Socio-economic aspects of the tobacco epidemic described in four stages

The socio-economic pattern of the tobacco epidemic can be divided into the following four stages (Cavelaars et al., 2000):

• stage 1: smoking is uncommon and mainly a habit of the higher socio-economic groups;
• stage 2: smoking becomes increasingly common. Rates among men peak at 50%-80% and are either the same for the different socio-economic groups or higher among higher socio-economic groups. This pattern is, however, delayed by 10-20 years for women. Smoking is first adopted by women from higher socio-economic groups;
• stage 3: prevalence rates among men decrease to about 40% as many men stop smoking, especially those with a higher educational level. Women reach their peak rate (35%-45%) during this stage, and at the end of this stage their rates also start to decline;
• stage 4: prevalence rates keep declining slowly for both men and women, and smoking progressively becomes more a habit of the lower socio-economic groups.

During the smoking epidemic there is a reversal from a positive to a negative association between socio-economic status and smoking.