Project background

Within most European populations, smoking prevalence rates differ substantially according to people’s educational level, occupational class and income level. Large inequalities in smoking are now emerging in all European countries, especially in the youngest generations. Tackling inequalities in smoking is therefore vital to any strategy that is aimed at avoiding a further widening of socio-economic inequalities in health, and making the narrowing of health inequalities a realistic goal.

Several effective interventions and programmes are now available to address smoking in Europe. These include bans on smoking in public places and cessation support services for those wanting to quit. In addition, several supply-side measures are potentially effective, including bans on advertisements, increased tax on tobacco, and restrictions on sales of tobacco products to young people. Most of these measures have been implemented, to a greater or lesser extent, in different European countries, stimulated by international initiatives such as the Framework Convention on Tobacco Control (FCTC). Scientific evaluations of tobacco control policies has provided strong evidence of their effectiveness in reducing overall smoking in the general population, e.g. in case of tax policies.

A main challenge for research is to assess which of these tobacco control measures also have the potential to reduce socio-economic inequalities in smoking, beside their impact on general smoking prevalence. For example, in England, the introduction of stop-smoking services in poor neighbourhoods resulted in a decrease in inequalities in quit attempts, although inequalities in smoking cessation rates decreased to a lesser extent. Unfortunately, much of the current evidence is derived from evaluations of controlled experiments in selective populations. As a result, it is still highly uncertain which policies will be effective in reducing smoking inequalities if they are implemented in the general population.

There is therefore an urgent need for evidence on the effectiveness of policies, programmes and interventions that have already been implemented at national or local levels. Evaluations of these actions may help to estimate more directly what has been achieved, and what can further be achieved, by real-world actions in the field of tobacco control.