Barnett Ross, Pearce Jamie, Moon Graham
Department of Geography, University of Canterbury, Canterbury, New Zealanad.
Soc Sci Med. 2009 Mar;68(5):876-84. doi: 10.1016/j.socscimed.2008.12.012. Epub 2009 Jan 10.
The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981-2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Māori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Māori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality.
新西兰吸烟的总体患病率从1981年的32%降至2006年的23.5%，但在所有社会、人口和种族群体中，戒烟率并不一致。1981年至2006年期间，新西兰还经历了宏观经济变化，导致社会和经济不平等现象大幅增加。在这种社会政治背景下，我们提出两个问题。第一，1981年至2006年间，新西兰吸烟患病率和戒烟情况是否出现了社会两极分化？第二，除社会经济地位外，社区不平等在多大程度上可以解释戒烟率的种族差异？我们发现，在过去二十年中，新西兰的吸烟行为在社会和种族层面上两极分化加剧，社会经济地位较高的群体以及欧洲裔新西兰人的戒烟率更高。毛利人和欧洲裔新西兰人之间戒烟率的差异不能完全由社会经济地位的种族差异来解释。社区不平等对毛利人（而非欧洲裔）的吸烟戒烟率产生了重大影响。这种与社区不平等的关联在女性以及居住在城市地区的特定年龄组中尤为显著。这些发现扩展了关于社会不平等与健康，尤其是吸烟行为之间关系的国际证据。该研究还证实了在试图阐明社会经济因素与健康结果之间的联系机制时，考虑背景因素作用的重要性。我们的研究结果强调，如果未来的戒烟策略要取得成功，关注点必须从仅仅侧重于促成个体行为改变的政策，转向纳入社区不平等等环境压力因素的作用。
