Gender, Tobacco Control Policies, and Persistent Smoking Among Older Adults: A Longitudinal Analysis of 11 European Countries

Abstract

Introduction Little is known about sociodemographic and macro-level predictors of persistent smoking when one has developed a health condition that is likely caused by smoking. We investigate the impact of gender, education, and tobacco control policies (TCPs) on persistent smoking among older Europeans. Methods Respondents (aged 50 +) with a smoking history and at least one smoking-related health condition were pooled from the Survey of Health, Aging and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) from four waves from 2004 to 2013. We fitted gender-specific logistic regression models with two-way fixed effects (country and year) and tested interaction terms between gender, education, and TCPs. Results Although women are less likely to smoke than men, they were more likely to smoke persistently. The effects of education and general TCPs on persistent smoking were significant for women only. Compared to women with low levels of education, those with moderate education (odds ratio [OR] = .63; .49–.82) and high education (OR=.57; .34–.98) are less likely to be persistent smokers. TCPs are associated with a reduced risk of women’s persistent smoking (OR = .70, .51–.95) and the association is stronger for those having less education. Conclusions Older women, particularly those with low levels of education, are vulnerable to persistent smoking. TCPs might be effective in reducing persistent smoking for older women, with greater effects for less-educated women. Future studies are needed to understand mechanisms that explain gender differences in responsiveness to TCPs. Implications Persistent smoking is a particularly harmful smoking behavior as it is associated with greater risks of comorbidity and mortality. By employing the framework of the multilevel social determinants of health, this study examined the behavior of persistent smoking among older adults in European countries. Women, especially women with low levels of education are vulnerable to persistent smoking. Moreover, tobacco control policies, in general, are significantly related to a reduction in persistent smoking among older women only and the negative association is stronger for those having less education, indicating gender and socioeconomic differences in responsiveness to tobacco control policies.

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“…A related study examined European countries. A related study examining persistent smoking behavior among older adults in European countries found that women, particularly those with low levels of education, were more likely to be persistent smokers [ 43 ]. The same results were obtained in Indonesia, where the overall upward trend was most pronounced, where the cohort RRs maintained a steady upward trend from 1910 to 1982 but showed a downward trend from 1985 to 1989, and where, as the world’s worst tobacco-using country, about 51.3% of adults and 66.2% of adolescents aged 13–15 years are regularly exposed to secondhand smoke [ 44 ].…”