Online first

Gender, age, social disadvantage and quitting smoking in Argentina and Uruguay

Jan Krakowiak 3,  
Tomasz Saran 4,  
Department of Tobacco Control, Preventive Medicine, Medical University of Lodz, Poland
Department of Hygiene and Epidemiology, Medical University of Lodz, Poland
Department of Social Medicine, Medical University of Lodz, Poland
Department of Rehabilitation, Witold Chodźko Institute of Rural Health in Lublin, Poland
Cessation of tobacco use has the potential to provide the greatest immediate benefits for tobacco control. Understanding the social determinants of smoking cessation is an essential requirement for increasing smoking cessation at the population level. The purpose of this study was to analyze the socio-economic dimensions associated with cessation success among adults in Argentina and Uruguay.

Material and Methods:
Data from the Global Adult Tobacco Survey (GATS), a cross-sectional, population-based, nationally representative survey conducted in Argentina (n=5,383) and Uruguay (n=4,833) was utilized. Univariable and multivariable logistic regression analyses with results being presented as odds ratios (OR) with 95% confidence intervals were applied to study differences among those respondents who sustained smoking abstinence (≥1 year) and those who continued smoking.

The GATS study revealed that social gradients in tobacco quitting exist in Argentina and Uruguay. Being aged 25–34, particularly men in Uruguay, women in Argentina, low educated men in Argentina and having a lower asset index were associated with reduced odds for quitting.

Factors that are driving differences in smoking cessation between diverse social groups in Latin America countries need to be considered when implementing relevant interventions to ensure tobacco control strategies work effectively for all population segments.

Dorota Kaleta   
Department of Tobacco Control, Preventive Medicine, Medical University of Lodz, Poland
1. Pan American Health Organization. Tobacco Control Report for the Region of the Americas. Washington, DC, USA, 2013.
2. World Health Organization. WHO global report: mortality attributable to tobacco. World Health Organization, Geneva, Switzerland, 2012.
3. De Maio FG, Konfino J, Ondarsuhu D, Goldberg L, Linetzky B, Ferrante D. Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS). Tobacco Control, 2014; pp.1–6. doi:10.1136/tobaccocontrol-2013–051525 2014 July 1.
4. Centers for Disease Control and Prevention (CDC). Best practices for comprehensive tobacco control programs. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007.
5. World Health Organization. Systematic review of the link between tobacco and poverty. World Health Organization, Geneva, Switzerland, 2011.
6. Fleischer NL, Diez Roux AV, Alazraqui M, Spinelli, Lantz PM. Socioeconomic patterning in tobacco use in Argentina, 2005. Nicotine Tobacco Res. 2011; 13: 894–902.
7. World Health Organization. Tobacco and i equalities. Guidance for addressing inequalities in tobacco-related harm”. World Health Organization, Copenhagen, Denmark, 2014.
8. Global Adult Tobacco Survey (GATS). Argentina Country Report. Ministry of Health Argentina: 2012. http://www.who.int/tobacco/surveillance/survey/gats/argentina/en/index.html (Accessed July 2014).
9. Pan American Health Organization. Global Adult Tobacco Survey. Uruguay GATS Report 2009, Uruguay. WHO/PAHO, 2011.
10. Centers for Disease Control and Prevention (CDC). Global Tobacco Surveillance System. Global Adult Tobacco Survey. Atlanta: Centers for Disease Control and Prevention, 1999.
11. Lee C, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007; 97: 1503–1509.
12. Bjornson W, Rand C, Connett JE, Lindgren P, Nides M, Pope F, Buist AS, Hoppe-Ryan C, O’Hara P. Gender differences in smoking cessation after 3 years in the Lung Health Study. Am J Public Health. 1995; 85: 223–230.
13. Srivastava S, Malhotra S, Harries AD, Lal P, Arora M. Correlates of tobacco quit attempts and cessation in the adult population of India: secondary analysis of the Global Adult Tobacco Survey, 2009–10. BMC Public Health. 2013; 13: 263. Published online 2013 March 22. doi: 10.1186/1471–2458–13–263 D.
14. Kaleta D, Usidame B, Dziankowska-Zaborszczyk E, Makowiec-Dąbrowska T. Correlates of Cessation Success among Romanian Adults. BioMed Research International. 2014: 675496. Published online 2014 June 4. doi: 10.1155/2014/675496.
15. West R, Mcewen A, Bolling K, Owen L. Smoking cessation and smoking patterns in the general population: a 1-year follow-up. Addiction. 2001; 96: 891–902.
16. Marti J. Successful smoking cessation and duration of abstinence-an analysis of socioeconomic determinants. Intern J Environ Res Public Health 2010; 7: 2789–2799.
17. Osler M, Prescott E. Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults. Tobacco Control. 1998; 7(3): 262–67; doi: 10.1136/tc.7.3.262.
18. Kabat GC, Wynder EL. Determinants of quitting smoking. Am J Public Health. 1987; 77(10): 1301–1305.
19. Kaleta D, Usidame B, Dziankowska-Zaborszczyk E, Makowiec-Dąbrowska T, Leinsalu M. Prevalence and factors associated with hardcore smoking in Poland: findings from the Global Adult Tobacco Survey (2009–2010). BMC Public Health. 2014; 14: 583; doi: 10.1186/1471–2458–14–583 2014 Jun 11.
20. Alderete M, Gutkowski PM. Health is Not Negotiable: Civil Society against the Tobacco Industry’s Strategies in Latin America. Case Studies 2014. Gutkowski; edited by Patricia Gutkowski. Second Edition. Buenos Aires: Inter-American Heart Foundation-Argentina, 2014. http://ficargentina.org/images/stories/Documentos/la_salud_no_se_negocia_2014_in_final.pdf.
21. Azevedo e Silva G, Valente JG. Tobacco control: Learning from Uruguay. Lancet 2012; 380: 1538–40.
22. Sebrié EM, Barnoya J, Perez-Stable EJ, Glantz SA. Tobacco industry successfully prevented tobacco control legislation in Argentina. Tobacco Control. 2005; 14: e2.
23. Kaleta D, Korytkowski P, Makowiec-Dabrowska T, Usidame B, Bak-Romaniszyn L, Fronczak A. Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009–2010). BMC Public Health. 2012; 12: 1020.
24. Health Canada. Available from: http://www.hc-sc.gc.ca/hecs-sesc/tobacco/research/ctums/2002/2002-supptables.eng.pdf. Accessed February 2014.
25. Edwards R. The problem of tobacco smoking. BMJ. 2004; 328: 217–219. doi:10.1136/bmj.328.7433.217.
26. Vangeli E, Stapleton J, Smit ES, Borland R, West R. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011; 106(12): 2110–2121.
27. Reid J, Hammond D, Boudreau C, Fong GT, Siahpush M. Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: Findings from the International Tobacco Control Four Country Survey. Nicotine Tobacco Res. 2010; 12, Suppl 1: S20–S33, 2010. doi: 10.1093/ntr/ntq051.
28. Kotz D, West R. Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tobacco Control. 2009; 18(1): 43–46.
29. Hyland A, Borland R, Li Q, Yong HH, McNeill A, Fong GT, Connor RJO, Cummings KM. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006; 15, suppl III: iii83-iii94.
30. Siahpush M, Borland R, Scollo M. Factors associated with smoking cessation in a national sample of Australians. Nicotine Tobacco Res.2003; 5: 597–602.
31. Marques-Vidal P, Melich-Cerveira J, Paccaud F, Waeber G, Vollenweider P, Cornuz J. Prevalence and factors associated with difficulty and intention to quit smoking in Switzerland. BMC Public Health. 2011; 13(11): 227.
32. Augustson EM, Wanke KL, S Rogers S, Bergen AW, Chatterjee N, Synder K, Albanes D, Taylor P, Caporaso NE. Predictors of sustained smoking cessation: a prospective analysis of chronic smokers from the alpha-tocopherol Beta-carotene cancer prevention study. Am J Public Health. 2008; 98: 549–555.
33. Donzé J, Ruffieux C, Cornuz J. Determinants of smoking and cessation in older women. Age and Ageing 2007; 36(1): 53–57. doi: 10.1093/ageing/afl120.
34. Emery S, Gilpin EA, Ake C, Farkas AJ, Pierce JB. “Characterizing and identifying ‘hard-core’ smokers: implications for further reducing smoking prevalence”. Am J Public Health. 2000; 90: 387e94.
35. Fernández E, Garcia M, Schiaffino A, Borràs JM, Nebot M, Segura A. Smoking initiation and cessation by gender and educational level in Catalonia, Spain. Prev Med. 2001; 32: 218–223.
36. Patrick DL, Cheadle A, DThompson DC, Diehr P, Koepsell T,. Kinne S. The validity of self-reported smoking: A review and meta-analysis. Am J Public Health. 1994; 84(7): 1086–1093.
37. Wilson LM, Avila TE, Chander G, Hutton HE, Odelola OA, Elf JL, Heckman-Stoddard BM, Bass EB, Little, Haberl, Apelberg BJ. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. J Environ Public Health. 2012: 961724. doi: 10.1155/2012/961724. Epub 2012 Jun 7.
38. Murray RL, Bauld L, Hackshaw LE, McNeill A. Improving access to smoking cessation services for disadvantaged groups: a systematic review. J Public Health. 2009; 31(2): 258–77. doi: 10.1093/pubmed/fdp008. Epub 2009 Feb 10.
39. Neumann T, Rasmussen M, Ghith N, Heitmann BL, Tønnesen H. The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting. Tobacco Control, 2012. doi:10.1136/tobaccocontrol-2011–050194.