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Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions
  1. Caroline E Smith1,
  2. Sarah E Hill2,
  3. Amanda Amos1
  1. 1Usher Institute, University of Edinburgh, Edinburgh, UK
  2. 2Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Sarah E Hill, Global Health Policy Unit, University of Edinburgh, Edinburgh, EH8 9LD, UK; s.e.hill{at}


Background While price increases and targeted cessation support have been found to reduce inequalities in smoking by socioeconomic status (SES), evidence on other measures is mixed. We aimed to update the most recent (2014) previous review by identifying and appraising evidence published since 2013 on the equity impact of population tobacco control measures.

Methods Systematic searching of 10 electronic databases and hand-searching of four key journals identified 68 primary research articles published since 2013 that sought to examine the equity impact of population tobacco control measures in high-income countries with a negative socioeconomic gradient in smoking. Reported equity impacts were categorised as positive (greater impact among lower SES), neutral (no difference by SES), negative (greater impact among higher SES) or mixed/unclear.

Results There was substantial growth in research seeking to evaluate the equity impact of tobacco control interventions, but the majority of new studies showed mixed/unclear results. Findings for price increases and targeted cessation support continue to suggest an equity-positive impact, but limitations in the available evidence make further assessment difficult. Substantial differences in the context, scale and implementation of tobacco control policies make straightforward comparison of findings from the previous 2014 and current reviews problematic.

Conclusion Researchers need to adopt more sophisticated, multidisciplinary approaches in evaluating the equity impact of tobacco control measures—developing robust measures of equity effect and using frameworks that take account of context, existing systems/processes and the likely mechanisms of action. Socioeconomic differences in intervention impact within low-income and middle-income countries require evaluation.

  • disparities
  • socioeconomic status
  • public policy

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors CES, SEH and AA conceived and designed the study. CES selected the articles, extracted the data and undertook the quality appraisal, with SEH and AA checking all results. CES, SEH and AA analysed the data and interpreted the findings. SEH wrote the first draft of the manuscript. CES, SEH and AA revised the draft and wrote the final version of the manuscript. All authors agreed with the results and conclusions of this article.

  • Funding This study was funded by the Cancer Research UK Tobacco Advisory Group (ref: C3721/A25743).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study adhered to the ethical review requirements of the University of Edinburgh whereby a self-audit checklist was submitted to the Usher Institute Research Ethics Subgroup.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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