Smoking in immigrants: do socioeconomic gradients follow the pattern expected from the tobacco epidemic?

Objectives: Although socioeconomic patterns of smoking across the different stages of the tobacco epidemic have been well researched, less is known about these patterns among immigrant populations. This paper aims to assess the smoking prevalence and its socioeconomic gradients among three immigrant populations. Methods: Three cross-sectional studies, using structured face-to-face interviews, were conducted in three representative (for socioeconomic status) samples of 385 Turkish, 316 Moroccan, and 1072 Surinamese first-generation immigrants aged 35 - 60 years in Amsterdam, the Netherlands. Information gathered included information about smoking behaviour, educational level and background characteristics. The associations between educational level and smoking rates were assessed using logistic regression analyses stratified by age and sex, for each ethnic group separately. Results: The prevalence of smoking differed per group, being highest among Turkish and Surinamese men (63% and 55%, respectively), followed by Moroccan men and Turkish and Surinamese women (30%, 32% and 27%, respectively). Higher smoking rates were found among women with higher educational levels, except for Surinamese women aged 35 - 44 years. However, among Turkish and Moroccan men aged 35 - 44 years and Surinamese men, smoking rates were higher in lower socioeconomic groups. Conclusions: The prevalence figures and educational associations suggest that the socioeconomic gradient changes in earlier stages of the epidemic in immigrant populations than in the Western host populations, particularly in men. This provides indications to suggest that smoking prevention measures in male immigrant groups need to be tailored to lower socioeconomic groups in particular throughout the tobacco epidemic, and to higher socioeconomic groups among women.