Academic journal article Central European Journal of Public Health

Socioeconomic Disparities in Age of Initiation and Ever Tobacco Smoking: Findings from Romania

Academic journal article Central European Journal of Public Health

Socioeconomic Disparities in Age of Initiation and Ever Tobacco Smoking: Findings from Romania

Article excerpt

INTRODUCTION

Smoking is in decline in most European countries including Romania (1). In 2008, the overall current daily tobacco smoking was an estimated 27.8% of adult inhabitants (38.6% in men and 17.7% in women) (2). As in 2011, nearly five million Romanians (24.3%) still smoke tobacco with over two times higher smoking prevalence among men compared to women 34.9% vs. 14.5%, respectively (3). Tobacco smoking has been identified as one of the major causes of health inequalities within the Romanian population (4, 5). Huge disparities in morbidity and mortality due to non-communicable diseases including tobacco attributable diseases are observed across genders (5). Evidence shows the earlier the attempts to smoke, the higher the risk of becoming a regular smoker, and the lower the likelihood to quit, and the higher the risk of relapse. Subsequently, research also shows that the earlier the smoking initiation, the longer the smoking exposure and the higher the risk of contracting lung cancer or experiencing a range of risk factors and health problems in adulthood. Smoking initiation is considered the crucial behaviour that determines the future health burden of tobacco smoking in a society (6). Preventing tobacco smoking among young people is critical to ending the tobacco epidemic. Therefore, it appears to be one of the leading challenges of tobacco control (7, 8). The objective of the study was to investigate the association of socio-demographic variables with initiation of ever regular smoking among Romanians.

MATERIALS AND METHODS

The data source was the 2011 Global Adult Tobacco Survey Romania (GATS). GATS is a nationally representative household survey. The target population of GATS includes all non-institutionalized men and women 15 years of age or older. In Romania, similarly to other GATS countries, a multistage cluster sample design was employed with households selected proportional to population size. GATS methodology was described in detail elsewhere (6, 9-11).

Study Variables

The main outcome variable was ever regular smoking. Regular smoking refers to smoking at least one cigarette per day, every day, during at least one year period in a lifetime. The category for ever smokers covered current and former smokers. Current tobacco smoking was defined as current daily smoking based on the question: "Do you currently smoke tobacco on a daily basis, less than daily, or not at all". Former tobacco users were defined as the number of ever tobacco smokers who currently do not smoke. Never tobacco users were defined as adults who reported that they never smoked in their life time. Less than daily smokers were not taking into consideration in the analysis. Age at smoking onset information was analyzed as well. Age at smoking onset was regarded as the age at which respondents started to smoke tobacco on a regular basis. Some of the variables included in the analyses were gender (male/female), and age of the respondents. We also used the data on educational attainment of all subjects in our analysis. Education level was reported as primary education including primary or less education including no formal education, primary school completed (4 grades), secondary school (gymnasium, grades 5-8) completed, and vocational school. Secondary education includes grades 9-10 or high school completed and post-high school completed. High education includes college (short-term study), university and post graduate degree completed.

The measure of occupational activity considered four categories: economically not active (pupils, students, persons occupied with household keeping, retired, and pensioners due to disability), employed (currently with permanent job), unemployed (unemployed - able to work, unemployed - unable to work). Furthermore, for the place of residence we distinguished two types of dwelling: rural or urban area. We also assessed the awareness of the adverse health consequences of tobacco smoking. …

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