Impact of the 1976 Tobacco Control Act in Finland on the proportion of ever daily smokers by socioeconomic status Satu Helakorpi ⁎ , Tuija Martelin, Jorma Torppa, Erkki Vartiainen, Antti Uutela, Kristiina Patja National Public Health Institute (KTL), Mannerheimintie 166, FI-00300 Helsinki, Finland Available online 17 November 2007 Abstract Objective. To assess the impact of the 1976 Tobacco Control Act (TCA) on smoking initiation across socioeconomic groups. Methods. Nationwide data from independent annual cross-sectional postal surveys in 1978–2002 in Finland. Subjects were 25–64-year-old men and women born 1926–1975 (n = 68 071). Socioeconomic status was derived individually from population census data. Logistic regression was applied to assess the impact of the 1976 TCA on the prevalence of ever daily smoking in birth cohorts and socioeconomic groups. Results. Clear socioeconomic differences in ever daily smoking among men and women were found. In all socioeconomic groups a declining cohort trend was observed among men whereas women showed an increasing trend in early cohorts and a declining one thereafter. A statistically significant decline in the proportion of ever daily smokers compatible with the impact of the TCA was found in all socioeconomic groups except farmers. Among women the decline was roughly similar in each socioeconomic group, while among men it varied and was most pronounced among white collar employees. Conclusions. The impact of the 1976 TCA was less pronounced among male lower socioeconomic groups. In spite of the even impact of the TCA on female smoking across socioeconomic groups, large socioeconomic disparities remain. Tobacco control policy measures specifically directed at lower socioeconomic groups are needed. © 2007 Elsevier Inc. All rights reserved. Keywords: Smoking initiation; Birth cohort; Socioeconomic status; Tobacco control policy; Finland Introduction Many health determinants, like smoking, differ across socio- economic groups, leading to major disparities in morbidity and mortality (Mackenbach et al., 1997)(Macintyre, 1997). At the population level smoking behavior can be characterized as a four- stage process (Lopez et al., 1994; Lopez, 1995; Cavelaars et al., 2000). Initially, smoking tends to rise among high socioeconomic groups. During the middle stages of the process it spreads throughout the rest of the population. In stage three male smoking is most prevalent. Then, however, it starts to decrease due to cessation, especially in the highest socioeconomic groups. In female smoking the peak follows a few years later than in male smoking. In the last stage of the process smoking declines slowly in both genders but remains high among lower socioeconomic groups. This pattern of change in smoking has been compared to the general model of diffusion of innovations and adoption and rejection of fashions (Rogers, 1995; Pampel, 2005). It appears that almost all Northern European countries were at the final stage of the spread of smoking by the late 1980s or early 1990s. Finland also seems to have reached the end of the third stage by the early 1990s (Cavelaars et al., 2000) and was still there at the beginning of this decade (Giskes et al., 2005). Smoking initiation and therefore ever smoking are influenced by various tobacco control policy measures such as anti-smoking campaigns (Vartiainen et al., 1998), special taxes on tobacco (Pekurinen and Valtonen, 1987; Townsend et al., 1994; Jha et al., 1999) and legislative norms (Helakorpi et al., 2004; Jha et al., 1999). There have been two major steps in Finnish tobacco control policy: the Tobacco Control Act of 1976 (TCA), supplemented by a total tobacco advertising ban in 1978, and the environmental tobacco smoke amendment of the TCA in 1995. The 1976 TCA prohibited smoking in most public places, including public trans- port, and the sale of tobacco products to those below 16 years of Available online at www.sciencedirect.com Preventive Medicine 46 (2008) 340 – 345 www.elsevier.com/locate/ypmed ⁎ Corresponding author. Fax: +358 9 4744 8338. E-mail address: satu.helakorpi@ktl.fi (S. Helakorpi). 0091-7435/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2007.11.001