Gender-Specific Trends and Determinants of Daily Smoking in Latvia (2009–2019): A Population-Based Cross-Sectional Study

Background and Objectives: Cigarette smoking remains a leading modifiable cardiovascular risk factor. This study aimed to analyze decade trends in daily smoking prevalence and its association with education level and physical activity by gender and age groups in Latvia. Materials and Methods: We analyzed data from two distinct waves of a population-based cross-sectional study conducted in Latvia. The study included a stratified random sample of adults aged 25–74 (N = 3807 in 2009; N = 4070 in 2019). Smoking status and education level were self-reported in both years; physical activity data were collected only in 2019. Multivariable logistic regression identified independent factors associated with smoking. Results: From 2009 to 2019, smoking prevalence decreased among men (from 43.6% to 36.0%, p < 0.01) and increased among women (from 15.0% to 18.1%, p < 0.01). Men and women with higher education were significantly less likely to be daily smokers (2019, Men: odds ratio (OR): 0.48, 95% confidence interval (CI) 0.38–0.59; Women: OR: 0.39, 95% CI 0.29–0.50). Among men, the proportion of daily smokers was higher in physically inactive (39.8%) and active (39.0%) groups compared to the moderately active group (31.4%, p < 0.01). However, physical activity level was not a significant predictor of smoking in the multivariable analysis. Conclusions: Over the decade, daily smoking prevalence decreased in men but increased in women in Latvia, with education level being a strong independent predictor. Although the proportion of smokers among men differed across physical activity groups, this factor was not an independent predictor of smoking. These findings underscore the need for targeted public health interventions in Latvia, specifically focusing on individuals with lower education levels to reduce the long-term cardiovascular burden.