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Maltese Medical Journal 45 Volume I Issue III 1989

SOCIO-ECONOMIC ASPECTS OF CIGARETTE SMOKING IN MALTAAND

Douglas G. Lockhart

Questions on smoking behaviour were in­ fies those neighbourhoods which have high, 40 per cent ofadult men were still smoking, cluded in the Census of Population and about average and low levels of smoking while the corresponding figure for women Housing taken in November 1985. Infor­ behaviour. was just 10.2 per cent. Moreover, 9.3 per mation was gathered on the number of cent of men indicated that they fonnerly cigarettes consumed bysmokers, those who INCIDENCE OF smoked regularly whereas only 2.2 percent had stopped smoking and those who had CIGARETTE SMOKING of women had given up cigarettes. never smoked. Since the Census, smoking has figured prominently in Maltese news­ A total of 61891 persons, 24.4 per cent of AGE-SEX CHARACTERISTICS OF papers and the Health Education Unit has the population aged 16 years and over indi­ CURRENT SMOKERS been active in publicising the health haz­ cated that they were regular smokers at ards associated with tobacco dependence. the 1985 Census. A further 14273 (5.6%) Smoking is a habit common in all age-sex Nevertheless relatively little research has declared that they had stopped smoking, categories, but to varying degrees ofinten­ been done on patterns ofcigarette smoking while the remaining 178033 (70%) claimed sity (Tables lA and 1B). Among men the and on the demographic, socio-economic that they had never smoked. In short, incidence of smoking and the number of and environmental factors that may go almost one-third of the adult population cigarettes smoked is heaviest in the 30-59 some way towards explaining the sharp are or havebeen exposedto the health risks age group. A second point is that the pro­ variations in cigarette addiction within associated with smoking. portion oflight smokers is negatively corre­ and Gozo. This paper explores a lated with ageing. Thirdly, cigarette smok­ number of these underlying dimensions There are however, marked diITerences in ing is less popular among Gozitans of all and using a simple statistical index identi­ smoking habits between the sexes. Almost age groups compared with their counter­ parts in Malta. Table 1 A The proportion of women smokers is appre­ Table lA Smoking patterns of adult men by age greup (%) ciably lower and in Gozo fewer than 1 in 20 women have ever smoked. In Malta, there Age groups 16-29 30-59 60 and over Malta Gozo Malta Gozo Malta Gozo is some evidence that smoking among women is becoming more popular. Lastly, Never smoked 61.6 67.7 45.0 46.3 43.0 59.9 only a very small percentage ofwomen aged Stopped smoking 3.2 2.7 9.5 8.4 17.8 15.9 60 and over were smoking in 1985.

Smoking 2-10 8.5 8.5 6.9 7.6 5.9 8.9 cigarettes/day EMPLOYMENT AND SMOKING HABITS Smoking 11-20 17.4 15.2 19.1 18.1 13.9 11.1 cigarettes/day Sinceinformationon cigarette smokingwas Smoking 21 or 19.5 11.3 gathered as part ofthe Population Census, more cigarettes/ 8.9 5.9 9.9 4.3 day it is possible to crosstabulate smoking hab­ its with a wide range ofsocio-economic and Source. The source for the tables in this paper are unpublished data household characteristics. Themes which supplied by the Central Office of Statistics, are covered by the Census include employ­ ment, wage levels, household size, tenure and geographical mobility. Space here Table 1 B permits analysis of only a few of the many possible relationships, however of these employment was one of the most useful Table lE Smoking patterns of adult women by age group ( %) diagnostic variables. Tables 2A and 2B Age groups 16-29 30-59 60 and over provide a detailed breakdown of the smok­ ing habits ofmen and women in six occupa­ Malta Gozo Malta Gozo Malta Gozo tional groupings. These suggest that ciga­ Never smoked 81. 5 96.1 86.0 96.6 96.1 99.4 rettesmokingis particularlypopularamong four groups of male workers: employers, Stopped smoking 2.6 0.6 2.6 0.6 1.3 0.1 the self-employed (own-account workers) and blue collar jobs represented by the Smoking 2-10 8.8 2.1 5.3 1.5 1.2 0.2 cigarettes/day skilled/semi-skilled and the unskilled cate­ gories (Fig 1). It is also noticeable that the Smoking 11-20 6.0 1.1 4.8 1.1 1.0 0.1 proportion of medium and heavy smokers cigarettes/day is also greatestin theseemployment grou ps. Smoking 21 or more cigarettes/ 1.1 0.1 1.4 0 . 2 0.3 0.1 day Douglas G. Lockhart, Lecturer in Geography, University ofKeele, Staffordshire, U.K. Maltese Medical Journal 46 Volume I Issue III 1989

Table 2 A lected (Table 3) and for each variable the Ta b le 2A Smoking patterns of men by employment in Malta and Gazo locality which displayed the lowest propor­ tion of smokers or the least consumption pattern was awarded rank 1 and the next neve r stopped smoking (ciga r ette s/day) lowest was given rank 2 and so on. The smoked smoking 2-10 1l ·· 20 21 or mor e index was calculated using the formula: e mp loyer 1034 227 321 ( 49.6 ) ( 1 0 .6) 14~ (6.9) ( 15.1 ) 3~; (1 7 .7) 44 4 8 I =100. 4246 1654 1547 (:C) o wn acco unt (49.0) (7 .9 ) (7 .3 ) (18.7) ( l7.1 ) ')17 6~; 6~~ 168 III

pro f essional, Where R is the individual rank score technical, 767 1483 (57.7) 10!~ ( 9.9 ) ( 7. 5) (14.5) 10~~ (10.4 ) N is the number of variables mana ge rial & 5~~~ 31 68 administrative and C is the number ofgeographical areas. 7309 1071 2253 executive .5. (55 .0) (8.0 ) 10~~ (8.1) ( 16.8) 1 6~ ~ ( 12.2) c lerical 31 7 31 7 1 At the locality level the index ranges from - skilled & 12899 ( 4 6 1 ) 3.9 Ghasri (the best) to 96.1 Scnglea (the 21~~ (7 .6) 21~~ (7 .5 ) 5 i~~ (20 . 5) 5n; (18.2 ) semI-skilled 550 . worst) (Table 4 and Fig 3). The regional unskilled 872 3016 scores are based on the average values of 5 ~~; (43.1) ( 6.5) i{~ (7.0) (21. 6) 3~~; ( 22.4) 107 260 their constituent localities and range from 17.4 Gozo and Comino (the best) to 72.7 Notel 1 Actual values a s veIl as percentages appear in this table and Table 2B because many of the crosstabulations p roduced small cell counts. Inner Harbour (the worst) (Table 5). Each cell containsl Malta count , Gazo count \average percentage) High scores are characteristic of the Inner Harbour Region as a whole. Even here Table 2 B there is a marked peak in The Three Cities Table 2B Smoking patterns of women by employment in Malta and Ga zo and the adjacent localities of Marsa and . Values about the average for Malta can be found in and Guar­ never stopped smoking ( cigarettes/day ) damangia. The Outer Harbour and South smoked smoking 2-10 11-20 21 or more Eastern Regions both contain some locali­ 124 employer ( 77.1 ) ( 1.1) 1 ~ (8.6) 19 (5.7) 1 ~ ( 7.4 ) ties with quite high scores (Zabbar, San 11 ~ Gwann, Birzebbugia) and a number of dis­ 18 own account 791 (86.3) (1.8 ) 5~ (5.7) 4 ~ ( 4.4 ) 1~ ( 1.8 ) 119 1 tricts which have lower levels of addiction (, , ). The locali· professional, ties ofWestern and Northern Regions form technical. 2361 (86.7) 7~ (2.7) 17~ (6.0) 10~ ( 3.5 ) 3g (1.0) managerial & 22 0 the bulk of areas of low addiction within administrative Malta. However, there are some excep· 5139 tions, notably Gharghur, andNaxxar executive & (82.5) 14~ (2.3) 47~ (7.5) 34~ (5 .4 ) 8g ( 1.2) clerical 262 which have above average values. Gow is 6103 characterised by low scores. Here too there skilled & ( 82.1 ) 15~ ( 2.0) 7~g (9.0) 44~ ( 5.7) 8~ ( 1.1) s e mi-skilled 386 are variations with the western parishes

87 recording somewhat lower levels than Vic­ unskilled 49 53 (84.3) ( 1.4 ) 44 ~ ( 7.0 ) 36~ (5.8) 9~ (1.5) 481 2 toria, and Ghajnsielem.

The explanation for these patterns is corn· Moreover, relatively few manual workers The location of high and low consumption plex and no doubt is related to many factors give up smoking (Fig 2). regions is similar among males and females including employment, age structure and in Malta and although the male residents of geographical location which have been dis­ Differences between the smoking habits of Gozo do smoke less than their Maltese cussed in this paper. working women are less obvious. Three cou nterparts, the greatest difference is the groups are slightly heavier smokers: em· very low incidence of smoking among It would be intriguing to know what influ­ ployers, skilled/semi-skilled and unskilled Gozitan women. In general, rates are high­ ence different life- styles, friendship pat­ workers. In all employmentcategories there est for both men and women in the urban terns, spending profiles and adolescent was a fairly even division between light area centred on Valletta and the Three experiences in the home and at school have smokers (up to 10 cigarettes/day) and those Cities, in many of the working class sub­ upon smoking behaviour. This would in­ smoking about double that amount. In urbs and in newer residential areas on the volve interviewing a representative sample proportional terms, only women employers fringe of the Harbour Regions. The corn· of the population in different localities. appear to be prone to heavy levels of addic· muter villages of South East Malta, with Instead it was decided to compare the tion. only a few exceptions, also tend to have high smoking index values with a measure ofthe rates of consumption. In contrast, North­ ------level of living in each of the census areas. CIGARETIE SMOKING BY ern and Western Malta together with Gozo are regions where non-smokers and light LOCALITY OF RESIDENCE The level ofliving index is based upon over smokers are in a majority in virtually every thirty measures of demographic, economic locality. Data on cigarette smoking habits are avail· and household structure together with data able for the 50 Census localities in Malta on housing tenure and amenities. (2) The A number ofthese trends were mapped and and 14 in Gozo, one of which, Ghajnsielem, values were mapped in the same way as the published in Volume III of the Census of includes the tiny residual population on smoking index (see Hyphen (1989) vol 6 (1) PopUlation (1), however it was felt that an Comino. These statistical areas were pp 1-7). Table 6 compares the relative index of smoking practice could provide a grouped into six regions, five in Malta with position of each locality in relation to both useful summary of differences at locality Gozo and Comino forming the sixth region. indices. The pattern which emerges is not level. Six diagnostic variables were se­ a simple correlation between high levels of Maltese Medical Journal 48 Volume I Issue III 1989

Fig 1 less well-off neighbours. The greatest deviations within the urban area however, ACKNOWLEDGEMENTS occur in the more modern suburbs. In this I wish to thank Mr. R. Camilleri, Economic PfRCEN1AGE OF MME $KIL U O AND respect, government housingestates(Santa SEMI- SKIL LE D WORKERS SMO KING 2 1 Secretary, Office of the Prime Minister for OR MOR E C IGARETTES PER DAY Lucia, Ta'Xbiex, San Gwann) character­ ised by young economically-activepopula­ his kind assistance with Census data. Mr. tions enjoying high standards ofliving are K.T. Mason, Map Curator, Department of among the communities whose impliE!d Geography, University of Keele produced health risks from smoking are greatest. all the maps in this paper and his support ~JL Localities with a mixture of government is gratefully acknowledged. estates and recent private housing develop­ ment are also high risk areas (, St. REFERENCES Julians). Indeed much of suburban Malta and villages in the South East fare badly 1. Department of Geography, University and are skewed towards a greater degree of of KeeleJCentral Office of Statistics, smoking than one might expect (Santa Malta (1987) Census '85 Vol III A com­ Venera, , Safi). puter-drawn demographic atlas of Malta and Gozo Government Press, In contrast, a belt of localities stretching Malta Fig 2 from Mellieha and Mgarr through western Malta to Mqabba and in the South 2. Lockhart, D.G. (1989) 'The quality of East are characterised by comparatively life in Malta and Gozo', Hyphen VI (1), PERC E "~T AGE OF MALE UNSKILLED Wm~ ". Ln S WHO HAVE STOPPE D SMOKING poor levels ofliving and moderate amounts pp1-7. of cigarette addiction. Finally, differences between the two indices are consistently greatest in Gozo owing to the generally Table 3 poor quality of life throughout the island and the lighter smoking habits of much of ~& the population. I , CONCLUSIONS Table) The indicant.s of c igarette slIIOlting in Millta and Gozo Data from the 1985 Census confirm the I 1 Ma,l e smokers very marked differentiation in smoking Z r e_le smokers 3 Ma l e s Yho have never smoked practice amongtheMaltese population. The 4 Fe_ I es ...ho hav e nev er smok ed variables discussed in this paper point to 5 Mal es smoking 2-10 ciga r ettes pe. d a y the existence of a number of fascinating 6 M" les smoking 21 or InO l'" e c iqarette,. pe. d il Y variations between men and women, by age group, between white collar and blue collar Fig 3 occupations and from one region and even one locality to the next. Among the most striking features are the high levels of addiction in the working-class population " ~/'. . ~. . I\ ...... ~. hl. _. " j in inner-urban areas, the tendencyfor above ~": ~ average levels of addiction to be prevalent in new and expanding neighbourhoods and Table 5 ' the increasing trend towards smoking 1!L among young women. However, undoubt­ c " edly the greatest contrast is the almost Le v e ls of cig. rette smok ing i n the Cen s us tegions __. ,,,,-U( north-south divide between a ruralllow density population who are light smokers A Ver~~ ~u!ndex A::~g e and the urban and suburban communities Inner Ha rbour .. ', '. ~".' where smoking is much more a way of life. Out.. r Ilarbour I"''' ''' South Eil stern 19.6

Accurate data on the nature of smoking IJv l!'O a nd Comino

behaviour is of course an important re­ 58.5 quirement if health educational initiatives Malta, '>Ol!' O il nd Comino addiction and poorquality oflife associated are to be effective. It is hoped that the with inner-city living conditions on the one information provided by the Census will be hand and substantially lower consumption used to target those groups who are most at patterns and suburban prosperity on the risk such as school leavers and the young other. Certainly, The Three Cities and residents of inner-urban areas. Mapping many of the working class neighbourhoods relationships between cigarette smoking adjacent the industrial areas do indeed habits and socio-economic variables dem­ have a poor record on the quality of life onstrates the value of a geographical per­ indicators and a heavy dependence upon spective because it answers vital questions cigarettes (, , Marsa). such as who are Malta's smoking popula­ Some such as Kalkara and although tion, where do they live and what are their enjoying a better level ofliving share smok­ household and occupational characteris­ ing patterns that are very similar to their tics. Maltese Medical Journal 49 Volume I Issue III 1989

Table 4

Table 4 Levels of cigarette smoking in the Census regions and localities

Index Rank Index Rank Index Rank SOUTH EASTERN GOZO AND COMI NO I NNER HARBOUR value value value Cospicua 95.8 63 8i rzebbugia 68 .8 52 Fontana 19.8 10 72.7 57 Ghaxag 56.0 35 Gha jnsielem (b) 48 . 4 26 Guardamangia 55 .2 33 60.4 42 Gharb 7.8 Gzira 67.7 50 Kirkop 72.1 55 Ghas ri 3.9 63.0 4 5 Marsascala 53.6 31 Kercem 11. 2 Kalkara 81.0 60 Marsaxlokk 43.5 22 21. 9 13 Harsa 81. 3 61 Mqa bba 47.1 25 Nadur 27. 9 16 Hsida 64.8 48 Qrendi 57.0 37 Qala 8.6 4 Paola 64 . 3 4 6 Sa f i 68.0 51 8.3 Pieta 59.4 38 Ze jtun 70 . 3 53 18 . 8 Santa Lucia 71.1 54 Zurri e q 59.4 38 Victoria 23.4 14 Senglea 96.1 64 Xaghra 10.9 1 WESTERN Sliema 54.9 32 Xevki ja 1 9 .8 10 ;':. t tard 25.3 15 Valletta 65.9 49 Zebbug 13.0 37 .8 20 Vittoriosa 93.5 62 vi ng l i 21.1 12 Ta ·Xbiex 76. 6 58 Notesl a The existence o f the St Vincent de Paule home for the Li ja 46. 9 24 e lderly is likely to have influenced the value for OUTER HARBOUR 51. 6 28 b inCludes Comino which has a population o f about seven 56 .3 36 persons Bi rkirkaca Rabat 3 5 .2 19 Fgura 72.4 56 SiggieW"i 30.7 18 Luqa (a) 48.4 26 lebbug 43.0 21 Qormi 55.2 33 San G""ann 64.6 4 7 NOR TH ER N St ,}ulians 60.7 43 Gharghur 61. 7 44 59. 9 41 Mellieha 29.9 17 59 .6 40 Mgarr 14.1 Zabhar 79 .9 59 Mos t a 53. 1 30 52.9 29

St Paul' 5 Bay 44.0 23

Table 6

Table 6 Comparison b e tween the level of living index and the

smoking index for localities in Mal ta and .JoZD

Difference Di fference Difference I NNER HARBOUR in rank SOUTIi EASTERN in rank GOZO AND COMI NO in rank Cospicua - 8 Birzebbugia -19 Fontana +39 Floriana - 6 Ghaxaq - 3 Gha j nsielem + 24 Guardamangia -14 Gudja -22 Gharb +55 Gzira -20 Ki rkop -24 Ghasri +53 Harnrun + 2 Mdrsascala -22 Kercern +46 Kalkara -23 Marsaxlokk - 7 Munxar +46 Marsa - 3 Mqabba +15 Nadur +44 Msida -24 Qrendi +11 Qa la +60 Paola - 4 Safi -37 San Lavrenz +42 Pieta -1 3 Zejtun -14 S annat +34 Santa Lucia -53 Zurrieq - 9 Victoria +2 2 - 1 Xaghra +51 Senglea WESTERN + 3 xewki j a +52 Sliema -12 Vallett-a +12 Zebbug +45 Balzan -13 Vittoriosa -16 + 9 Note l positive differenges occur where the level of living index Ta'Xbiex -53 Li j a -13 exceeds the smoking index and negative differences arise OUTER HARBOUR Mdina +10 where the rank of the smoking index is the greater. -20 Rabat + 21 Fgura - 52 Siggiewi + 5 Luqa +18 Zebbug + 1

Qormi - 4 NORTHERN San Gvann -45 Gharghur -26 St .} ulians -35 M.ellieha + 9 Santa Venera -29 Mgarr +26 Tarxien -27 Mosta -20 -31 Zabbar Naxxar -23 St Paul' s Bay - 6 The copyright of this article belongs to the Editorial Board of the Malta Medical Journal. The Malta Medical Journal’s rights in respect of this work are as defined by the Copyright Act (Chapter 415) of the Laws of Malta or as modified by any successive legislation.

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