Socioeconomic inequalities in the delivery of brief interventions for smoking and excessive drinking: findings from a cross-sectional household survey in England

BMJ Open. 2019 May 1;9(4):e023448. doi: 10.1136/bmjopen-2018-023448.


Objectives: Brief interventions (BI) for smoking and risky drinking are effective and cost-effective policy approaches to reducing alcohol harm currently used in primary care in England; however, little is known about their contribution to health inequalities. This paper aims to investigate whether self-reported receipt of BI is associated with socioeconomic position (SEP) and whether this differs for smoking or alcohol.

Design: Population survey of 8978 smokers or risky drinkers in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures: Survey participants answered questions regarding whether they had received advice and support to cut down their drinking or smoking from a primary healthcare professional in the past 12 months as well as their SEP, demographic details, whether they smoke and their motivation to cut down their smoking and/or drinking. Respondents also completed the Alcohol Use Disorders Identification Test (AUDIT). Smokers were defined as those reporting any smoking in the past year. Risky drinkers were defined as those scoring eight or more on the AUDIT.

Results: After adjusting for demographic factors and patterns in smoking and drinking, BI delivery was highest in lower socioeconomic groups. Smokers in the lowest social grade had 30% (95% CI 5% to 61%) greater odds of reporting receipt of a BI than those in the highest grade. The relationship for risky drinking appeared stronger, with those in the lowest social grade having 111% (95% CI 27% to 252%) greater odds of reporting BI receipt than the highest grade. Rates of BI delivery were eight times greater among smokers than risky drinkers (48.3% vs 6.1%).

Conclusions: Current delivery of BI for smoking and drinking in primary care in England may be contributing to a reduction in socioeconomic inequalities in health. This effect could be increased if intervention rates, particularly for drinking, were raised.

Keywords: alcohol; brief interventions; health inequalities; primary care; public health; smoking.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / prevention & control
  • Alcohol Drinking / therapy*
  • Cost-Benefit Analysis
  • Cross-Sectional Studies
  • England / epidemiology
  • Family Characteristics
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prevalence
  • Primary Health Care / economics
  • Primary Health Care / methods*
  • Self Report
  • Smoking / epidemiology
  • Smoking / therapy*
  • Smoking Cessation / methods*
  • Socioeconomic Factors*
  • Young Adult