Patterns of disparity: age and socioeconomic differences in women’s smoking and quitting outcomes in Great Britain

IntroductionThis study aimed to (1) provide up-to-date estimates of how changes in the prevalence of e-cigarette use have been associated with changes in smoking cessation activities and use of licensed treatments among smokers in England and (2) explore any changes in these associations over time.MethodsData were aggregated quarterly on 67 548 past-year smokers between Q1-2007 and Q4-2022. Explanatory variables were the prevalence of (1) current e-cigarette use among smokers and (2) e-cigarette use during a quit attempt. Outcomes were rates of quit attempts and overall quits among past-year smokers, and the quit success rate and use of licensed treatments among those who made a quit attempt.ResultsThe success rate of quit attempts increased by 0.040% (95% CI 0.019; 0.062) for every 1% increase in the prevalence of e-cigarette use during a quit attempt. No clear evidence was found for an association between current e-cigarette use and the quit attempt rate (Badj = 0.008 [95% CI −0.045; 0.061]) or overall quit rate (Badj = 0.063 [−0.031; 0.158]); or between use of e-cigarettes during a quit attempt and the overall quit rate (Badj = 0.030 [−0.054; 0.114]), use of prescription medication (varenicline/bupropion/nicotine replacement therapy [NRT]: Badj = −0.036 [−0.175; 0.102]), or use of over-the-counter NRT (Badj = −0.052 [−0.120; 0.015]). There was no clear evidence this pattern of associations has changed substantially over time.ConclusionsChanges in the prevalence of e-cigarette use in England through 2022 have been positively associated with the success rate of quit attempts but not clearly associated with the quit attempt rate, overall quit rate, or use of licensed smoking cessation treatments.ImplicationsIf the association between the increase in e-cigarette use and the quit success rate is causal, then the use of e-cigarettes in quit attempts has helped in the region of 30 000 to 50 000 additional smokers in England to successfully quit each year since they became popular in 2013, over and above the number who were quitting before the advent of e-cigarettes.

Background: Tobacco quit rates in the adult U.S. population range from 4% to 8% annually. Lung cancer screening (LCS) provides an opportunity for discussion of smoking cessation. Outside of LCS, Blacks have been shown to make more quit attempts and have higher readiness to quit, but have lower quit rates among current smokers and higher relapse rates among former smokers. In this study, we determined quit and relapse rates after a provider referral for LCS in Black and White patients. Methods: We conducted an observational study within an integrated health system that has both a LCS program and an independent smoking cessation program. Patients, aged 55-77 years who received at least one provider referral (order) for LCS between September 2016 and April 2022 and a second order within 9-36 months, were included in this study.Smoking status was captured in LCS orders. Demographic variables, completion of a low-dose screening CT (LDSCT), smoking cessation counseling referral and medication prescription were captured from the electronic medical record. Pearson Chi-squared test and multivariable logistic regression were used to determine group differences and important predictors of tobacco quit and relapse. Results: During the study period, 6,096 patients (21% Black) received a referral to LCS and 75% of these patients completed an LDSCT between orders. Among current smokers (N=3715) the quit rate was 14% and relapse occurred in 10% of former smokers (N=2381), overall. Rates of quit (12.0% LDSCT no vs. 14.6% LDSCT yes, p=0.048) and relapse (13.7% LDSCT no vs. 9.4% LDSCT yes, p=0.006) were worse for those who did not complete the LDSCT between orders. Black patients had lower quit (11% vs. 14%, p=0.003) and higher relapse (13.6% vs. 9.7%, p=0.03) rates than Whites. Among Black former smokers who did not complete the LDSCT, the relapse rate was nearly 20% and these patients received referrals to counseling and prescriptions for cessation medications at higher rates than White former smokers. In multivariable models, older age, receiving a prescription for a cessation medication, and completing the LDSCT were associated with smoking cessation, while Black race and receiving a referral for counseling were associated with lower odds of quitting. Black race and longer duration between orders were associated with greater likelihood of relapse, while older age and completing the LDSCT were associated with lower likelihood of relapse. Discussion: Rates of smoking cessation appear higher in patients referred for LCS than in the general population. In the context of LCS, Black patients still have lower quit and higher relapse rates than White patients. Relapse is particularly high in Black former smokers who do not complete LDSCT after a referral for screening. Lung screening and smoking cessation programs will need to work together to find culturally appropriate resources and ways to reach out to patients referred for screening, especially those who do not complete the LDSCT, to encourage quitting and provide equitable cessation support. Citation Format: Christine Neslund-Dudas, Amy Tang, Katie Zarins, Elizabeth Alleman, Amanda Holm, Vritti Gupta, Michael Simoff. Smoking cessation and relapse among Black and White patients referred for lung cancer screening [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A111.

IntroductionThis study aimed to assess the impact of Greater Manchester’s Making Smoking History program—a region-wide smoking cessation programs launched in January 2018—on key smoking and quitting outcomes.MethodsData were from a nationally representative monthly survey, 2014-2022 (n = 171 281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalized additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the program’s first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (preregistered outcomes), and current smoking prevalence among adults (unregistered outcome).ResultsResults showed mixed effects of the program on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = –11.03%; 95% CI –18.96; –3.11) and overall quit rates in Greater Manchester compared with the rest of England (–2.56%; 95% CI –4.95; –0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95% CI –11.64; 17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following the initiation of the program (–2.14%; 95% CI –4.02; –0.27).ConclusionsThe first five years of Greater Manchester’s Making Smoking History program did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period.ImplicationsTaken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the program has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the program’s impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the program over a longer timeframe.

Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women's current smoking prevalence was lower than men's in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.

Prior work suggests that the prevalence of cigarette smoking is persistently higher among people with mental health problems, relative to those without. Lower quit rates are one factor that could contribute to higher prevalence of smoking in this group. This study estimated trends in the cigarette quit rates among people with and without past-month serious psychological distress (SPD) from 2008 to 2016 in the United States. Data were drawn from 91 739 adult participants in the 2008-2016 National Survey on Drug Use and Health, a repeated, cross-sectional, national survey. Linear time trends of cigarette quit rates, stratified by past-month SPD, were assessed using logistic regression models with continuous year as the predictor. Cigarette quit rates among individuals with past-month SPD were lower than among those without SPD every year from 2008 to 2016. Quit rates did not change appreciably among those with past-month SPD (odds ratio = 1.02 [0.99, 1.06]) from 2008 to 2016, whereas quit rates increased among those without past-month SPD (odds ratio = 1.02 [1.01, 1.02]). In the United States, quit rates among individuals with past-month SPD are approximately half than quit rates of those without SPD and have not increased over the past decade. This discrepancy in quit rates may be one factor driving increasing disparities in prevalence of smoking among those with versus without mental health problems. Tobacco control efforts require effective and targeted interventions for those with mental health problems. Cigarette smoking quit rates have not increased among persons with serious mental health problems over the past decade. This work extends prior findings showing that smoking prevalence is not declining as quickly among persons with serious mental health problems. Findings suggest that diverging trends in quit rates are one possible driver of the persistent disparity in smoking by mental health status. Innovation in both tobacco control and targeted interventions for smokers with mental health problems is urgently needed.

Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. Little is known about the epidemiology of tobacco use among older homeless individuals. This longitudinal cohort study examines smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. We recruited a prospective cohort of 350 homeless individuals sampled from the community in Oakland, California. At 6 months follow-up, participants reported their cigarette quit attempts and 30-day abstinence. We used multivariable logistic regression to examine factors associated with making a quit attempt at follow-up, hypothesizing that heavier smokers would be less likely to make a quit attempt. Of the 272 ever-smokers, 229 (84.2%) were current smokers (quit ratio 15.8). Among current smokers at enrollment who had a follow-up interview at 6 months, 43.6% (n = 71) reported making a quit attempt during the follow-up. Of those who reported making a quit attempt, 14.3% (n = 10) reported 30-day abstinence at follow-up. Among those who had reported making a quit attempt at follow-up, 22.5% had used nicotine replacement therapy (NRT). Staying in shelters (adjusted odds ratio [AOR] = 2.5, 95% confidence interval [CI] = 1.0-5.8) was associated with higher odds of making a quit attempt at follow-up. Higher cigarette consumption was associated with lower odds of making a quit attempt (AOR = 0.9, 95% CI = 0.8-0.9). In this study of tobacco use in older homeless adults, rates of quit attempts were similar to that observed in the general population, but successful quitting was lower. The current study is among the first studies to focus specifically on tobacco use and cessation behaviors among older homeless adults. The high prevalence of smoking and the low rates of successful quitting highlight numerous opportunities to intervene to increase quitting rates among this population. Among these, increasing access to smoke-free living environments and identifying effective cessation therapies will be critical to reducing tobacco-related disease burden among older homeless adults.

BackgroundStudies conducted during the early stages of the pandemic documented mixed changes in smoking behaviour: more smokers quitting successfully but little change in prevalence. This study aimed to examine whether there have been sustained impacts of the COVID-19 pandemic on smoking patterns in England.MethodsData were from 101,960 adults (≥ 18 years) participating in the Smoking Toolkit Study, a monthly representative household survey, between June 2017 and August 2022. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March 2020) with current smoking, uptake, cessation, quit attempts, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure.ResultsBefore the COVID-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RRΔtrend = 1.06, 95% CI = 1.02, 1.09). This slowing was evident in more but not less advantaged social grades (RRΔtrend = 1.15, 1.08, 1.21; RRΔtrend = 1.00, 0.96, 1.05). There were sustained step-level changes in different age groups: a 34.9% (95% CI = 17.7, 54.7%) increase in smoking prevalence among 18–24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95% CI = 4.4, 21.9%) decrease among 45–65-year-olds. In both age groups, these step-level changes were followed by the pre-pandemic declines stopping, and prevalence remaining flat. There were sustained increases in quitting among past-year smokers, with a 120.4% (95% CI = 79.4, 170.9%) step-level increase in cessation and a 41.7% (95% CI = 29.7, 54.7%) increase in quit attempts. The main limitation was the change in modality of data collection when the pandemic started; while this may have contributed to the step-level changes we observed, it is unlikely to explain changes in the slope of trends.ConclusionsIn England, the rate of decline in adult smoking prevalence stagnated during the COVID-19 pandemic through to 2022. At the start of the pandemic, a potential reduction in smoking prevalence among middle-aged adults and increases in quitting among smokers may have been offset by an increase in smoking among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.

Background:Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. Despite this, few studies have systematically examined the explanatory mechanisms that might clarify why menthol-flavored tobacco is linked to poorer cessation outcomes among participants in tobacco cessation programs.Aims:This study aimed to investigate the potential mechanisms by which menthol tobacco use is associated with lower quit rates across three types of smoking cessation interventions.Methods:Participants were randomized into one of three smoking cessation interventions: in-person (CEASE), self-help, or online/hybrid programs. Smoking abstinence was assessed three months post-intervention as the primary outcome. Secondary analyses explored whether demographic, socioeconomic, or behavioral factors mediated the association between menthol use and quit rates across the intervention arms.Results:Menthol tobacco use was significantly associated with lower quit rates (p < 0.01). This association was not explained by demographic, socioeconomic, health, or addiction-related factors. While menthol use was associated with lower education and employment levels, demographic characteristics, physical or mental health, or addiction did not explain the effect of menthol on tobacco cessation. These findings suggest that the lower quit rates observed among menthol users cannot be attributed to any third factors assessed in this study.Conclusions:Menthol tobacco use independently predicts lower quit rates, and the mechanisms behind this disparity remain unclear. The consistent findings across different intervention types highlight the need for further research to uncover the underlying pathways and to design targeted strategies to improve cessation outcomes for menthol users.

Occupations: The Vocational Guidance JournalVolume 21, Issue 4 p. 283-287 Conscription of Women in Great Britain MARGARET G. BONDFIELD, MARGARET G. BONDFIELD Minister of Labour, Great Britain, 1929–1931Search for more papers by this author MARGARET G. BONDFIELD, MARGARET G. BONDFIELD Minister of Labour, Great Britain, 1929–1931Search for more papers by this author First published: December 1942 https://doi.org/10.1002/j.2164-5892.1942.tb01259.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume21, Issue4December 1942Pages 283-287 RelatedInformation

Objectives To estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed...

To assess the prevalence of smoking, quit rates, and perceived levels of stress as a barrier to quitting in the most disadvantaged area in metropolitan Adelaide in comparison to smokers recruited from a neighbouring, more affluent area. To assess how frequently general practitioners (GPs) in the two areas use stress management as a smoking cessation strategy and to assess how effective this strategy is for each area. One thousand smokers aged between 18 and 75 were recruited from general practices in the two areas; eligibility criteria included having had at least one puff of a cigarette in the past week. A baseline survey was administered at recruitment and at follow-up 12 months later. Semi-structured telephone interviews were also conducted at the 12-month follow-up with 50 randomly selected participants from the two areas. The disadvantaged area had a higher prevalence of smoking, significantly higher levels of perceived stress as a barrier to cessation, and significantly lower quit rates compared with the more affluent neighbouring area. Stress management as a smoking cessation strategy occurred less frequently and was less effective with the disadvantaged group. The prevalence rate for the disadvantaged area has not changed in the past 10 years. Stress may present as a significant barrier to smoking cessation in disadvantaged areas. Higher levels of stress may therefore, at least in part, explain the lower quit rate and higher prevalence of smoking in disadvantaged areas. More effective stress management strategies need to be developed and promoted in disadvantaged areas.

Cigarette Smoking Among Adults in the United States

Background: Pregnant women in Great Britain were recommended to receive influenza A(H1N1)pdm09 vaccines during the 2009/10 influenza pandemic, however uptake of the vaccines by pregnant women was reported to have been very low.Aim: We sought to estimate uptake of influenza A(H1N1)pdm09 vaccines and to investigate predictors of vaccine uptake in pregnant women in Great Britain during the 2009/10 pandemic.Methods: Uptake rates were calculated using data from the UK General Practice Research Database (GPRD). Predictors of vaccination were identified using a Cox proportional hazards model.Results: Uptake of influenza A(H1N1)pdm09 vaccines by pregnant women was 21.6%. Pregnant women with an underlying health condition increasing the risk of influenza-related complications had a higher vaccination rate than pregnant women without such conditions. The hazard ratio comparing these two groups decreased logarithmically throughout pregnancy from 9.3 in the first week to 1.3 by the end of pregnancy. Increasing maternal age (HR 1.01, CI95 1.01–1.01), having a previous delivery recorded (HR 1.21, CI95 1.16–1.27) and living in Scotland (HR 2.58, CI95 2.34–2.85) or Wales (HR 1.37, CI95 1.20–1.57) as opposed to England were all also associated with an increase in vaccination uptake rates throughout pregnancy.Discussion: Uptake of influenza A(H1N1)pdm09 vaccines by pregnant women was low. None of the potential predictors evaluated in this study were strong enough to account for this, however information on health beliefs and GP recommendation were not available. If the low rates reported here are to be improved new strategies to increase uptake of influenza vaccine in pregnant women need to be identified, evaluated and implemented.

ObjectivesMonthly changes in the prevalence of high-risk drinking and smoking in England appear to be positively correlated. This study aimed to assess how far monthly changes in high-risk drinking were...

BackgroundIt has been claimed that use of e-cigarettes in combination with cigarettes outside of a quit attempt (‘dual use’) reduces quitting among smokers. This study aimed to assess whether dual e-cigarette users have lower smoking cessation rates than (i) exclusive cigarette smokers or (ii) dual users of nicotine replacement therapy (NRT) and cigarettes. MethodsProspective cohort study of 1,498 smokers in England. The independent variable was dual use of e-cigarettes (n = 292), dual use of NRT (n = 117), or exclusive smoking (n = 1089), assessed at baseline. Outcomes were overall quit rate, past-year quit attempts, and success of quit attempts at 12-month follow-up. Baseline sociodemographic and smoking-related covariates were included. ResultsOverall quit rates were not lower in dual e-cigarette users than exclusive smokers (OR = 1.31, 0.90–1.89). Dual users of e-cigarettes were more likely than exclusive smokers to make a quit attempt, but this difference was not significant after adjustment for covariates (OR = 1.27, 95%CI 0.95–1.69). Among those attempting to quit, success rates did not differ significantly. Dual users of e-cigarettes were less likely to make a quit attempt than dual users of NRT (OR = 0.61, 95%CI 0.38–0.98) but the success rate of quit attempts and overall quit rates did not differ significantly. ConclusionsIn England, dual use of e-cigarettes is not associated with reduced overall quit rates compared with exclusive smoking or dual use of NRT. However, dual use of e-cigarettes is associated with a slightly higher quit attempt rate than exclusive smoking but lower than dual use of NRT.