Smoking and quitting inequalities among gender-diverse adults in Great Britain: a population-based study

Tobacco smoking is a leading cause of health inequalities, and smoking rates are higher among people who are gender-diverse. This study examined smoking prevalence, dependence, quit attempts, and cessation behaviours among gender-diverse adults in Great Britain, compared with adults identifying as men or women. Cross-sectional data were drawn from the Smoking Toolkit Study, a nationally representative survey of adults aged 16 years and above in Great Britain, collected between October 2020 and June 2025. Gender identity was self-reported as male, female, or in another way, with the latter defined as gender-diverse. Outcomes included smoking prevalence, markers of tobacco addiction and motivation to quit, past-year quit attempts and motivations, quit success, and use of evidence-based cessation aids. Logistic and linear regression models were used to examine associations, adjusting for age and social grade and survey wave, with additional covariates included for quit success analyses. The analytic sample consisted of 387,629 adults, including 906 (0.2%) individuals who identified as gender-diverse. Current tobacco smoking prevalence was higher among gender-diverse adults (28.0%) than among men (18.7%; aOR = 1.38, 95% CI 1.17–1.63) and women (14.8%; aOR = 1.76, 95% CI 1.49–2.07). Among current smokers, those who were gender-diverse were more likely to smoke within 30 min of waking compared with men (aOR = 1.45, 95% CI 1.08–1.94) and women (aOR = 1.52, 95% CI 1.13–2.04), indicating greater tobacco addiction. Motivation to quit was lower among gender-diverse smokers compared with women (aOR = 0.61, 95% CI 0.39–0.95) and possibly men (aOR = 0.67, 95% CI 0.43–1.04). Past-year quit attempts and quit success did not differ significantly by gender identity. Gender-diverse adults in Great Britain experience substantially higher smoking prevalence and greater tobacco addiction. While the quit attempt rates were broadly similar across groups, motivation to quit generally appeared lower among gender-diverse people who smoke. These findings highlight the need for inclusive, equity-focused tobacco control strategies that address the specific barriers faced by gender-diverse communities.