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E-cigarettes: an evidence update <br /> <br />40 <br />5. Smoking, e-cigarettes and inequalities <br />Smoking and inequalities <br />Whilst smoking prevalence overall has been declining over the past 50 years, smok ing <br />has become increasingly concentrated in more disadvantaged groups in society. Over <br />the last decade, the gap between smoking in the different social groups has not <br />narrowed (Figure 9) and some of the most disadvantaged groups in society (such as <br />people with serious mental illness or prisoners) have shown no change in smoking <br />prevalence over time (e.g. Figure 10). Furthermore, among smokers, the level of <br />nicotine dependence increases systematically as deprivation increases [2]. A key <br />challenge in tobacco control is therefore how to encourage smokers from <br />disadvantaged groups to stop smoking. <br /> <br />Whilst quitting cigarettes and all nicotine use should remain the main goal across all <br />social groups, EC are of interest because, as with other cleaner nicotine delivery <br />systems, they potentially offer a wide reach, low-cost, intervention to reduce smoking <br />and improve health in these more deprived groups in society where smoking is elevated <br />[2]. It is therefore important to examine the potential impact of EC on inequalities. <br /> <br />Figure 9: Smoking trends by socioeconomic group status (GHS data) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />