Why do lower educated people continue smoking? Explanations from the longitudinal GLOBE study.

This article describes the effect of educational level on the decision to continue smoking among 1,354 initially smoking participants (age > or = 20 years) in the Dutch GLOBE study. The effect of education on continued smoking was explained from baseline information (1991) on smoking characteristics, individual characteristics, and environmental factors. Smoking status was reassessed after 6.5 years. Lower educated smokers more often continued smoking (odds ratio 2.09). Poor perceived health and earlier smoking initiation in lower educated groups were main predictors of educational differences in smoking maintenance. Educational differences in chronic illness, perceived control, neuroticism, and emotional support also contributed to the explanation of educational differences in continued smoking. These results have important implications for intervention programs and policy.