Which population groups are at risk and why?
This section will focus on core epidemiological issues that take account of fixed risk factors (such as age, gender, ethnicity, family history) and modifiable risk factors (such as behaviour). The wider determinants of health (such as housing, transport and environment) are also considered.
Age
Adolescents and young adults, particularly between 16 and 24 years, as this is a period of increased vulnerability to peer pressure, experimentation and exposure to tobacco marketing and social influences6.
Gender
Men remain more likely to be current smokers than women7. However, girls aged 11-15 were slightly more likely than boys to have ever smoked with 4% of girls and 2% of boys identified as current smokers8.
Socioeconomic status
People from lower socioeconomic groups are the greatest risk of starting and continuing due to income, education, employment status and housing conditions 7, 9.
Qualifications
Those with lower educational qualifications7 as this group is less likely to receive effective smoking cessation intervention and more likely to experience persistent smoking-related harm10.
Mental health
Individuals with mental health conditions are significantly more at risk of starting smoking and the relationship is bidirectional11. They are also less likely to receive smoking cessation support12.
Ethnicity
White ethnic groups, particularly White British individuals have historically shown the highest rates of smoking initiation and prevalence13.
Sexual Orientation
LGBTQ+ individuals are at higher risk in comparison to heterosexual peers14 as are more likely to experience poverty and social exclusion which are associated with higher smoking rates15.
Vulnerable Children
Vulnerable children are at significantly higher risk of starting smoking due to factors such as being in care, experiencing poverty or facing mental health challenges8. Starting smoking in childhood (especially before age 15) doubles the risk of premature death16.
Users of drugs and/or alcohol
Research shows there is a bidirectional relationship between drug and alcohol use and smoking (and vice versa). It is suggested that this relationship may reflect shared underlying risk factors such as impulsivity and risk-taking behaviours, genetic predispositions, adverse childhood experiences and mental health conditions such as ADHD 17, 18, 19.
Diagnosed long term condition
People diagnosed with long term conditions are more likely to be current smokers than the general population with 44% of heavily addicted smokers self-reporting a long-term illness or disability20.
There is no direct evidence that people diagnosed with long-term conditions are more likely to start smoking after diagnosis, smoking is often used to manage stress and symptoms associated with chronic conditions, particularly mental health conditions. This can make cessation more difficult and perpetuate smoking behaviour21 .
Routine and Manual workers
Routine and manual workers consistently show higher rates of current smoking in the UK and England compared to other occupational groups. For example, in England in 2020, 24.5% of routine and manual workers smoked, with these groups being over twice as likely to smoke as those in higher occupational groups21.