The evolution of educational inequalities in smoking: a changing relationship and a cross-over effect among German birth cohorts of 1921–70.

Aims To investigate the evolution of the relationship between education and smoking behaviour (ever-smoking and age of initiation) among German birth cohorts of 1921–70. Participants A total of 5297 respondents to the German Federal Health Survey of 1998 were divided into 10-year sex–birth–education cohorts. Measurements Self-reported smoking histories (ever-smoking and the age of starting smoking). Findings There was an inversion of the educational gradient around the birth cohorts of 1931–40 for men and 1941–50 for women. For men, the educational cross-over in smoking was due to a stronger decrease of the ever-smoking prevalence of the highly educated compared to the least educated. In women it was due to a stronger increase in ever-smoking prevalence among the least educated compared to the highly educated. This educational cross-over effect was also be detected for the average age of starting smoking, and involved the same cohorts. Additionally, in the youngest birth cohorts the differences between the least and highest educated of each gender were greater than the differences between the genders. Conclusions The educational differences in smoking prevalence are stable in men but in women they are widening. Hence, socio-economic inequalities in health due to smoking will rise in women in the next decades, while they will stabilize in men. [ABSTRACT FROM AUTHOR]