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    • The results of Poisson regression are shown in Table

    2018-11-02

    The results of Poisson regression are shown in Table 2 (men) and 3 (women). Age-adjusted PRs (95% CIs) for each outcome by survey year and p-values for temporal trends are presented. Although point estimates varied by year, the associations of SRH and health behavior with SES were observed, with some exceptions. For example, the associations between SRH and class identification, and between smoking and education were clear for both genders. These associations were significant for all survey years. In contrast, no significant associations were seen between SRH and occupation for either gender or between income and physical activity for men, regardless of the survey year. Similar temporal trends in smoking disparities were seen when we used RII. The results are summarized in Fig. 1 and the details are shown in Appendices A (men) and B (women). Among women, a significant increasing trend in the association of education with smoking was also observed; therefore, all of the four SES indices showed significant or marginally significant increasing trends in RII for smoking. Among men, trends in the association between smoking and income were no longer statistically significant, while trends in the associations of smoking with class identification were significant. The results of SII are also summarized in Fig. 1 and the details are shown in Appendices C (men) and D (women). Significant increasing trends were observed in the associations of smoking with occupation (for women) and class identification (for men and women).
    Discussion Using the JGSS data from 2000 to 2010—a representative sample of Japanese adult lxr agonist obtained by repeated cross-sectional social surveys—we found that socioeconomic differences in smoking between 2000 and 2010 increased in the general population and especially among women. In contrast, no such temporal expanding trends were seen for the associations of SRH and physical activity with SES indices. Our analysis has an advantage over the previous studies (Asada & Ohkusa, 2004; Hiyoshi, Fukuda, Shipley, & Brunner, 2013b; Kachi et al. 2013; Kondo et al., 2008) in that we used a variety of health outcomes and SES indices. This approach resulted in the detection of increasing trends in smoking disparity depending on occupation and class identification, which has not been examined in the previous studies. The reason for the expansion of smoking disparity related to SES might be associated with recent changes in policies and social environment of Japan. Some policy changes occurred during our study period, for example introducing smoking cessation therapy covered by health insurance, smoking bans in specific locations (e.g., the workplace or the street) as well as the repeatedly raised tobacco prices. These changes might have also affected the social norms directed against smoking. Such changes in policies and norms may have contributed to the reduction of smoking rates. However, they could have also accompanied the expanding socioeconomic disparity in smoking; health intervention might benefit the high SES populations more than the low SES ones at the early stage of such policies, as indicated by the inverse equity hypothesis (Victora,Vaughan, BarrosSilva, & Tomasi, 2000). Fukuda (2008) has anticipated the expansion of smoking disparities related to SES with a decrease in smoking rates in Japan. In fact, an earlier study in Japan had found that the white collar workers tend to quit smoking more often in comparison with the outdoor workers or small factory employees (Honjo et al., 2010). White-collar workers at a large company might be more health conscious and more likely to stop smoking, encouraged by health checkups and smoking restrictions at their workplace. Tabuchi, Fujiwara, and Shinozaki (2016) have found that the tobacco price increase in 2010 (implemented after our study period) was associated with an increase in smoking cessation among all income subgroups. Previous studies had indicated that the increases in tobacco price had been more effective in reducing smoking among the low income adults (Thomas et al. 2008). It is possible that Japan is still at the “early stage” of the tobacco intervention policies, and therefore, the differences in smoking rates depending on SES have been widened.