Socioeconomic status and nicotine addiction
An emerging phenomenon of the utmost significance over the past two decades has been the increasing association of continued smoking with markers of social disadvantage.

Among affluent men and women in the United Kingdom, the proportion of ever smokers who have quit has more than doubled since the early 1970s, from about 25% to nearly 60%, whereas in the poorest groups the proportion has remained at around 10%. Part of the explanation for this phenomenon may be found in the growing evidence that poorer smokers tend to have higher levels of nicotine intake and are substantially more dependent on nicotine. It is evident that future progress in reducing smoking is increasingly going to have to tackle the problems posed by poverty.

Smoking as a chronic disease
Cigarette dependence is a chronic relapsing condition that for many users entails a struggle to achieve long term abstinence that extends over years or decades. Successful interventions need to tackle the interacting constellation of factors —personal, family, socioeconomic, and pharmacological —that sustainuse and can act as major barriers to cessation.

Competing interests: MJJ has received speaker’s honorariums from GlaxoSmithKline and Pharmacia. He is also director of an NHS funded smoking cessation clinic. See chapter 1 for the series editor’s competing interests.

References

1. Royal College of Physicians. Nicotine addiction in Britain. London: RCP, 2000.
2.   Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. N Engl J Med 1988;319:1318-30.
3.   National Institutes of Health. Risks associated with smoking cigarettes with low machine-measured yields of tar and nicotine. Bethesda, MD: Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2001. (NIH publication No 02-5074.)
4.   Jarvis MJ. Patterns and predictors of unaided smoking cessation in the general population. In: Bolliger CT, Fagerstrom KO, eds. The tobacco epidemic. Basle: Karger, 1997:151-64.

Martin J Jarvis

Edited by - JOHN BRITTON
Professor of Epidemiology at the University of Nottingham