; France; Gender; Germany; Smoking; Tobacco epidemic; USA.

Figure 1. Proportion having ever smoked regularly by age in the different educational groups – France

Isced=0, 1, 2 (Low) to 5A(High - long): educational level (see Measures section) OR = adjusted OR for relative education with controls (age in 2010, follow-up, follow-up², native born, and citizen), i.e. RII OR Gender (M/F) = adjusted OR for gender (male relative to female) with controls (and relative education) OR Gender* relative education= adjusted OR for gender*relative education with controls (i.e., RII for males relative to females)

Figure 2. Proportion having ever smoked regularly by age in the different educational groups – USA

Isced=0, 1, 2 (Low) to 5A (High - long): educational level (see Measures section) OR = adjusted OR for relative education with controls (age in 2010, follow-up, follow-up², native born, and citizen), i.e. RII OR Gender (M/F) = adjusted OR for gender (male relative to female) with controls (and relative education) OR Gender* relative education= adjusted OR for gender*relative education with controls (i.e., RII for males relative to females)

Figure 3. Proportion having ever smoked regularly by age in the different educational groups – Germany

Isced=0, 1, 2 (Low) to 5A (High - long): educational level (see Measures section) OR = adjusted OR for relative education with controls (age in 2010, follow-up, follow-up², native born, and citizen), i.e. RII OR Gender (M/F) = adjusted OR for gender (male relative to female) with controls (and relative education) OR Gender* relative education= adjusted OR for gender*relative education with controls (i.e., RII for males relative to females)