How cultural background and community composition shape cigarette consumption in one of the world's most diverse cities
Imagine a substance so pervasive that its users consume over 78 million units of it every single day across Great Britain. This isn't a story about caffeine or sugar, but about cigarettes—a public health challenge that continues to shape lives, communities, and health outcomes in ways we are only beginning to fully understand 1 . In the sprawling, diverse metropolis of London, where over 11% of adults still smoke, the story of cigarette consumption becomes particularly fascinating when viewed through the lens of ethnicity 4 .
The question of how many cigarettes someone smokes daily has traditionally been answered by looking at broad factors like income, education, or gender. But emerging research reveals a more complex picture, one where cultural background, community composition, and ethnic identity interact in surprising ways to influence smoking behavior. This article explores the intricate relationship between ethnicity and cigarette consumption in London, revealing how the very fabric of our neighborhoods might be shaping health behaviors in ways we never anticipated.
To understand London's smoking landscape, we must first appreciate its ethnic diversity and how smoking patterns vary across communities. National data reveals striking differences in smoking prevalence across ethnic groups, challenging simplistic narratives about tobacco use.
Source: Office for National Statistics (2022) 5
These statistics reveal a surprising pattern: people from Black, Asian, and Chinese backgrounds are significantly less likely to smoke than White people in England, while those with mixed ethnicity report the highest smoking rates of all 3 5 . This pattern holds true when we zoom in on London specifically, though the city's overall smoking rate of 11.5% is lower than the England average of 13% 4 .
But prevalence alone doesn't tell the whole story. The quantity of cigarettes consumed daily matters tremendously for health outcomes, and here too we find important variations. A 2025 study found that smokers in London consume an average of 8.4 cigarettes per day—significantly lower than the national average and the lowest of any region in Great Britain 1 8 . This suggests that London's unique social environment may influence not just who smokes, but how much they smoke.
One of the most compelling theories to emerge from recent research is the "ethnic density effect"—the phenomenon whereby members of ethnic minority groups tend to have better health outcomes when they live in areas with a higher concentration of people from the same ethnic background 7 . This concept, previously explored predominantly in mental health research, is now being applied to understand smoking behaviors.
The protective effect of ethnic density operates through multiple mechanisms, creating community-level resistance to smoking behaviors.
Source: 7
This effect isn't uniform across all groups or circumstances. The relationship between ethnic density and smoking behavior appears to be nonlinear, with varying strength across different ethnic groups and between men and women 7 . For instance, the effect is particularly pronounced for South Asian groups, where research has consistently found large gender differences in smoking prevalence, with men much more likely to smoke than women 3 7 .
To truly understand how neighborhood composition influences smoking behavior, let's examine a crucial study that explored this relationship across south and east London.
Patient records analyzed
London boroughs studied
Ethnic groups analyzed
This groundbreaking research, published in 2017, analyzed the electronic health records of 688,397 patients registered with general practitioners across four inner-city London boroughs: Hackney, Lambeth, Newham, and Tower Hamlets 7 . The study employed several sophisticated approaches:
Statistical technique accounting for individuals nested within neighborhoods and boroughs
Percentage of people from same ethnic group in each neighborhood based on 2011 Census
Controlled for age, practice, borough, and socioeconomic deprivation
Used restricted cubic splines to explore complex patterns
The findings revealed a consistent protective effect of ethnic density against smoking across most groups. As the percentage of people from the same ethnic background in a neighborhood increased, the likelihood of being a current smoker decreased significantly 7 .
| Ethnic Group | Effect of Increased Ethnic Density | Notable Variations |
|---|---|---|
| White British/Irish | Reduced odds of smoking | Effect consistent across group |
| South Asian Groups | Significant protective effect | Particularly strong for women |
| Black African | Reduced odds of smoking | Consistent pattern |
| Black Caribbean | Protective effect | Exception: No significant effect for women |
| All Other Groups | Generally protective | Strength varied by sex and ethnicity |
Source: Adapted from Ethnic Density Study (2017) 7
The relationship between ethnic density and smoking was found to be nonlinear, with the strength of association varying significantly by sex and ethnic group. For instance, the research identified that Black Caribbean women did not experience the same protective effect from ethnic density as other groups, suggesting complex intersections of gender, ethnicity, and cultural factors 7 .
When analyzing smoking intensity (number of cigarettes smoked per day) among current smokers, the patterns became even more nuanced. The study classified smoking intensity into low intensity (≤20 cigarettes per day) and high intensity (>20 cigarettes per day), finding that the ethnic density effect operated differently on smoking initiation versus smoking intensity 7 .
This research represents a significant shift in how public health experts understand smoking behavior. By moving beyond individual-level factors to consider neighborhood and cultural contexts, the study:
The findings are particularly relevant for London, where ethnic diversity and residential patterns create natural variations in ethnic density across neighborhoods. Understanding these patterns allows health authorities to differentially target smoking cessation services to individuals and groups living in relative ethnic isolation, who may not benefit from the cultural and social factors associated with reduced tobacco consumption 7 .
Understanding the relationship between ethnicity and smoking requires sophisticated tools and methods. Researchers in this field rely on several key approaches, each offering unique insights into different aspects of this complex public health issue.
Collect representative data on smoking behaviors, beliefs, and demographics
Example: The Smoking Toolkit Study conducts monthly surveys with ~1,700 adults in England
Provide large, detailed datasets linking health behaviors, diagnoses, and demographics
Example: Analysis of 688,397 patient records to examine neighborhood effects 7
Statistical technique that accounts for nested data (individuals within neighborhoods)
Provides contextual information about neighborhood composition and characteristics
Track the same individuals over time to understand how behaviors change
These methods each have distinct strengths. While surveys can capture attitudes and beliefs, electronic health records provide enormous sample sizes for detecting patterns. Multilevel modeling is particularly crucial for this field, as it acknowledges that health behaviors are shaped simultaneously by individual characteristics and environmental contexts.
Recent technological advances have enhanced these tools. Geographic Information Systems (GIS) now allow more precise mapping of environmental influences on health, while improved statistical techniques better account for the complex interactions between multiple factors influencing health behaviors.
The relationship between ethnicity and cigarette consumption in London reveals a story far more complex than simple statistics about "smoking rates." It's a story about how our communities shape our health behaviors, how cultural norms can provide protection against harmful habits, and how public health strategies must evolve to acknowledge these nuanced realities.
As London continues its journey toward becoming a smokefree city, this research offers both challenges and opportunities. The challenge lies in developing more sophisticated, targeted approaches that recognize the diverse needs and protective factors across different communities. The opportunity is the potential to harness these community-level protective factors to develop more effective, culturally sensitive smoking cessation programs.
What remains clear is that reducing smoking-related harm requires looking beyond the individual smoker to the broader social fabric. In a city as diverse as London, understanding how ethnicity, community, and behavior interact may hold the key to helping all residents breathe easier.