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Education-smoking gradient and upstream health policies: comparing Generation X with millennials

Maryam Dilmaghani (Economics, Saint Mary's University, Halifax, Canada)

Health Education

ISSN: 0965-4283

Article publication date: 29 April 2021

Issue publication date: 21 May 2021




Over the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies.


The study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995.


At the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern.

Social implications

The implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed.


This paper is the first study of the kind using Canadian data.



Dilmaghani, M. (2021), "Education-smoking gradient and upstream health policies: comparing Generation X with millennials", Health Education, Vol. 121 No. 4, pp. 368-387.



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