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Objective: To assess the socioeconomic variations in call rates to the Quitline (Victoria, Australia) and in the impact of anti-tobacco television advertising on call rates., Design: The outcome measure was the number of calls to the Quitline in Victoria for each week for each socioeconomic group for the period January 2001 to March 2004. Socioeconomic status (SES) was derived from the caller's postcode using the Index of Socioeconomic Disadvantage provided by the Australian Bureau of Statistics. The exposure measure was weekly Target Audience Rating Points (TARPs, a standard measure of television advertising weight) for anti-tobacco advertising broadcast in Victoria over the same period. Negative binomial regression was used to examine the interaction of SES and TARPs in their effect on the number of Quitline calls., Results: SES and call rates were positively associated. Adjusted call rate was 57% (95% CI 45% to 69%) higher in the highest than the lowest SES quintile. SES differences in call rates were stable over time. In the study period, the effect of the presence or increasing levels of antismoking TARPs on call rates did not vary across categories of SES., Conclusions: In the study period, different SES groups had a similar level of responsiveness to antismoking television advertisements, at least as measured by the rate of calls to the Quitline. However, the present media campaigns are not likely to diminish SES differences in call rates, and more needs to be done to encourage disadvantaged groups to call the Quitline.

Objective: To examine Australian smokers' attitudes towards regulation of the tobacco industry and to compare their attitudes with those of three similar countries--the United Kingdom (UK), the United States (US), and Canada., Method: A telephone survey of 2,056 adult Australian smokers and 6,166 Canadian, US, and UK smokers was conducted in 2004 as the third wave of the International Tobacco Control Policy Evaluation Four-Country Survey., Results: Australian smokers display the strongest support for regulation. Only 16% believe that tobacco companies should be allowed to advertise/promote cigarettes as they please, 70% agree that tobacco products should be more tightly regulated, and 64% agree that governments should do more to tackle the harms of smoking. Smokers see government failure to do so in cynical terms -77% agree that governments do not really care about smoking because of money from tobacco taxes. Opposition comes largely from smokers who hold self-exempting beliefs about smoking's risks, have a positive attitude to smoking, do not accept that smoking is socially denormalised, and do not hold tobacco companies responsible for harms caused by smoking., Conclusions and Implications: The majority of Australian smokers believe that the tobacco industry is partly responsible for the predicament they find themselves in and want governments to act more strongly in their real interests. The strong relationship between support for regulation and cynicism about government inaction should stimulate governments into action.

Aims: To determine the prevalence and characteristics of smokers who experience smoking-induced deprivation (SID), and to examine its effect on quit attempts, relapse and cessation., Methods: Waves 2 and 3 (2003-5) of the International Tobacco Control Policy Evaluation Survey were used, which is a prospective study of a cohort of smokers in the US, Canada, UK and Australia. SID was measured with the question "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" A total of 7802 smokers participated in the survey in wave 2, of whom 5408 were also interviewed in wave 3., Findings: The proportion of smokers who reported SID was highest in Australia (33%) and lowest in the UK (20%). Younger age, minority status and low income were associated with a higher probability of SID. Some of the other factors related to a higher probability of SID were higher level of nicotine dependence, having an intention to quit, and smoking to help one socialise or control weight. The relationship between SID and quit attempt was mediated by having an intention to quit and worrying that smoking would damage health and reduce the quality of life. The relationship between SID and relapse was mediated by perceived stress. SID was not associated with successful cessation., Conclusions: Many smokers experience deprivation that is the result of their smoking. Strategies to reduce the prevalence of smoking probably effect a general improvement in standards of living and reduction in deprivation.

Issue Addressed: To explore and describe the social-environmental influence upon the likelihood of smoking tobacco for the Australian experience, in particular, Victoria., Methods: A multilevel (hierarchically structured regression) method was used. The micro-level units (characteristics of individuals) came from the annual surveys conducted by the Cancer Council of Victoria from 1990-97. The dependent variable was smoking status. The socio-demographic variables of age, marital status, education, employment status and ethnicity of individuals were used. The macro-level units (partitioned by postcode) came from the Australian Bureau of Statistics' Socioeconomic Index for Areas, split into quartiles., Results: Residential neighbourhood had a unique but modest influence in the likelihood of smoking for both men and women. Also as the level of disadvantage increased within the residential area so did the odds of smoking for both men and women; however, the effect was not consistent. The odds of smoking were highest in the most disadvantaged areas for men, contrasting with women for whom the highest odds were in areas of more but not most disadvantage., Conclusions: The level of disadvantage of the residential neighbourhood has a unique, statistically significant influence, but not to the same degree as previously published Australian research. The effect is consistent across individual characteristics such as age and level of education for men. The effect is small and less consistent for women. Indeed, area of residence seems less important for women as a whole, suggesting differential influences according to gender.

The aim of this study is to examine the association of smoking status with income inequality, relative deprivation, perception of relative material well-being and community-level social capital, controlling for individual-level indicators of social capital, and common socio-economic variables. Data were from telephone interviews of approximately 126 residents selected at random (using the Electronic White Pages) from each of 22 local government areas (LGAs) in the Melbourne metropolitan region, Victoria, Australia (total n = 2762). We used logistic regression to assess the association of covariates with smoking status. Being a smoker was associated with a higher level of perceived income inequality, lower perception of relative material well-being and living in a community with a lower degree of trust and safety. While the cross-sectional design of the study does not allow causal inferences, the results imply that smoking is less prevalent in communities that are more egalitarian and have a higher stock of social capital.

Objective: To assess the contribution of smoking to the inverse association of mortality with years of formal education in men in Australia., Design: Data were obtained from a prospective cohort study that included 17 049 men in Melbourne recruited from 1990 to 1994, most of whom were aged between 40 and 69 years at baseline. The outcome measured was all-cause mortality. The contribution of smoking to socioeconomic status differentials was estimated by including smoking as a variable in a Cox's proportional hazards model that also included education and other potential confounding variables., Results: In men, the association between education and mortality was attenuated after adjustment for smoking, and the aetiological fraction for low levels of education was reduced from 16.5% to 10.6%., Conclusions: In men, smoking contributes substantially to socioeconomic differentials in mortality. Effective policies and interventions that target smoking among socially disadvantaged groups may substantially reduce socioeconomic differentials in health.

Background: This study examines changes in the extent of inequalities in life expectancy at birth and other ages in the United States between 1980 and 2000 by gender and socioeconomic deprivation levels., Methods: A factor-based deprivation index consisting of 11 education, occupation, wealth, income distribution, unemployment, poverty, and housing quality indicators was used to define deprivation deciles, which were then linked to the US mortality data at the county-level. Life expectancy estimates were developed by age, gender, and deprivation levels for three 3 year time periods: 1980-82, 1989-91, and 1998-2000. Inequalities in life expectancy were measured by the absolute difference between the least-deprived group and each of the other deprivation deciles. Slope indices of inequality for each gender and time period were calculated by regressing life expectancy estimates on deprivation levels using weighted least squares models., Results: Those in less-deprived groups experienced a longer life expectancy at each age than their counterparts in more-deprived groups. In 1980-82, the overall life expectancy at birth was 2.8 years longer for the least-deprived group than for the most-deprived group (75.8 vs 73.0 years). By 1998-2000, the absolute difference in life expectancy at birth had increased to 4.5 years (79.2 vs 74.7 years). The inequality indices also showed a substantial widening of the deprivation gradient in life expectancy during the study period for both males and females., Conclusions: Between 1980 and 2000, those in higher socioeconomic groups experienced larger gains in life expectancy than those in more-deprived groups, contributing to the widening gap.

Aims: Our aim was to examine the association between financial stress and subsequent smoking cessation among smokers, and relapse among ex-smokers., Design and Participants: Data came from the first two waves of the Household Income and Labour Dynamics in Australia (HILDA) survey. The size of the subsample of smokers was 2076, and that of ex-smokers was 2717. Data collection was based on face-to-face interviews., Measurement: Eight questionnaire items (e.g. difficulty paying electricity, gas or telephone bills and going without meals due to shortage of money) were used to construct a nine-point financial stress index., Findings: Smokers with more financial stress were less likely to quit, with the odds of quitting reducing by 13% (95% CI: 4-21%; P = 0.008) per unit of the financial stress index. Ex-smokers with more financial stress were more likely to relapse (P < 0.001)., Conclusions: Special programmes may have to be implemented to counter the potentially adverse effects of tobacco price increases on smokers who have financial stress and fail to quit smoking.

Older smokers represent an important subgroup that has been shown to benefit considerably from quitting smoking. However, to date little is known about relevant beliefs, intentions, and motivations. This study examined factors associated with older smokers' (aged 60 years and above) intention to quit smoking using data gathered via the International Tobacco Control Policy Evaluation Survey (ITCPES), a random digit dialed telephone survey of over 9000 adult smokers from United Kingdom, United States, Canada, and Australia. Having smoked for a long time and having survived, it was hypothesized that older smokers would perceive themselves as being less vulnerable to the harm of smoking (self-exempting beliefs); be less concerned about the health effects of smoking; be less confident about being able to quit successfully (self-efficacy); not perceive any health benefit of quitting, and hence be less willing to want to quit. Controlling for possible confounders, the hypotheses were all confirmed. Further analysis into reported considerations for quitting revealed that price of cigarettes, health professional advice, cheap quitting medication, and information on health risks were important predictors of quitting intention, with cigarette price and cheap medication also associated with recent quit attempts. Together, these findings have important implications for developing strategies for encouraging older smokers to give up smoking.

Objective: Lone mothers are among the most disadvantaged groups in many countries. Smoking prevalence among this demographic group is considerably higher than the general population. Previous work has shown that only part of this difference can be explained by age, not having a partner, living alone, and socio-economic factors. This study examined the contribution of mental health, the social environment, and the lifecourse in explaining the effect of lone motherhood on smoking status., Methods: Cross-sectional data from the 1995 National Health Survey and 2001 National Drug Strategy Survey were used. Smoking was defined as daily smoking. Mental health was assessed using a 14-item scale from the SF-36. Proportion of friends who smoke was used as an indicator of the social environment. Age started smoking daily (< or = 18 and > 18) was used as a lifecourse factor., Results: Mental health, proportion of friends who smoke and age of smoking initiation had strong associations with smoking status. However, they accounted for a small part of the association of being a lone mother and a smoker. After controlling for these factors, the odds of being a smoker among lone mothers were still twice those of mothers with partners (OR 2.1, 95% CI 1.7-2.7)., Conclusions and Implications: Improving the socio-economic status (SES), mental health and the social environment of lone mothers could help reduce their high smoking prevalence. However, much of the effect of being a lone mother remains even after controlling for these factors. More research is needed to discover why prevalence is so high among this demographic group.

The association of sociodemographic and selected behavioral and social environmental factors with successful smoking cessation was examined using cross-sectional data from the 1998 Australian National Drug Strategy Household Survey, which used an area multistage stratified design. Data collection involved a mixture of interviews and self-administered questionnaires. We used a subsample of 2,526 Australians aged 14 years and older. The outcome measure distinguished between current smokers and those who had stopped smoking in the past 2 years and had not smoked for at least 1 month prior to the survey. Knowing that environmental tobacco smoke is harmful and having first smoked at age 14 or younger were associated with a higher likelihood of cessation. The odds of having quit smoking were 4.5 times greater for respondents who lived in households where smoking was not permitted than for those in households with no smoking restrictions. The odds of having quit were 3.2 times greater for respondents who reported that few or none of their friends smoked than for those who said most or all of their friends smoked. After including social environmental variables, associations of education and cessation disappeared. The study confirmed the difficulty of quitting if the proximal social environment is filled with smokers. Results call for an integrated approach in which smoking cessation interventions target the social environment as well as the individual. Efforts to intervene in smoking behavior will have limited effectiveness unless they take into account the social contexts in which smoking behavior takes place.

Background: Knowledge of sociodemographic variations in cervical cancer screening can help identify population groups at risk of underutilization of cervical cancer procedures and practices. The aim of this research was to examine sociodemographic predictors of receipt, currency (being up-to-date for), and knowledge of Pap test., Methods: We used data from the 1995 National Health Survey. A subsample of women was given self-administered questionnaires that included questions about the Pap test. The sample size was 7,572. Using multiple logistic regression, we examined the association of age, marital status, region of residence, country of birth, Index of Relative Socioeconomic Disadvantage (IRSD), and education with Pap test receipt, currency, and knowledge., Results: Women under 30 and over 49 years of age, those not presently married, those with lower levels of education, and those born in the Middle East or Asia (compared with the Australian/New Zealand-born women) were at a greater risk of not receiving and having no knowledge of Pap test., Conclusions: The results of this study suggest that, as part of a comprehensive cancer screening strategy, women who are unlikely to obtain a Pap smear might benefit from targeted interventions to improve adherence to cervical cancer screening programs., (Copyright 2002 American Health Foundation and Elsevier Science (USA))

Background: Knowledge of sociodemographic variations in breast cancer screening can help identify population groups that are at risk of underutilization of breast cancer screening procedures and practices. We examined sociodemographic variations in breast cancer screening behavior among Australian women., Methods: We used a subsample of women aged 18 years and older (n = 10,179) from the 1995 National Health Survey. We examined the association of sociodemographic variables with mammography, clinical breast examination, and breast self-examination., Results: Being in the oldest age group, never being or previously being married, living in rural regions (except in the case of breast self-examination), residing in more disadvantaged areas (except in the case of breast self-examination), and having lower levels of education were all associated with a smaller likelihood of screening. Ethnicity was also significantly associated with screening., Conclusion: Strategies to promote breast cancer screening practices should pay particular attention to the underserved groups and should be part of a more comprehensive policy that ensures the accessibility to regular health care of these population groups.

Background: Despite evidence to the contrary from overseas research, the introduction of smoke-free legislation in South Australia (SA), which required all restaurants to go smoke-free in January 1999, sparked concerns among the hospitality industry about loss of restaurant business. This study aimed to determine whether the law had a detrimental impact on restaurant business in SA., Methods: Using time series analysis, we compared the ratio of monthly restaurant turnover from restaurants and cafés in SA to (a) total retail tumover in SA (minus restaurants) for the years 1991 to 2001 and (b) Australian restaurant tumover (minus SA, Westem Australia and the Australian Capital Territory) for the years 1991-2000., Results: There was no decline in the ratio of (a) SA restaurant turnover to SA retail turnover or (b) SA restaurant tumover to Australian restaurant turnover., Conclusion: The introduction of a smoke-free law applying to restaurants in SA did not adversely affect restaurant business in SA.

Objectives: This study examined rural-urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age., Methods: Using a 10-category rural-urban continuum measure and 1970-1997 county mortality data, we estimated rural-urban differentials in suicide mortality over time by multiple regression and Poisson regression models., Results: Significant rural-urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural-urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural-urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas., Conclusions: The slope of the relationship between rural-urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural-urban disparities in suicide may reflect differential changes over time in key social integration indicators.

Background: This study examined the extent to which areal socio-economic gradients in all-cause and cardiovascular disease (CVD) mortality among US men and women aged 25-64 years increased between 1969 and 1998., Methods: Using factor analysis 17 census tract variables were used to develop an areal index of socio-economic status that was used to stratify all US counties into five socio-economic categories. By linking the index to county-level mortality data from 1969 to 1998, we calculated annual age-adjusted mortality rates for each area socio-economic group. Poisson regression models were fitted to estimate areal socio-economic gradients in mortality over time., Results: Areal socio-economic gradients in all-cause and cardiovascular mortality have increased substantially over the past three decades. Compared to men in the highest area socio-economic group, rates of all-cause and CVD mortality among men in the lowest area socio-economic group were 42% and 30% greater in 1969-1970 and 73% and 79% greater in 1997-1998, respectively. The gradients in mortality among women were steeper for CVD than for all causes. Compared to women in the highest area socio-economic group, rates of all-cause and CVD mortality among women in the lowest area socio-economic group were 29% and 49% greater in 1969-1970 and 53% and 94% greater in 1997-1998, respectively., Conclusions: Although US all-cause and cardiovascular mortality declined for all area socio-economic groups during 1969-1998, the gradient increased because of significantly larger mortality declines in the higher socio-economic groups. Increasing areal inequalities in mortality shown here may be related to increasing temporal differences in the material and social living conditions between areas.

Objective: To report smoking prevalence among Australian lone mothers by age and socio-economic group and to examine the extent to which the difference in smoking prevalence between lone mothers and other women is due to socio-economic factors., Methods: This was a secondary analysis of data from the 1995 National Health Survey (NHS), which was conducted by the Australian Bureau of Statistics (ABS). Information was collected from 53,800 respondents using face-to-face interviews. This analysis was limited to single mothers (n=1,184) who had at least one dependent child aged under 15. The outcome measure was smoking status, distinguishing regular smokers from occasional smokers, ex-smokers and never-smokers., Results: The overall smoking prevalence among lone mothers was 46.3% (Cl 43.5%-49.1%). Lone mothers who were younger, less educated, received government pension/benefits, occupied rental housing or who lived in more disadvantaged areas were more likely to smoke than others. A strong 'lone mother effect' remained after controlling for socio-economic variables. The odds of smoking for lone mothers were 2.4 times greater than for married mothers (95% Cl 2.0-2.9) and twice as large as those for women living alone (95% CI 1.62.4)., Conclusion: As the prevalence for this population group is considerably higher than the prevalence for other women within each age category, programs to assist lone mothers to quit smoking are a priority for the long-term health of these women and their children. Furthermore, we discuss how policies and interventions that enhance the material conditions and social circumstances of lone mothers can bring about a decline in their smoking prevalence.

This study examines the extent to which various ethnic-immigrant and US-born groups differ in their risks of all-cause and cause-specific mortality, morbidity, and health behaviors. Using data from the National Longitudinal Mortality Study, 1979-1989, we estimated, for major US racial and ethnic groups, mortality risks of immigrants relative to those of the US-born. The Cox regression model was used to adjust mortality differentials by age, sex, marital status, rural/urban residence, education, and family income. Logistic regression was fitted to the National Health Interview Survey data to determine whether health status and behaviors vary among ethnic-immigrant groups and by length of US residence. Compared with US-born whites of equivalent socioeconomic and demographic background, foreign-born blacks, Hispanics, and Asians/Pacific Islanders (APIs), US-born APIs, US-born Hispanics, and foreign-born whites had, respectively, 48%, 45%, 43%, 32%, 26%, and 16% lower mortality risks. While American Indians did not differ significantly from US-born whites, US-born blacks had an 8% higher mortality risk. Black and Hispanic immigrants experienced, respectively, 52% and 26% lower mortality risks than their US-born counterparts. Considerable differentials were also found in mortality for cancer, cardiovascular, respiratory, infectious disease, and injury, and in morbidity and health behaviors, with API and Hispanic immigrants generally experiencing the lowest risks. Consistent with the acculturation hypothesis, immigrants' risks of smoking, obesity, hypertension, and chronic condition, although substantially lower than those for the US-born, increased with increasing length of US residence. Given the substantial nativity differences in health status and mortality, future waves of immigrants of diverse ethnic and cultural backgrounds will likely have a sizeable impact on the overall health, disease, and mortality patterns in the United States.