Impact of tobacco control policies on socioeconomic inequalities in smoking prevalence and quit ratios: an ecological study in the European Union (2009–2020)

Abstract

Background Tobacco control efforts have succeeded in reducing smoking prevalence and increasing smoking cessation rates in the European Union Member States (EU27). However, the impact of these policies has been unequal across different income groups. Methods Ecological study with the country as unit of analysis. We used the Tobacco Control Scale (TCS) in EU27 in 2010 and the prevalence of smoking and quit ratios from the Eurobarometer surveys (2009, n=27 788; and 2020, n=28 288). We analysed the relationship between the TCS scores (2010) and smoking indicators and their relative changes (between 2009 and 2020) using scatter plots and multiple linear regression models. Findings In the EU27, high inequalities exist among different income groups. High-income residents had lower smoking prevalence (19 vs 40%) and higher quit ratios (55 vs 32%) compared with the low-income group. Positive changes in smoking indicators from 2009 to 2020 were stronger in the high-income group. There was a stronger negative correlation between TCS scores and smoking prevalence in high-income groups (r(sp)=-0.615, p<0.01; r(sp)=-0.498; p=0.01) and between its relative changes but only in the high-income group (r(sp)=-0.478; p=0.01). A positive correlation was observed between TCS scores and quit ratios (r(sp)=0.580, r(sp)=0.548, both p<0.01) in high- and moderate-income populations. Conclusions Declines in smoking prevalence and increases in quit ratios were considerably lower in moderate- and low-income groups. Tailoring tobacco control policies to address financial, social and structural barriers, such as ensuring free access to cessation services, implementing targeted outreach programmes, adopting culturally and linguistically appropriate interventions, among others, is essential for making these measures more equitable, which is key for the EU27 to achieve its tobacco-free goal by 2040.