Investigating the role of cultural and material influences in the persistence of socio-economic inequalities in smoking in England

Background and aims: Differential consumption patterns in health related behaviours such as smoking and drinking play an important role in contributing to health inequalities. It is therefore important to understand the underlying mechanisms that contribute to these behaviours, in order to reduce social inequalities in health. Since the early 1970’s, there has been a dramatic reduction in smoking in the UK and a noticeable decline in alcohol consumption from 2008, however, social inequalities in smoking and drinking have widened, with smoking and heavy drinking disproportionately concentrated amongst adults in the most disadvantaged socio-economic groups. Existing research on the relationship between SEP and smoking and drinking in the UK has tended to use SEP as a generic or interchangeable measure and has not investigated the different mechanisms that underlie different measures of SEP. This project was designed to address this gap in the literature through two specific aims. These were, a) to provide sociological explanations about long-term trends in the social patterning of smoking behaviour, and b) to determine how far social inequalities in drinking behaviour are similar to or distinctive from social

inequalities in smoking behaviour.

Methods: These aims were examined through analysis of data from the General Household and General Lifestyle Surveys from 1973 to 2011. The relationship between smoking and drinking and three socio-economic indicators (education level, occupation, equivalized household income) was analysed to assess the relative explanatory power of cultural and material explanations for the different elements of smoking and drinking behaviour.

Results: The results found that when all socio-economic indicators were mutually adjusted, education appeared to have the strongest relationship with most smoking outcomes, whilst income appeared to have the strongest relationship with most drinking outcomes. The results for whether the gaps between the lowest and highest socio-economic groups strengthened or weakened over time for smoking and drinking behaviour was mixed.

Discussion: The findings suggest that cultural factors appeared to have the strongest influence on smoking behaviours whilst material factors appeared to have the strongest influence on drinking behaviours. These findings can help inform the wider debate about social inequalities in health and the relative

influences of consumption-related factors such as smoking and drinking.