PMID- 31857097 OWN - NLM STAT- MEDLINE DCOM- 20210126 LR - 20210126 IS - 1096-0260 (Electronic) IS - 0091-7435 (Linking) VI - 131 DP - 2020 Feb TI - 24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program: The case of Brazil. PG - 105957 LID - S0091-7435(19)30440-2 [pii] LID - 10.1016/j.ypmed.2019.105957 [doi] AB - Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25-69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born >/=1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979-1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Bandi, Priti AU - Bandi P AD - Surveillance and Health Services Research, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, USA. Electronic address: priti.bandi@cancer.org. FAU - Chang, Virginia W AU - Chang VW AD - College of Global Public Health, New York University, 726 Broadway, New York, NY 10012, USA; Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY 10016, USA. FAU - Sherman, Scott E AU - Sherman SE AD - Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY 10016, USA. FAU - Silver, Diana AU - Silver D AD - College of Global Public Health, New York University, 726 Broadway, New York, NY 10012, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191217 PL - United States TA - Prev Med JT - Preventive medicine JID - 0322116 SB - IM MH - Adult MH - Aged MH - Brazil/epidemiology MH - Cross-Sectional Studies MH - *Educational Status MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prevalence MH - Sex Factors MH - Socioeconomic Factors MH - *Tobacco Smoking/epidemiology/trends MH - *Tobacco Use/legislation & jurisprudence/trends OTO - NOTNLM OT - Disparities OT - Inequalities OT - Low- and middle-income countries OT - Population programs OT - Socioeconomic status OT - Tobacco control OT - Tobacco smoking EDAT- 2019/12/21 06:00 MHDA- 2021/01/27 06:00 CRDT- 2019/12/21 06:00 PHST- 2019/07/01 00:00 [received] PHST- 2019/10/17 00:00 [revised] PHST- 2019/12/16 00:00 [accepted] PHST- 2019/12/21 06:00 [pubmed] PHST- 2021/01/27 06:00 [medline] PHST- 2019/12/21 06:00 [entrez] AID - S0091-7435(19)30440-2 [pii] AID - 10.1016/j.ypmed.2019.105957 [doi] PST - ppublish SO - Prev Med. 2020 Feb;131:105957. doi: 10.1016/j.ypmed.2019.105957. Epub 2019 Dec 17.