Decennial trends of social differences in smoking habits in Italy: a 30-year update.

To update educational inequalities in smoking in Italy up to 2009, with an in-depth analysis of female prevalence.Data from 15 national health surveys (1980, 1983, 1986-1987, 1990, 1994, 1999-2003, 2005-2009) were analyzed. The overall sample size was representative of the population older than 25 years of age (3,300,000 men and 3,620,000 women). Main measures smoking prevalence rates standardized to the 2,000 European population, prevalence ratios by educational level (high: university degree or high school diploma; low: primary or middle school diploma), area (north, center, south and islands), and age-group (25-44, 45-59, >=60 years). Trends in tobacco prevalence were also analyzed with a multivariate approach using the negative binomial distribution.Although male prevalence steadily declined of about 2\% annually from 56.1\% in 1980 to 30.2\% in 2009, educational inequalities slightly widened, recording in 2009 a 53\% higher prevalence in men with low educational level compared to graduates. Even though female prevalence stalled around 18\% in the last three decades, this was the result of opposite trends by educational group. In fact, highly educated women, with the highest prevalence during 1980s, decreased their tobacco use, determining a reversal similar to men in educational inequalities in smoking. This reversal occurred from the 1980s onwards with a time gradient starting from north to south and from younger to older women.To achieve a fairer reduction in smoking habits, tobacco control policies focusing on lower social groups are needed.