Development in the smoking behavior of Danes compared to changes in smoking policy

Background: Smoking is the single most important factor regarding the Danes' short life expectancy and there has been made great efforts to reduce the proportion of smokers. The policy has through the 1980's and 1990's primarily been individually oriented through information campaigns and counseling. At the same time inequality in smoking behavior has increased. The article compares developments in Danish smoking policy to changes in smoking behavior in order to analyze whether there is consistency between the two. Doing so provides an important link between policy and behavior.

Method: The study is based on data from six cross-sectional studies of inhabitants in Copenhagen during the period 1978-2006. Smoking behavior and socioeconomic status are collected through questionnaires, and participants are randomly drawn from the Danish CPR register. Between 928 and 6,784 respondents have answered the questionnaires in each of the studies, and there are data from a total of 16,980 respondents. The studies are compared to smoking policies in the period to examine whether and how the policy prevention initiatives have had an effect on people’s smoking behavior.

Results: From 1978 until 2006 the prevalence of daily smokers has declined from 60 % to 30 %. Furthermore, the prevalence has declined more in individuals with more than 4 years of education than in individuals without vocational training. In men with no vocational training the prevalence decreased from 70% to 49% over the period whereas for men with more than 4 years of education the smoking prevalence decreased from 63% to 20 %; similar picture was seen for women.

Conclusions: Policy initiatives that address campaigns and individual counseling seem to increase disparities and creating inequality in smoking behavior as well as inequality in chronic diseases. In order to eliminate social inequalitiy, new strategies, smoking bans and tax regulations as well as focused offers to the most vulnerable groups in society are required.