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Bruno Federico, MSc, Giuseppe Costa, MD and Anton E. Kunst, PhD

Bruno Federico and Anton E. Kunst are with the Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands. Bruno Federico is also with the Department of Health and Sport Sciences, University of Cassino, Italy. Giuseppe Costa is with the Department of Public Health and Microbiology, University of Turin, Italy.

Correspondence: Requests for reprints should be sent to Bruno Federico, MSc, Department of Health and Sport Sciences, University of Cassino, viale Bonomi 03043, Cassino (FR) Italy (e-mail: b.federico{at}unicas.it).

Objectives. We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resultant inequality in smoking prevalence among 3 consecutive Italian birth cohorts.

Methods. We used data from the 1999–2000 Italian National Health Interview Survey, which included 28958 men and 29769 women who were born between 1940 and 1969. The association between smoking variables and level of education was assessed with logistic regression and life table analyses.

Results. Inequalities in the lifetime prevalence of smoking increased across the 3 birth cohorts in Italy. At age 40, lower-educated persons in the youngest cohort reported on average 1 to 5 years of additional exposure to regular smoking compared with higher-educated persons. Inequalities in smoking prevalence increased among both men and women because of widening inequalities in initiation rates. Among women, growing inequalities in cessation rates also played a role.

Conclusions. The relative contribution of initiation and cessation to socioeconomic inequalities in smoking rates varied by both gender and birth cohort. For the youngest birth cohort, policies that address inequalities in smoking should focus on both initiation and cessation.

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