Beyond Willpower: What Our Study Reveals About Smoking Cessation Among Adults Living with Disability

Smoking cessation is often framed as a matter of personal choice, motivation, or willpower. But for many adults living with disability, the reality is far more complex. In our recent paper published in Public Health, we examined smoking cessation among 147,691 adults living with disability in the UK and found that quitting smoking is shaped not only by individual behaviour, but also by social and economic conditions that make cessation easier for some and much harder for others.

Using nationally representative data from the Annual Population Survey collected between 2017 and 2023, we focused on adults with disability who had ever smoked and compared those who had quit with those who were still smoking. Overall, 65.7% were ex-smokers, while 34.3% remained current smokers. Encouragingly, the proportion who had quit increased over time, rising from 61.8% in 2017 to 70.7% in 2023. That trend suggests progress, but it does not tell the full story. Behind those headline numbers were clear and persistent inequalities in who was more likely to quit.

Smoking cessation was strongly socially patterned.

One of the clearest findings from the study was that smoking cessation was strongly socially patterned. Older adults were much more likely to be ex-smokers than younger adults. Being married or cohabiting, and having a degree, were also associated with higher odds of cessation. In contrast, unemployment, economic inactivity, renting rather than owning a home, and lower life satisfaction were all associated with lower odds of having quit smoking. Severe activity limitation was also linked to a lower likelihood of cessation. In other words, the barriers to quitting were not just clinical or behavioural. They were tied to broader conditions of daily life.

The barriers to quitting were not just clinical or behavioural. They were tied to broader conditions of daily life.

Understanding the pathways, not just the patterns.

This is where the paper makes an important contribution. Rather than stopping at description, we also examined pathways. We asked not only whether severe disability was associated with lower smoking cessation, but also how that association might operate. The results showed that much of the relationship was explained by differences in employment status, housing tenure, and life satisfaction. Put simply, smoking cessation inequality among adults living with disability appears to be closely intertwined with material insecurity and psychosocial wellbeing.

About one third of the total association co-occurred with these socioeconomic and psychosocial differences.

The implications for public health.

The implication is straightforward but important. If we want to improve smoking cessation among adults living with disability, it is not enough to focus only on individual counselling, motivation, or nicotine dependence. Those supports matter, but they are unlikely to be sufficient on their own. Effective cessation strategies should also recognise the role of poverty, insecure housing, exclusion from employment, and poor wellbeing.

Public health cannot afford to treat smoking in disability populations as an isolated lifestyle issue when it is also deeply connected to structural disadvantage.

This study does not claim causality, and the cross-sectional design means the pathways should be interpreted with appropriate caution. But the message is still clear. To reduce smoking-related inequalities among adults living with disability, we need a broader approach — one that combines cessation support with action on the social determinants of health.

Quitting smoking is not only about choice. For many people, it is also about whether the conditions around them make that choice genuinely achievable.

Yusuff Adebayo Adebisi

Pharmacist and epidemiologist advancing equity-driven, policy-relevant public health research. PhD Researcher at the University of Glasgow. Director of Research at Global Health Focus.

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