Associations of socio-economic factors and built environment characteristics with smoking behaviors among adults in Cyprus

INTRODUCTION: Previous studies from Cyprus and elsewhere have demonstrated consistent associations between socio-economic characteristics and smoking behaviours in adults. However, the role of built environment characteristics in shaping smoking behaviour as well as their interaction with individual level socio-demographic factors remains unclear. METHODS: Individual level socio-economic and smoking behaviour data for Greek Cypriot adults were obtained from the 2023 national cross-sectional survey from the Cyprus National Addictions Authority. Information for built environment characteristics were obtained from the Copernicus Land Monitoring Service. Multivariate binary logistic regression models were employed to address these associations at the postal code level. To account for the influence of surrounding areas, analyses were also carried out spatially weighted scores of built environment characteristics. RESULTS: Across 2643 adults (>18 years old), income, marital status, education, labour status, gender showed mixed associations with smoking behaviours. At the postal code level, greater building height was associated with reduced odds of attempting to quit smoking, whereas proximity to residential green urban areas had the opposite effect. In the spatially weighted analysis, greater building height was associated with both greater odds of active smoking and reduced odds of ever attempting to quit smoking; access to sports and leisure facilities was negatively associated with ever attempting to quit smoking. CONCLUSIONS: Among adults in Cyprus, we confirm the association of socio-economic factors with smoking behaviours. Furthermore, we observed novel associations between building height and smoking behaviours while mixed results were observed for green urban area and access to sports and leisure facilities. IMPLICATIONS: These findings highlight the importance of considering built environment characteristics alongside socio-economic factors in tobacco control strategies. Urban environment, particularly building density and access to green spaces, may influence smoking behaviours and should be incorporated into future public health interventions and tobacco control research.