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Int. J. Environ. Res. Public Health 2016, 13(12), 1230;

Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision

Institut national d’études démographiques (Ined), 133 boulevard Davout, Paris 75020, France
Population Program, University of Colorado, Boulder, CO 80302, USA
Institut de recherche et documentation en économie de la santé (Irdes), 117 bis rue Manin, Paris 75019, France
Institut national de la statistique et des études économiques (Insee), 6 Rue Legrand, Malakoff 92240, France
Centre de recherche en épidémiologie et santé des populations (CESP), Faculté de médecine—Université Paris-Sud, Faculté de médecine—UVSQ, INSERM, Université Paris-Saclay, Villejuif 94805, France
Author to whom correspondence should be addressed.
Academic Editors: Linda Bauld and Rosemary Hiscock
Received: 28 October 2016 / Revised: 2 December 2016 / Accepted: 7 December 2016 / Published: 11 December 2016
(This article belongs to the Special Issue Tobacco Control and Priority Groups)
Full-Text   |   PDF [572 KB, uploaded 11 December 2016]   |  


The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications. View Full-Text
Keywords: cigarette smoking; inequalities; social behavior; addiction; public policy cigarette smoking; inequalities; social behavior; addiction; public policy

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Khlat, M.; Pampel, F.; Bricard, D.; Legleye, S. Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision. Int. J. Environ. Res. Public Health 2016, 13, 1230.

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