How have smoking trends changed during the COVID-19 pandemic in England?

The coronavirus disease 2019 (COVID-19) pandemic affected life in many areas. Among these, smoking patterns were studied in a recent study from England. The study observed changes from 2017 to 2022 regarding smoking habits and attempts to quit smoking.

Introduction

Earlier research showed no significant change in smoking prevalence over the early stages of the pandemic. However, some scientists did report that more people were trying to quit or had successfully quit smoking during the first lockdown in England, from April to July 2021. In contrast, others were less certain about the trend of smoking prevalence.

Previous studies showed that pandemic-related lifestyle changes are sustained for a considerable period. For instance, alcohol abuse and dependence symptoms were found to rise for three years following the outbreak of severe acute respiratory syndrome (SARS) in China in 2003 among those exposed to the virus. Conversely, once life returns to normal such lifestyle modifications may also wane in importance.

Few studies focused on the changes in smoking prevalence with the onset and continuance of the pandemic. Most researchers were more interested in tracing the association between COVID-19 severity or prevalence and outcomes and the individual’s smoking habit alone or in association with other factors.

The current study, published as a preprint on the medRxiv* server, covered over 100,000 adults interviewed in person or over the phone. Monthly interviews were conducted over five years on a nationally representative sample, covering not only several years before but also after the pandemic began. This helped to uncover sustained changes in smoking and cessation.

The monthly data collection pattern sets this study apart from most other research, which depends on more coarse-grained data from yearly data acquisition.

What did the study show?

The results of the study showed a fall in the prevalence of smoking by over 5% a year before the pandemic began. Over the pandemic period, however, this slowed to an annual decline of 0.3%, down from 12%. Thus, the prevalence remained at 15% from March 2020 to July 2022.

This slowing was mostly observable among people of higher social strata, who showed a 20% increase in smoking prevalence at the onset of the pandemic. This was followed by an observed slowing of the decline, as compared to pre-pandemic years, and finally, a reversal of the trend such that the progress made in reducing the prevalence was lost. Conversely, prevalence failed to increase among the lower social classes, and in fact, there was a continued drop of 3% per year.  

When examined by age groups, there was an increase in smoking by well over a third among the population between 18 and 24 years of age. This could indicate that more people in this subgroup were taking up smoking, spread across all social classes.

However, among those aged 45-60 years, smoking prevalence dropped by almost a seventh. Importantly, these effects were sustained rather than brief impulses induced by pandemic conditions.

The results showed a rise in the number who quit smoking among those who had smoked the previous year. Overall, the number of people who successfully quit smoking increased by 120%. The trend was highest in the lower social classes, which showed a decline in the rate of smoking cessation before the pandemic hit, but a rise during the pandemic.

Also, there was a ~42% rise in quit attempts among those who had smoked the previous year. This arrested the rate of slowing of quit attempts, from 8% to 1.4% per year, mostly due to increased cessation attempts among the lower social grades. In addition, medium-term (6-12 months) abstinence from tobacco smoking was observed to increase in prevalence, from a declining trend (by 18% per year) pre-pandemic to an increase of 16% per year after the pandemic hit.

Support for smoking cessation was used to a greater extent after the pandemic in terms of behavioral support, with a 133% increase. In contrast, e-cigarette use dropped briefly by a fifth before the pandemic, reversing the trend to increase by 18% per year after the onset of COVID-19. Prescription drug use patterns were unchanged.

What are the implications?

The scientists infer from their results that smoking prevalence among adults stopped its sustained decline in England during the COVID-19 pandemic. However, significantly fewer middle-aged adults reported being smokers, and successful quitting attempts showed a steady increase. This could have been due to the pandemic.

This trend could have been more than compensated for by the considerable potential increase in young adults who smoked, accounting for the stagnant prevalence of smoking among adults overall. This seems to be mostly due to smoking among those of higher social classes.

Smoking cessation could have been encouraged by various pandemic-related factors, such as better daily routines or reduced social cues, as well as openness to knowledge about the dangers of smoking. On the other hand, insecurity, stress, and social isolation could have driven smoking prevalence up among younger adults, who are recorded to have responded worse to the pandemic-induced stress and loneliness than older adults.

Most smokers did not use any form of support among the three described above in their cessation attempts, which shows a gap that could be closed, such as by national media strategies to encourage control of tobacco use.

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.”

Such a plan should not only effectively stop the uptake of tobacco smoking among young people but should also support smokers who want to quit.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.