A new paper in Nicotine and Tobacco Research, published by Oxford University Press, finds that people experiencing more economic disadvantages are more likely to smoke cigarettes, have higher levels of tobacco addiction, and find it harder to quit than those who are most advantaged. This pattern was consistent across different forms and severity of disadvantage.
Despite decades of work by policymakers and reductions in smoking rates, tobacco use is still a leading cause of preventable mortality worldwide. In England, official estimates suggest 11.9% of adults smoke cigarettes. Some 11.6% of American adults smoke. Greater smoking prevalence leads to more tobacco-related disease, disability, and premature death, and prevalence remains higher among more disadvantaged groups.
Researchers from the University of Oxford, University College London and the University of Massachusetts, Amherst, supported in part by the National Institute for Health and Care Research , used data from the Smoking Toolkit Study, an ongoing, cross-sectional survey of adults in England, between January 2014 and December 2023, to examine links between smoking behaviors and different measures of disadvantage (measured by occupational social grade, employment status, type of housing, educational level, and household income). They were interested in smoking prevalence, how addicted people were to tobacco, and the number, approach and success of past-year quit attempts of participants.
The investigators found that among the 195,543 adults surveyed inequalities in smoking persist across multiple forms and measures of socioeconomic disadvantage. They found that the odds of smoking were higher with increasing disadvantage when measured by occupational social grade, housing type, educational level, and household income. They also found that urges to smoke were stronger among people experiencing greater disadvantage, when measured by occupational social grade, educational level, and household income, suggesting a greater level of tobacco addiction.
People from lower-status occupations, those with lower household incomes, and those with less education were less likely to have made a quit attempt in the past year compared to those in the most advantaged groups. Electronic cigarettes were the most common aid to help people quit. There were some differences in use of vapes by different types of disadvantage, but patterning of this varied or was not clear.
The researchers also found that, of the people who tried to quit, those who rented or were living in social housing had lower odds of quitting successfully compared to those who owned their houses.
Across all measures of socioeconomic position, the investigation revealed that people experiencing greater disadvantage in England were more likely to smoke than those who were more advantaged and had higher levels of tobacco addiction; this finding was consistent when measured by different measures of economic disadvantage. People from more disadvantaged occupational social grades, with lower household incomes, and with less education were also less likely to have tried to quit smoking in the past year compared to those in the higher status groups.
"While smoking rates have fallen over the last decade, these findings show that smoking remains much higher among people from disadvantaged groups, who tend to be more dependent and find it more difficult to quit," said the paper's lead author, Annika Theodoulou. "This pattern was consistent across different forms and types of socioeconomic disadvantage. Continued efforts to increase access to and uptake of stop smoking services among more disadvantaged groups are critical steps for addressing health inequalities caused by disparities in tobacco use."
The paper, "Smoking and quitting behaviours by different indicators of socioeconomic position in England: a population study, 2014 to 2023," is available (at midnight on February 11th) at https://doi.org/10.1093/ntr/ntag003 .
Direct correspondence to:
Annika Theodoulou
Nuffield Department of Primary Care Health Sciences
University of Oxford
Radcliffe Observatory Quarter, Woodstock Road
Oxford, UNITED KINGDOM
