PLOS ONE · 8 authors, 3 centres
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This study examined how the cost-of-living crisis in Great Britain affected smoking cessation and alcohol reduction attempts from 2021 to 2022. The proportion of attempts motivated by cost remained stable among smokers but increased among less advantaged high-risk drinkers, and use of e-cigarettes in quit attempts rose. Clinically, rates of GP offers of support for smoking and alcohol reduction remained low, highlighting missed opportunities to help patients during financial strain.
**Background:** The cost-of-living crisis in Great Britain, beginning in late 2021, has reduced real disposable incomes. Smoking and excessive drinking are costly habits; the average smoker spends £20/week on cigarettes and the average household spends £11/week on alcohol. This study aimed to assess whether the crisis changed the motives for and methods of smoking cessation and alcohol reduction attempts, and whether GP offers of support changed. **Methods:** Data came from the monthly Smoking and Alcohol Toolkit Studies (January 2021–December 2022), representative of Great Britain adults. The sample included 14,567 past-year smokers and high-risk drinkers (AUDIT-C ≥5). Outcomes were: cost as a motive for the most recent quit/reduction attempt; use of paid support (e-cigarettes, OTC NRT) and evidence-based support; and receipt of GP offer of support. Log-binomial regression modelled time trends using restricted cubic splines, adjusting for age, gender, region, social grade, and cigarette type. Moderation by occupational social grade (ABC1 vs C2DE) and main cigarette type (manufactured vs hand-rolled) was tested via interaction terms. **Key Results:** Among smokers who tried to quit, 25.4% (95%CI 23.8–26.9%) cited cost as a motive, with no significant change over time. Among high-risk drinkers who tried to reduce, 13.9% (95%CI 12.8–15.0%) cited cost; this increased from 12.0% in December 2021 to 16.3% in December 2022 (p=0.076). The increase was significant among less advantaged social grades (C2DE): from 15.3% (12.1–19.3) to 29.7% (20.1–44.1) (p-interaction=0.044). Use of paid support for smoking cessation rose from 41.4% to 52.0% (p=0.006), driven by e-cigarette use increasing from 28.1% to 38.2% (p=0.006). OTC NRT use did not change significantly. Use of evidence-based support remained stable among smokers (40.9% overall) and high-risk drinkers (9.3% overall). Among those visiting their GP, 27.0% of smokers received an offer of support for smoking cessation, and 1.4% of high-risk drinkers received an offer for alcohol reduction; neither changed significantly over time. **Clinical Implications:** The cost-of-living crisis has not broadly altered the nature of smoking cessation attempts, but cost is increasingly motivating alcohol reduction among disadvantaged drinkers. The rise in e-cigarette use for quitting is encouraging, as e-cigarettes are cheaper than smoking and increase quit success. However, the persistently low rates of GP offers of support—especially for alcohol reduction—represent missed opportunities. Clinicians should proactively offer evidence-based support, which is often free, to help patients reduce the financial and health burdens of smoking and high-risk drinking.