Current Inequities in Smoking Prevalence on District Level in Iran: A Systematic Analysis on the STEPS Survey

Background: The prevalence of tobacco smoking and its burden on societies is not homogenous atthe national and district levels. This nationwide study aimed to investigate current inequalities in theprevalence of smoking at the district level and the association of smoking behaviors with gender, wealth,education, and urbanization in Iran.Study design: A cross-sectional study.Methods: This study was conducted by analyzing the data of the STEPS survey ۲۰۱۶ with ۳۰ ۵۴۱ participants.The small-area estimation method using the Bayesian spatial hierarchical multilevel regression model wasemployed to generate district-level prevalence of all types of smoking by gender. The inequalities betweenthe groups by wealth, education, and urbanization were investigated via concentration index.Results: The prevalence rates of current daily cigarette smoking were found to be at the range of ۴.۶-۴۰.۹and ۰-۴.۵ among men and women, respectively. Current daily cigarette smoking was higher in men thanin women: ۱۹.۰ (۹۵% CI: ۹.۵-۲۸.۷) vs ۰.۷ (۹۵% CI: ۰-۶.۹). Women with lower wealth, education, orurbanization were more likely to smoke tobacco or be exposed to secondhand smoking. On the otherhand, men with higher wealth or education indices were more likely to smoke tobacco. Men with lowerwealth, education, or urbanization were more likely to be exposed to secondhand smoking.Conclusion: The smoking behavior varied significantly at the district level in Iran. Gender, wealth,education, and urbanization were determinants of smoking prevalence.