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.