Current and past trends in tobacco and e-cigarette use and the impact of control measures: an analysis of survey data and other evidence

Current and past trends in tobacco and e-cigarette use and the impact of legislative and regulatory controls on smoking and e-cigarette use behaviours are outlined in this multi-method research.

About the study

In the programme of work reported here, commissioned and funded by NIHR (National Institute for Health Research), we explored the impact and consequences of policy changes relating to tobacco consumption and supply in England and Scotland over the last decade, as well as the characteristics of e-cigarette use. The research questions were:

• Have the prevalence, intensity and attitudes towards smoking in the UK changed with the implementation of recent tobacco regulations? Do effects vary across characteristics such as age, ethnicity, socioeconomic status or gender?
• What are the characteristics of individuals who start or stop smoking?
• How does the UK compare with other European countries in terms of trends in smoking consumption? How do inequalities in smoking in the UK compare to those in other countries?
• What can current literature and available data tell us about the use of e-cigarettes?

Findings

Prevalence of tobacco smoking among adults:

• Men are more likely to smoke when compared with women. The rate of smoking has decreased more steeply in women between 2008 and 2016, although differences were found between England and Scotland.
• The greatest decline in smoking over time was seen in age groups 16–24.
• Health may be a precipitating factor for not smoking; those with a known heart condition were consistently less likely to smoke than those without any such diagnosis.

Smoking behaviours among adults – quitting, taking up, or re-starting:

• Those more likely to quit included: ‘lighter smokers’; those who were employed; those holding a degree; those who were married or in a civil partnership; and those living in a two-person household.
• Those more likely to start smoking included: young people (aged 16–24); single individuals; those who were unemployed; those who had no qualifications; and those who were living in households with other smokers.

Tobacco smoking among children and young people:

• The proportion of young people smoking had fallen over the last decade, although young people in Scotland seemingly smoked more heavily than those in England.
• The number of children being able to purchase cigarettes halved between 2006 and 2016.

Smoking behaviours among children aged 10–15:

• Family characteristics seemed to be crucial, with children more likely to smoke if their parents currently smoked or had smoked in the past. Girls were more likely to smoke if their father had no formal qualifications, was in a routine or lower supervisory role, or was unemployed.
• Boys whose fathers had poor mental health were five times more likely to smoke, compared with boys whose fathers did not have any mental health conditions.

E-cigarette use among adults (16+):

• Our analysis of Understanding Society (USoc) survey data showed a small increase in e-cigarette use, with around 3% of adults starting to use e-cigarettes between Wave 8 (2016–2018) and Wave 9 (2017–2019).
• In exploring the demographic and socioeconomic characteristics of those that used e-cigarettes only, or used them alongside their tobacco smoking, we found that the normally accepted narrative of smoking behaviours (i.e., strongly linked to deprivation and social inequality) were reversed.

E-cigarette use among children and young people:

• USoc data suggesting that over one-fifth of boys and just under one-fifth of girls aged 15 had ever used e-cigarettes was of concern given that, as yet, the short and long-term health impacts were unknown.

Impact of policy and legislation on tobacco and e-cigarette use:

• Legislation appeared to have an impact on access to tobacco for children and young people, despite any models being non-significant.
• While this research did not identify statistically significant impacts from specific legislative controls, the cumulative impact of the number and extent of legislative actions around smoking is likely to be having an impact on prevalence and consumption.

Methodology

We adopted a multi-method approach to the study:

• We explored trends in smoking prevalence, intensity and attitudes in England and Scotland through analysis of four national surveys (Health Survey for England (HSE), the Scottish Health Survey (SHeS), the Smoking Drinking and Drug Use among Young People Survey (SDD), and the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)), alongside analysis of the impact of specific pieces of tobacco control legislation enacted between 2007–2011.
• Through analysis of data from the Understanding Society survey (USoc), we delivered a comprehensive profile of adults who take up, quit or re-start smoking; and children who smoke. In addition, this analysis explored the use of e-cigarettes among adults and children.
• Findings on smoking prevalence were supported by a further strand of work addressing the impact of socioeconomic inequality on smoking prevalence (alongside that of legislative controls). The Eurobarometer Survey as well as two country-level indicators (the Tobacco Control Scale and the Gini Coefficient) were applied to examine the relationship between prevalence of smoking, the extent of tobacco controls, and the level of social inequality.
• Finally, the analysis of USoc data on e-cigarettes was complemented by a Rapid Evidence Assessment (REA) detailing the current literature on e-cigarette consumption in the UK and abroad, as well as an assessment of the impact of restrictive / non-restrictive legislation on e-cigarette use.