Future smoking prevalence by socioeconomic status in England: a computational modelling study

Abstract

BackgroundThe difference in smoking across socioeconomic groups is a major cause of health inequality. This study projected future smoking prevalence by socioeconomic status, and revealed what is needed to achieve the tobacco-free ambition (TFA) by 2030 in England.MethodsUsing data from multiple sources, the adult (≥18 years) population in England was separated into subgroups by smoking and highest educational qualification (HEQ). A discrete time state-transition model was used to project future smoking prevalence by HEQ deterministically and stochastically.ResultsIn a status quo scenario, smoking prevalence in England is projected to be 10.8% (95% uncertainty interval: 9.1% to 12.9%) by 2022, 7.8% (5.5% to 11.0%) by 2030 and 6.0% (3.7% to 9.6%) by 2040. The absolute difference in smoking rate between low and high HEQ is reduced from 12.2% in 2016 to 7.9% by 2030, but the relative inequality (low/high HEQ ratio) is increased from 2.48 in 2016 to 3.06 by 2030. When applying 2016 initiation/relapse rates, achievement of the TFA target requires no changes to future cessation rates among adults with high qualifications, but increased rates of 37% and 149%, respectively, in adults with intermediate and low qualifications.ConclusionsIf the current trends continue, smoking prevalence in England is projected to decline in the future, but with substantial differences across socioeconomic groups. Absolute inequalities in smoking are likely to decline and relative inequalities in smoking are likely to increase in future. The achievement of England’s TFA will require the reduction of both absolute and relative inequalities in smoking by socioeconomic status.

From silos to policy coherence: tobacco control, unhealthy commodity industries and the commercial determinants of health

“…While tobacco control has sought to address such inequities, broader policy efforts are urgently required. Inequities in smoking threaten aspirations of a tobacco endgame,40 whose attainment will not be achieved without dramatic reductions in tobacco exposure among poor and ethnic minority populations41–44 and greater support for FCTC implementation in LMICs 45. At the same time, inequities will increase where tobacco control is pursued via a narrowly defined (product/behaviour-focused)46 agenda, since most interventions have greater success among advantaged smokers 47 48.…”

Blinded by worries: sin taxes and demand for temptation under financial worries

“…Although overall smoking rates and cigarette consumption have been gradually decreasing in the last decades, not all tobacco products are price elastic; in particular, rolling tobacco has an estimated price elasticity of À0.57 (Whitaker, 2019). Among OECD countries, in 2016 UK exhibited one of the highest average cigarette prices (Whitaker, 2019), yet the prevalence of smoking and, more importantly, inequality in smoking habits, remains high: the difference between smoking rates of individuals with low education levels compared to high reaches 15-20% points and is expected to keep growing for the next decade (Song et al, 2020). To combat child obesity problem, in 2018 the United Kingdom has implemented a new type of sin tax-sugar-sweetened beverage tax (SSB).…”

The effects of prenatal smoke exposure on language development ‐ a systematic review

“…A recent study predicted that the prevalence of smoking in England is projected to decrease to 10.8% by 2022, down from 14.4% in 2018 (Song, Elwell‐Sutton, & Naughton, 2020). However, significant differences have been reported across socioeconomic groups (Song, Elwell‐Sutton, Naughton, & Gentry, 2020) whereby individuals from lower socioeconomic backgrounds are more likely to smoke.…”