NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, Lisbon, 1600-560, Portugal.
Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
BMC Public Health. 2023 Jul 18;23(1):1382. doi: 10.1186/s12889-023-16182-w.
While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood.
This study used longitudinal data from the EPITeen Cohort, which recruited adolescents enrolled in schools in Porto, Portugal. We included the 1,038 participants followed at ages 13 (2003/2004), 17, 21, and 24 years. We computed the odds ratio (OR) for the prevalence of smoking states (never smoking, experimenter, less-than-daily, daily and former smoker) and the incidence of transitions between these states, as function of age and education, stratified by sex. We also added interaction terms between age and education.
Educational inequalities in daily smoking prevalence, with higher prevalence among those with lower educational level, emerged at 17 years old and persisted until higher ages. They were formed in a cumulative way by the increased risk of experimenting between 13 and 17 years, and increased risk of becoming daily smoker between 17 and 21 years. The incidence of smoking cessation was higher among the higher educated. Inequalities were formed similarly for women and men, but with lower level and showed no significance among women.
These results highlight that actions to prevent smoking should also take in account the potential impact in smoking inequalities, and should focus not only on middle adolescence but also on late adolescence and early adulthood.
虽然已知吸烟的教育不平等始于青少年早期和中期，但尚不清楚它们在成年后如何进一步发展。本文的目的是在葡萄牙背景下，描绘吸烟的教育不平等如何从青春期前到成年早期出现。
本研究使用了来自 EPITeen 队列的纵向数据，该队列招募了葡萄牙波尔图学校的青少年。我们纳入了在 13 岁（2003/2004 年）、17 岁、21 岁和 24 岁时接受随访的 1038 名参与者。我们计算了吸烟状态（从不吸烟、尝试者、少于每日、每日和前吸烟者）的流行率和这些状态之间的转换发生率的优势比（OR），作为年龄和教育的函数，按性别分层。我们还添加了年龄和教育之间的交互项。
17 岁时出现了每日吸烟流行率的教育不平等，受教育程度较低的人吸烟率较高，并且这种不平等一直持续到较高年龄。这种不平等是通过 13 至 17 岁之间尝试吸烟的风险增加以及 17 至 21 岁之间成为每日吸烟者的风险增加而累积形成的。受教育程度较高的人戒烟的发生率较高。女性和男性的不平等情况相似，但水平较低，女性的差异无统计学意义。
这些结果强调，预防吸烟的行动还应考虑到吸烟不平等的潜在影响，不仅应关注青少年中期，还应关注青少年后期和成年早期。
