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Socioeconomic differences in smoking trends among pregnant women at first antenatal visit in Sweden 1982-2001: Increasing importance of educational level for the total burden of smoking.
  1. Kontie M Moussa1,
  2. P-O Östergren1,
  3. Mathias Grahn1,
  4. Anton E Kunst2,
  5. Frida Eek1,
  6. Birgitta Essén3
  1. 1 Lund University, Sweden;
  2. 2 Erasmus University Medical Center, Sweden;
  3. 3 Uppsala University, Sweden
  1. E-mail: kontie.moussa{at}


Background: There was a decrease 1982-2001 in smoking during early pregnancy in Swedish women. We sought to determine whether there was a parallel decrease in socio-economic inequality in smoking.

Methods: Registry data indicating educational level and smoking status at first antenatal visit in all 2,022,469 pregnancies in Sweden 1982–2001 was analysed. Prevalence differences, odds ratios based on prevalences, and total attributable fractions were compared for five-year intervals.

Results: The prevalence differences of smoking showed greater decrease at the lowest and middle compared with the highest educational level (14.5, 15.7 and 10.2%, respectively) indicating reduced inequality in absolute terms. However, odds ratios regarding low educational attainment versus high, increased from 5.6 to 14.2, signifying increased inequality in relative terms. Moreover, the total attributable fraction of low and intermediate educational level regarding smoking at first antenatal visit increased from 61% to 76% during the period studied.

Conclusions: Smoking at first antenatal visit in Sweden 1982–2001 decreased in a way that conclusions regarding trends in inequalities in smoking at first antenatal visit depend on the applied type of measure. However, using the measure of total attributable fraction, which takes into consideration the impact of the exposure on the individual as well as the effect of the varying size of the group of exposed, the growing importance of educational level for the behaviour in the population, was demonstrated.

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