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Themenschwerpunkt

To What Extent Do Age, Period, and Cohort Patterns Account for Time Trends and Social Inequalities in Smoking?

Welchen Einfluss haben Alters-, Perioden- und Kohorteneffekte auf zeitliche Veränderungen und soziale Ungleichheiten im Rauchverhalten?

Published Online:November 18, 2010https://doi.org/10.1024/0939-5911/a000047

Abstract

Aims: This paper evaluates nonconfounded and independent age, period, and cohort effects on time trends and social disparities in smoking behavior. Methods: Data from nine waves of the German Epidemiological Survey of Substance Abuse (ESA) conducted between 1980 and 2009 were used. A total of N = 73,782 individuals aged 18 and older were included in the analyses. Using cross-classified random-effects models, fixed effects of age (level 1) as well as random effects of periods and cohorts (level 2) on 30-day smoking prevalence and average number of cigarettes per day were estimated. Analyses were stratified by socioeconomic status (SES). Results: Independent of SES, positive and curvilinear age effects emerged. Prevalence and amount of smoking declined sharply over time and revealed an inversion of the social gradient in 2003. This was due to a stronger decrease of smoking in the highest SES group compared to the other groups. Cohort effects were nonlinear and inconsistent. Conclusion: The emergence of increasing social disparities in smoking implies the need to specifically address the situation of low-SES groups when developing tobacco control measures.


Ziele: Ziel dieser Studie ist die Analyse unabhängiger Alters-, Perioden- und Kohorteneffekte auf zeitliche Trends und soziale Ungleichheiten im Rauchverhalten. Methode: Die Analysen basieren auf Daten von neun Erhebungszeitpunkten des Epidemiologischen Suchtsurveys (ESA), die zwischen 1980 und 2009 realisiert wurden. Insgesamt wurden N = 73,782 Personen im Alter zwischen 18 und 64 Jahren eingeschlossen. Mithilfe von Mehrebenen-Modellen wurden feste Effekte von Alter (Ebene 1) sowie Zufallseffekte von Perioden und Geburtskohorten (Ebene 2) auf die 30-Tage-Prävalenz des Rauchens und die durchschnittliche Konsummenge geschätzt. Die Analysen wurden getrennt für drei sozioökonomische Schichten durchgeführt. Ergebnisse: Unabhängig vom sozialen Status ergaben sich positive und kurvenförmige Alterseinflüsse. Prävalenz und Konsummenge nahmen über die Zeit signifikant ab, wobei sich die Unterschiede zwischen den sozialen Gruppen im Jahr 2003 umkehrten. Dies resultierte aus einem stärkeren Rückgang des Rauchens in der höchsten im Vergleich zu den anderen Schichten. Kohorteneffekte waren nicht linear und inkonsistent. Schlussfolgerung: Aufgrund zunehmender sozialer Ungleichheiten im Rauchverhalten ist es notwendig, die spezifische Situation benachteiligter Gruppen bei der Entwicklung von künftigen Tabakkontrollmaßnahmen zu berücksichtigen.

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