Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014)

José Luis Sandoval; Teresa Leão; Stéphane Cullati; Jean-Marc Theler; Stéphane Joost; Jean-Paul Humair; Jean-Michel Gaspoz; Idris Guessous

doi:10.1136/tobaccocontrol-2017-053986

Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014)

José Luis Sandoval, Teresa Leão, Stéphane Cullati, Jean-Marc Theler, Stéphane Joost, Jean-Paul Humair, Jean-Michel Gaspoz, Idris Guessous

Centro de Investigação em Saúde Pública (CISP/PHRC)

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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.

Original language	English
Pages (from-to)	663-669
Journal	Tobacco Control
Volume	27
Issue number	6
Early online date	26 Jan 2018
DOIs	https://doi.org/10.1136/tobaccocontrol-2017-053986
Publication status	Published - 2018

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Journal Article

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10.1136/tobaccocontrol-2017-053986

Sandoval Tobacco Control 2018Final published version, 708 KBLicence: Unspecified

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Sandoval, J. L., Leão, T., Cullati, S., Theler, J-M., Joost, S., Humair, J-P., Gaspoz, J-M., & Guessous, I. (2018). Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014). Tobacco Control, 27(6), 663-669. Advance online publication. https://doi.org/10.1136/tobaccocontrol-2017-053986

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TY - JOUR

T1 - Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation

T2 - a cross-sectional population-based study in Geneva, Switzerland (1995-2014)

AU - Sandoval, José Luis

AU - Leão, Teresa

AU - Cullati, Stéphane

AU - Theler, Jean-Marc

AU - Joost, Stéphane

AU - Humair, Jean-Paul

AU - Gaspoz, Jean-Michel

AU - Guessous, Idris

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1136/tobaccocontrol-2017-053986

DO - 10.1136/tobaccocontrol-2017-053986

M3 - Article

C2 - 29374093

SN - 0964-4563

VL - 27

SP - 663

EP - 669

JO - Tobacco Control

JF - Tobacco Control

IS - 6

ER -

Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014)

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