Have there been sustained impacts of the COVID-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017–2022

Abstract

Background Studies conducted during the early stages of the pandemic documented mixed changes in smoking behaviour: more smokers quitting successfully but little change in prevalence. This study aimed to examine whether there have been sustained impacts of the COVID-19 pandemic on smoking patterns in England. Methods Data were from 101,960 adults (≥ 18 years) participating in the Smoking Toolkit Study, a monthly representative household survey, between June 2017 and August 2022. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March 2020) with current smoking, uptake, cessation, quit attempts, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure. Results Before the COVID-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RRΔtrend = 1.06, 95% CI = 1.02, 1.09). This slowing was evident in more but not less advantaged social grades (RRΔtrend = 1.15, 1.08, 1.21; RRΔtrend = 1.00, 0.96, 1.05). There were sustained step-level changes in different age groups: a 34.9% (95% CI = 17.7, 54.7%) increase in smoking prevalence among 18–24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95% CI = 4.4, 21.9%) decrease among 45–65-year-olds. In both age groups, these step-level changes were followed by the pre-pandemic declines stopping, and prevalence remaining flat. There were sustained increases in quitting among past-year smokers, with a 120.4% (95% CI = 79.4, 170.9%) step-level increase in cessation and a 41.7% (95% CI = 29.7, 54.7%) increase in quit attempts. The main limitation was the change in modality of data collection when the pandemic started; while this may have contributed to the step-level changes we observed, it is unlikely to explain changes in the slope of trends. Conclusions In England, the rate of decline in adult smoking prevalence stagnated during the COVID-19 pandemic through to 2022. At the start of the pandemic, a potential reduction in smoking prevalence among middle-aged adults and increases in quitting among smokers may have been offset by an increase in smoking among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.

Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England

“…Previous analyses of data from the Smoking Toolkit Study suggested that smoking rates may have increased among young adults in England during the early stages of the COVID-19 pandemic [ 21 , 33 ]. However, the uncertain rise in smoking we observed among more advantaged women of reproductive age does not appear to have been driven by the pandemic: changes in smoking prevalence since the start of the pandemic were similar in this group to those among all adults and men of the same age from more advantaged social grades.…”

“…However, they largely mirrored changes observed among all adults, which were likely linked to the COVID-19 pandemic. A recent study found the start of the Covid-19 pandemic was associated with sustained increases in quitting among adults in England [ 33 ]. Our data show a similar pattern among women of reproductive age.…”

Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023

“…To date, smoking prevalence among young people in England has remained low despite an increase in vaping prevalence, 2 although there are warning signs that the decline in smoking may have leveled off or reversed in recent years. 2 , 34 There is a need to clearly communicate the risks of vaping compared with smoking to ensure this pattern does not change.…”

Seven days in medicine: 3-9 January 2024

“…A decades long decline in smoking has stalled in England since the covid pandemic, a study reported in BMC Medicine 1. Researchers at University College London surveyed nearly 102 000 adults from 2017 to 2022 and found that smoking prevalence fell by 5.2% a year but that this rate of decline slowed to 0.3% during the pandemic (April 2020 to August 2022).…”