Background:
In most developed countries today the prevalence of smoking is higher among men and women with lower education levels. Furthermore, educational differences in smoking have increased over the last decades. As smoking prevalence is influenced by both smoking initiation and quitting, we analyzed the extent of educational inequalities in smoking uptake and cessation for different birth cohorts in Germany.

Methods:
The analyses were based on pooled data of three waves (2009, 2010, 2012) of the nationwide telephone health survey “German Health Update” (GEDA) (n=62,606 aged 18 years and older). Seven 10-year birth cohorts (1920s-1980s) were included (n=59,757). Smoking behaviour was assessed by several questions on current and previous smoking status. Educational status was assessed by the highest school-leaving certificate and classified as low, middle, and high.

Results:
For men and women born since the 1950s, the share of ever smokers was higher among those with lower education levels. The educational gradient in smoking initiation increased in younger cohorts among both sexes. In the 1980-89 birth cohort the share of ever smokers was about 30 percentage points higher in lower than in higher educated men (78.8% vs. 47.6%) and women (74.9% vs. 44.9%). Quitting rates, however, were higher among the higher educated compared with the less educated, especially in women born in the 1960s (54.8% vs. 30.6%) and 1970s (48.9% vs. 23.3%).

Conclusions:
Particularly in the younger birth cohorts, lower educated men and women were more likely to start smoking and less likely to quit than higher educated men and women. When implementing tobacco prevention and cessation initiatives, efforts to reach also the lower educated population groups are necessary. If educational inequalities in smoking are not reduced, educational inequalities in tobacco-related morbidity and mortality are likely to increase in the future.