Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer and Nutrition (EPIC): the influence of the educational level

Prev Med. 2003 Apr;36(4):448-54. doi: 10.1016/s0091-7435(02)00047-6.


Background: Several studies in Germany and other European countries have already shown smoking prevalence to be related to education. This study was aimed to investigate time trends in smoking habits in the German cohorts Heidelberg and Potsdam of the European Prospective Investigation into Cancer and Nutrition (EPIC) according to sex, birth cohort, and level of education.

Methods: Within EPIC, 25,546 and 27,548 participants were recruited in Heidelberg and Potsdam, respectively. Data on smoking were collected by means of a computer-guided interview during the baseline examination between 1994 and 1998. For each birth cohort smoking prevalence and mean number of cigarettes smoked per day at different ages were calculated. Odds ratios and 95% confidence interval for associations between smoking prevalence and educational level were computed by using logistic regression.

Results: Smoking prevalence was higher among men than among women, with a smaller difference in younger birth cohorts. Between 1950 and 1960, smoking prevalence among women in the Heidelberg cohort rose sharply (from 12.8% to 51.8% in the least educated group). This strong increase was delayed by 10 years in the Potsdam cohort. Men and women in Heidelberg smoked more cigarettes per day than their counterparts in Potsdam, but in both study centers less educated subjects smoked more than subjects with a higher education.

Conclusions: Smoking patterns in the Potsdam and Heidelberg cohorts are quite similar with respect to prevalence and years of lifetime smoking. Since an increasing difference between smoking prevalence of less and high educated individuals is observable, programs on smoking cessation should especially concentrate on persons of lower educational level.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Cohort Studies
  • Educational Status
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Sex Distribution
  • Smoking / epidemiology*
  • Smoking / trends*