Tob Control 14:106-113 doi:10.1136/tc.2004.008573
  • Research paper

Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries

  1. M Huisman,
  2. A E Kunst,
  3. J P Mackenbach
  1. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to:
 Martijn Huisman
 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands;
  • Received 15 April 2004
  • Accepted 2 November 2004


Objective: To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries.

Design: Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union.

Subjects: Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union.

Outcome measures: Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups.

Results: A north–south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16–24 years were observed for all countries, with the exception of women from Greece and Portugal.

Conclusions: Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.


  • Competing interests: none

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