- Socioeconomic Factors: These can include sub-factors like financial stressors, which can impact people to rely more on smoking as a coping mechanism. This factor can increase smoking behaviour not only due to the increase in stressors themselves, but also by financially limiting other coping options and opportunities. Additionally, those from lower socio-economic backgrounds may lack the same opportunities for education as those from higher socio-economic backgrounds, which is correlated with lower awareness about the risks of smoking to one’s health.
- Environmental factors: Social norms are a powerful influence on our behaviour, and can contribute to the discrepancy in smokers’ and non-smokers' backgrounds. Seeing others in your social circle smoke can make it easier to pick up the habit yourself, but it can also make quitting that much harder.
The current picture – who smokes?
Overall, smoking is higher in those aged between 18 and 21 years compared to the national average, and perhaps most worryingly, it is also highest in the most deprived areas and communities compared with those with the least deprivation.
While there are smokers in every segment of society, in the past decade smoking has lost its associated lustre and has become almost invisible in wealthier areas. Today, the people most at risk of smoking are those that have no qualifications (28.3%), those in routine or manual occupations (23.2%), and those who are living in social or rented housing (28.6%) compared to those with a degree or higher qualification (7.3%), a managerial or professional occupation (9.3%), and those who own their own homes (7.6%).
Additionally, based on 2019/20 statistics from Public Health England (now known as UK Health Security Agency (UKHSA), there is a higher prevalence of smoking in those who live with a long-term mental health condition, including those living with anxiety and depression (25.8%), which rises among people with serious mental illnesses (40.5%).
It is therefore no surprise that the number of smoking-related cancer diagnoses in the most deprived quintile of England’s adult population is almost double that of the least deprived quintile.
Why are certain people more vulnerable?
So why are certain groups of people more vulnerable to smoking? And why do some groups find it harder to quit than others? After decades of research in this area, we do know a few things. As in most cases, more than one factor is responsible, and it is this complex relationship between several significant factors that can make it harder for people to cut smoking out of their lives.
- Community deprivation: Those living in the most deprived areas often face multiple challenges, which can translate into limited opportunity to access resources and support that help break the habit of smoking.
- Mental health: The combination of the aforementioned factors can heavily impact on an individual’s mental health, and can exacerbate the need for quick and easy ways to cope with stress. This, combined with an absence of access to more healthy ways of coping with stress, can make it difficult to stop relying on smoking as a coping mechanism.
What we know works, and what doesn’t
Michie et al., (2011) have broken down the ‘active ingredients’ of smoking cessation interventions into four main groups, which include:
- Leveraging motivational processes by rewarding abstinence from smoking
- Providing education and support on using other coping strategies, developing self-regulation skills, and problem-solving
- Increasing access to using additional support resources, such as smoking cessation medication
- Other behaviour change techniques, like building a rapport between smokers and medical and support services.
This taxonomy makes it easier to compare and contrast different behavioural interventions, and build on literature to identify the best application for different situations, however it is important to note that often the most effective interventions are those that involve several elements of the taxonomy.
According to recent meta-analysis, the behavioural interventions most associated with smoking behaviour mainly fall under the second group identified by Michie and her colleagues; those that target self-regulatory processes, as well as specific techniques such as prompting commitment, social rewards for abstinence, and associating their identity with smoking cessation (as opposed to smoking).
Likewise, research has identified that certain interventions are not effective, and can even exacerbate existing smoking behaviour. For example, approaches that are stigma-based that use shame or guilt to discourage smoking. These approaches usually cause additional stress and anxiety, and can lead to people smoking more rather than less, however they are commonly employed as shock imagery on tobacco products.
Additionally, smoking cessation is a journey, rather than a single decision-point event. Consequently, approaches that are too short in scale that do not provide access to ongoing support and multiple interactions also tend to be ineffective, though this is unlikely to cause more smoking like the previous intervention. So, while resource provision can be a useful and effective way to encourage quitting, this is dependent on the intervention’s scale, focus, resources, and other characteristics.
Solutions from a behavioural science perspective
Perhaps one of the most effective strategies that could be deployed would be to prevent people from becoming smokers in the first place. An independent review has suggested that increasing the legal age of tobacco product sales from 18 years of age, by one year ever year could be an especially useful tactic. This legislation passed earlier this year and is set to prevent one of the most vulnerable population groups from picking up the habit, with an estimated 18,000 new smokers being prevented yearly, all by adding more friction to performing the undesirable behaviour.
However, we will still have people who are smokers, and it is important to try reduce smoking in this population while also preventing additional smokers. Considering the impact of social norms and the decrease of branding smoking as a popular and stylish past time, there has indeed been a decrease in smoking in England’s population. To continue moving us closer to Smokefree 2030, local and national bodies would need to leverage available data to frame smoking as increasingly less popular, taking advantage of the Attractive and Social elements of the EAST framework. The more local and targeted these statistics are, the more effective they can be.
Additionally, policy makers should take advantage of the present bias and temporal discounting demonstrated by smokers, where people are more biased towards the present and tend to discount the future. This could be done by emphasising the more immediate consequences of smoking, and the more immediate benefits of quitting. Policy makers can similarly use smokers’ loss aversion to encourage quitting by framing the financial effects of smoking as losses, as opposed to framing them as financial gains and ‘savings’ when quitting.
An intervention with significant potential to help England reach Smokefree 2030 revolves around creating personalised plans for smokers that can be tailored to their personality, characteristics and circumstances in real time based on the collection of their behavioural data over a period of time. Given that the personalisation of different smoking cessation plans manually would be incredibly resource intensive, automated options using artificial intelligence algorithms and chatbots could be a promising alternative. Considering that each individual’s smoking cessation journey may look different, these types of personalised and automated interventions could be highly effective. Applications hosting such programmes could then include social aspects to connect smokers with other smokers working to quit via forums, provide tracking and progress metrics, on-demand tips and resources, as well as lessons on different emotion-regulation and problem-solving techniques.
With more than 20 year's experience working in smoking cessation using behavioural science, get in touch with our team today to put some of the above ideas to the test!
