Despite the ever-decreasing use of tobacco, smoking remains a primary cause of early death in the developed world. Tackling the harms to people’s health from tobacco use is a major global public health priority, and a number of legislative actions have been taken in the UK in the last decade relating to the supply and consumption of tobacco and e-cigarettes.
A recent NatCen study funded by the National Institute for Health Research set out to explore the impact of these policy changes in England and Scotland in the last decade and to explore current and past trends in tobacco and e-cigarette use. The research team analysed five different surveys looking at the smoking behaviours of both adults and children, examining the data in relation to specific pieces of legislation. The study also looked at international literature to understand the prevalence of e-cigarette use and the impact of legislation regulating their use.
Prevalence of smoking and e-cigarette use
The number of adults and children smoking in England and Scotland has declined significantly between 2008 and 2016. This decrease was steeper for women than for men, and the 16-24 age group saw the greatest decline (although this age group was also the most likely to take-up or re-start smoking).
The research found smoking to be more common among both adults and children in Scotland than in England, with women in Scotland smoking at approximately the same rate as men in England. In contrast to this decrease in smoking tobacco, there was a sharp increase in the use of e-cigarettes amongst adults after their introduction in 2008, and a steadier increase since 2014, reaching an estimated 3.6 million e-cigarette users in the UK in 2019.
Amongst children aged 10 to 15, just over one fifth of boys and just under one fifth of girls had used e-cigarettes. Whilst this is not quite the epidemic that some media coverage has suggested, it is of concern given that the short- and long-term health implications of e-cigarettes are not yet known.
Who is most likely to smoke or use e-cigarettes?
Our research found people who are single, unemployed or who have no qualifications to be among the most likely to take-up or re-start smoking. Those most likely to quit smoking included people who were employed, held a degree, or who were married or in a civil partnership. These findings echo previous research and broadly fit the accepted narrative of smoking being tied to social inequality.
In the case of e-cigarettes, however, familiar narratives relating to smoking behaviours (i.e., strongly linked to deprivation and social inequality) were reversed. For example, people who used e-cigarettes were more likely to be white, employed, working in professional occupations and to be married.
When considering smoking amongst children aged 10 to 15, family relationships were crucial. Girls were more likely to smoke if their father had no formal qualifications or was unemployed, or if their father was not present in the household. Meanwhile, boys whose fathers had poor mental health were five times more likely to smoke than those whose fathers did not have mental health conditions.
Both boys and girls were more likely to smoke if their parents currently smoke or smoked in the past. This finding highlights the protective role that positive parental relationships can play, which may prevent children from smoking.
Policy and legislation
Whilst it is difficult to discern any direct impact resulting from specific policy changes, the cumulative effect of new legislation over the previous decade is likely having an impact on the prevalence and overall consumption of tobacco and e-cigarettes.
It is also likely that legislative action is partly responsible for the decrease in children’s access to cigarettes. For example, the number of children able to purchase cigarettes halved between 2006 and 2016, with access to cigarettes from vending machines falling to almost zero in this time. However, none of the individual policy changes explored as part of this study were found to have a specific, identifiable impact.
Overall, this study illuminates the importance of demographic and socioeconomic factors in reducing smoking over the impact of any single policy intervention. Given the differences in the demographic characteristics of tobacco smokers and e-cigarette users, it is evident that there can be no “one-size-fits-all” policy approach, with legislative measures that are used to tackle tobacco smoking unlikely to be effective in addressing e-cigarette use. Policies must instead reflect the complex nature of smoking behaviours, taking into account the profile of the population, and be flexible in tackling changes to smoking patterns through the life-course.
Read our report: Current and past trends in tobacco and e-cigarette use and the impact of control measures: an analysis of survey data and other evidence