A new comprehensive analysis published in Nicotine and Tobacco Research, under the auspices of Oxford University Press, provides compelling evidence linking socioeconomic disadvantage with increased cigarette smoking rates, elevated tobacco dependence, and reduced success in smoking cessation efforts. This extensive study underscores the persistent disparities that exist in tobacco use behaviors across various indices of economic and social deprivation, casting a stark light on the challenges faced by socially disadvantaged populations.
Despite considerable progress over past decades aimed at curbing tobacco consumption through policy interventions and public health campaigns, smoking remains a leading cause of preventable disease and mortality worldwide. In England, the adult smoking rate hovers around 11.9%, closely mirrored by the United States at approximately 11.6%. These figures belie a more troubling reality: social stratification significantly influences smoking prevalence, with economically disadvantaged groups bearing a disproportionate burden of tobacco-related morbidity and mortality. This study illuminates the nuanced interplay between different dimensions of socioeconomic status and tobacco use.
The research team, consisting of experts from the University of Oxford, University College London, and the University of Massachusetts Amherst, utilized data from the longitudinal Smoking Toolkit Study—a large-scale, cross-sectional survey conducted among adults in England from 2014 to 2023. By analyzing data from nearly 200,000 participants, the researchers sought to unravel the association between tobacco behaviors and multiple measures of socioeconomic disadvantage, including occupational social grade, employment status, housing type, educational attainment, and household income.
Their findings reveal a consistent gradient: individuals experiencing greater socioeconomic disadvantage had significantly higher odds of smoking compared to their more advantaged counterparts. This gradient was robust across several indicators, demonstrating that the relationship between social disadvantage and tobacco use is both multifaceted and enduring. Occupational status, housing security, educational level, and disposable income all independently correlated with smoking prevalence. These results highlight the complex structural roots of tobacco addiction beyond individual behavioral choices.
Moreover, the study found that tobacco dependence was markedly higher among disadvantaged groups. Measured by the intensity of urges to smoke, dependence was greater in people occupying lower occupational grades, with less educational attainment and lower household incomes. This suggests that tobacco use is not merely a habit but a deeply ingrained addiction that is intensified by socioeconomic factors, complicating cessation efforts. The data argue for a more targeted public health approach that addresses the underlying drivers of addiction in vulnerable populations.
Importantly, disadvantaged smokers were less likely to attempt quitting within the preceding year compared to those in higher socioeconomic strata. This gap in quit attempts points towards barriers that are not only behavioral but also structural, such as reduced access to cessation resources or support networks. Electronic cigarettes emerged as the most frequently used smoking cessation aid, yet their adoption showed variability across different social strata, lacking a clear pattern that would suggest equitable access or acceptance.
Housing tenure also played a critical role in cessation success. Individuals residing in rented or social housing demonstrated substantially lower odds of quitting successfully than homeowners. This finding implicates instability or poorer living conditions as potential risk factors that hinder effective quitting. It also raises important questions about how social policies and housing supports might indirectly influence health behaviors like smoking cessation.
The persistence of these patterns across various socioeconomic indicators strongly suggests that disparities in tobacco use are systemic rather than incidental. Individuals experiencing economic disadvantage not only smoke more but also suffer from higher addiction levels and face greater challenges in quitting. The robustness of these associations across occupation, income, housing, and education underscores the need for comprehensive health equity strategies.
Annika Theodoulou, the study’s lead author and Associate Editor at Nicotine & Tobacco Research, emphasizes the critical nature of these findings. She points out that although smoking prevalence has decreased overall during the past decade, the remaining smokers are disproportionately from disadvantaged backgrounds. These groups exhibit higher dependency and reduced cessation success, necessitating intensified public health interventions tailored to their particular social and economic realities.
The study advocates for enhanced access to and utilization of smoking cessation services among disadvantaged populations. This includes culturally and socioeconomically sensitive outreach, affordable and accessible treatment options, and policies that address broader social determinants of health. Such measures are essential to mitigating health inequalities engendered by tobacco use.
This investigation, titled “Smoking and quitting behaviours by different indicators of socioeconomic position in England: a population study, 2014 to 2023,” builds a compelling case for stratified, evidence-based tobacco control interventions. By leveraging one of the largest datasets spanning a decade, it provides a definitive picture of how deeply rooted socioeconomic factors are in influencing smoking behaviors and cessation outcomes.
In sum, this pivotal study marks a significant advancement in understanding the social epidemiology of tobacco use in England. It lays bare the persistent inequities in smoking and quitting behaviors and calls for urgent, equity-focused action to reduce the health burden borne disproportionately by socioeconomically disadvantaged groups. As tobacco remains a leading preventable cause of death globally, such insights are crucial to devising more effective, inclusive public health strategies.
Subject of Research: People
Article Title: Smoking and quitting behaviours by different indicators of socioeconomic position in England: a population study, 2014 to 2023
News Publication Date: 11-Feb-2026
Web References: https://doi.org/10.1093/ntr/ntag003
Keywords: Addiction, Social class, Social problems, Poverty
