The decline in how many people smoke (smoking prevalence) in England has nearly ground to a halt since the start of the pandemic, according to a new study funded by Cancer Research UK.
The study, led by researchers at University College London, looked at survey responses from 101,960 adults between June 2017 and August 2022.
Prior to the pandemic (from June 2017 to February 2020), smoking prevalence fell by 5.2% per year, but the study revealed that this rate of decline slowed to 0.3% during the pandemic (from April 2020 to August 2022).
“Smoking prevalence has been falling among adults in England at a steady rate for more than 20 years,” said Dr Sarah Jackson lead author of the study, citing evidence from the Office for National Statistics.
However, in this study, the rate of decline since the pandemic appears much slower than in the years leading up the pandemic.
“These findings make bold policy action more urgent,” Jackson continued. The Government was already not on track to meet its target for England to be smokefree by 2030. This study suggests we could be even further off track than we thought.”
What’s behind the stall?
Based on the survey responses, the researchers estimated the proportion of people who smoke in England as 16.2% in June 2017, falling to 15.1% by the start of the pandemic in March 2020.
They report that nearly y two and a half years later, in August 2022, this figure was virtually unchanged, at 15.0%.
The smoking rates reported in this study are slightly higher than those found in the Annual Population Survey, which is the official source of smoking prevalence statistics in England and is how the Government will assess whether the smokefree 2030 target is met. The Annual Population Survey found smoking rates were 14.9% in 2017, 13.8% in 2020, and 12.7% in 2022.
Although there are differences in the figures in these two surveys, due to factors in the research, they both highlight the decline in smoking rates slowing – this is far from what we need if we are to reach a Smokefree UK.
Interestingly, the study showed that this stall in decline was not caused by fewer people giving up smoking in that period.
The team found an increase in people quitting during the pandemic compared to pre-pandemic and the proportion of people stopping smoking more than doubled.
However, they also observed a rise in the number of people taking up smoking during the same period.
During the pandemic, the number of people accessing their local free stop smoking service fell dramatically due to COVID-19 restrictions. Specialist support from these services gives the best chance of quitting successfully and they are still seeing many fewer people than before the pandemic.
They also found that smoking prevalence had increased among 18- to 24-year-olds at the start of the pandemic and decreased among 45- to 65-year-olds at the same time.
They noted that younger adults experienced higher levels of stress, upheaval, and social isolation during the pandemic, which might have contributed to increased smoking prevalence. Nevertheless, the diverging changes in smoking prevalence for the two age groups were observed only at the start of the pandemic. For both age groups, this was followed by a flattening of smoking prevalence which was a reversal of the pre-pandemic decline.
Though we might initially be alarmed by a slowing down of the decline in smoking rates, it is something to be expected. With fewer people, the size of decline will also fall. Those who remain smoking will be those who are least able to or most resistant to quit.
An unequal picture
The flattening in the decline of smoking prevalence in this study was particularly pronounced among advantaged social groups – that is, people in households whose highest earners were in professional, managerial or clerical jobs, as opposed to other jobs, those who are long-term unemployed or have never worked.
Among people in disadvantaged social groups, smoking prevalence continued to decline very slightly.
The study didn’t investigate why trends in smoking prevalence were different between social groups. But the researchers suggested the switch to home working for many non-manual jobs during the pandemic may have contributed to loneliness and poor mental health, which could have made stopping smoking more difficult.
The researchers suggest that manual workers, meanwhile, may have had more financial disruption, leading to smoking becoming less affordable, as well as increased exposure to COVID-19 due to work, making quitting a higher priority for health reasons.
“These findings demonstrate why we can’t be complacent when it comes to tobacco,” said Dr Ian Walker, Cancer Research UK’s executive director of policy. “It can be easy to start smoking but notoriously hard to quit.
“World-leading measures, such as changing the age of sale of tobacco, alongside critical funding to boost smoking cessation services, are essential to help us achieve a Smokefree UK. We call on MPs from all parties to support the age of sale legislation at the free vote.”
The UK Government is aiming for England to be smokefree by 2030, defined as average adult smoking rates of 5% or less.
Cancer Research UK’s projections suggest that England is currently 9 years off-target for the smokefree 2030 ambition. Wales also has a 2030 target, while Scotland’s smokefree target is 2034.
