Smokers Now Less Likely to Quit, Study Finds

Peter Russell

January 09, 2020

Smokers in England became less dependent on cigarettes over a recent 10-year period, but less likely to try to quit or cut down, a study concluded.

Those who tried to quit smoking were less likely to use behavioural support and more likely to turn to pharmacological methods, researchers found.

Also, the proportion of smokers from more disadvantaged backgrounds did not change significantly during the period between 2008 and 2017.

Impact of Tobacco Control Policies

During the 10 years, official statistics showed that the prevalence of cigarette smoking in England decreased from 21.1% in 2008 to 14.9% in 2017.

Since 2007 there have been a number of major changes in tobacco control policy in England, including smoke-free legislation, a change in the minimum age to buy cigarettes, licensing of nicotine replacement therapy for harm reduction, a point-of-sale ban, and introduction of plain packaging.

Researchers from the Department of Behavioural Science and Health at University College London (UCL) said there had been little analysis of data to show whether smoking and quitting behaviour had changed.

The study, published in the journal, Addiction , involved repeated cross-sectional surveys of 208,813 adults aged 16 and over.

Reduction in Smokers Who Quit

Dr Claire Garnett, a research associate at UCL, and lead author, said: "One of the findings from this study was that the proportion who are currently trying to cut down or trying to quit has decreased, which is a worrying trend, and could potentially reflect budget cuts for tobacco control, mass media expenditure, and stop smoking services."

At the end of the 10-year study period, smokers were found to smoke fewer cigarettes each day, with an average of 10.9 in 2017 compared with 13.6 in 2008. Also, fewer of them smoke within an hour of waking up.

The proportion of tobacco users who do not smoke every day increased from 9.1% to 13.4%.

"The findings from this study actually go against the hypothesis that as smoking prevalence falls, there's a 'hardening' of smokers," Dr Garnett told Medscape News UK. "The idea behind that hardening hypothesis is that the remaining smokers, as smoking prevalence declines, are unable or unwilling to quit smoking.

"But this study has actually shown that as the smoking prevalence decreased over this 10-year period, the remaining smokers in England seem to be less dependent on cigarettes."

However, the proportion of smokers who tried to stop smoking in the past year declined from 37.0% to 29.9%.

Smoking Among Disadvantaged Groups

A further finding from the study was that the proportion of smokers in low paid and manual occupational groups did not appear to have risen. "There hasn't been a change in the proportion of smokers who are in low-paid and manual occupation groups, indicating that the social gradient in smoking prevalence still exists," said Dr Garnett.

"This suggests both that England's approach to reducing smoking prevalence has been equally successful across different occupational groups but it does also indicate a lack of progress in reducing this social gradient, and so more targeted action is required to the reduce inequality."

She said that another notable finding was that the proportion of smokers turning to roll-your-own cigarettes increased markedly over the 10 years from 35.3% to 50.7%, "especially among more disadvantaged smokers", as tobacco users sought to avoid progressive tobacco tax increases more likely to target manufactured cigarettes. "Focusing policies on reducing affordability of hand-rolled cigarettes could have a role in reducing the social gradient", she said.

The authors concluded: "Attempts to quit and cut down have decreased, as has use of behavioural support such as National Health Service stop-smoking services, highlighting the need to reinstate and improve easy to access effective services.

"Of those smokers making quit attempts, fewer use no support while more use pharmacological support, due probably to the rapid rise in the prevalence of e-cigarette use."

Kruti Shrotri, tobacco control manager at Cancer Research UK, which part-funded the study, commented: "It's concerning that smokers are now less motivated to quit than a decade ago.

"Mass media campaigns such as Stoptober and January Health Harms are vital in encouraging people to quit smoking but have seen significant budget cuts in recent years.

"The Government must invest more in these health campaigns to save lives from cancers that could have been prevented."

Claire Garnett and two other authors declared no competing interests. Two other authors have received unrestricted research grants from Pfizer related to smoking cessation. Another author received research funding and had undertaken consultancy for companies that manufacture smoking cessation medications.

Garnett C, Tombor I, Beard E, Jackson SE, West R, and Brown J (2019) Changes in smoker characteristics in England between 2008 and 2017. Addiction 115: doi: 10.1111/add.14882/

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