Smoking prevalence decline stalls since pandemic

A new study has looked into the lasting impact that the Covid-19 pandemic has had on smoking prevalence in England, as concerns are raised over the stall in the decline of smoking rates in the years since lockdown.

34.9% increase in 18 – 24 year olds smoking since Covid began
The study follows on from previous research by University College London that took place in the early stages of the pandemic. It found that more smokers were successfully quitting smoking but this was having little impact on smoking prevalence overall.

The data was collected from 101,960 adults representative of the population participating in the Smoking Toolkit Study, a monthly survey operating between June 2017 and August 2022. In the years preceding the Covid-19 pandemic smoking prevalence fell by 5.2% per year, but alarmingly this slowed to just 0.3% per year during the pandemic. In June 2017 when the study began smoking prevalence was estimated at 16.2%, by the start of the pandemic in March 2020 this was down to 15.1%, but by the end of the study in August 2022 this was virtually unchanged at 15.0%.

While the study identified a 120% rise in the proportion of people giving up smoking, this was not reflected in a significant decline in smoking prevalence, but was rather offset by a rise in people taking up the habit. This increased uptake was most significant among 18 – 24 year olds, who experienced a 34.9% increase in smoking prevalence, in stark contrast to 45 – 65 year olds who experienced a 13.6% decrease in prevalence.

The original study, released in August 2021, identified an increase in quit attempts, but even in these early stages of Covid-19 they observed a 25% increase in smoking among 18 – 34 year olds. This meant that over 652,000 more young adults were smoking compared to before the pandemic began.

Unfortunately we can see that this trend has continued in the years since, and smoking decline has stalled in spite of the increased number of people making quit attempts.

Why are young adults turning to smoking?
The pandemic had a profound impact on nearly every aspect of our lives, and during the early stages many observed an increase in the number of quit attempts and cessation among smokers, as people attempted to quit smoking for the sake of their health.

However, the high levels of stress and social isolation among young adults during the pandemic has been suggested as a main reason for the increase in smoking prevalence among this group, as well as an increase in alcohol consumption. There is a common misconception that cigarette smoke can help lessen feelings of stress and anxiety, so loneliness and poor mental health could have made those who already smoked less inclined to give up, and it is possible that former smokers who returned to smoking during the pandemic may also contribute to the slow decline during this time.

Experts are concerned that the problem could be missed, as many people are working under the assumption that smoking among young people is a thing of the past.

Lead author of the study, Dr Sarah Jackson, of UCL's Institute of Epidemiology and Health Care explained to BBC News:

"It definitely does seem like progress in reducing the number of young adults taking up smoking has slowed down. It's really concerning there has almost been the assumption that we have solved the problem of smoking among young people.

There has been lot of talk about vaping and there has been a real disconnect about the risks of vaping and risks of smoking among young people. The risks of vaping are substantially lower than the risks of smoking. Smoking is uniquely lethal, yet most of the concern is about young people vaping.”

Dr Jackson has suggested that the negative media around vaping could be a contributing factor, and the concern is that young adults may believe that e-cigarettes are equally as bad for them as smoking.

Unfortunately, this misunderstanding of the risks of vaping compared to smoking is not exclusive to young adults, with the latest Action on Smoking and Health (ASH) ‘Use of e-cigarettes among adults in Great Britain’ study finding that four in every ten smokers (39%) in Britain incorrectly believe that vaping is as harmful, if not more so, than smoking.

While a lot of attention has been paid to the increase in young people vaping over the last few years, little has been heard about this alarming increase in smoking prevalence. As important as it is that we tackle youth vaping, experts have warned against demonising e-cigarettes for fear of losing track of the benefits they can have as a stop smoking aid for adults.

Smoking-related hospital admissions up 5%
2022-23 has also seen a 4.8% increase in the amount of hospital admissions due to smoking, compared to the previous year. The latest statistics from NHS England shows that there were an estimated 408,700 smoking-related admissions, up from 389,800 in 2021-22.

The statistics reveal that smoking was responsible for 16% of all respiratory disease admissions, 8% of all cancer admissions, and 7% of all cardiovascular disease admissions.

Fortunately, although there has been an increase in the last year, these numbers were still lower than those before the pandemic.

How vaping can help smokers to quit
The Government recently held an open consultation on smoking and youth vaping, outlining a number of suggested policy changes that could help to tackle the increase in youth vaping. Many were quick to express that any actions taken need to balance the need to reduce youth access to vaping products, with the need to ensure they are widely available as a smoking cessation tool for adults.

Michelle Mitchell, Chief Executive at Cancer Research UK, explained:

“Preventing young people from taking up vaping is an area that needs stronger regulation… But it’s important to remember that based on current evidence, vaping is far less harmful than smoking cigarettes, and can help people to quit. The government is right to consider how any changes will impact people who use e-cigarettes as a smoking cessation tool.”

The Office for Health Improvement and Disparities (OHID) have found that vaping is at least 95% less harmful than smoking, and research has shown that it is twice as effective as common nicotine replacement therapy (NRT) like nicotine gum and patches at helping people quit. A study from Brunel University London has even found that if 50% of current smokers made the switch from smoking to vaping it could save the NHS £518 million on average per year.

Many healthcare authorities in the UK actively encourage smokers to switch to vaping, and earlier this year the Government even announced plans for a ‘swap to stop’ scheme which would see a million vaping starter kits provided to smokers in an effort to help them quit.

When trying to stop smoking most people will need the support of an alternative nicotine source, and vapes are one of the most popular alternatives due to how they replicate the feel of smoking a cigarette. Because e-liquids are available in a range of different nicotine strengths, they allow you to give up smoking while maintaining the nicotine intake your body is used to. This means that you are no longer inhaling the many toxic chemicals found in tobacco smoke like carbon monoxide and arsenic, but can manage cravings and ease withdrawal symptoms. Over time there is also the ability to decrease your nicotine strength, which can help you quit nicotine altogether.

Are we on track for smoke-free 2030?
Back in 2019, the Government announced their ambition for England to be smoke-free by 2030, which entails smoking prevalence dropping to 5% of the population or less. With this deadline growing ever closer, and the slow in smoking decline, it is clear that bold action needs to be taken. Last year the independent report ‘Making smoking obsolete’ identified that England is currently set to miss this target by at least 7 years.

The report, often referred to as the Khan review, praised e-cigarettes as a crucial tool in helping to reach this goal. Since then the Government has announced plans for a ‘smoke-free generation’, by increasing the smoking age by a year every year so that anyone born on or after 1st of January 2009 will never legally be able to purchase cigarettes. While this historic new legislation could eventually mean that the entire population is eventually smoke-free, that is far in the future and does not address the increase in smoking prevalence we are currently seeing in those who are legally of age to purchase tobacco products.

If we are to have any hope of reaching the smoke-free 2030 target it is important to recognise the impact that the Covid-19 pandemic has had on smoking prevalence. The stress and isolation has clearly lead many people to pick up the highly addictive and incredibly harmful habit of smoking, and as we strive to return to normalcy these people will need support with stopping smoking.

While the Department of Health and Social Care has doubled funding for stop-smoking services, correcting false perceptions of vaping is also an important part of this. Making a clear distinction between the harms of vaping relative to smoking could encourage thousands of people to make the switch and kick the habit for good.

At a glance
·The decline in smoking prevalence in England has slowed substantially from 5.2% per year before Covid, to 0.3% per year during and since the pandemic

·A University College London study identified a 120% rise in the proportion of people giving up smoking during the pandemic

·The increase in quit attempts was counteracted by an increase in smoking among 18 - 24 year olds by 34.9%

·Experts fear that the negative media around vaping could be a contributing factor in the increase of smoking prevalence among young adults