Application of the varying coefficient model to the behaviour risk factor surveillance data in Italy: a study of changing smoking prevalence among sub-populations (original) (raw)
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Decennial trends of social differences in smoking habits in Italy: a 30-year update
Cancer Causes & Control, 2013
Purpose To update educational inequalities in smoking in Italy up to 2009, with an in-depth analysis of female prevalence. Methods Data from 15 national health surveys () were analyzed. The overall sample size was representative of the population older than 25 years of age (3,300,000 men and 3,620,000 women). Main measures smoking prevalence rates standardized to the 2,000 European population, prevalence ratios by educational level (high: university degree or high school diploma; low: primary or middle school diploma), area (north, center, south and islands), and agegroup (25-44, 45-59, [=60 years). Trends in tobacco prevalence were also analyzed with a multivariate approach using the negative binomial distribution. Results Although male prevalence steadily declined of about 2 % annually from 56.1 % in 1980 to 30.2 % in 2009, educational inequalities slightly widened, recording in 2009 a 53 % higher prevalence in men with low educational level compared to graduates. Even though female prevalence stalled around 18 % in the last three decades, this was the result of opposite trends by educational group.
International Journal of Environmental Research and Public Health, 2013
This study aimed to describe past time trends of the prevalence of former smokers in Italy and to estimate prevalence projections using a Bayesian approach. An age-period-cohort (APC) analysis has been carried out in order to investigate the effect of the age, period and birth cohort on the prevalence of former smokers during 1980-2009. A Bayesian APC model with an autoregressive structure for the age, period and cohort parameters has been used to estimate future trends. Results showed that awareness of harm from smoking occurred at younger ages with each advancing cohort, and that women were more likely to attempt to stop smoking during pregnancies and breastfeeding, whereas men attempted to quit only when smoking-related diseases became evident. Projections of future trend recorded a further increase in the number of former smokers in future decades, showing an estimate of the "end of smoking" around years 2060 and 2055 in men and women, respectively. The application of the APC analysis to study the prevalence of former smokers turned out to be a useful method for the evaluation of past smoking trends, reflecting the effects of tobacco control policies on time and generations, and to make projections of future trend.
Predicting the future prevalence of cigarette smoking in Italy over the next three decades
European journal of public health, 2011
Smoking prevalence in Italy decreased by 37% from 1980 to now. This is due to changes in smoking initiation and cessation rates and is in part attributable to the development of tobacco control policies. This work aims to estimate the ageand sex-specific smoking initiation and cessation probabilities for different time periods and to predict the future smoking prevalence in Italy, assuming different scenarios. Methods: A dynamic model describing the evolution of current, former and never smokers was developed. Cessation and relapse rates were estimated by fitting the model with smoking prevalence in Italy, 1986-2009. The estimated parameters were used to predict prevalence, according to scenarios: (1) 2000-09 initiation/cessation;
Trends of smoking habits in northern Italy (1986–1990
European Journal of Epidemiology, 1995
The trends of age-gender specific prevalence of self-reported smoking habits are presented, observed in two population surveys, performed in 1986–87 and 1989–90 in Area Brianza, a northern Italian industrialized district where a WHO MONICA Centre is located. Methods were internationally standardized to obtain comparable data on two inde pendent random samples, each composed of 1,600 subjects, age-sex stratified and extracted from the 25–64 year old residents. A closed question interview was administered to identify smoking condition (smoker, past-smoker, occasional smoker, never smoker), number of cigarettes consumed per day and attained educational level, categorized in compulsory school and post-compulsory school. Serum thiocyanate was measured as a validation index, using a cutpoint of >100 µmol l−1 to detect false negatives. Trends in smoking prevalence are analyzed taking into account influences of education in the presence of an anti-smoking policy that was started in Italy toward the end of the eighties. Self-reported data, confirmed by serum thiocyanate, show a consistent decline of smokers among males (from 48 to 41%), more evident in younger age groups. In females, smoking prevalence is stable (23–24%), although thiocyanate levels in the whole samples indicate a slight but significant tendency to decrease. Education demonstrates positive influences against smoking, particularly in younger male classes. In females a crossover effect is observable: in the second survey youngest group, education results protective against smoking; the contrary is true in the older groups. Our data, detailing what was initially recognized in previous Italian surveys, may be useful to specify the directions of future preventive actions.
Socioeconomic inequalities in smoking habits are still increasing in Italy
BMC Public Health, 2014
Background: Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation. Methods: In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20-44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA). Results: Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation. Conclusion: Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.
A double-hurdle approach to modelling tobacco consumption in Italy
Applied Economics, 2008
This article analyzes the determinants of tobacco expenditures for a sample of Italian households. A Box–Cox double-hurdle model adjusted for heteroscedasticity is estimated to account for separate individual decisions concerning smoking participation and tobacco consumption and to correct for nonnormality in the bivariate distribution of the error terms. Nested univariate and bivariate models are found to be excessively restrictive, supporting the adequacy of a generalized specification. Estimation results show that consumption decisions are significantly affected by income and demographic characteristics. In particular, income positively impacts tobacco expenditure, while participation probability substantially declines as age increases. The existence of significant gender differences in both smoking participation and tobacco consumption patterns is found, while high education and white-collar occupation reduces the likelihood to smoke and tobacco expenditure levels. Single adult households have a lower probability of smoking initiation even if, conditional on smoking, they consume more. Finally, complementarity between tobacco and alcohol beverages suggests the necessity of joint public health strategies.
Time trends in smoking habits among Italian young adults
Respiratory Medicine, 2006
Background: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. Methods: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and log-rank test were used to compare probability of remaining a lifetime non-smoker across birth cohorts