Smokers In England Research Articles

Trends in non-daily cigarette smoking in England, 2006–2024

BackgroundCigarette smoking is incredibly harmful, even for people who do not smoke every day. This study aimed to estimate trends in non-daily smoking in England between 2006 and 2024, how these differed across population subgroups, and to explore changes in the profile of non-daily smokers in terms of their sociodemographic and smoking characteristics and vaping and alcohol consumption.MethodsData were collected monthly between November 2006 and April 2024 as part of a nationally representative, repeat cross-sectional survey of adults (≥ 18 years; n = 353,711). We used logistic regression to estimate associations between survey wave and non-daily smoking and used descriptive statistics to characterise the profile of non-daily smokers across 3-year periods.ResultsThe proportion who smoked non-daily was relatively stable between November 2006 and November 2013, at an average of 10.5% [10.1–10.9%] of cigarette smokers, then increased to 27.2% [26.0–28.4%] of cigarette smokers (4.0% [3.7–4.2%] of adults) by April 2024. This increase was particularly pronounced among younger adults (e.g. reaching 52.8%, 20.4%, and 14.4% of 18-, 45-, and 65-year-old cigarette smokers by April 2024) and those who vape (reaching 34.2% among vapers vs. 23.1% among non-vapers). Over time, there were reductions in non-daily smokers’ mean weekly cigarette consumption (from 34.3 in 2006–2009 to 21.1 in 2021–2024), urges to smoke (e.g. the proportion reporting no urges increased from 29.2 to 38.0%), and motivation to stop smoking (e.g. the proportion highly motivated to quit within the next 3 months decreased from 30.8 to 21.0%).ConclusionsAn increasing proportion of adults in England who smoke cigarettes do not smoke every day, particularly younger adults. Although non-daily smokers report smoking fewer cigarettes and weaker urges to smoke than they used to, which may make it easier for them to stop smoking, they appear to be decreasingly motivated to quit.

A microsimulation model of smoking prevalence in England: exploring potential impacts of ‘Tobacco 21’ and e-cigarette policy scenarios on socioeconomic and regional inequalities

Background The burden of morbidity and mortality in England, is greater among priority groups such as those with lower income or routine and manual occupations. Using a microsimulation model, we estimate projected changes in smoking prevalence according to socio-economic position under selected policy scenarios that are relevant to ongoing policy implementation and debate. Methods Initiated using real-world data from adult (16+) respondents to the Smoking Toolkit Study (STS), the ‘QuitSimX’ microsimulation model projects individual-level smoking uptake and cessation in England over time. The simulation was run under two separate policy scenarios, raising the age of sale of tobacco products to 21 (simulations run from 2013–2023), and moving a proportion of all individuals quitting using a certain method (such as over the counter nicotine replacement therapy), or no method, to using e-cigarettes instead (simulations run from 2015–2025). Under each scenario, the size of effect were specified, and the outcomes simulated and assessed by indicators of socio-economic position. Absolute and relative inequalities were examined by comparing at the initial and final timepoint the i) absolute difference in smoking prevalence between less and more advantaged groups subgroups and ii) the ratio of smoking prevalence. Results While absolute and relative inequalities in smoking prevalence declined across the simulated period under all policy scenarios and the counterfactual ‘no intervention’ scenario, at the final time point absolute and relative inequalities between social grades and regions were similar across all scenarios, with the exception that the relative (but not absolute) inequality under the most impactful tobacco 21 scenario as marginally higher than under the baseline scenario. Conclusion A microsimulation model of smoking in England illustrates that absolute inequalities are projected to decrease under a Tobacco 21 or quitting with e-cigarettes scenario but that some policy solutions (Tobacco 21) may result in an increase in relative inequalities.

Evaluation of a Regional Tobacco Control Program (Greater Manchester’s Making Smoking History) on Quitting and Smoking in England 2014–2022: A Time-Series Analysis

Abstract Introduction This study aimed to assess the impact of Greater Manchester’s Making Smoking History program—a region-wide smoking cessation programs launched in January 2018—on key smoking and quitting outcomes. Methods Data were from a nationally representative monthly survey, 2014-2022 (n = 171 281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalized additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the program’s first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (preregistered outcomes), and current smoking prevalence among adults (unregistered outcome). Results Results showed mixed effects of the program on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = –11.03%; 95% CI –18.96; –3.11) and overall quit rates in Greater Manchester compared with the rest of England (–2.56%; 95% CI –4.95; –0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95% CI –11.64; 17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following the initiation of the program (–2.14%; 95% CI –4.02; –0.27). Conclusions The first five years of Greater Manchester’s Making Smoking History program did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period. Implications Taken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the program has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the program’s impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the program over a longer timeframe.

Impact of Standardised Packaging of Tobacco Products Regulations on cigarette consumption and youth smoking in England: interrupted time-series analysis

BackgroundIn the UK in May 2016, standardised packaging of tobacco products was implemented, including minimum pack sizes of 20 sticks or 30 g loose tobacco. The change was intended to...

Social smoker identity and associations with smoking and quitting behaviour: A cross-sectional study in England

Background'Social smoking' typically occurs predominantly or exclusively in the presence of others who are smoking. Relatively little is known about changes in the prevalence of 'social smoking identity' over time and its association with other smoking-related correlates. MethodsData were from the Smoking Toolkit Study, a nationally-representative cross-sectional survey in England. Participants were 26,774 adults who currently smoked or had quit in the past year, surveyed between February-2014 and April-2021. We estimated the proportion identifying as having a social smoking identity, changes over time, and associations with smoking in social situations, cigarette dependence, motivation to stop, quit attempts and success. ResultsOf adults who currently smoked or had quit in the past year, 34.0% (95% Confidence Interval (CI)=33.5–34.6) identified as having a social smoking identity. There was a near linear increase in this proportion from 31.9% (95%CI=29.7–34.2) in February-2014 to 36.5% (95%CI=34.1–38.9) in April-2021. Adults who currenty smoked identifying as having a social smoking identity were less cigarette dependent (adjusted B=0.34, 95%CI=0.31–0.37) and more motivated to stop (aOR=1.20, 95%CI=1.15–1.26) than those who did not. Adults who currently smoked or had quit in the past year identifying as having a social smoking identity reported more smoking in social situations (aOR=6.45, 95%CI=6.13–6.80) and past-year quit attempts (aOR=1.22, 95%CI=1.14–1.30) than those who did not. Quit success was not associated with having a social smoking identity among adults who currently smoked or had quit in the past year and who had attempted to quit (aOR=0.90, 95%CI=0.79–1.02). ConclusionsAn increasing proportion, over a third, of adults who currently smoked or had quit in the past year in England identify as having a social smoking identity. Despite being associated with lower dependence, greater motivation to quit and more quit attempts, social smoking identity is not associated with greater quit success, suggesting a complex interplay between identity and smoking-related behaviours.

Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008-2023.

This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and toexplore differences by key potential moderators. We used data from 57778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly orexclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%-32.1%] in 2008 to 52.1% [49.7%-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January 2008 to 5.0 [4.7-5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco. While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.

Trends in Exclusive Non-Cigarette Tobacco Smoking in England: A Population Survey 2013-2023.

The UK Government intends to implement a "smokefree generation" policy prohibiting the sale of all tobacco products to people born after 2008. National surveys provide comprehensive data on cigarette smoking, but little is known about patterns of non-cigarette tobacco smoking across key population groups. Using data from a nationally representative cross-sectional survey of adults in England, collected monthly between September 2013 and September 2023 (n = 196721), we estimated time trends in exclusive non-cigarette tobacco (eg, cigar/pipe/shisha) smoking prevalence, overall and by age, gender, occupational social grade, region, ethnicity, and vaping status. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. From September 2013 to September 2023, there was a non-linear increase in exclusive non-cigarette tobacco smoking prevalence (from 0.36% to 1.68%; prevalence ratio = 4.72 [95% CI = 3.43-6.48]). Prevalence was relatively stable up to February 2020 (at an average of 0.46%), then increased sharply at the start of the COVID-19 pandemic (at the same time as survey methods changed), to 0.90% (0.82%-0.99%) in March 2020. This was followed by a steadier rise, peaking at 1.97% in May 2022, before falling slightly to 1.68% by September 2023. In 2022/2023, 1 in 10 smokers (10.8% [9.64%-12.0%]) exclusively used non-cigarette tobacco. The rise in prevalence was observed across all subgroups but was most pronounced among younger adults (eg, reaching 3.21% of 18-year-olds vs. 1.09% of 65-year-olds). Prevalence was consistently higher among men and current vapers. Although exclusive use of non-cigarette combustible tobacco remains rare among adults in England, it has increased in recent years, particularly among younger ages. As of September 2023, there were approximately 772800 adult exclusive non-cigarette tobacco smokers in England; around five times more than a decade earlier. The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people. The inclusion of non-cigarette combustible tobacco products under the proposed "smokefree generation" policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.

Associations of Prevalence of E-cigarette Use With Quit Attempts, Quit Success, Use of Smoking Cessation Medication, and the Overall Quit Rate Among Smokers in England: A Time-Series Analysis of Population Trends 2007-2022.

This study aimed to (1) provide up-to-date estimates of how changes in the prevalence of e-cigarette use have been associated with changes in smoking cessation activities and use of licensed treatments among smokers in England and (2) explore any changes in these associations over time. Data were aggregated quarterly on 67 548 past-year smokers between Q1-2007 and Q4-2022. Explanatory variables were the prevalence of (1) current e-cigarette use among smokers and (2) e-cigarette use during a quit attempt. Outcomes were rates of quit attempts and overall quits among past-year smokers, and the quit success rate and use of licensed treatments among those who made a quit attempt. The success rate of quit attempts increased by 0.040% (95% CI 0.019; 0.062) for every 1% increase in the prevalence of e-cigarette use during a quit attempt. No clear evidence was found for an association between current e-cigarette use and the quit attempt rate (Badj = 0.008 [95% CI -0.045; 0.061]) or overall quit rate (Badj = 0.063 [-0.031; 0.158]); or between use of e-cigarettes during a quit attempt and the overall quit rate (Badj = 0.030 [-0.054; 0.114]), use of prescription medication (varenicline/bupropion/nicotine replacement therapy [NRT]: Badj = -0.036 [-0.175; 0.102]), or use of over-the-counter NRT (Badj = -0.052 [-0.120; 0.015]). There was no clear evidence this pattern of associations has changed substantially over time. Changes in the prevalence of e-cigarette use in England through 2022 have been positively associated with the success rate of quit attempts but not clearly associated with the quit attempt rate, overall quit rate, or use of licensed smoking cessation treatments. If the association between the increase in e-cigarette use and the quit success rate is causal, then the use of e-cigarettes in quit attempts has helped in the region of 30 000 to 50 000 additional smokers in England to successfully quit each year since they became popular in 2013, over and above the number who were quitting before the advent of e-cigarettes.

Alcohol and smoking brief interventions by socioeconomic position: a population-based, cross-sectional study in Great Britain.

Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers.

Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018–2020 International Tobacco Control Four Country Smoking and Vaping Surveys

BackgroundThis study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries. MethodsData came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels (‘never/low’, ‘moderate’ or ‘heavy’ consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country. ResultsCompared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57–0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15–0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19–0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17–4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45–4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success. ConclusionHeavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.

Real-world effectiveness of smoking cessation aids: A population survey in England with 12-month follow-up, 2015–2020

ObjectiveTo examine the real-world effectiveness of popular smoking cessation aids, adjusting for potential confounders measured up to 12 months before the quit attempt. Methods1,045 adult (≥18y) smokers in England provided data at baseline (April 2015-November 2020) and reported a serious past-year quit attempt at 12-month follow-up. Our outcome was smoking cessation, defined as self-reported abstinence at 12 months. Independent variables were use in the most recent quit attempt of: varenicline, prescription NRT, over-the-counter NRT, e-cigarettes, and traditional behavioural support. Potential confounders were age, sex, social grade, alcohol consumption, and level of dependence (measured at baseline), variables relating to the most recent quit attempt (measured at 12-month follow-up), and survey year. ResultsParticipants who reported using varenicline in their most recent quit attempt had significantly higher odds of abstinence than those who did not, after adjustment for potential confounders and use of other aids (OR = 2.69, 95 %CI = 1.43–5.05). Data were inconclusive regarding whether using prescription NRT, over-the-counter NRT, e-cigarettes, or traditional behavioural support was associated with increased odds of abstinence (p > 0.05; Bayes factors = 0.41–1.71, expected effect size OR = 1.19), but provided moderate evidence that using e-cigarettes was more likely associated with no effect than reduced odds (Bayes factor = 0.31, expected effect size OR = 0.75). ConclusionsUse of varenicline in a quit attempt was associated with increased odds of successful smoking cessation. Data were inconclusive regarding a benefit of e-cigarettes for cessation but showed use of e-cigarettes was unlikely to be associated with reduced odds of cessation. Associations between other cessation aids and cessation were inconclusive.

Smoking in social housing among adults in England, 2015–2020: a nationally representative survey

ObjectivesTo analyse associations between living in social housing and smoking in England and to evaluate progress towards reducing disparities in smoking prevalence among residents of social housing compared with other...

Prevalence of use and real-world effectiveness of smoking cessation aids during the COVID-19 pandemic: a representative study of smokers in England.

AimTo measure whether the prevalence of use and real‐world effectiveness of different smoking cessation aids has changed in England since the coronavirus disease 2019 (COVID‐19) pandemic.DesignRepresentative monthly cross‐sectional surveys, January 2015–June 2021.SettingEngland.ParticipantsA total of 7300 adults (≥18 y) who had smoked within the previous 12 months and had made ≥1 quit attempt during that period.MeasurementsThe independent variable was the timing of the COVID‐19 pandemic (pre‐pandemic [January 2015–February 2020] vs pandemic [April 2020–June 2021]). We analysed (i) the association between the pandemic period and self‐reported use (vs non‐use) during the most recent quit attempt of: prescription medication (nicotine replacement therapy [NRT]/varenicline/bupropion), NRT bought over‐the‐counter, e‐cigarettes, traditional behavioural support and traditional remote support (telephone support/written self‐help materials/websites) and (ii) the interaction between the pandemic period and use of these cessation aids on self‐reported abstinence from quit date to survey. Covariates included age, sex, social grade, level of cigarette addiction and characteristics related to the quit attempt.FindingsAfter adjustment for secular trends, there was a significant increase from the pre‐pandemic to pandemic period in the prevalence of use of traditional remote support by past‐year smokers in a quit attempt (OR = 2.18; 95% CI, 1.42–3.33); specifically telephone support (OR = 7.16; 95% CI, 2.19–23.45) and websites (OR = 2.39; 95% CI, 1.41–4.08). There was also an increase in the prevalence of use of prescription medication (OR = 1.47; 95% CI, 1.08–2.00); specifically varenicline (OR = 1.66; 95% CI, 1.09–2.52). There were no significant changes in prevalence of use of other cessation aids after adjustment for secular trends. People who reported using prescription medication (OR = 1.41; 95% CI, 1.09–1.84) and e‐cigarettes (OR = 1.87; 95% CI, 1.62–2.16) had greater odds of reporting abstinence than people who did not. There were no significant interactions between the pandemic period and use of any cessation aid on abstinence, after adjustment for covariates and use of the other aids, although data were insensitive to distinguish no change from meaningful modest (OR = 1.34) effects (Bayes factors 0.72–1.98).ConclusionsIn England, the COVID‐19 pandemic was associated with an increase in use of remote support for smoking cessation and varenicline by smokers in a quit attempt up to June 2021. The data were inconclusive regarding an association between the pandemic and changes in the real‐world effectiveness of popular smoking cessation aids.

Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time-series analysis between 2007 and 2018.

AimsTo assess how changes in the prevalence of e‐cigarette use among young adults have been associated with changes in the uptake of smoking in England between 2007 and 2018.DesignTime–series analysis of population trends with autoregressive integrated moving average with exogeneous input (ARIMAX models).SettingEngland.ParticipantsData were aggregated quarterly on young adults aged 16–24 years (n = 37 105) taking part in the Smoking Toolkit Study.MeasuresIn the primary analysis, prevalence of e‐cigarette use was used to predict prevalence of ever regular smoking among those aged 16–24. Sensitivity analyses stratified the sample into those aged 16–17 and 18–24. Bayes’ factors and robustness regions were calculated for non‐significant findings [effect size beta coefficient (B) = 3.1].FindingsThere was evidence for no association between the prevalence of e‐cigarette use and ever regular smoking among those aged 16–24 [B = –0.015, 95% confidence interval (CI) = –0.046 to 0.016; P = 0.341; Bayes factor (BF) = 0.002]. Evidence for no association was also found in the stratified analysis among those aged 16–17 (B = 0.070, 95% CI –0.014 to 0.155, P = 0.102; BF = 0.015) and 18–24 (B = –0.021, 95% CI –0.053 to 0.011; P = 0.205; BF = 0.003). These findings were able to rule out percentage point increases or decreases in ever regular smoking prevalence greater than 0.31% or less than −0.03% for 16–17‐year‐olds and 0.01 or −0.08% for 18–24‐year‐olds for every 1%‐point increase in e‐cigarette prevalence.ConclusionPrevalence of e‐cigarette use among the youth population in England does not appear to be associated with substantial increases or decreases in the prevalence of smoking uptake. Small associations cannot be ruled out.

Estimated Failure to Report Unsuccessful Quit Attempts by Type of Cessation Aid: A Population Survey of Smokers in England.

It has been estimated that smokers tend to fail to report unsuccessful quit attempts that lasted a short time and occurred a longer time ago. However, it is unclear whether the failure to report unsuccessful quit attempts varies by the type of cessation aid used. A total of 5,892 smokers aged 16+ years who had made 1+ quit attempts in the past year were surveyed between January 2014 and December 2020 as part of the Smoking Toolkit Study. Respondents indicated when their most recent quit attempt started, how long it lasted, and which cessation aid(s) were used (e.g., unaided, varenicline, and behavioural support). The percentage failure to report for each cessation aid and 95% bootstrap confidence intervals (CIs) were estimated with an established method. Test for equality of proportions was performed to examine whether quit attempts lasting between one day and one week and that started >6 months ago failed to be reported at a different rate depending on the cessation aid used. We estimated that after three months, 97% (95% CI = 96%-98%) of unaided quit attempts lasting less than one day, 80% (95% CI = 79%-81%) of those lasting between one day and one week, and 60% (95% CI = 59%-61%) of those lasting between one week and one month fail to be reported. Compared with unaided attempts, the estimated percentage failure to report quit attempts that lasted between one day and one week and that started >6 months ago was significantly lower for attempts involving behavioural support (92% of unaided attempts vs. 75% of attempts involving behavioural support, χ 2(1) = 9.29, p = 0.002). No other significant differences were detected. Smokers in England appear to fail to report a substantial proportion of unsuccessful quit attempts. This failure appears particularly prominent for attempts that last a short time or occurred longer ago and appears lower for attempts involving behavioural support compared with unaided attempts.

Understanding long-term trends in smoking in England, 1972-2019: an age-period-cohort approach.

Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age-period-cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour. APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys. England (1972-2019). Individuals aged 18-90 years. We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-73 to 2018-19) and 20 groups of 5-year birth cohorts (1907-11 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18-25 years and those aged over 25 years. Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41-1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04-0.08). They also decreased almost linearly with period relative to 1972-73 (for 2018-19: OR = 0.30, 95% CI = 0.26-0.34) and with birth cohort relative to 1902-06, with the largest decreased observed for birth cohort 1992-96 (OR = 0.44, 95% CI = 0.35-0.46) and 1997-2001 (OR = 0.35, 95% CI = 0.74-0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods and by an average of 5% in those aged over 25. Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

Association Between Social Isolation and Smoking in Japan and England.

BackgroundExisting evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status.MethodsWe performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode.ResultsAfter exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs) were 1.06 (95% credible interval [CrI], 1.05–1.08) for men and 1.08 (95% CrI, 1.04–1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs of 1.32 (95% CrI, 1.14–1.50) for men and 1.30 (95% CrI, 1.11–1.49) for women in England.ConclusionsOlder people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive,...

Moderators of the association between regular smoking exposure and motivation and attempts to quit: a repeat cross-sectional study.

AimsTo estimate the associations between regular exposure to smoking by other people and motivation and attempts to quit among current smokers. To examine whether socio‐demographic and other factors moderate these associations.DesignA repeat nationally representative cross‐sectional survey. Data were collected monthly between November 2014 and February 2019.SettingEngland.ParticipantsCurrent smokers ≥16 years of age from the Smoking Toolkit Study (n = 15 136).MeasurementsParticipants were asked whether other people regularly smoke in their presence, how motivated they were to quit and whether they had made a quit attempt in the past year. Moderators assessed were occupation‐based social grade, housing tenure, urges to smoke, high‐risk alcohol consumption, and disability. Adjusted analyses included moderators, socio‐demographic (age/sex/ethnicity/sexual orientation/marital status/children in household) and seasonal (quarter/year) confounders.FindingsCurrent smokers who were regularly exposed to other people smoking in their presence were less likely to be highly motivated to quit (OR = 0.88 [95% CI 0.80–0.97]), but were no less likely to have made a quit attempt in the past year (OR 1.04 [0.97–1.13], Bayes Factor (BF) = 0.05). The inverse relationship between regular smoking exposure and motivation to quit was moderated by urges to smoke, such that exposure was only associated with a reduction in motivation among those without strong urges to smoke (OR 0.83 [0.75–0.93] versus OR 1.04 [0.86–1.26]; P = 0.048). None of the other factors significantly moderated the association with motivation to quit, and none moderated the relationship between regular smoking exposure and quit attempts. All non‐significant interactions, except social grade (BF = 1.44) with quit attempts, had Bayes Factors that supported the hypothesis of no moderation (BF range: 0.12–0.21).ConclusionsAmong current smokers in England, regular exposure to other smokers appears to be associated with lower motivation to quit in people without strong urges to smoke, yet there appears to be no association with quit attempts in the previous year. Social grade, housing tenure, high‐risk alcohol consumption and disability do not moderate these associations.

Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England.

AimsTo establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio‐demographic profile of those smokers.Design and settingNationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019.ParticipantsA total of 219 720 adults.MeasurementsAll participants reported their current smoking status and socio‐demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio‐demographic characteristics relative to non‐smokers.FindingsThe prevalence of smoking between January 2009 and July 2019 was highest among those aged 21–30. In 2019, 15.6% [95% confidence interval (CI) = 12.8–18.8%] of 18–20‐year‐olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18–20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40–1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06–1.24 range) and HSI (ORs = 1.05–2.85 range). Compared with non‐smokers aged 18–20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1–E (lower social grades) compared with AB (higher social grades) (OR = 1.19–1.83 range).ConclusionIncreasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18–20, who have less motivation to quit.