1. Smoking in England 2007-2014 Robert West Jamie Brown University College London www.smokinginengland.info robertwest100@gmail.com @robertjwest 1

2. Funding Cancer Research UK (2007-2014) English Department of Health (2007-2011) Pfizer (2007-20010) Glaxo SmithKline (2007-2008) 2

3. Background and methods It is important to have up to date information on smoking patterns and smoking cessation activities to evaluate tobacco control policies and plan future strategy The Smoking Toolkit Study (STS) involves monthly household surveys of nationally representative samples of approximately 1800 adults (16+ years) per month in England, with questions covering key performance indicators in smoking The presentation provides annual figures on the main variables from 2007 to 2014 Full details of methods: www.smokinginengland.infowww.smokinginengland.info 3

4. Margins of error Approximate samples sizes and 95% confidence intervals for annual percentage estimates Annual sample 95% Confidence interval Whole sample21,000±0.6% Half the sample10,500±1.0% Smokers4,500±1.5% Half of smokers2,250±2.0% People who have smoked in past 12 months 5,000±1.3% Smokers who have tried to stop in past 12 months 1,800±2.1% 4

5. Cigarette smoking prevalence by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Adults 5

6. Cigarette smoking prevalence by gender Data from smoking toolkit study: www.smokinginengland.info Base: Adults 6

7. Cigarette smoking prevalence by age group Data from smoking toolkit study: www.smokinginengland.info Base: Adults 7

8. Take up of smoking by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Adults aged 16-24 8

9. Take up of smoking by gender Data from smoking toolkit study: www.smokinginengland.info Base: Adults aged 16-24 9

10. Average daily cigarette consumption by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 10

11. Average daily cigarette consumption by gender Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 11

12. Average daily cigarette consumption by age group Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 12

13. Smoking of hand-rolled cigarettes by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 13

14. Smoking of hand-rolled cigarettes by gender Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 14

15. Smoking of hand-rolled cigarettes by age group Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 15

16. Amount spent per week on cigarettes by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 16

17. Amount spent per week on cigarettes by gender Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 17

18. Amount spent per week on cigarettes by age group Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers 18

19. Percent reporting having been advised to stop or offered help by GP Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked cigarettes in the past 12 months 19

20. Percent reporting having been advised to stop or offered help by GP Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked cigarettes in the past 12 months 20

21. Percent reporting having been offered help with stopping by GP Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked cigarettes in the past 12 months 21

22. Percent who tried to stop smoking in the previous 12 months by social grade Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in the past 12 months 22

23. Percent who tried to stop smoking in the previous 12 months by gender Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in the past 12 months 23

24. Percent who tried to stop smoking in the previous 12 months by age group Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in the past 12 months 24

25. Use of aids to cessation in the past 12 months Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers who tried to quit in past 12 months 25

26. Success rate of quit attempts by social grade Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers who tried to quit in past 12 months 26

27. Success rate of quit attempts by gender Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers who tried to quit in past 12 months 27

28. Success rate of quit attempts by age group Data from smoking toolkit study: www.smokinginengland.info Base: Cigarette smokers who tried to quit in past 12 months 28

29. Overall smoking cessation rate by social grade Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in past 12 months 29

30. Overall smoking cessation rate by gender Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in past 12 months 30

31. Overall smoking cessation rate by age group Data from smoking toolkit study: www.smokinginengland.info Base: People who smoked in past 12 months 31

32. Factors associated with odds of success in most recent quit attempt: methods N=14,813 smokers and recent ex-smokers who had tried to quit in the past 12 months of whom 2,084 were currently not smoking Predictors all entered together in logistic regression model Time since quit attempt started (<1w, 1-4w, 4-8w, 8-12w, 12-26w, 26-52w) Gender Age group Social grade (C2-E routine and manual versus AB-C1 non-manual occupation) Year of survey (entered as categorical, data not shown) Number of prior quit attempts that year (0, 1, 2, 3+) (data not shown) Level of addiction to cigarettes (measured by strength of urges to smoke on scale from 1 to 6) In most recent quit attempt Abrupt quit versus cut down first Quit as soon as decided versus planned in advance Used NRT (licensed nicotine replacement therapy) bought over the counter Used NRT obtained on prescription Used Zyban (bupropion) Used Champix (varenicline) Used specialist behavioural support 32

33. Factors associated with odds of success in most recent quit attempt: results Vertical lines represent 95% confidence intervals; Odds ratio of 1 means no association Data from smoking toolkit study: www.smokinginengland.info Base: Smokers who tried to quit in past 12 months 33

34. Factors associated with odds of success in most recent quit attempt: notes The overall model is additive which means that effect of behavioural support is over and above the positive association with of success with NRT or Champix; and effects of all these aids is over and above the positive association with abrupt quitting The time since the quit attempt started can be anywhere up to 12 months and followed the distribution shown below 34

35. Percentage of smokers reporting currently trying to reduce the amount they smoke by social grade Data from smoking toolkit study: www.smokinginengland.info 35

36. Percentage of smokers reporting currently trying to reduce the amount they smoke by gender Data from smoking toolkit study: www.smokinginengland.info 36

37. Percentage of smokers reporting currently trying to reduce the amount they smoke by age group Data from smoking toolkit study: www.smokinginengland.info 37

38. Percentage of cigarette smokers reporting also using a nicotine product Data from smoking toolkit study: www.smokinginengland.info 38 Base=35,946 cigarette smokers

39. Percentage of recent (past 12 months) ex-smokers reporting using a nicotine product Data from smoking toolkit study: www.smokinginengland.info 4.5 27.2 39

40. Percentage of never smokers using a nicotine product Data from smoking toolkit study: www.smokinginengland.info 0.1 0.3 40

41. Percentage of long-term (>12 months) ex-smokers using a nicotine product Data from smoking toolkit study: www.smokinginengland.info 1.7 4.9 3.2 41

42. Conclusions Cigarette smoking prevalence has declined by 0.8 percentage points per year Take up of smoking has declined by 1.5 percentage points per year Daily cigarette consumption has declined by 0.3 cigs per day Exclusive use of hand-rolled cigarettes has increased by 2.9 percentage points per year Average cost of smoking has increased by 49p per week per year 42

43. Conclusions The percentage of smokers trying to quit each year decline from 2007 to 2011 and then increased to 2014 Use of most cessation aids declined but Champix increased to 2010 and then declined slightly while use of e-cigarettes increased markedly after 2011 Medium term (up to 1 year) smoking cessation rates declined slightly from 2007 to 2011 and then increased Smokers quitting abruptly and using NRT on prescription, Champix, e- cigarettes and/or behavioural support were more likely to achieve medium term smoking cessation than those using no aid. Smokers using NRT bought over the counter were not more likely to be successful at quitting. 43

44. Conclusions The percentage of smokers trying to reduce the amount they smoke declined from 2007-2014 The percentage of smokers also using a nicotine product increased because of an increase in use of e-cigarettes that was larger than a decline in use of NRT The percentage of recent ex-smokers (<12 months) also using a nicotine product increased because of an increase in use of e- cigarettes that was larger than a decline in use of NRT The proportion of never smokers using a nicotine product remained at less than 0.5% with similar proportions for NRT and e-cigarettes The proportion of long term (>12 months) ex-smokers increased to 7% with similar proportions using NRT and an e-cigarette 44

45. Conclusions Similar trends were observed for all indices across age, social grade and gender Smoking prevalence remained higher in men, those with lower social grade and in younger smokers Smoking cessation rates were lower in those with lower social grade but similar in men and women and in older vs younger smokers 45

46. Comment Steady progress is being made in reducing cigarette smoking prevalence. If this level of progress continues smoking prevalence will reach 5% by 2030. The rate of decline is similar in absolute terms across the social spectrum but this means that the proportion of smokers who are from disadvantaged groups is increasing The cost of smoking continues to rise despite reductions in cigarette consumption and increased use of hand-rolled cigarettes Smoking cessation rates in England have increased as e-cigarette use has increased and e-cigarettes are not being used by substantial numbers of non-smokers 46