In Australia, the prevalence of smoking remains substantially higher among those with low educational attainment and lower income levels compared with the population as a whole (see Section 9.1). Smoking exacerbates financial stress and poverty both for adults,1 and children2—see Section 9.4. Australians who are socioeconomically disadvantaged and smoke have reported frequent experiences of deprivation and financial stress caused by their smoking, such as going without meals, substituting food choices and paying bills late in order to purchase cigarettes.3 Several studies have found that increases in income support/wages among socioeconomically disadvantaged people who smoke are associated with increases in smoking cessation.4,5 Subsidised cessation medications are also associated with increased use among disadvantaged groups6 (see Section 9.9).
Social (e.g., low social support for quitting), psychological (e.g., low self-efficacy) and physical factors (e.g., greater nicotine dependence) all contribute to the higher tobacco use among socially disadvantaged populations7 (see Section 9.7). Qualitative research in Australia has found that socially disadvantaged populations may be resistant to cessation interventions and feel a lack of control over their smoking and the stressful life circumstances that sustain it.8 Feelings of guilt, shame and stigma can impede help-seeking among low socioeconomic status Australians who smoke.9 Nonetheless, the most disadvantaged people who smoke in Australia are equally likely to make a quit attempt (albeit with less success), and equally, or more, likely to use quit aids, as those who are more socioeconomically advantaged.10
The development of individual-level smoking cessation interventions that address smoking among low socioeconomic groups is a high priority for reducing health inequalities and improving life expectancies.11 However, a systematic review of research into cessation among low socioeconomic and other disadvantaged groups concluded that research output has not been optimal for guiding design of policies and programs to decrease smoking prevalence.11 Even so, reviews have found evidence that individual-level smoking cessation interventions in socioeconomically disadvantaged groups can be effective.12-15
A 2022 systematic review13 of smoking cessation interventions for socioeconomically disadvantaged women examined a several approaches, including face-to-face and group support, telephone support, NRT in conjunction with other support, and print-based self-help. The review found that both behavioural and combined behavioural-pharmacotherapy interventions were effective in the short term, though the effect diminished over longer follow-up periods. Overall, the certainty of the available evidence on smoking cessation in low socioeconomic women was rated as relatively poor.13
The 2024 US Surgeon General’s report15 on Eliminating Tobacco-Related Disease and Death: Addressing Disparities concluded that while tailored interventions developed to date have generally not been associated with increased successful cessation compared with non-tailored interventions among adults of lower socioeconomic groups, behavioural interventions such as in-person and telephone counselling, digital support, and brief clinical interventions are effective for smoking cessation among lower socioeconomic population groups.15
A 2025 Cochrane review14 on the Differences in the effectiveness of individual-level smoking cessation interventions by socioeconomic status found no clear evidence to support using different quit interventions for people from lower versus higher socioeconomic groups, or that any one intervention would have an effect on health inequalities, due to little or no confidence in the evidence for all treatments. However, the authors stated this conclusion could change as more research becomes available.14
Examples of specific interventions and research on effectiveness are outlined below.
For a discussion of whether individual-level interventions increase (or decrease) disparities in smoking prevalence between low socioeconomic groups and more advantaged groups, see Section 9.9, and for population-wide strategies, effective at reducing smoking among low socioeconomic groups—see Section 9.8.
9.6.1 Behavioural support
9.6.1.1 Print-based self-help behavioural interventions
A 2025 Cochrane review14 found that print-based self-help behavioural interventions were more successful among higher socioeconomic groups compared to lower socioeconomic groups, suggesting these interventions may widen rather than narrow health inequities. The evidence was of low certainty.
9.6.1.2 Telephone, mobile and Internet-based interventions
While research in the US has suggested there may be barriers to using the Quitline among low socioeconomic groups such as not having access to a phone18 and the cost of making the call from a mobile,19 low socioeconomic groups in Australia appear to be just as, or more, likely to contact the Quitline10,20 (see Section 9.9). The 2024 US Surgeon General’s report15 concluded that the evidence is sufficient to infer that Quitlines can increase access to cessation treatments among population groups affected by tobacco-related disparities, particularly when Quitline promotion and services are developed, delivered, and evaluated with attention to their reach and relevance to these groups.15 In a 2025 Cochrane review, telephone counselling was associated with a greater likelihood of smoking cessation among lower compared to higher socioeconomic groups, however the authors noted limited confidence in these results.14
Australian research has suggested that text messaging-based9 interventions have potential for reducing smoking among low socioeconomic groups. A 2022 randomised controlled trial21 found that a 12-week tailored text message smoking cessation program produced approximately four times greater 30-day smoking abstinence in socioeconomically disadvantaged young adults compared to usual care. Among participants who continued smoking, the intervention also significantly increased confidence and desire to quit, while reducing the number of days smoked.21 While these results show promise, research has found the success of text-messaging based interventions to be lower in lower socioeconomic groups compared to higher groups.14
Australian research22 has also suggested that internet-based interventions have potential for reducing smoking among low socioeconomic groups. A 2025 Cochrane review found internet interventions were associated with a greater likelihood of smoking cessation among lower compared to higher socioeconomic groups, however the authors noted limited confidence in these results.14
See Section 7.14 for a broader discussion of these interventions.
9.6.1.3 Individual counselling
A 2025 Cochrane review14 found very low-certainty evidence of no difference in smoking cessation by socioeconomic status for face-to-face counselling when compared to less intensive counselling, balanced components, or usual care. However, the confidence interval included the possibility of favouring lower and higher socioeconomic groups, indicating a possible neutral impact on health equality.14
Mindfulness
A 2025 systematic review and meta-analysis23 examined six randomised control trials on the effectiveness and feasibility of mindfulness-based interventions (MBIs) both in in-person and in various digital formats for smoking cessation in low socioeconomic groups. It found that MBIs have statistically significantly higher odds of helping low socioeconomic groups quit compared with miscellaneous comparators at a 6-12-month follow-up. However, the authors' confidence in the evidence was low, as several effect sizes came from pilot studies. Combined with a non-significant sensitivity analysis, these results should be considered inconclusive. Further research is needed to examine the efficacy of MBIs for low socioeconomic groups.23
See Section 7.15.1 for more information on individual counselling, and Section 7.15.1.4 for more information on mindfulness.
9.6.1.4 Financial incentives
Several studies have examined the potential of offering low socioeconomic groups financial incentives to quit. A study in the US assessed two strategies (direct mail and opportunistic telephone referrals) that offered financial incentives to low-income people who smoke for being connected to a Quitline. Both strategies successfully connected people who smoke to the Quitline and encouraged quit attempts and continuous smoking abstinence.24 Another US study similarly found that financial incentives encouraged Quitline use among socioeconomically disadvantaged people who smoked.25 There is evidence supporting the effectiveness of financial incentives that are large,26 and also modest incentives,27 as well as those that are not contingent on outcomes,28 for increasing engagement and quitting behaviours among low-income people who smoke.
The 2024 US Surgeon General’s report15 concluded that the evidence is suggestive, but not sufficient, to conclude that incentives paired with cessation treatments increase smoking cessation among low socioeconomic groups.15 Moreover, when comparing the effectiveness of financial incentives by socio-economic status, research14 found incentives to be more effective for higher socioeconomic groups, than low socioeconomic groups.
See Section 7.17 for a detailed discussion of financial incentives for smoking cessation.
9.6.2 Pharmacological support
A 2025 Cochrane review14 found nicotine electronic cigarettes and cytisine each were associated with a greater likelihood of smoking cessation among lower compared to higher socioeconomic groups. This suggests each of these interventions may have a possibly positive impact on health equality compared to the control intervention. The review found that bupropion had a greater effect on cessation in higher than in lower socioeconomic groups, indicating a possibly negative impact on health equality. The evidence on nicotine replacement therapy was unclear, and no evidence was available for varenicline. The authors were very uncertain about these results due to limitations of the evidence available.14
For more on pharmacotherapies for smoking cessation, see Section 7.16.
9.6.3 Smoking bans in social housing
People living in social housing are more likely to smoke or experience secondhand smoke compared to the general population. A 2024 scoping review29 on tobacco control interventions in subsidised housing found that smokefree housing policies were the most evaluated intervention. Findings suggest the smokefree housing policies could increase cessation behaviours and reduce secondhand smoke exposure in the short term. However, long-term adherence was uncertain. The review found evidence suggesting some residents may have switched from smoking on balconies to smoking inside their home, with some reports of interference with smoke alarms and air monitoring devices.29
For legislative information on smoking in multi-unit house in Australia see Section 15.6.4.1.
9.6.4 Role of healthcare providers and community organisations
Integrating interventions into community programs holds promise for promoting cessation among low socioeconomic groups.30-33 In the UK, stop-smoking services appear to reduce inequalities in smoking through increased relative reach through targeting services to low socioeconomic groups.34,35 For example, one UK study found that a mobile, drop-in, community-based stop smoking service effectively increased reach to disadvantaged people who smoked.36 Two studies in the US have examined interventions among Salvation Army clients who smoked: one that showed that a brief, targeted motivational intervention increased the initiation of an evidence-based tobacco cessation treatment,37 and another that challenged beliefs about the effectiveness of various quit methods, which was associated with greater smoking reduction and greater likelihood of contacting the Quitline.38 Disadvantaged Australians who smoke report being open to receiving information and support to quit from community service organisations.39 Peer support interventions also appear to have potential to address the high prevalence of smoking in vulnerable populations, particularly among disadvantaged groups who experience fewer opportunities to access such support informally.7,32,40
Healthcare professionals can also play an important role in reducing smoking among disadvantaged populations by integrating cessation interventions into routine care.35 In Australia, GPs and other healthcare providers are a known and trusted source of cessation information and advice for disadvantaged people who smoke,39 and low socioeconomic groups are just as likely as mid-high-socioeconomic groups to report being advised to quit by their doctor (see Section 9.9). Such interventions can promote and assist smoking cessation – see Section 7.10 for a broader discussion.
9.6.5 Increasing the effectiveness of cessation interventions
Tailoring and adapting evidence-based cessation treatments to address the needs of socioeconomically disadvantaged groups has been suggested as a pathway to increasing their effectiveness; however a 2019 review found that while individual-level interventions were effective, there were no differences in the effectiveness of socioeconomic-position-tailored and non-tailored cessation interventions for reducing smoking among disadvantaged groups. The authors suggest that multifaceted approaches and improvements in current tailored interventions may be needed to reduce disparities.12 A major review in 2024 also found current tailoring strategies generally do not appear to be more effective at increasing cessation than nontailored strategies for lower socioeconomic groups and suggest that additional research is needed to further the understanding of tailoring strategies that could be effective, including what types of interventions and the ‘dose’ of tailoring that may be needed.15
Several reviews have concluded that multicomponent cessation interventions are needed for low socioeconomic populations,41,42 and have highlighted the importance of social support, employing community-based participatory approaches to develop tailored approaches, effective combination pharmacotherapies (varenicline and NRT),42 incentives, and peer facilitators.41
Despite being just as likely to make quit attempts, low socioeconomic groups experience less success in sustaining cessation.10 Increasing the likelihood that quit attempts are successful is therefore an important step in reducing smoking prevalence and smoking-related disparities. People of low-income who smoke are more likely to discontinue treatment early (see Section 9.9.2.2); therefore interventions that increase compliance may help to increase the success of quit attempts.43 For example, interventions that enhance resilience,44 motivation, and self-efficacy45 and address life stressors.46 Providing greater choice/sampling of NRT47-49 can also help to promote adherence and cessation among low socioeconomic groups.
9.6.6 Increasing engagement with cessation interventions
Disadvantaged people who smoke have traditionally been a hard-to-reach group, and researchers have examined factors that could promote engagement with cessation interventions among socioeconomically disadvantaged populations. Targeting interventions in areas with high numbers of low socioeconomic people who smoke by healthcare and community organisations can help compensate for the relatively low quit rate among this population, thereby reducing health disparities.35 In Victoria, Quit is geotargeting several low socioeconomic Local Government Areas with high numbers of people who smoke, with strategies including additional campaign messaging in outdoor and shopping locations, geotargeted messaging on social and digital media, and community organisations amplifying Quit’s messages. The project aims to increase self-efficacy to quit and maintain cessation among those who smoke, as well as to educate and encourage those surrounding them (health professionals, family, friends) to provide support.50
To increase recruitment for smoking cessation trials, studies have found that mailed invitations and follow-up from health professionals,51 and in-person field-based methods,52,53 appear to be effective strategies. Among disadvantaged people who smoke in Australia, one trial found that retention was higher among those with higher motivation to quit, more recent quit attempts, increased age, higher level of education and for those recruited through Quitline or newspaper advertisements.54 Proactively contacting people who smoke and offering cessation support, regardless of their interest in quitting, can also be effective in promoting quitting among socioeconomically disadvantaged groups.25,55
A major review in 2024 suggests that future research studies examine preferences for cessation medications among lower socioeconomic people who smoke, identify innovative strategies to increase medication use, and identify approaches to ensure equitable access to counselling and pharmacotherapy, particularly in lower resource settings.15
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References
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