Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS).

OBJECTIVE: To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets. METHODS: Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression. RESULTS: Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance. CONCLUSIONS: Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data.

Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys.

OBJECTIVES: To identify changes in the social gradients for Pap smears and mammograms in Argentina. STUDY DESIGN: Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys. METHODS: Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance. RESULTS: The proportion of women who received a Pap smear in the previous 2 years increased from 51.6% in 2005 to 60.5% in 2009 (χ(2) = 344.8, P < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous 2 years by women aged ≥50 years, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ(2) = 279.6, P < 0.001). In 2005, low-income women were most likely not to have received a Pap test [odds ratio (OR) = 3.27, 95% confidence interval (CI) = 2.70-3.98], followed by medium-income women (OR = 1.73, 95% CI = 1.41-2.12), compared with high-income women. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed to be high priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to high-income women, low-income women experienced higher odds of not having a mammogram, but the gap diminished over time [OR = 4.14 (95% CI = 2.96-5.78) in 2005 vs OR = 2.37 (95% CI = 1.81-3.11) in 2009]. CONCLUSION: Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in priority provinces are growing. Surveillance of population indicators is needed to verify whether these short-term changes persist over time.