Explaining socio-economic inequalities in daily smoking: a social-ecological approach

Background: This study assessed the contributions of individual, household and neighbourhood-level factors to socio-economic inequalities in smoking. Methods: Data came from 2706 participants of the 2004 wave of the Dutch GLOBE study. Participants were asked about several social and material characteristics of their households, neighbourhoods and smoking in their environment. Indicators of socio-economic position were education and income. Associations with daily smoking were examined using logistic regression analyses. Results: Education and income were independently associated with daily smoking (mutually adjusted odds ratios for the lowest education and income groups: odds ratio (OR): 2.87, 95% confidence interval (95% CI): 1.78-4.62; OR: 1.55, 95% CI: 1.09-2.23, respectively). Individual beliefs about smoking contributed most to the association of education with daily smoking. Individual beliefs about smoking and household material adversity contributed most to the association of income with daily smoking. We found no evidence that negative perceptions of the neighbourhood contributed to smoking inequalities. In fully adjusted models, associations between income and smoking were fully attenuated, but an independent association between education and smoking remained. Conclusion: Education and income were related to smoking through partly different pathways. Reducing inequalities in smoking may require a multidimensional approach targeting material and social factors, with strategies targeted towards the individual and the household level.