Tobacco Control and Socioeconomic Inequalities in Adolescent Smoking in Europe

Kuipers MAG, Monshouwer K, van Laar M, Stronks K, Kunst AE.

Am J Prev Med. 2015 Nov;49(5):e64-72.


The strength of national tobacco control varies by country, but it is unclear how this relates to smoking in adolescents of high and low SES. This study examined the association between tobacco control policies and adolescent smoking and investigated the differences in this association between adolescents of high and low SES.


Data of 90,351 adolescents aged 15–16 years from 13 European countries were obtained from the 2003, 2007, and 2011 European Survey Project on Alcohol and other Drugs databases. Logistic regression analyses were performed in 2014 with a random intercept at the country level and with daily smoking as the outcome. The Tobacco Control Scale was the score for national tobacco control policy. SES was based on parental education.


In all studied countries, except Portugal, adolescent smoking prevalence rates were highest among low-SES respondents. Stronger tobacco control policies were associated with lower smoking rates in all three survey waves (2003, OR=0.75, 95% CI=0.55, 1.01; 2007, OR=0.84, 95% CI=0.73, 0.98; 2011, OR=0.85, 95% CI=0.74, 0.98). The association was consistently stronger in high-SES than in low-SES individuals, but the difference was not statistically significant.


Countries with stronger tobacco control policies tend to have lower smoking rates. We are unable to demonstrate significant socioeconomic inequalities in the effect of tobacco control policies on adolescent smoking.

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