Summary of evidence for equity impact of tobacco control interventions
| Intervention | TCS weighting* | Likely equity impact† | Strength of evidence |
|---|---|---|---|
| Price increases | 30 | Positive | Strong evidence of greater price-responsiveness in low-income groups.20 34–37 Mixed evidence in relation to impact by education19 36 38 39 |
| Smoke-free environments | 22 | Mixed | Consistent evidence that workplace exposure to tobacco smoke is higher among less advantaged social groups,45–47 56 but no clear evidence on how the introduction of smoke-free legislation may affect this gradient (since evaluative studies have not demonstrated a differential impact by SES50–52) |
| Educational media campaigns | 15 | Mixed | Mixed evidence base. Several studies suggest media campaigns are less effective among low-SES groups.57 Some evidence that advertisements using personal testimony may do better in reaching low-SES smokers; cf more traditional advertisments60 61 |
| Advertising bans | 13 | – | No evidence |
| Health warnings | 10 | – | No evidence |
| Smoking cessation support | 10 | Negative | Consistent evidence of lower quit rates in low-SES smokers using cessation services.24 72 74 75 78–80 94–96 101 109 Negative equity impact may be attenuated by concentrating services in more deprived areas72 76 |
| Multi-faceted (community-based) | NA | No clear effect | Very limited evidence |
*Maximum score on 100-point Tobacco Control Scale.17 ,18
†That is, whether the intervention is associated with a decrease (=positive) or increase (=negative) in the SES gradient in smoking.
SES, socioeconomic status; TCS, Tobacco Control Scale.