Elsevier

Preventive Medicine

Volume 38, Issue 1, January 2004, Pages 114-119
Preventive Medicine

Smoking patterns in a community sample of Portuguese adults, 1999–2000

https://doi.org/10.1016/j.ypmed.2003.09.040Get rights and content

Abstract

Background. Southern European cultural specificities might influence the dynamic of the tobacco epidemic. Thus, we aimed to evaluate the distribution and determinants of smoking patterns in an urban Portuguese population.

Methods. We evaluated 1,644 community dwellers (1,015 women, 629 men) using a structured questionnaire, comprising social, behavioral, and clinical information. Number of cigarettes smoked, age at smoking initiation, and quitting were self-reported. Proportions were age adjusted for the European population and the magnitude of associations computed using logistic regression.

Results. Smoking was more common in younger, unemployed, normal weighted, and less physically active men. Female smoking prevalence was higher in younger, more educated, and overweighed. Compared to females, males had a higher prevalence of smoking (35.0%; 95% confidence intervals [CI] 31.3–38.8 vs. 17.6%; 95% CI 15.4–20.1; P < 0.001), a higher mean number of cigarettes smoked (21.2; 95% CI 12.4–15.0 vs. 14.1; 95% CI 19.6–22.6; P < 0.001), and a higher proportion began smoking before 18 years of age (60.1%; 95% CI 55.5–64.5 vs. 42.6%; 95% CI 36.9–48.5; P < 0.001).

Conclusion. Among Portuguese, adults smoking remains more frequent in men but the prevalence is reaching a disturbing proportion in women, especially young and more educated. This smoking pattern places Portugal in stage 2 of smoking epidemic.

Introduction

The World Health Organization (WHO) recognized tobacco smoking as the expected leading cause of premature death, disease, and suffering for decades to come, both in industrialized countries and in many regions of the developing world [1], [2].

In developed countries, about 62 million deaths from tobacco use were estimated to occur over the second half of the twentieth century, mainly in middle-aged (39–65 years) men. In this age group, those killed by tobacco lost on average more than 20 years of expected life [3].

The risk of dying from smoking far exceeds that of any addiction, exposure, or injury. Smoking has been associated with an increased risk of several cancers, cardiovascular diseases, bronchitis and emphysema, and increased antenatal and perinatal death [4], [5]. Moreover, smokers are often unaware of the decrease in risk that occurs soon after cessation, especially for coronary heart disease [6].

During the past few decades, the prevalence of smoking declined in Western Europe and North America, mainly in men. In Southern Europe, this trend is also observed in men but not in women [7], [8].

Previous national health surveys showed a markedly higher prevalence of male smoking in Portugal, but decreasing from 33.3% in 1987 to 29.3% in 1999. However, in women, it increased from 5.0% to 7.9% during the same period. Also, regional differences in smoking prevalence were found in the national health surveys [9], [10].

The benefit of smoking cessation is expected to play a major role in Portugal, where cardiovascular diseases cause more than 40% of the deaths and smoking has a large population attributable fraction [11].

In industrialized countries alone, smoking-related health care accounts for 6–15% of all annual health care cost [1], and these costs are mainly supported by taxpayers if health care is essentially provided by the public sector, as occurs in Portugal.

National surveys gave a global recent picture of the smoking epidemic in the population [9], [10]. However, there was no information on smoking determinants and associated lifestyles, such as occupation, physical activity and alcohol consumption, or information on initiation and quitting. This study was aimed to describe the distribution and determinants of smoking patterns in a representative sample of the general population of Porto.

Section snippets

Methods

Data were obtained as part of an ongoing cross-sectional health and nutrition survey of adults living in Porto, Portugal, during 1999–2000. Random digit dialing was used for recruitment, having households as sampling frame. In each house, a single person older than 17 years old was randomly selected without allowing for substitution of refusals. A participation rate of 70% was achieved [12]. The mini-mental state examination (MMSE) [13] was used for the evaluation of cognitive impairment in

Results

In this sample, the overall prevalence of smokers was 24.3% (95% CI 22.2–26.4), 55.7% (95% CI 53.3–58.1) were never-smokers, and 20.0% (95% CI 18.1–22.0) were ex-smokers. Men had a significantly higher prevalence of smoking (35.0%; 95% CI 31.3–38.8 vs. 17.6%; 95% CI 15.4–20.1; P < 0.001) and daily smoked a significantly larger mean number of cigarettes (21.2; 95% CI 12.4–15.0 vs. 14.1; 95% CI 19.6–22.6; P < 0.001).

Table 1, Table 2 show the age-adjusted distribution of social, demographic, and

Discussion

The dynamic of the smoking epidemic in societies can be described according to four stages [18]. In stage 1, smoking is an exceptional behavior and it is typical of the advantaged classes. In stage 2, smoking becomes more common in men, in all social classes or advantaged ones, and smoking prevalence in women is lagged 10–20 years behind that of men, the habit being adopted by upper social classes. In stage 3, smoking prevalence in men decreases sharply and prevalence peaks in women. During

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