Diffusion of health-related habits: Changes in gender, educational, and urban-rural inequalities in non-smoking, leisuretime exercise, and alcohol use in Norway
Elstad, Jon Ivar
Health and social inequality studies Norwegian Social Research (NOVA), Oslo, and Department of sociology and human geography, University of Oslo Norway,
Background/objective. The diffusion approach suggests that social inequalities may emerge because social categories differ in their rate of adoption of new practices. Health behaviours may spread via personal networks which are structured by social divisions, thereby generating changes over time both in overall levels and in inequality patterns. Health promotion campaigns and impulses from international lifestyle trends have engendered an increase in non-smoking, leisuretime physical activity, and frequent alcohol consumption, in Norway during recent decades. This paper analyses how the diffusion of these practices varied by gender, education, and place of residence, and shows how inequality patterns were affected. Methods. Data were obtained from Statistic Norway?s Health Surveys, conducted in 1975, 1985, 1995/1998 and 2002/2005. The samples (34,000 men and women aged 22-69) are analysed by age-adjusted prevalence rates, logistic regression, and measurements of rate of adoption. Preliminary results. Around 1980, non-smoking occurred more among women, highly educated, and rural residents. Physical activity was more prevalent among women, highly educated, and residents of the Oslo capital area. Frequent alcohol consumption was more prevalent among highly educated men in the Oslo area. Generally, physical exercise and alcohol use increased similarly in all subcategories. Non-smoking had a more complex pattern, increasing more among men than women, more among high than low education, and more in the Oslo area than elsewhere. Among low educated women in rural areas, non-smoking actually decreased, while low educated men in the Oslo area adopted non-smoking at a relatively high speed. Preliminary conclusions. Health-related behaviours are relatively volatile phenomena, and inequality patterns may change considerably over a few decades. In line with previous studies, these results suggest that emerging practices first become prevalent in privileged strata in urban centers and later on spread in the population. Diffusion patterns do not differ between health-beneficial habits (non-smoking, exercise) and more doubtful practices (frequent alcohol consumption). The rate of adoption seems not primarily associated with material deprivation, but rather with the social/geographical distance to change agents; thus, in this study, the rising practices spread particularly slowly among low educated women in remote areas. Various interpretations and implications are discussed.