People living in the most disadvantaged circumstances in England are not only more likely to smoke, but tend to be more addicted to tobacco and find it harder to quit – according to new research led by the Nuffield Department of Primary Care Health Sciences at the University of Oxford.
The study, published in Nicotine and Tobacco Research, analysed data from nearly 200,000 adults surveyed between 2014 and 2023 as part of the Smoking Toolkit Study – an ongoing national survey tracking smoking behaviours in England.
Researchers from Oxford, University College London, and the University of Massachusetts Amherst examined how smoking behaviours varied across five different measures of socioeconomic position: occupational grade, employment status, housing type, educational level, and household income.
They found a consistent pattern: regardless of which measure of disadvantage was used, people in more disadvantaged groups were more likely to smoke, reported stronger urges to smoke (suggesting greater addiction), and were less motivated to quit.
People from more disadvantaged occupations, those with lower household incomes, and those with less education were also less likely to have attempted to quit smoking in the past year compared to those in the most advantaged groups.
The researchers also looked at what happened when people did try to quit. They found that those who rented their homes – whether privately or through social housing – had lower odds of quitting successfully compared to homeowners, even after accounting for how addicted they were. This suggests that factors associated with housing circumstances may play a distinct role in whether quit attempts succeed.
When examining quitting aids, more people used e-cigarettes than any other quit aid among those who tried to stop smoking, followed by nicotine replacement therapy bought over the counter (for example, nicotine patches or gum). However, the pattern of e-cigarette use varied across different measures of disadvantage, with students, and people who were retired or not in paid work less likely to use them compared to those in paid employment – possibly reflecting the cost of vaping products, while people with less education were more likely to use e-cigarettes.
Annika Theodoulou, a DPhil researcher in the Nuffield Department of Primary Care Health Sciences and lead author of the study, said:
"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. 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."
Despite decades of policy efforts and overall reductions in smoking rates, tobacco use remains a leading cause of preventable death worldwide. Official estimates suggest 11.9% of adults in England smoke, but rates are significantly higher among disadvantaged groups – contributing to stark health inequalities across the country.
The UK government has set an ambition to reduce smoking rates to 5% or below by 2030, but a recent independent review warned that without further intervention, England will not reach this target until 2037 – and the poorest areas will not meet it until 2044.
The research was supported in part by the Society for the Study of Addiction (SSA), the Rotary Foundation, Cancer Research UK, and the NIHR Applied Research Collaboration Oxford and Thames Valley (ARC OxTV), which supported the work of co-author Thomas Fanshawe.
Full publication
Annika Theodoulou, Jamie Hartmann-Boyce, Nicola Lindson, Thomas R Fanshawe, Sarah E Jackson, Smoking and Quitting Behaviors by Different Indicators of Socioeconomic Position in England: A Population Study, 2014 to 2023, Nicotine & Tobacco Research, 2026;, ntag003, https://doi.org/10.1093/ntr/ntag003