Inequalities in quitting smoking and use of support among women by age and socioeconomic position: a population study in England

Jackson, Sarah E., Notley, Caitlin ORCID: https://orcid.org/0000-0003-0876-3304, Robson, Deborah and Cox, Sharon (2026) Inequalities in quitting smoking and use of support among women by age and socioeconomic position: a population study in England. BMC Medicine. ISSN 1741-7015 (In Press)

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Abstract

Background: Mid-life may be a particularly challenging period to quit smoking among women, especially those from less advantaged socioeconomic groups. Differences in quit attempt characteristics, use of evidence-based support, and nicotine dependence may contribute to lower quit success, but their relative importance remains unclear. Methods: We analysed data from 7,791 women in the Smoking Toolkit Study (England, 2013–2026) who attempted to stop smoking in the past year. Age was categorised as younger (16-44 years), mid-life (45-60 years), and older (>60 years), and social grade as more (ABC1) or less advantaged (C2DE). Logistic regression models examined differences in quit attempt characteristics (planned vs. unplanned, abrupt vs. gradual), use of evidence-based support (e-cigarettes, prescription nicotine replacement therapy, non-nicotine pharmacotherapy, face-to-face behavioural support), and quit success, adjusted for survey year and relevant covariates. Results: Mid-life women had the lowest quit success (18.1%) compared with younger (22.3%) and older women (20.6%), with the lowest quit success observed among less advantaged mid-life women (15.8% vs. 25.2% among more advantaged younger women; adjusted odds ratio [aOR]=0.56, 95%CI 0.45-0.69). Yet, mid-life women being among the most likely to use evidence-based support (more advantaged: 45.8%; less advantaged: 47.4%), comparable to younger less advantaged women (46.4%) and higher than other groups (36.9-40.0%). Adjustment for quit attempt characteristics and use of evidence-based support had minimal impact on age-related differences in quit success. However, adjustment for nicotine dependence attenuated the lower odds of success in mid-life women. In fully adjusted models with younger more advantaged women as the reference category, less advantaged mid-life women had the lowest odds of quitting (aOR=0.75, 95%CI 0.58-0.98), older more advantaged women had higher odds (aOR=1.36, 95%CI 1.02-1.82), and differences for other groups were not evident (aORs 0.93-1.16). Conclusions: Less advantaged mid-life women are the least likely to be successful in their attempts to stop smoking, despite relatively high uptake of evidence-based support. Higher nicotine dependence partly explains this disparity, but other factors also likely contribute and warrant further investigation.

Item Type:	Article
Additional Information:	Data availability: The data that support the findings of this study are available from the authors upon reasonable request.
Uncontrolled Keywords:	mid-life women,smoking cessation,socioeconomic inequalities,menopause,nicotine dependence,inequities,quit attempts,behavioural support,pharmacotherapy,e-cigarettes,das in place,data availability the data that support the findings of this study are available from the authors upon reasonable request.,2026 ,/dt/atira/pure/keyword/DAStatement/das_in_place
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	27 Oct 2026 10:46
Last Modified:	27 Oct 2026 10:46
URI:	https://ueaeprints.uea.ac.uk/id/eprint/104869
DOI:	issn:1741-7015

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