Smoking Rates Rise in Parts of England After 20 Years

New research from University College London shows that smoking rates are on the rise in England for the first time in over twenty years.

The researchers found that while overall smoking prevalence in England fell from 25.3% to 16.5% between 2006 and 2024, this decline has stalled in some regions.

Since 2020, some areas have started to see an increase in smoking rates.

The greatest decline in smoking rates was in the North of England where rates dropped from 28.8% to 15.8%, an almost 50% reduction.

This suggests that smoking rates in the north, previously the regions with the highest levels of smoking in England, are now lower than in the south.

This success has been attributed to the effectiveness of dedicated tobacco control programmes concentrated in northern regions.

Our research also indicates that the north of England has some of the highest rates of use of alternative nicotine products such as nicotine pouches and vapes.

However, it is not all good news.

Since 2020 the rate of decline has flatlined in some areas of England and smoking rates are actually on the rise again in the southern regions.

In the South, smoking rates have increased by an average of 10%.

Between 2020 and 2024, smoking rates in London increased by 8%. The southwest had the greatest jump in smoking rates, rising by a massive 17% to 18.7% in the period.

While effective stop-smoking services explain the reduction in the North, what could be driving the recent increases in smoking rates in the South?

The researchers have identified several possible explanations, including changes in social norms, demographics, or employment patterns.

One other possible factor is the lower number of smokers switching to alternative nicotine products such as vapes.

Research suggests this could be because of consumer confusion about how harmful cigarettes are compared with alternative nicotine products such as vapes or nicotine pouches.

If consumers believe the products to be similarly harmful, they are less likely to make the switch from smoking.

The Haypp Vape Report on the behaviour and attitudes of vape users in the UK shows just how much of a challenge this might be.

We surveyed 500 vape users and asked them to rank cigarettes, vapes and nicotine pouches from 1 – 10 on a scale of harmfulness.

Surprisingly, survey respondents believed the products were similarly harmful, rating all three between 4.5 to 6 out of 10, on a scale from not harmful to very harmful.

This is worrying given there is so much evidence, including NHS research, that proves that cigarettes are many times more harmful than vapes and nicotine pouches.

One of the causes of this confusion is misinformation.

There is a great deal of misinformation about vapes and other reduced-risk products in the media, and these can often go unchallenged due to the strict regulations on how any advantages of vaping compared to smoking can be communicated.

In 2024, the Royal College of Physicians warned that one of the reasons for underutilisation of vapes by people who wish to quit smoking is perceptions of the risks of vaping relative to smoking.

Too often, the media portrays vapes as being as harmful as smoking, despite strong evidence to the contrary.

The Royal College of Physicians noted that interventions to increase accurate perceptions of the risks of vaping, especially relative to smoking are important.