[Educational differences in smoking and smoking cessation among young adults. Results from the "German Health Update"...

Studies show that adolescents attending upper secondary schools are less likely to smoke than their peers attending lower secondary school types. This article examines how educational differences in smoking behaviour continue in young adulthood. Besides frequency and intensity of tobacco use the main focus is on smoking cessation.

The analyses were based on information of the 18- to 29-year-old men and women who participated in the nationwide representative telephone survey "German Health Update" (GEDA) 2009 and 2010 carried out by the Robert Koch Institute (n=7,620). Smoking behaviour was measured by several questions on smoking frequency and intensity. Educational status was assessed by the highest school-leaving certificate and classified as low (no school-leaving certificate/Hauptschule certificate), middle (General Certificate of Secondary Education/Realschule certificate), and high (general qualification for university entrance (Abitur)/advanced technical college entrance qualification). In addition to prevalence estimates, age-adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were calculated using logistic regression.

According to the GEDA study, the prevalence of smoking was 42.6% among men and 36.7% among women aged 18-29 years. The prevalence of current smoking increased with decreasing educational level. The odds of current smoking was 3.72-times higher in lower as compared to higher educated men (95% CI 2.90-4.77) and 3.00-times higher in lower as compared to higher educated women (95% CI 2.30-3.92). Moreover, high intensity of tobacco use was also associated with lower education in men and women. The odds of successful quitting was significantly reduced in the lowest compared to the highest educational group (men: OR=0.45; 95% CI 0.31-0.66; women: OR=0.65; 95% CI 0.44-0.94).

Our findings suggest that young adults with low education are more likely to start smoking and less likely to quit than their higher educated peers. Therefore, tobacco prevention and cessation initiatives should more focus on lower educated young adults.