Smoking

We look at the effectiveness of NHS Stop Smoking Services, smoking by deprivation and smoking patterns among young people.

Indicator

Last updated: 31/03/2022

Effective clinical care Equity and fairness
Public health Children and young people

Background

Smoking is a leading cause of preventable death in the UK, accounting for nearly 100,000 deaths each year. 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.


How has the percentage of people using NHS Stop Smoking Services who were successful in quitting changed over time? 31/03/2022

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Although smoking prevalence has fallen in the UK (from 20% in 2011 to 14% in 2019), 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 since two weeks after the quit date.

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 estimates 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.

To gain an indication of the level of tobacco use we can also measure the level of carbon monoxide 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 carbon monoxide validation among 32% of service users. 

In March 2020, due to the Covid-19 pandemic, carbon monoxide monitoring was paused and there were only 3,115 CO validated quitters in 2020/21, a 96% reduction from 2019/20. As of January 2021, guidance states that face-to-face stop smoking support can resume, but remote consultations may remain the best option. Public Health England recommends that carbon monoxide monitoring can resume wherever face-to-face consultations are being delivered.


How has the number of people using NHS Stop Smoking Services changed over time? 31/03/2022

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The number of people using NHS Stop Smoking Services who set a quit date has fallen for eight consecutive years, from 816,444 in 2011/12 to 178,815 in 2020/21 (data not comparable, see ‘About this data’ for more information). Between 2016/17 and 2020/21, the number of people setting a quit date decreased by 28%.

The reduction in recent years may partly 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 to 6.4% in 2020. 


How does the proportion of adults who smoke vary by deprivation? 31/03/2022

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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. This indicator shows the extent to which smoking varies by deprivation. In 2020, 14.8% of people aged 18 and over in the most deprived areas were current smokers compared with only 9.0% of people in the least deprived areas (data not comparable to previous years, see ‘About this data’ for more information).

Since 2011, the percentage of current smokers has declined at every level of area deprivation. 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 2020, there was a 5.8 percentage point gap between the most and least deprived areas with regards to smoking prevalence. 


How has smoking prevalence among young people changed over time? 26/02/2020

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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 2018, the proportion of 15-year-old pupils who were regular smokers decreased from 23% to 5.3%. In general, a greater proportion of 15-year-old girls are regular smokers compared to 15-year-old boys. If the 2022 target is to be met, the proportion of young people who smoke must decrease by 2.3 percentage points.


About this data

This indicator uses data from NHS Digital on Stop Smoking Services in England, the Office for National Statistics on e-cigarette use, Public Health England on smoking inequalities, and the Smoking, Drinking and Drug Use among Young People survey (SDD).

NHS Stop Smoking Services

  • Successful quitter (self-reported): a person is counted as having successfully quit smoking at the four-week follow-up if he/she says they have not smoked at all since two weeks after the quit date.
  • Successful quitter (confirmed by carbon monoxide validation): measuring the level of carbon monoxide in the bloodstream provides an indication of the level of tobacco use. This is a motivational tool as well as a validation of smoking status. It should be attempted on all people who self-report as having successfully quit at the four-week follow-up, except for those who are followed up by telephone.

The NHS Digital data for 2016/17 onwards is not directly comparable with previous years because it has not been adjusted to estimate for local authorities that did not provide any data, or only provided data for some quarters. Data on the percentage of current e-cigarette users is comparable over time.

Smoking inequalities

Local Tobacco Control Profiles use data from the Annual Population Survey (APS) to calculate smoking prevalence in adults aged 18 and over. The number of respondents is weighted, taking into account survey design and non-response, to improve representativeness of the sample. Prior to 2019, deprivation deciles were defined using the Index of Multiple Deprivation 2015 local authority scores. From 2019, the Index of Multiple Deprivation 2019 local authority scores were used so data is not comparable with previous years.

In 2020, due to the impact of the COVID-19 pandemic, the mode of the APS changed from face-to-face interview to telephone only from Q2 2020. The Office for National Statistics concluded that this change in mode of interview has impacted the final prevalence figures. Consequently, data for 2020 is not comparable with previous years. 

Smoking patterns among young people

The SDD survey is a biennial survey of secondary school pupils in years 7 to 11 (mostly aged 11 to 15) in England, published by NHS Digital. The last survey was in 2018. Prior to 2014, the survey was conducted annually.

Pupils were categorised in three ways based on the responses given:

  • regular smokers (defined as usually smoking at least one cigarette per week);
  • occasional smokers (defined as usually smoking less than one cigarette per week); or
  • non-smokers.

The government's ambition to reduce the number of 15-year-olds who regularly smoke to 3% or less by the end of 2022 will be measured via the SDD survey.

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