Factors influencing smoking levels among high smoking prevalence groups

Higher smoking rates in different population groups are associated with a range of interacting psychological, social, economic and cultural factors that influence people taking up smoking, smoking patterns and behaviours and attempts to quit (see Figure 1).

Enablers to smoking

Research has identified a range of factors that influence uptake and patterns of smoking, including:

• low income, poor housing and unemployment; (26)
• nicotine exposure during childhood; (27)
• financial pressure and stress; (28)
• anxiety and depression; (29)
• parental and peer example; (30)
• targeted and more intensive marketing by the tobacco industry; and (31, 32)
• a lower likelihood of working indoors.(33)

In particular, population groups with higher smoking rates are more likely to be in environments where smoking is the norm and to have family and friends who smoke. Pro-smoking environments influence the uptake of smoking, smoking patterns and quitting intentions. (34) For example, research shows that children who grow up in households where adults smoke are themselves more likely to take up smoking.(35, 36)

Barriers to quitting

A range of factors have been identified as barriers to quitting, including:

• heavier nicotine dependence; (37)
• lower awareness of the harms of smoking; (38)
• being unaware of, or having misconceptions about, available cessation services;(39, 40)
• the perceived cost and the time it takes to access nicotine replacement therapy (NRT); (39, 41, 42)
• financial stress; (43)
• lack of support for quitting among family and friends; (41, 44)
• lower levels of confidence in ability to stop smoking; (45, 46) and
• regarding smoking as their ‘only pleasure’ and having a role in relieving boredom. (44, 45, 47)

Researchers highlight the pivotal role that smoking plays as a perceived coping mechanism for people experiencing multiple disadvantage and suggest that it is an important factor influencing high smoking levels. Smoking is often seen as a means of coping with stressful circumstances such as financial pressure, living in unsafe environments and limited opportunities for enjoyment and recreation.(39, 45) Research has shown that disadvantaged smokers are as interested in quitting as other smokers, but are less likely to succeed without further assistance.(20, 48, 49) 

Figure 1

A systematic reinforcement of smoking

Smoking as a health issue is often overlooked or ignored by service providers as it is seen as ‘the least of clients’ problems’ or as ‘their little bit of pleasure’.(55, 56) Across a range of health, social and community service providers there are beliefs that people from disadvantaged groups are not interested in quitting, cannot quit, or that it is unreasonable to raise the subject.(57) As a result, people facing multiple disadvantage are less frequently asked about their smoking and whether they would like to quit.(57, 58)

Historically, smoking has been accepted as part of normal routine and therapy and sometimes promoted in services such as mental health facilities and drug and alcohol rehabilitation, often resulting in a pro-smoking organisational culture.(59) In addition, workers employed in these sectors are more likely to be smokers thus impacting upon the provision of smoking cessation services. For example, a review suggests that smoking among Aboriginal health workers is a barrier to the delivery of smoking cessation to Aboriginal and/or Torres Strait Islander peoples. Aboriginal health workers report that their own smoking inhibits their provision of cessation advice to clients as they fear appearing hypocritical. (60)

Key points

• There are numerous psychological, social, economic and cultural factors that influence high smoking rates in disadvantaged population groups.
• As levels of disadvantage increase/accumulate, smoking rates increase.
• People from disadvantaged groups are more likely to be in environments where smoking is the norm and where little support is provided for quit attempts.
• It is important to understand the role that smoking plays in the lives of disadvantaged smokers.
• There is subtle but systematic reinforcement of smoking behaviour in disadvantaged population groups among service providers.
• Disadvantaged smokers are less likely to be asked if they want to quit.
  • previous page
  • next page