Understanding Inequalities in Smoking in Pregnancy: Disentangling Maternal Age and Social Disadvantage

Rachel Ganly , Leverhulme Centre for Demographic Science, University of Oxford
Melinda Mills, University of Oxford

Educational disparities in smoking have existed since the 1970s and continue to be one of the main drivers of inequalities in health and mortality for adults in high-income countries. Such inequalities are particularly important during pregnancy; not only for maternal health, but because tobacco exposure in-utero is the largest behavioural risk factor which impacts infant morbidity and chronic childhood conditions. Reducing disparities in smoking during pregnancy is thus critical for the intergenerational transmission of disadvantage. We examine whether tobacco tax increases contributed to reducing educational inequalities in rates of smoking during pregnancy in Finland. Finland declared a policy of becoming ‘smoke-free’ by 2030 with a reduction in smoking to a rate of less than 2% of the population. A key feature of the policy was large and regular increases in tobacco tax. We leverage data from the medical birth records on smoking status at the start and end of pregnancy for all births in Finland from 2000 to 2018, to examine whether national cigarette price increases contribute to reducing rates of smoking during pregnancy, immediately and in the long-term. Applying interrupted time-series analysis, we find that rates of smoking during pregnancy reduced immediately and several years after the first price increase in January 2009, but only for women with the lowest levels of education. However, reductions in May 2012 and June 2014 were more modest. Our results suggest that tobacco tax increases are successful in reducing social inequalities by making cigarettes immediately more unaffordable for those with lower disposable incomes.

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 Presented in Session P2. Health, Mortality, Ageing - Aperitivo