Trends in educational inequalities in smoking in northern, mid and southern Italy, 1980-2000

Background. We aimed to determine the direction and magnitude of socioeconomic inequality in smoking in Italy over the last two decades, focusing on both national and macro-regional patterns. Methods. We used data from six National Health Interview Surveys from 1980 to 2000, whose sample size ranged between 60,000 and 140,000. We calculated age-adjusted prevalence rates of current smoking and estimated odds ratios (OR) and relative indexes of inequality (with 95% confidence intervals) using logistic regression analysis. Results. In men aged 25-49, the OR of current smoking of low compared to high educated was 1.26 (95% CI: 1.16, 1.37) in 1980 and 1.71 (95% CI: 1.62, 1.80) in 2000. A reversal of the association between education and tobacco use from positive (OR = 0.43) to negative (OR = 1.12) was found for women of the same age group. Changes in educational inequalities in smoking were similar between different macro-regions for men, whereas among women, smaller differentials over all the study period were found in southern regions compared to central and northern regions, despite similar direction in trends. Conclusions. The gap between high- and low-educated groups has widened, especially in the youngest generations. Southern regions lag behind central and northern Italy in the progression of the smoking epidemic. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.