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Population tobacco control interventions and their effects on social inequalities in smoking: systematic review

¹ MRC Social and Public Health Sciences Unit, United Kingdom;
² Centre for Reviews and Dissemination, University of York, United Kingdom;
³ MRC Epidemiology Unit, United Kingdom;
⁴ London School of Hygiene and Tropical Medicine, United Kingdom;
⁵ University of Liverpool, United Kingdom

To whom correspondence should be addressed. E-mail: sian.thomas{at}btinternet.com

ABSTRACT
Objective: To assess the effects of population tobacco control interventions on social inequalities in smoking.

Data sources: Medical, nursing, psychological, social science and grey literature databases, bibliographies, hand-searches, and contact with authors.

Study selection: Studies were included (n=84) if they reported the effects of any population-level tobacco control intervention on smoking behaviour or attitudes in individuals or groups with different demographic or socio-economic characteristics.

Data extraction: Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second.

Data synthesis: Data were synthesised using graphical (‘harvest plot’) and narrative methods. No strong evidence of differential effects was found for smoking restrictions in workplaces and public places, although those in higher occupational groups may be more likely to change their attitudes or behaviour. Smoking restrictions in schools may be more effective in girls. Restrictions on sales to minors may be more effective in girls and younger children. Increasing the price of tobacco products may be more effective in reducing smoking among lower-income adults and those in manual occupations, although there was also some evidence to suggest that adults with higher levels of education may be more price-sensitive. Young people aged under 25 are also affected by price increases, with some evidence that boys and non-white young people may be more sensitive to price.

Conclusions: Population-level tobacco control interventions have the potential to benefit more disadvantaged groups and thereby contribute to reducing health inequalities.