Impact of the UK’s smokefree generation policy on tobacco-related equity in England: a simulation study

BACKGROUND: Modelling studies find the smokefree generation (SFG) policy could help achieve the tobacco endgame. The UK is on course to introduce an SFG in 2027 that prohibits tobacco sales to individuals born in or after 2009. METHODS: We adapted an individual-level microsimulation model with a synthetic representative English population, and used previously validated smoking initiation, quit and relapse probabilities by age and deprivation quintile. We simulated four scenarios from 2023 to 2075: no intervention, pessimistic SFG, central SFG and optimistic SFG. Proportionate universalism sensitivity analyses assumed effective targeting led to greater effects in more deprived areas and smaller effects in less deprived areas. Equity was assessed using slope and relative indices of inequality. RESULTS: The central SFG scenario forecast smoking prevalence to be reduced to