Between 2008 and 2017 smokers appear to have become less dependent on cigarettes but also less likely to try to quit or cut down. For those who tried to quit, fewer used behavioural support and more used pharmacological support, a study has found.

Data were used from the Smoking Toolkit Study (STS), an ongoing, monthly population survey in England. The STS consists of cross-sectional monthly household surveys of representative samples of 1,800 adults (aged 16 and older).

A total of 208,813 adults responded to the survey between January 2008 and December 2017. Of these, 19.9% were current smokers and 41,610 respondents were included in the analyses assessing whether smoking and quitting behaviour of adult smokers had changed from 2008 to 2017.

Changes in smoking and quitting behaviour during the study period are shown in table 1, above. The mean number of daily cigarettes smoked decreased from 13.6 to 10.9. The time to first cigarette score (a marker of dependence, with lower scores representing longer time) fell from 1.5 to 1.2. The proportion of smokers who smoked every day fell from 90.9% to 86.6%. These data suggest decreased levels of dependence.

The proportion of smokers attempting to cut down or quit also decreased from 37.0% to 39.9%; odds ratio (OR) 0.96 (95% CI: 0.96-0.97). For those trying to quit use of behavioural support decreased; OR 0.89 (95% CI: 0.86-0.92) and use of no support decreased; OR 0.98 (95% CI: 0.96-0.99). Overall use of pharmacological support, including e-cigarettes, increased; OR 1.04 (95% CI: 1.02-1.05). P < 0.001 for all changes.

Current use of nicotine replacement therapy decreased, while use of e-cigarettes increased.

There was no significant change in the difference in social characteristics between smokers and non-smokers between 2008 and 2017, with a high percentage of smokers still coming from lower socioeconomic groups.

Changes in smoking and quitting behaviour were independent of changes in sociodemographic characteristics.

The past 15 years have seen considerable changes in tobacco control policy in the UK, including the passing of smoke-free legislation in 2007 and the introduction of plain packaging in 2017.

A further cultural shift has been the popularisation of e-cigarettes as an alternative to tobacco. Alongside this the prevalence of cigarette smoking in England has decreased from 21.1% in 2000 to 14.9% in 2017.¹

However, there had been little analysis of whether the characteristics of smoking and quitting behaviour had changed over this time.

The study found no evidence to support the ‘hardening’ hypothesis that continuing smokers are more heavily dependent.

Dr Jez Thompson