Smoking and Quitting Behaviors by Different Indicators of Socioeconomic Position in England: A Population Study, 2014 to 2023

INTRODUCTION: The social gradient in smoking is well-established but how associations differ across different indicators of socioeconomic position (SEP) is less clear. This study aimed to estimate associations of five SEP indicators with smoking and quitting-related behaviors. METHODS: We used nationally representative, cross-sectional survey data on 195 543 adults aged ≥18 years in England surveyed between January, 2014 and December, 2023. Exposures were occupational social grade, employment status, housing tenure, educational-level, and household income. Outcomes were smoking prevalence; motivation to stop smoking; level of tobacco addiction and past-year quit attempts; and use of cessation aids and quitting success. Associations between exposure and outcome variables were estimated using logistic or linear regression, as appropriate. Covariates included age, gender, survey year, and (for the latter two outcomes) level of tobacco addiction. RESULTS: Across all measures of SEP, increasing disadvantage was associated with higher odds of smoking, higher levels of tobacco addiction, and lower motivation to stop smoking. People from more disadvantaged occupational social grades, on lower household incomes and with less education were less likely to have made a quit attempt in the past year relative to those in the most advantaged categories. Odds of quitting success were lower in more disadvantaged housing tenures; however no clear evidence was observed when looking at other indicators of SEP. There were some differences in use of e-cigarettes as a cessation aid by SEP, but these either varied greatly across different SEP indicators or were inconclusive. There was a lack of clear evidence for all other cessation aids. CONCLUSIONS: Inequalities in smoking persist across multiple forms and degrees of disadvantage across England. IMPLICATIONS: Findings suggest that research investigating smoking prevalence, level of tobacco addiction, motivation to stop smoking, quit attempts, and quitting success may not need to assess multiple indicators of socioeconomic position when exploring relationships between these outcomes and disadvantaged groups, as results are similar regardless of the measure used to assess socioeconomic position. However, this does not necessarily imply that tailoring smoking cessation interventions for people with, for example, less education or on less income, will equivalently address socioeconomic inequalities in smoking, or that one type of tailored intervention will be similar in effectiveness across different forms, or degree, of disadvantage.