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
Authors: Jackson Sarah E. , Tattan-Birch Harry , Shahab Lion , Beard Emma , Brown Jamie 
Published: December 2022

Background

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 (≥18y) participating in a monthly representative household survey between June-2017 and August-2022. Interview 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, medium-term abstinence, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure.

Findings

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. 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.

Interpretation

In England, the rate of decline in adult smoking prevalence stagnated during the Covid-19 pandemic. Potential reductions in smoking prevalence among middle-aged adults and sustained increases in quitting among smokers may have been offset by a sustained rise in uptake among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.

Funding

Cancer Research UK.

Putting research into context

Evidence before this study

We searched PubMed up to 1 September 2022 for papers on the Covid-19 pandemic and changes in smoking patterns among adults in England published since March 2020, using the terms “smok*” AND (“Covid*” OR “pandemic”) AND (“England” OR “UK”) AND “adults”. Of the 167 studies that were identified, none reported on trends in smoking behaviour among adults in England during the Covid-19 pandemic using more than two data points. Three prospective studies compared smoking and quitting behaviour before and during the initial stages of the pandemic using a pre-post design: two observed no notable change in smoking prevalence but documented increases in quit attempts and cessation during the first lockdown in England (April-July 2020); the other reported an uncertain decline in smoking prevalence in April 2020. Two prospective studies compared self-reported changes in consumption and attempts to quit at two time points, 12 months apart, during the pandemic; neither observed any change over time. Two cross-sectional studies and two qualitative studies described self-reported changes in smoking behaviour during the pandemic. The majority of other search results reported on the association between smoking status and risk of Covid-19 infection and outcomes; or included smoking status as a covariate in analyses of associations between other factors and the pandemic.

Added value of this study

This study uses a nationally representative survey of adults in the general population in England, conducted monthly over a 5-year period, to estimate sustained impacts of the Covid-19 pandemic on smoking patterns. Unlike previous studies, which have focused on changes that occurred early in the pandemic, this study includes data up to August 2022 (two and a half years after the pandemic started) which allows us to understand whether any initial changes in smoking and quitting behaviour have been sustained over time. By collecting data monthly, this study is the first of its kind to have a large enough number of data points to undertake this kind of analysis (most representative surveys collect data annually). The findings are of direct relevance to the UK government’s aim to reduce smoking prevalence in England to less than 5% by 2030 and should inform a new tobacco control plan in England.

Implications of all the available evidence

Before the Covid-19 pandemic, smoking prevalence had been falling among adults in England at a near linear rate for more than 20 years. This historic steady decline has almost completely stopped since the start of the pandemic. This may have been caused by a potential rise in uptake of smoking among young adults. These changes demand urgent, bold policy action, including measures to deter youth uptake of smoking and to support smokers to quit.