Inequality relates to the diversity in society and the unequal treatment these sub-sections of society face. In terms of smoking, there are inequalities across a number of groups:
- Ethnic minorities
- Health inequalities
- Sexual orientation and gender identity
Smoking rates among certain ethnic minority groups are higher than those of the general population. The groups with the highest rates of smokers are Afro Caribbean men at 37%, closely followed by Bangladeshi men at 36%. Smoking rates among female ethnic minorities are lower than the average population1.
It is important to note the different ways in which ethnic minorities may consume tobacco. Hookahs and chewable tobacco are particularly popular amongst South Asian and Middle Eastern groups. In order to aid ethnic minorities with smoking cessation it is important that smoking cessation services are available in a variety of languages1.
Data collected in Great Britain since 1974 has shown that the percentage of males who smoke is consistently higher than that of females. However, since 1990 the gender gap has decreased significantly, with the overall smoking prevalence across both genders decreasing. In 1974, 51% of men and 41% women smoked in Great Britain, compared to 20% of men and 17% of women smoking in Great Britain in 2014. Currently 21% of men and 18% of women smoke in Wales (2015 figures)2.
NB: Since 2000 data have been weighted. Since 2012 figures are from the Opinions & Lifestyle Survey3; previous data are from the General Household / General Lifestyle Surveys4.
Smoking prevalence rates among the less well-off population are significantly greater than those of the more affluent population. There is a well-evidenced link between socio-economic status and smoking prevalence. In Wales in 2015 the percentage of adults from the least deprived areas of Wales reported as being a smoker was 11% compared to a figure of 29% recorded among the most deprived adults within the Welsh population.
The link between poverty and tobacco use and purchase can be seen by the fact that a higher percentage of poorer smoker’s household income is spent on tobacco.
There are substantial financial gains that can be made for a young family or a single parent through giving up smoking. In 2014, a 20-a-day smoker of a premium cigarette brand will have spent about £2,900 a year on cigarettes. The price of tobacco has increased by 80.2% over the last ten years from 2003 to 2013, making it 22.1% less affordable5.
ASH research shows that in the UK 1.7million households which include a smoker are currently in poverty but around 28% (over half a million) could be lifted out of poverty if they stopped smoking. This means 365,000 fewer children could be living below the poverty line.
It is important to identify the particular problems faced by smokers in less financially rich populations, such as:
- Less supportive network of family and friends to encourage them to quit smoking
- More likely that their family and friends are smokers themselves
- The belief that smoking is more common within the general population than it actually is, making it more socially acceptable for less wealthy smokers to continue to smoke and giving them less encouragement to quit
- The age someone starts smoking within a poorer population is much lower than those who are better off - the longer a person has been addicted to nicotine, the harder it is for them to quit
- They are more likely to use smoking as a coping mechanism for difficult life circumstances, for example stress, pregnancy, unemployment, redundancy and mental health issues
- They are more likely to disengage from smoking cessation programs6
Sexual Orientation and Gender Identity
A report conducted by ASH Scotland investigated the rate of smoking among the Lesbian, Gay, Bisexual and Transgender (LGBT) people and communities. It is important to recognise that LGBT people and communities tend to experience greater health and economic inequalities. Higher percentages of the LGBT community smoke and are less likely to quit in comparison to the general population. It is essential that health care professionals who deliver smoking cessation initiatives are adequately educated about LGBT communities7. It is also important that health promotion campaigns are inclusive of this group.
- Smoking in LGBT communities. Research from University of Colorado
- Gruer, Laurence, et al. "Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study." BMJ 338 - 2009
1 ASH (2011). Tobacco and ethnic minorities
2 Welsh Government (2015). Welsh Health Survey 2014
3 2014 Opinions and Lifestyle Survey. Office for National Statistics, Feb 2016
4 2011 General Lifestyle Survey. Office for National Statistics, March 2013. PSA Delivery Agreement 18: Promote better health and well-being for all. The Treasury, Oct 2007 (pdf)
5Health and Social Care Information Centre (2014). Statistics on smoking: England, 2012
6NCSCT (2013). Stop Smoking Services and Health Inequalities. Briefing: 10
7 Partnership Action on Tobacco and Health (PATH) (2010). Stop-smoking service provision for Lesbian, Gay, Bisexual and Transgender (LGBT) communities in Scotland