What are the effects of population level tobacco control interventions on social inequalities in smoking?

Reducing social inequalities in smoking and its health consequences is a public health and political priority. However, little is known about the actual effects of measures to reduce health inequalities in general or about the differential impacts of tobacco control measures in particular.

This systematic review was conducted by researchers from the Centre for Reviews and Dissemination at the University of York, the London School of Hygiene and Tropical Medicine, and the universities of Liverpool and Cambridge. The aim was to assess the effects of population tobacco control interventions on social inequalities in smoking.

The review combines 84 previous studies and represents the most comprehensive and robust review to date of the potential effects on heath inequalities of population-level tobacco control interventions and makes an important contribution towards understanding the effects of interventions in different social groups.

In terms of reducing social inequalities in smoking, the researchers found evidence to support increasing the price of tobacco products. However, further increases in tobacco taxation may require extra measures to support cessation among low-income households.

The evidence on restrictions on sales to minors suggests that these may be effective in deterring younger smokers, though their effectiveness depends on enforcement.

Little evidence was found of policies that have the potential to increase inequalities. In particular, no strong evidence was found that smoking restrictions in workplaces and public places are more effective among more advantaged groups.

Notes for editor
Further information can be obtained from Paul Wilson, Tel: 01904 321073; email: pmw7@york.ac.uk

1. Sian Thomas, Debra Fayter, Kate Misso, David Ogilvie, Mark Petticrew, Amanda Sowden, Margaret Whitehead, and Gill Worthy. Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Tobacco Control doi:10.1136/tc.2007.023911 (published online 21 April 2008).

The article is available at: http://tobaccocontrol.bmj.com/onlinefirst.dtl

2. Population-level tobacco control interventions as those applied to populations, groups, areas, jurisdictions or institutions with the aim of changing the social, physical economic or legislative environment to make them less conducive to smoking. This includes interventions such as:

• Tobacco crop substitution or diversification
• Removing subsidies on tobacco production
• Restricting trade in tobacco products
• Measures to prevent smuggling
• Measures to reduce illicit cross-border shopping
• Restricting advertising of tobacco products
• (Enforcing) restrictions on selling tobacco products to minors
• Mandatory health warning labels on tobacco products
• Increasing the price of tobacco products
• Restricting access to cigarette vending machines
• Restricting smoking in the workplace
• Restricting smoking in public places
3. This systematic review was led by researchers from the Centre for Reviews and Dissemination (CRD) and was funded by the Department of Health Policy Research Programme (reference number RDD/030/077). The views expressed in this paper are those of the authors and do not necessarily reflect those of the Department of Health.

4.CRD is a department of the University of York and is part of the National Institute for Health Research (NIHR). CRD aims to provide decision makers with research-based information about the effects of interventions used in health and social care. For more information: www.york.ac.uk/inst/crd

5. If publishing online, please carry a hyperlink to the CRD website: http://www.york.ac.uk/inst/crd