Educational differences in cigarette smoking among adult population in Estonia, 1990–2010: does the trend fit the model of tobacco epidemic?

BACKGROUND: In developed countries, smoking spreads through society like an epidemic in which adults from higher socioeconomic groups are the first to adopt and earlier to quit smoking, and in which exists a lag in adoption of smoking between men and women. The objective of this study was to describe trends in daily and occasional smoking, to investigate association between smoking status and education, and to examine if the associations in 1990–2010 in Estonia fit the pattern predicted by the model of tobacco epidemic. METHODS: The study was based on a 20–64-year-old subsample (n = 18740) of nationally representative postal cross-sectional surveys conducted every second year in Estonia during 1990–2010. Cigarette smoking and education were examined. χ(2) test for trend was used to determine daily and occasional smoking trends over study years. Multinomial logistic regression model was used to test educational differences in daily and occasional smoking for every study year. Adjusted relative risk ratios (RRRs) with 95% confidence intervals were calculated. RESULTS: In 1990–2010, daily smoking varied largely between genders showing decreasing trend among men, but not among women. In 2010, one third of men and one fifth of women were daily smokers. Daily smoking was not clearly associated with education among men in 1990–1994 and among women in 1990–2000. Men revealed inverse relationship between daily smoking and education since 1996, but women since 2002. In 2010, compared to men and women with higher education, relative risk ratio of daily smoking was 2.92 (95% CI = 2.01–4.25) among men and 2.29 (95% CI = 1.65–3.17) among women with secondary education, but 4.98 (95% CI 3.12–7.94) among men and 6.62 (95% CI = 4.07–10.76) among women with basic education. In 1990–2010, occasional smoking was stable and similar (varying between 7–10%) among men and women, no association with education was found. CONCLUSIONS: Daily smoking patterns in Estonia fit the model of tobacco epidemic in developed countries. Educational differences in daily smoking highlight the importance of addressing smoking behaviour in the general population by educational subgroups in Estonia.