Smoking

Background

Smoking is a leading cause of preventable illness and premature death in England. Not only does it have a detrimental effect on nearly every organ of the body, but it also contributes to health inequality and worsening social mobility. Reducing the number of people who smoke is therefore a key priority in improving the health of the population, and Stop Smoking Services are a key NHS intervention to reduce smoking. In October 2023, the government announced the prohibition of the sale of tobacco products to anyone born on or after 1 January 2009, further contributing to the suite of laws in place to reduce the prevalence of smoking.

Although smoking prevalence has fallen in the UK (from 20% in 2011 to 13% in 2022; data not shown), the health consequences of smoking continue to present a major public health challenge. NHS Stop Smoking Services offer intensive group therapy or one-to-one support to help people quit smoking. Their effectiveness can be measured by the percentage of people who say, at the four-week follow-up, that they have not smoked at all in the two weeks after the quit date.

The number of people using NHS Stop Smoking Services who set a quit date has fallen for 11 consecutive years, from 816,444 in 2011/12 to 176,566 in 2022/23 (data not comparable, see ‘About this data’ for more information). Between 2016/17 and 2022/23, the number of people setting a quit date decreased by 43%. This may in part be due to the reduced prevalence of smoking in the population. It may also be due to the increased use of e-cigarettes, which are widely available outside of Stop Smoking Services. According to the Opinions and Lifestyle Survey, the percentage of people in Great Britain aged 16 and over who currently use e-cigarettes increased from 3.7% in 2014/15 to 8.7% in 2022/23.

The percentage of people using NHS Stop Smoking Services who self-reported that they were successful in quitting at four weeks remained fairly steady between 2007/08 and 2019/20, fluctuating at around 50%.

In 2020/21, during the coronavirus (Covid-19) pandemic, the percentage of people who self-reported that they were successful in quitting increased to 59%. This may reflect concerns about smokers being at increased risk of more severe Covid-19 symptoms. Research from surveys carried out during the pandemic estimate that over a million people in the UK have stopped smoking since the onset of the pandemic, and a public awareness campaign was launched in July 2020 to encourage more smokers to quit. In 2022/23, 54% of people using NHS Stop Smoking Services claimed to be successful in quitting, lower than the proportion in 2020 but an improvement from the average proportion before the pandemic.

To gain an indication of the level of tobacco use we can also measure the level of carbon monoxide (CO) in the bloodstream. The percentage of ‘carbon monoxide validated quitters’ is significantly lower, which indicates that the self-reported data is prone to bias. In 2019/20, 51% of people using NHS Stop Smoking Services self-reported that they had quit at four weeks, but this was only confirmed by CO validation among 32% of service users.

In March 2020, due to the Covid-19 pandemic, CO monitoring was paused as it is usually carried out face-to-face with a health professional. There were only 3,115 CO validated quitters in 2020/21, a 96% reduction from 2019/20. As of January 2021, guidance stated that face-to-face stop smoking support can resume, but remote consultations may remain the best option. In 2022/23, only 8% of those who set a quit date were CO validated, potentially reflecting the continued trend of increased remote consultations.

NHS Stop Smoking Services were first set up in 1999/2000 with the aim of reducing health inequalities and improving the health of local populations. Since 2011, the percentage of current smokers has declined at every level of area deprivation. In 2022, 16% of people aged 18 and over in the most deprived areas were current smokers compared with only 10% of people in the least deprived areas.

The gap in smoking prevalence between the most and least deprived areas has also decreased, from a 9-percentage point gap in 2011 to an 8.2 percentage point gap in 2018. In 2022, there was a 6.4 percentage point gap in smoking prevalence between the most and least deprived areas.

The Smoking, Drinking and Drug Use among Young People survey (SDD) asks secondary school pupils in years 7 to 11 in England about their tobacco consumption. Pupils were categorised as regular smokers if they usually smoked at least one cigarette per week. In July 2017, the Tobacco Control Plan for England set a national ambition to reduce the number of 15-year-olds who regularly smoke from 8% to 3% or less by the end of 2022.

Between 2000 and 2021, the proportion of 15-year-old pupils who were regular smokers decreased from 23% to 3.3%. To meet the target for 2022, the proportion of young people who smoke must decrease by 0.3 percentage points in the next year. Regarding gender, a greater proportion of 15-year-old girls were regular smokers compared to 15-year-old boys for most years for which data is presented above. In 2021, the proportion of 15-year-old pupils who were e-cigarette users was 18%. The increased use of vapes or e-cigarettes (data not shown) may be contributing to the decrease in smoking in young people, but concerns have been raised about young people taking up e-cigarettes who have not previously smoked. A ban on disposable vapes may be introduced in 2024, which could help reduce usage.