Impact of the UK's smokefree generation policy on tobacco-related equity in England: a simulation study

Modelling studies find the smokefree generation (SFG) policy could help achieve the tobacco endgame. The UK is on course to introduce an SFG in 2027 that prohibits tobacco sales to individuals born in or after 2009.

We adapted an individual-level microsimulation model with a synthetic representative English population, and used previously validated smoking initiation, quit and relapse probabilities by age and deprivation quintile. We simulated four scenarios from 2023 to 2075: no intervention, pessimistic SFG, central SFG and optimistic SFG. Proportionate universalism sensitivity analyses assumed effective targeting led to greater effects in more deprived areas and smaller effects in less deprived areas. Equity was assessed using slope and relative indices of inequality.

The central SFG scenario forecast smoking prevalence to be reduced to <5% in 12-30 year-olds by 2049, but not until 2055 for males and not until 2059 for those living in the most deprived quintile. Absolute socioeconomic inequalities were reduced but not relative inequalities. Under proportionate universalism, <5% prevalence is achieved a year earlier (2048) and both absolute and relative inequalities by index of multiple deprivation quintile are substantially reduced by 2050. By 2075, 87 899 (85 293-90 791) discounted quality-adjusted life years were gained in the central scenario compared with baseline.

The SFG policy has potential to reduce absolute inequalities among its target population and achieve significant gains in quality and length of life. Achieving reductions in relative inequalities will likely require targeted interventions that lead to greater effectiveness in lower socioeconomic areas and for males.