Increase in smoking among younger women in more advantaged social groups in England: Study

Smoking among women under 45 from more advantaged social groups in England appears to have increased over the past decade, according to a new study by UCL researchers.

The researchers focused on women between 18 and 45 as these are the ages when women are most likely to become pregnant and for whom smoking tobacco carries extra risks.

The study, published in BMC Medicine, estimated that the proportion of more advantaged women in this age group who smoked rose from 12% to 15% between 2013 and 2023.

This was in contrast to less advantaged women of the same age, who are more likely to smoke overall but whose smoking rates fell steadily during the same period, from 29% to 22%. Among adults overall, smoking declined over the 10 years, although this decline flattened during the pandemic.

The study looked at survey responses from 197,266 adults in England between 2013 and 2023.

Lead author Dr. Sarah Jackson of UCL's Institute of Epidemiology & Health Care said, "It is concerning to find an apparent increase in smoking among women under 45 from more advantaged social groups in England. We did not see this in all adults or in men of the same age."

"These findings suggest this group may benefit from targeted intervention to prevent the uptake of smoking or relapse."

"Reducing smoking is especially important among women in this age group as smoking reduces fertility and increases the chances of complications during pregnancy, miscarriage, and poor infant health."

The researchers used data from the Smoking Toolkit Study, in which a different sample of 1,700 adults in England (who are representative of the population) were interviewed each month.

Survey respondents were classed as more advantaged if they were in households whose highest earners were in professional, managerial, or clerical jobs (ABC1).

People were considered less advantaged if they belonged to households whose highest earners were in manual, semi- or unskilled jobs or were unemployed (C2DE).

The researchers also found an increase over 10 years in smokers mainly using hand-rolled cigarettes (from 42% to 54%). This increase was greater among women aged 18 to 45 (41% to 61%), with men of the same age showing a smaller increase (49% to 62%).

Senior author Dr. Sharon Cox (UCL Institute of Epidemiology & Health Care) said, "The reasons for the possible increase in smoking among more advantaged women under 45 are unclear. However, it may be that the financial pressures of smoking were less influential for this group."

"Some may also have moved to cheaper hand-rolled cigarettes—a trend that was most pronounced among less advantaged female smokers, 68% of whom rolled their own cigarettes by 2023."

The researchers noted that financial pressures in the last decade may have hit women harder, with higher rates of job loss during the pandemic and a greater burden of housework and childcare.

In addition, job sectors in which women are overrepresented have been under significant stress, for example with teaching and nursing pay freezes, the researchers said.

Cancer Research UK's prevention policy manager, Alizee Froguel, said, "Smoking is the biggest cause of cancer and death in the UK. We cannot afford to be complacent about the devastating harm tobacco use continues to cause across the whole of our society."

"Smoking rates fall with decisive political action. The government must implement bold and robust measures to prevent people from taking up smoking while ensuring that people who already smoke have access to quit tools and adequately funded cessation services."