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Page last updated: Mon, 11 Feb 2013 13:18:58 GMT

Smoking in England

The London Health Observatory is the lead Public Health Observatory on smoking for the Public Health Observatories in England. These pages provide some key facts about smoking and tobacco use in England and the UK, signposting relevant data and resources.

Local tobacco control profiles for England, produced by London, Eastern region and East Midlands Public Health Observatories on behalf of the Public Health Observatories in England, contain information on a range of smoking indicators for comparison locally, regionally and nationally.

Information, data and other resources about smoking which are specific to London can be found here.

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Smoking is the biggest single preventable cause of disease and premature death in the UK. One in two regular smokers is killed by tobacco - half dying before the age of 70, losing an average of 21 years of life1. Preventing people from starting smoking is key to reducing the health harms and inequalities associated with tobacco use.

Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD, bronchitis and emphysema) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix.1

Stopping smoking is a public health priority. The risk of heart disease reduces to about half that of a continuing smoker within a year or so of stopping smoking, while the risk of lung cancer reduces to almost the same as the risk for people who have never smoked within 15-20 years. Encouraging cessation among adults is also important in providing reducing non-smoking role models for children and young people.

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Prevalence of smoking and tobacco use
Smoking amongst adults
  • In England, 22% of men and 20% of women aged 16 and over were regular smokers in 20092. People who were classified as ‘current smokers’ in 2009 smoked an average of 13 cigarettes a day 3. However, there are marked differences in sections of the community in smoking prevalence and consumption, varying by factors such as age, sex, social class and ethnicity.

  • Data from the Integrated Household Survey 2011/12 shows that smoking prevalence in England is 20% for adults aged 18 and over, this compares with a higher proportion of ex-smokers; 33%, and people that have never smoked; 47%. Smoking prevalence is higher in the routine and manual group; 30%. The proportion of ex-smokers is similar at 29%. The proportion of people in the routine and manual group that have never smoked is 40%, lower than for England overall.4. The figures for ex-smoking and never smoked differ somewhat from those based on the General Household Survey 3, which may be due to the methodology used. The balance of smokers and ex-smokers has been steadily shifting towards ex-smokers since 2005, when there were equal proportions (both 24%).3

  • Smoking prevalence amongst adults is highest among those aged 20-24, and gradually declines with age, through quitting or dying. In England, almost a third (28%) of people aged 20-24 were smokers in 2009. The lowest level of smoking (14%) was among people aged 60 and over.3

  • Of all the regions of England in 2011/12, smoking was generally higher in the North than in the South. However, every region of England had at least one local authority area with smoking levels that were higher than the national average and at least one local authority area with levels lower than average.4

  • Smoking levels have fallen markedly in recent decades. In 1982, 35% of adults in England smoked, compared to 28% in 1998 and 21% in 20093. The proportion of adults who never or only occasionally smoked has increased from 43% in 1982 to 53% in 20093. The proportion of adults who never or only occasionally smoked has increased from 43% in 1982 to 53% in 20093.

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Smoking and young people

Taking up smoking at an early age greatly increases the health risks of smoking, such as the risk of developing lung cancer. Children and young people who start smoking are more likely to continue smoking as adults, and are less likely to give up than those who start smoking in later life.

  • Almost two thirds (65%) of adult smokers in England in 2009 started before they were 18 years old. Only 6% of smokers started at the age of 25 or over3.

A survey is conducted annually in schools across England to provide information about self-reported smoking among young people aged 11-15. Results from the 2010 survey5 show that:

  • More than a quarter of young people (27%) have tried smoking at least once, while 5% smoke regularly (defined as smoking at least one cigarette a week). Young people classified as regular smokers smoked an average of 37 cigarettes a week (just over 5 per day).

  • Although very few 11-year-olds smoke regularly (less than 0.5%), the prevalence of smoking increases sharply with age. In 2010, 12% 15-year-olds smoked regularly, despite the fact that it is illegal to sell cigarettes to children aged under 18.

  • Overall, girls are more likely to be regular smokers than boys – 9% compared with 6%.

  • In addition to age and sex, socio-economic factors are associated with regular smoking among young people. Students who received free school meals were more likely to be regular smokers than with those who did not. Further, risky behaviour such as drinking alcohol and taking drugs is also strongly associated with smoking.

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Smoking in pregnancy

Smoking during pregnancy increases the risk of complications during pregnancy and labour, including miscarriage. Women who smoke, or who are exposed to secondhand smoke, while pregnant are more likely to have a baby with low birth weight than non-smoking mothers. Low birth weight is associated with higher risks of death and disease in infancy and early childhood. Smoking during pregnancy, and after, pregnancy also increases the risk of sudden infant death (‘cot death’).

  • About one in seven (13.2%) women who gave birth in England in 2011/12 reported smoking during their pregnancy. However, the national average masks the wide inequality in the proportion of women who smoked during pregnancy - from 3% in Westminster to 30% in Blackpool.4

  • Smoking in pregnancy is a major contributor to higher infant mortality in the routine and manual socio-economic group in many regions of England compared with all (couple) births in England and Wales. It has been estimated that 57% of the gap in infant mortality between the routine and manual group in the East of England and all couple births in England in 2008/09 was due to smoking in pregnancy.6 For further information on this for other parts of England please see the Health Inequalities Intervention Tool.

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Smoking, tobacco use and ethnicity

The main source of information about cigarette smoking among minority ethnic groups is the Health Survey for England 2004.7 It found that:

  • Bangladeshi men were 43% more likely (risk ratio of 1.43) and Irish men were 30% more likely (risk ratio of 1.30) to smoke cigarettes than the general male population after accounting for age. Indian men were less likely (risk ratio of 0.78) to smoke cigarettes than the general male population in England.

  • Smoking is less common among women in most - but not all - minority ethnic groups compared to the general female population, when age is taken into account. Compared to the general female population, Bangladeshi women were the least likely to smoke cigarettes (risk ratio of 0.11), followed by Pakistani women (risk ratio of 0.19), Indian women (risk ratio of 0.23), Chinese women (risk ratio of 0.32) and Black African women (risk ratio 0.34). However, Irish and Black Caribbean women were as likely to report cigarette smoking as the general population for women.

Smokeless tobacco (also called oral tobacco) use is prevalent in the UK’s South Asian community, while water pipes (also known as hookahs, narghiles, shisha or hubble-bubble pipes) are used primarily by the Middle Eastern and Eastern Mediterranean communities. Although the use of these other forms of tobacco is not well researched, some of the health impacts are likely to be similar to those of cigarette smoke. 8, 9

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Smoking and health inequalities

The prevalence of smoking varies markedly between socio-economic groups. People in deprived circumstances are not only more likely to take up smoking but generally start younger, smoke more heavily and are less likely to quit smoking , each of which increases the risk of smoking-related disease.

  • In England, 28% of adults in routine and manual occupations smoked regularly in 2009 compared with 15% of adults in managerial and professional occupations2

  • Smoking accounts for a significant proportion of inequalities in life expectancy at birth in the UK. The health impact for London has been estimated in the London Health Inequalities Forecast. This found that 37% of the difference in life expectancy at birth in males and 30% of the difference in females between the 11 London authorities in the worst fifth for deprivation and health and all English local authorities, was accounted for by mortality attributable to smoking.10

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Smoking related ill-health and deaths
  • Smoking caused an average of 82,500 estimated deaths per year of adults aged 35 and over in England during the period 2008-10. This figure includes a yearly average of 10,800 deaths from heart disease and 3,600 deaths from stroke that were attributed to smoking in 2008-10.4

  • There were 28,100 deaths from lung cancer and 22,400 deaths from chronic obstructive pulmonary disease (COPD) on average per year in England over the period 2008-10. The vast majority of these deaths were caused by smoking.4

  • During the period 2008-10, there were 99,500 lung cancer registrations in England, on average 33,200 a year. Registration is a measure of each new diagnosis of cancer.4

  • Smoking is responsible for a larger proportion of deaths among men than women. In England in 2009, an estimated 23% of all deaths among men aged 35 and over were attributed to smoking, compared with 14% of all deaths among women. The number of deaths in 2009 that were attributed to smoking was 49,100 among men and 32,300 among women.3

  • In 2010/11, the equivalent of 476,500 hospital admissions among adults aged 35 and over in England were attributed to smoking. Rates varied across the English regions, from 1,113 admissions per 100,000 population in the South East to 2,064 in the North East.4

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Secondhand smoke exposure

Breathing other people's smoke causes both short and long term health problems. Immediate effects include eye irritation, cough, dizziness and nausea. Longer term exposure raises the risk of death from lung cancer and from coronary heart disease. For people who already have asthma or coronary heart disease, other people's smoke can precipitate severe symptoms.

A child exposed to secondhand smoke has an increased risk of sudden infant death (‘cot death’), asthma, wheeze, lower respiratory infection, middle ear disease and meningitis.11

  • Among non-smoking children aged 4-15 in England in 2006-2008, three in five had recently been exposed to secondhand smoke. Children from lower income households were more likely to have been exposed to secondhand smoke than those from higher income households.12

  • In the 18 months after the introduction of the smokefree legislation (July 2007 – December 2008), children aged 8-15 in England reported being exposed to other people’s smoke in their own homes (26% of both boys and girls), in other people’s homes (25% of boys, 31% of girls) and ‘other places’ (41% of boys, 44% of girls). Of those who said they were exposed to other people’s smoke, more than half (58%) of children felt bothered by it.12

  • Secondhand smoke exposure among children in the UK is thought to result in over 165,000 new episodes of disease, 9,500 hospital admissions, at least 200 cases of bacterial meningitis, and about 40 sudden infant deaths each year.11

  • The introduction of smoke-free legislation in England in July 2007 resulted in approximately 9,600 fewer bed days for myocardial infarction admissions in the following 12 months, and an estimated cost saving to acute hospital care of £8.4 million.13

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Stopping smoking
  • More than two thirds (67%) of adult smokers (aged 16 and over) who were surveyed in Great Britain in 2008/09 said they would like to give up smoking. There was no significant difference between men and women in 2008/09).3

  • Estimates suggest that, in 2008/09, more than a quarter (26%) of adult smokers in Great Britain attempted to give up smoking in the previous year.3

NHS Stop Smoking Services (SSS) provide counselling and support to smokers wanting to quit. Monitoring of the NHS SSS is carried out via quarterly monitoring returns and reported in an annual bulletin .

  • About 401,000 people in England reported successfully quitting smoking with NHS Stop Smoking Services at the 4 week follow-up in 2011/12.4

  • Nearly half (49%) of people who set a quit date through NHS SSS had successfully quit at the 4 week follow-up in 2011/12.14

  • There were an estimated 4,700 quitters with NHS SSS per 100,000 smokers in England in 2011/12. Of all the regions in England, the North East had the highest estimated number of quitters per 100,000 smokers (6,200), while South East Coast had the lowest (3,739).4

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Policies and legislation

Smoking was banned in all enclosed public places and workplaces in England from 1 July 2007, following earlier implementation of similar legislation in Wales, Scotland and Northern Ireland. Since July 2008, the English legislation also applies to mental health facilities.

From 1 October 2007, it became illegal to sell tobacco products to anyone under the age of 18.

Healthy Lives, Healthy People: a Tobacco Control Plan for England was published in March 2011.15 The plan aims to stop the promotion of tobacco, make tobacco less affordable and effectively regulate tobacco products. Aside from this, the plan has three national ambitions:

  1. to reduce adult (aged 18 or over) smoking prevalence in England from 21.2% to 18.5% or less by the end of 2015.

  2. to reduce rates of regular smoking among 15 year olds in England from 15% to 12% or less by the end of 2015.

  3. to reduce rates of smoking throughout pregnancy from 14% to 11% or less by the end of 2015.

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Smoking – national – LHO resources

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Smoking – national – other resources

Information, data and other resources about smoking which are specific to London can be found here.

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