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Changing smoking habits reveal health inequalities, study warns

People in lower socioeconomic groups are less likely to give up smoking, research suggests.

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The research study found that the raising of tobacco prices was a factor in people opting to give up smoking. Image: Henrietta Hassinen / Yle

People in Finland belonging to lower socioeconomic groups are more likely to smoke than their peers in higher groups, and the proportion between the two has grown, according to a study currently under review by the University of Helsinki.

In order to divide people by socioeconomic status, researchers can take into account factors like a person’s highest level of education, their household income and their job.

In the long term, such lifestyle differences between groups could contribute to increased health inequality between people of differing socioeconomic status, with those in lower groups more likely to experience health problems during their lifetimes.

"We know smoking has directly adverse effects on human health. Based on the study, it can be said that if this trend continues, so too will the growth of health inequalities," said Otto Ruokolainen, an expert at the National Institute for Health and Welfare (THL) and author of the study.

Ruokolainen's doctoral thesis investigated the use of tobacco products among different socioeconomic groups, the factors that can help predict whether or not a person will give up smoking and the wider population's attitude towards tobacco policy in Finland.

Access to support

The study looked at population data covering a 40-year period from 1978 to 2017. The number of respondents in the surveys that make up the data varied from fewer than 1,000 to around 400,000. Similar results have previously been obtained from other studies in Finland and other western countries.

People in lower socioeconomic groups also quit smoking less often than those in higher groups. Ruokolainen said it is particularly important that government policy should address this difference.

"There should be better support for smokers and a particular focus on supporting people in lower socioeconomic groups in order to reduce their smoking to the same level as those in higher groups," he said.

There are also large differences in the rate of smoking among students at vocational colleges and high schools. The study found that students from vocational colleges smoked and used snus more than their high school-educated peers. Snus saw a smaller difference in usage between socioeconomic groups, amid an overall increase in use among the general population.

"The use of snus among boys with a vocational college background increased from 4 to 13 percent, during 2008 to 2017," Ruokolainen said.

Price increases reduced tobacco use

The study found that the policy of raising tobacco prices was effective at encouraging young people from lower socioeconomic backgrounds to stop smoking.

"Restricting access for young people through price increases for both cigarettes and other tobacco products is the most effective way to prevent smoking," Ruokolainen said.

"The price increases that have been implemented in Finland since 2009 should therefore be continued."

People with higher socioeconomic status can often access medical and social support more easily than the low-status or the unemployed, he noted

"The challenge is to provide lower-status people with support services. For example, it is easier for people with jobs to get support for quitting smoking through occupational health [programmes]," he said.

The study also found that people with a lower socioeconomic status receive less social support from their family or circle of friends than those with in higher socioeconomic brackets. The study suggests that more support should be provided through alternative avenues, such as during regular visits to health centres.

"It would be important to talk about smoking and to ask if the patient would be willing to quit, regardless of the original reason for visiting," Ruokolainen suggested.

Various counselling and support services are available for smokers, for example online, in peer groups or in individual sessions. In addition, a variety of nicotine replacement therapy products are available to support smoking cessation.

However, Ruokolainen warned that tobacco replacement products should be used according to guidance from a healthcare professional to ensure the correct dosage and use.

"Previous studies have found that people often use tobacco replacement products too sparingly, which does not help to stop smoking," he explains.

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