Anti-smoking information is less effective among low-SES adults. But why?

Author: Tim van Meurs, PhD Candidate
Cigarette package with warning, burning cigarette and a lighter
No smoking sign

Unfortunately, citizens with a lower socioeconomic status (SES) are less positively affected by information interventions directed at aiding smoking cessation. In order to improve this, it is vital that it becomes clear exactly why such interventions have lower effectiveness among low-SES individuals.

In a recently published scoping review in Drug and Alcohol Review, researchers from Smarter Choices for Better Health explore and synthesize the explanations proposed for why anti-smoking information interventions are (in)effective among low-SES adults. After a systematic selection process, 38 studies with a wide range of research methods, published in English and between January 2009 and October 2021, were selected for analysis. A thematic analysis was applied to analyze the suggested explanations.

Explaining the (in)effectiveness

Seventeen of the 38 studies suggested an explanation for the (in)effectiveness of the intervention among low-SES adults, categorized into the following six themes: message engagement, material conditions, cognition, risk perception, social environment, and self-efficacy. However, the explanations were mostly proposed post-hoc instead of tested empirically. Nine studies did offer some form of empirical scrutiny: four qualitative studies presented in-depth discussions about reasons for (not) adhering to anti-smoking information interventions; three studies included their proposed explanation in an experimental design; and two studies accounted for the explanation in the design of the intervention beforehand.

Moving the field forward

With only less than a quarter of all analyzed studies covering some form of empirical evidence explaining the (in)effectiveness of information interventions amongst low-SES adults, and more than half of the studies offering no explanation at all, it may be difficult to design future interventions without falling into the same pitfalls as past interventions. Scrutinizing why an intervention was effective or not in low-SES groups instead of only whether or not it was, enables intervention designers to specifically target or circumvent that element in future interventions. As such, it is vital that an empirical test of why an intervention is (in)effective becomes the rule, rather than the exception, in future intervention studies. That way, we can apply the knowledge gained to new interventions, increasing their effectiveness among low-SES groups and thus paving the way for reduced inequalities in smoking prevalence.

More information

Tim van Meurs is a PhD candidate in the Department of Public Administration and Sociology of the Erasmus University Rotterdam. His main focus is on educational differences in the receptiveness for informational and structural nutrition interventions. You can contact him via and find his work here.

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