Article Text

Download PDFPDF
Trends in smoking behaviour between 1985 and 2000 in nine European countries by education
  1. K Giskes1,
  2. A E Kunst1,
  3. J Benach2,
  4. C Borrell3,
  5. G Costa4,
  6. E Dahl5,
  7. J A A Dalstra1,
  8. B Federico1,
  9. U Helmert6,
  10. K Judge7,
  11. E Lahelma8,
  12. K Moussa9,
  13. P O Ostergren9,
  14. S Platt10,
  15. R Prattala11,
  16. N K Rasmussen12,
  17. J P Mackenbach1
  1. 1Erasmus Medical Centre, Netherlands
  2. 2Universitat Pompeu Fabra, Spain
  3. 3Agència de Salut Pública de Barcelona, Spain
  4. 4University of Turin, Italy
  5. 5Norwegian Health Services Research Centre
  6. 6University of Bremen, Germany
  7. 7University of Glasgow, Scotland
  8. 8University of Helsinki, Department of Public Health, Finland
  9. 9University of Lund, Sweden
  10. 10University of Edinburgh, Scotland
  11. 11National Public Health Institute, Finland
  12. 12National Institute for Public Health, Denmark
  1. Correspondence to:
 Dr K Giskes
 Department of Public Health, Erasmus Medical Centre, PO Box 1738, 3000DR Rotterdam, Netherlands;


Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group.

Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points.

Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain.

Participants: 451 386 non-institutionalised men and women 25–79 years old.

Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers.

Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups.

Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

  • smoking
  • education
  • Europe

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: the research received financial support from the “Tackling Socioeconomic Inequalities in Smoking” project funded by European Commission. The funding body had no direct involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

  • Competing interests: none declared.

Linked Articles