Smoking and socioeconomic status in England: the rise of the never smoker and the disadvantaged smoker

BACKGROUND: Since 2000 various tobacco control measures have been implemented in the UK. Changes in the smoking status of low and high socioeconomic status (SES) groups in England during this period (2001-08) are explored. METHODS: Secondary analysis of the Health Survey for England general population samples was undertaken. Over 88 000 adults, age 16 or over, living in England were included. Smoking status (current, ex or never) was reported. SES was assessed through a count of seven possible indicators of disadvantage: National Statistics Socio-Economic Classification (NSSEC), neighbourhood index of multiple deprivation, lone parenting, car availability, housing tenure, income and unemployment. RESULTS: Smoking rates were four times higher among the most disadvantaged 60.7% (95% CI: 58.2-63.3) than the most affluent 15.3% (95% CI: 14.8-15.8). Smoking prevalence declined between 2001 and 2008 except among the multiply disadvantaged. This trend appeared to be due to an increase in never smoking rather than an increase in quitting. Disadvantage declined among non-smokers but not smokers. CONCLUSIONS: In general never smoking and affluence increased in England over this period. The disadvantaged, however, did not experience the decline in smoking and smokers missed out from the increase in affluence. Smoking and disadvantage may increasingly coexist.