England's Smoking Decline Stalls Amid Pandemic

University College London

A decades-long decline in smoking prevalence in England has nearly ground to a halt since the start of the pandemic, according to a new study led by UCL researchers.

The study, funded by Cancer Research UK and published in the journal BMC Medicine, looked at survey responses from 101,960 adults between June 2017 and August 2022.

Before the Covid-19 pandemic, from June 2017 to February 2020, smoking prevalence fell by 5.2% a year, but this rate of decline slowed to 0.3% during the pandemic (from April 2020 to August 2022), the study found. This stall in the decline of smoking was particularly pronounced among advantaged social groups.

Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: "Smoking prevalence has been falling among adults in England at a steady rate for more than 20 years. Our data show that this decline has stalled, with an increase in quitting potentially having been offset by a rise in people taking up smoking or an increase in late relapse.

"These findings make bold policy action more urgent. The Government was already not on track to meet its target for England to be smokefree by 2030. This study shows we are even further off track than we thought."

Based on the survey responses, the researchers estimated the proportion of smokers in England as 16.2% in June 2017, falling to 15.1% by the start of the pandemic (in March 2020). Nearly two and a half years later, in August 2022, this figure was virtually unchanged, at 15.0%.

The researchers used data from the Smoking Toolkit Study, in which a different sample of 1,700 adults in England (who are representative of the population) are interviewed each month. They aimed to see if the pandemic, which had such a profound impact on everyday life, had resulted in sustained changes in smoking patterns.

The team found a 40% increase in quit attempts during the pandemic compared to pre-pandemic and a sustained 120% increase in the proportion of people stopping smoking (i.e., this figure more than doubled), but this was offset by a rise in the number of people taking up smoking during the same period.

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. In both age groups, these immediate changes were followed by the pre-pandemic declines stopping, and prevalence remaining flat.

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