Tobacco control policies and socio-economic inequalities in smoking cessation: Evaluating natural experiments

Smoking has been the most important cause of death and disease throughout the world for many years. Although smoking rates have steadily decreased, this was mostly just the case among the higher educated. Many policies and interventions have been implemented to encourage adults to quit smoking, and many of these policies have been effective in reducing the smoking prevalence in the total population. However, there is very little evidence that they can reduce inequalities between the low and high educated. The aim of this thesis was to provide evidence on how to reduce inequalities, based on evaluations of recent natural experiments in tobacco control policy across Europe. The studied tobacco control policies seem to have made a strong contribution to increases in smoking cessation rates throughout Europe over the past decades. However, they have not been able to achieve the same effect among low educated, compared to high educated, and may thus have contributed to a widening of inequalities. This lack of strong policy effects among the low educated might be explained in part by: a prevailing pro-smoking norm within this group, the low reach of policies among low educated smokers, and a generally lower quit success rate among lower educated smokers. Current policy types, such as smoking cessation services and media campaigns, could be made more effective by using a targeted approach, focused on low educated groups. Additionally, full implementation of the framework convention on tobacco control can still lead to significant reductions in smoking levels across Europe.