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Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995–2014)
  1. José Luis Sandoval1,2,
  2. Teresa Leão3,
  3. Stéphane Cullati1,2,4,
  4. Jean-Marc Theler1,
  5. Stéphane Joost1,5,
  6. Jean-Paul Humair6,
  7. Jean-Michel Gaspoz6,
  8. Idris Guessous1,6,7
  1. 1 Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
  2. 2 Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
  3. 3 Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
  4. 4 Swiss NCCR “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
  5. 5 Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
  6. 6 Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
  7. 7 Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Professor Idris Guessous, Department of Community Medicine, Primary Care and Emergency Medicine, Unit of Population Epidemiology, Geneva University Hospitals, Geneva 1205, Switzerland; idris.guessous{at}hcuge.ch

Abstract

Introduction Smoking bans were suggested to reduce smoking prevalence and increase quit ratio but their equity impact remains unclear. We aimed to characterise the socioeconomic status (SES)-related inequalities in smoking prevalence and quit ratio before and after the implementation of a public smoking ban.

Methods We included data from 17 544 participants in the population-based cross-sectional Bus Santé study in Geneva, Switzerland, between 1995 and 2014. We considered educational attainment (primary, secondary and tertiary) as a SES indicator. Outcomes were smoking prevalence (proportion of current smokers) and quit ratio (ex-smokers to ever-smokers ratio). We used segmented linear regression to assess the overall impact of smoking ban on outcome trends. We calculated the relative (RII) and slope (SII, absolute difference) indexes of inequality, quantifying disparities between educational groups in outcomes overall (1995–2014), before and after ban implementation (November 2009).

Results Least educated participants displayed higher smoking prevalence (RII=2.04, P<0.001; SII=0.15, P<0.001) and lower quit ratio (RII=0.73, P<0.001; SII=−0.18, P<0.001). As in other studies, smoking ban implementation coincided with a temporary reduction of smoking prevalence (P=0.003) and increase in quit ratio (P=0.02), with a progressive return to preban levels. Inequalities increased (P<0.05) in relative terms for smoking prevalence (RIIbefore=1.84, P<0.001 and RIIafter=3.01, P<0.001) and absolute terms for both outcomes (smoking prevalence: SIIbefore=0.14, P<0.001 and SIIafter=0.19, P<0.001; quit ratio: SIIbefore=−0.15, P<0.001 and SIIafter=−0.27, P<0.001).

Conclusions Implementation of a public smoking ban coincided with a short-lived decrease in smoking prevalence and increase in quit ratio but also with a widening in SES inequalities in smoking-related outcomes.

  • socioeconomic status
  • public policy
  • cessation
  • disparities

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Footnotes

  • Contributors JLS and IG contributed to study design and wrote the manuscript. JLS performed the data analysis. J-MT, J-MG and IG collected data. All authors contributed to interpreting and discussing the results as well as revising and approving the manuscript.

  • Funding The Bus Santé study is funded by the General Directorate of Health, Canton de Geneva, Switzerland and the Geneva University Hospitals.

  • Competing interests None declared.

  • Ethics approval Institute of Ethics Committee of the University of Geneva.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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