9.7 Explanations of socio-economic disparities in smoking

Last updated: November 2022

Suggested citation:
Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.7 Explanations of socio-economic disparities in smoking. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from: http://www.tobaccoinaustralia.org.au/chapter-9-disadvantage/9-7-explanations-of-socioeconomic-disparities-in-s


'The relation between SES and smoking patterns is complex involving cumulative and multiple effects across the human life course, possibly extending from one generation to the next.' Gilman et al 2003 1 p807

Low socioeconomic status (SES) groups have substantially higher smoking rates than the overall population, both in Australia and internationally (see Section 9.1). Higher smoking rates among low-SES groups are associated with a web of interacting physiological, psychological, social, economic, commercial, and cultural factors,2 including:

  • nicotine exposure in utero and during childhood3-6
  • parental and peer relationships and modelling7-16
  • lower achievement and satisfaction at school16-18 and lower educational attainment in adulthood19-21
  • stress,22 , 23 mental illness,24-29 and substance use/dependence30
  • a greater likelihood of belonging to a priority population among whom smoking is more common, such as Aboriginal and Torres Strait Islander peoples, people experiencing incarceration, or LGBTQI+ people
  • social isolation31
  • for minority groups, experiencing discrimination.32-34
  • a lesser tendency to consider and value future outcomes35-38
  • the endorsement of beliefs that minimise or discount the risks of smoking39
  • workplaces40 and social circles41 that normalise smoking
  • job loss42 and financial stress43
  • a lower likelihood of working indoors44-46
  • living in a disadvantaged neighbourhood47-50 or low-income housing51
  • representations of smoking in popular culture52-55
  • a history of targeted and intensive marketing56-60
  • less success in maintaining cessation, despite being just as likely to make a quit attempt and to use cessation aids (see Section 9.8)

The above factors vary in importance in explaining socio-economic disparities at different developmental stages61 and at different stages in the tobacco addiction cycle.1 , 61 As with other aspects of social disadvantage, many factors driving tobacco-related disparities originate in childhood62-67 and accumulate throughout the individual’s life.64 , 68-70 It is also important to consider heterogeneity within groups, and that possessing multiple attributes that are associated with high smoking prevalence (for example, belonging to a priority group and having a lower education level) may interact and further increase a person’s risk of smoking.71 , 72

While a wealth of information is available on associations between social disadvantage and tobacco use,73-75 understanding the causal mechanisms underlying these associations is more challenging.76 Nonetheless, recent studies suggest that some of these factors can causally impact a person’s risk of smoking. For example, a large study in the UK found that more years of education leads to reduced likelihood of smoking uptake, and reduced heaviness of smoking and greater likelihood of quitting among smokers.19 Another UK study suggests that the relationship between disadvantage and smoking uptake can largely be explained by parental modelling of smoking. That is, reducing disadvantaged children’s exposure to smoking may largely reduce future disparities in tobacco use.77

Figures 9.7.1 and 9.7.2 show how a variety of physiological, psychological and sociological factors may maintain socio-economic disparities in smoking uptake and smoking cessation. 


Figure 9.7.1

Figure 9.7.1
Factors driving socio-economic disparities in smoking uptake


Figure 9.7.2

Figure 9.7.2
Factors driving socio-economic disparities in smoking cessation

Source: Thank you to Dr Ron Borland for helping to simplify a previous version of these two diagrams.
Points in yellow indicate factors known or likely to drive disparities.

See InDepth 9A for a detailed discussion of smoking prevalence, the role of smoking in health and social inequalities, and cessation interventions tailored and targeted for: people living in regional and remote areas of Australia; culturally and linguistically diverse groups; people with substance use and mental disorders; people experiencing homelessness; people experiencing incarceration; lesbian, gay, bisexual, trans, queer and intersex (LGBTQI+) people; military personnel and veterans; and single parents

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated April 2022)



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2. Siahpush M. Why is lone motherhood so strongly associated with smoking in Australia? Australian and New Zealand Journal of Public Health, 2004; 28(1):37–42. Available from: https://europepmc.org/article/MED/15108745

3. Macleod J, Hickman M, Bowen E, Alati R, Tilling K, et al. Parental drug use, early adversities, later childhood problems and children's use of tobacco and alcohol at age 10: birth cohort study. Addiction, 2008; 103(10):1731–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18705686

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14. Kim MJ, Fleming CB, and Catalano RF. Individual and social influences on progression to daily smoking during adolescence. Pediatrics, 2009; 124(3):895–902. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19706575

15. DiNapoli P. Early initiation of tobacco use in adolescent girls: key sociostructural influences. Applied Nursing Research : ANR, 2009; 22(2):126–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19427575

16. Pedersen W and Soest TV. How is low parental socioeconomic status associated with future smoking and nicotine dependence in offspring? A population-based longitudinal 13-year follow-up. Scand J Public Health, 2017; 45(1):16–24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27913689

17. Moor I, Rathmann K, Lenzi M, Pfortner TK, Nagelhout GE, et al. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. European Journal of Public Health, 2015; 25(3):457–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25713016

18. Fergusson DM, Horwood LJ, Boden JM, and Jenkin G. Childhood social disadvantage and smoking in adulthood: results of a 25-year longitudinal study. Addiction, 2007; 102(3):475–82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17298656

19. Gage SH, Bowden J, Davey Smith G, and Munafo MR. Investigating causality in associations between education and smoking: a two-sample Mendelian randomization study. Int J Epidemiol, 2018; 47(4):1131–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29961807

20. Gugushvili A, Zhao Y, and Bukodi E. Intergenerational educational mobility and smoking: a study of 20 European countries using diagonal reference models. Public Health, 2020; 181:94–101. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31981813

21. Villanti AC, Johnson AL, and Rath JM. Beyond education and income: Identifying novel socioeconomic correlates of cigarette use in U.S. young adults. Preventive Medicine, 2017; 104:63–70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28647547

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23. Jahnel T, Ferguson SG, Shiffman S, and Schuz B. Daily stress as link between disadvantage and smoking: an ecological momentary assessment study. BMC Public Health, 2019; 19(1):1284. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31606051

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32. Parker LJ, Kinlock BL, Chisolm D, Furr-Holden D, and Thorpe RJ, Jr. Association Between Any Major Discrimination and Current Cigarette Smoking Among Adult African American Men. Substance Use and Misuse, 2016; 51(12):1593–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27484877

33. Agunwamba AA, Kawachi I, Williams DR, Finney Rutten LJ, Wilson PM, et al. Mental Health, Racial Discrimination, and Tobacco Use Differences Across Rural-Urban California. Journal of Rural Health, 2017; 33(2):180–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27074968

34. Pearson JL, Waa A, Siddiqi K, Edwards R, Nez Henderson P, et al. Naming Racism, not Race, as a Determinant of Tobacco-Related Health Disparities. Nicotine & Tobacco Research, 2021; 23(6):885–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33822185

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