Smoking prevalence and the changing risk profiles in the UK ethnic and migrant minority populations: implications for stop smoking services

Objectives: Smoking is the leading risk factor for disability-adjusted life-years, yet evidence with which to establish the smoking rates of people with different ethnic backgrounds and how they are changing in relation to recent migration is lacking. The objective is to provide current information on the changing risk profiles of the UK population.

Study design: Observational study using cross-sectional surveys.

Methods: Data from the Integrated Household Survey (pooled for the years 2009/10-2011/12), obtained under Special Licence, and the GP Patient Survey (2012) have been used to establish smoking prevalence in a wider range of ethnic groups in England and Wales, including the 'mixed' groups and amongst East European migrants, and how such prevalence differs across socio-economic classes.

Results: Smoking prevalence is substantially higher amongst migrants from East European countries (that for males exceeding 50% from three such countries and for females over 33% from four countries) and from Turkey and Greece, compared with most other non-UK born groups, and amongst ethnic groups is elevated in the 'mixed' groups. Rates are highest in the Gypsy or Irish Traveller group, 49% (of 162) and 46% (of 155) for males and females respectively. Across ethnic groups, rates are almost always higher in the UK born than non-UK born population with the notable exception of the 'White Other' group, with Prevalence Ratios (PRs) indicating a larger migrant-non-migrant differential amongst females (e.g. Indians 2.95 (2.33-3.73); Black Caribbeans 3.28 (2.73-3.94). Age-adjusted rates show the persistence of these differentials in females across age groups, though young males (18-29) in seven minority ethnic groups show lower rates in the UK-born groups. The 'White' and 'Chinese' groups show a strong socio-economic gradient in smoking which is absent in the South Asian groups and diminished in the 'mixed' and black groups.

Conclusions: Given the evidence that smoking behaviour is significantly different in some of the new groups, notably East European migrants, stop smoking services are failing to optimize the acceptability and, consequently, favourable outcomes for these programmes. These services need to be adapted to the particular patterns of smoking behaviour and language skills within different communities of descent.