A cross-national comparative study of smoking prevalence and cessation between English and Dutch South Asian and African origin populations: the role of national context

Evidence suggests that Dutch people smoke substantially more than their British counterparts. These differences have been suggested to relate, in part, to the health-related policy differences between the two countries. It is unclear whether these differences affect smoking among ethnic minority groups in similar ways. We assessed whether the lower smoking prevalence in the U.K. general population compared with the Netherlands is also observed in ethnic minority groups (i.e., Dutch vs. English South Asians and Dutch- vs. English-Africans). We used similar surveys from the United Kingdom and the Netherlands to explore these questions. The response rate ranges from 60% in the Health Survey for England and the SUNSET study to 67.5% in Newcastle Heart Project (n = 21,429). After adjustment for other factors, compared with White-Dutch, the prevalence ratio (PR) of current smoking was lower in White-English men (PR = 0.58, 95% CI: 0.49-0.67) and women (PR = 0.56, 0.49-0.65). Among African groups, compared with Dutch-African, the prevalence of current smoking was lower in English- African Caribbean men (PR = 0.48, 0.31-0.75) and women (PR = 0.47, 0.39-0.69) and Sub-Saharan African men (PR = 0.53, 0.29-0.99) and women (PR = 0.37, 0.14-0.99). Among South Asian groups, compared with Dutch South Asian, the prevalence of smoking was lower in English-Indian men (PR = 0.67, 0.51-0.89) and women (PR = 0.16, 0.07-0.37), Pakistani men (PR = 0.62, 0.46-0.82) and women (PR = 0.13, 0.05-0.33), and Bangladeshi men (PR = 0.77, 0.59-0.99) and women (PR = 0.11, 0.03-0.45). Ever-smoking rates were lower and smoking cessation rates were higher in the English ethnic groups than in the Dutch ethnic groups except for smoking cessation among the South Asian women. Similar to the White group, the prevalence of smoking was lower in South Asian and African men and women in England than their corresponding Dutch counterparts. These differences suggest that, among other factors, antismoking policies might have a similar influence on both ethnic majority and minority groups and illustrate the potential importance of national context on public health policy on ethnic minority groups' smoking behavior.