Adult Smoking Habits in Great Britain, 2013

• The proportion of the GB adult population who smoke cigarettes has fallen by more than a half in the last 40 years, from 46% in 1974 to 19% in 2013. Not only have fewer people taken up smoking, but more of those who did smoke have quit

• Women accounted for the fall on the previous year - the proportion of women who smoke cigarettes fell from 19% to 17% between 2012 and 2013. There was relatively little change in this proportion for men

• Unmarried people were almost twice as likely to be cigarette smokers as married people

• The proportion who smoke cigarettes was higher amongst unemployed people, people working in routine and manual occupations and those with lower level educational qualifications. These are all factors associated with poverty

• E-cigarettes are almost exclusively used by smokers and ex-smokers. Almost none of those who had never smoked cigarettes were e-cigarette users

In 2013 the proportion of the GB population who smoke cigarettes was less than half the proportion in 1974, Figure 1. Fewer people had taken up cigarette smoking, and more of those who did smoke had quit.

The likelihood of being a cigarette smoker is complex and related to a number of factors. These include employment status, job type, educational achievement, income and marital status. Unemployed people, those with more routine jobs, lower levels of educational achievement and lower incomes were more likely to be cigarette smokers than others. Married people, those with high levels of academic achievement and older people were all less likely to be cigarette smokers than others.

E-cigarette use was almost solely confined to smokers and ex-smokers, and was negligible amongst those who have never smoked cigarettes. E-cigarettes were mainly used to help smokers quit smoking, and because users saw them as being less harmful than cigarettes.

Smoking is the leading cause of preventable death in Great Britain. In 2009, smoking caused nearly 80,000 deaths in England alone. Estimates from the Scottish and Welsh governments suggest that smoking is responsible for around 13,500 deaths per year in Scotland and 5,500 in Wales. Exposure to second-hand smoke (passive smoking) can lead to a range of diseases, many of which are fatal, with children especially vulnerable to the effects of passive smoking.

Smoking also has economic costs, adding significantly to the burden on the NHS. Research from Oxford University suggests that smoking cost the NHS in the UK £5.2 billion in 2005/06. It is estimated that in 2011/12, approximately 5% of all hospital admissions in England for those aged 35 and over were attributable to smoking.

Reducing the prevalence of cigarette smoking is therefore a key objective for the Government and devolved administrations. The Government has set a smoking prevalence target for England of 18.5% by 2015. The Welsh Government has a target of 20% by 2016, and 16% by 2020. The Scottish Government has a target of 17% by 2016, with a longer term target of 5% by 2034.

The UK Government and Welsh and Scottish governments have published the papers ‘Healthy Lives, Healthy People – A Tobacco Control Plan for England’, ‘Tobacco Control Action Plan for Wales’ and ‘Creating a Tobacco-Free Generation – A Tobacco Control Plan for Scotland’. These set out their respective strategies for reducing the proportion of the population that smokes and the harm caused by tobacco use.

The proportion of the population who smoke cigarettes has fallen gradually over the past 40 years, from 46% in 1974 to 19% in 2013. This latest figure is similar to the 2013 cigarette smoking levels reported in the Integrated Household Survey (IHS). Over the 40 years this fall was seen amongst both men and women, Figure 2, and in all age groups.

Over this time the proportion of the population who had never smoked cigarettes increased from 37% to 58%. The increase was most notable in men; in particular men aged 50-59 where the proportion who had never smoked more than tripled from 17% to 55%.

The proportion of cigarette smokers who had quit doubled between 1974 and 2013, from 27% to 54%. Although in 1974 the proportion was lower amongst women than men (21% vs. 32%), by 2013 women had closed this gap (55% vs. 53%).

Why are fewer people taking up smoking now than 40 years ago, and why are more smokers quitting?

In 1974 more than 6 in 10 people had at some point smoked cigarettes regularly. By 2013 this had fallen to 4 in 10.

Greater effort is made nowadays to alert the public to the dangers of smoking. Many initiatives and legislative changes have been made over this time (see background note 8 for further details), although it is difficult to say to what extent each initiative has contributed to the fall in the proportion who smoke. There is greater encouragement and pressure to stop smoking, and initiatives such as No Smoking Day and Stoptober are well publicised and promoted.

Smoking has become more expensive over this period, with tobacco prices increasing well above the rate of inflation as measured by the Consumer Price Index (CPI), Figure 3. Consequently there has been a gradual increase in the proportion of a smoker’s income that has been needed to fund their habit.

Smokers now have access to a range of products and services to help them quit smoking that were not available in the 1970s. Smokers can access smoking cessation support groups, and there are various nicotine replacement therapies (NRTs) available, such as nicotine gum, spray and patches. More recently, e-cigarettes have also been introduced to the marketplace.

The fall between 1974 and 2013 in the proportion who smoke cigarettes was seen in all age groups, Figure 4, with the largest falls seen in the 50-59 and 35-49 age groups. Both fell by just over 30 percentage points.

The proportion of the population who smoke cigarettes has been consistently higher in the 16-24 and 25-34 age groups since the late 1990s. Although the proportion has fallen in these groups, they have remained the highest groups up to 2013.

General Lifestyle Survey data from 2008-2011, Figure 5, show that among those aged 25 and over the proportion of cigarette smokers who either wanted to or had quit remained constant as age increased. The fact that more had quit smoking was the driver behind the decreasing proportion of cigarette smokers in older age groups. It can take people many attempts to quit smoking, and people who are older may be more likely to have found a method that works for them.

Children’s exposure to cigarette smoke

Exposure to second-hand smoke is hazardous to health, in particular to the health of children. The tobacco control plans for England, Wales and Scotland each highlight the need to reduce children’s exposure to second-hand smoke, and to reduce the proportion of children who smoke. The tobacco control plan for England refers to findings that a 15 year old who lives with a parent who smokes is almost twice as likely to smoke as one who lives with parents who do not.

Women who lived with dependent children (under the age of 16) were just as likely to smoke cigarettes as those who did not, Figure 6. This is because women tend to give up smoking at a younger age compared with men. For men the proportion who smoke cigarettes was lower amongst those who lived with dependent children. Men were more likely to stop smoking at an older age than women but it is not clear whether having children is a factor.

Children’s exposure to cigarette smoke cannot be defined simply by the proportion of parents who smoke. The tobacco control plans of the UK, Scottish and Welsh governments refer to the need to reduce exposure to second-hand smoke in the home and family car. Questions around children’s exposure to second-hand smoke are asked on the Health Surveys for England, Wales and Scotland.

Differences in the proportion who smoke cigarettes, by marital status

The proportion of the population who smoke cigarettes was lowest amongst those who were married, Figure 7.

This is partly because of age. Single people are more likely to be younger, with married people, cohabiters and those who are widowed, divorced or separated are more likely to be older. However when age was controlled for, unmarried people were almost twice as likely to be cigarette smokers as married people.

Married smokers were more likely than other smokers to have quit, but it is not clear whether those who had quit had done so before or after marriage.

Cigarette smokers were more likely to have characteristics associated with poverty. This supports findings from an ONS report published in April 2014 which looked at the links between deprivation and smoking.

The proportion who smoked cigarettes was highest amongst those with lower level educational qualifications (Figure 8), unemployed people, those working in routine and manual occupations and those with low incomes. However these factors are themselves related. For example those with lower level educational qualifications are more likely to be unemployed or working in routine and manual occupations, and subsequently they are also more likely to have less income.

When people who shared the same characteristics were compared, those whose highest qualification was equivalent to an A-Level were almost twice as likely (1.7 times) to be cigarette smokers as those with a degree. Those with lower level qualifications were increasingly likely to be cigarette smokers; those with a qualification equivalent to GCSE (D-G) were more than four times as likely as those with a degree to be cigarette smokers.

Those with no qualifications were less likely than those with lower level qualifications to be cigarette smokers. However once we account for factors such as age, employment status and job type, the likelihood that someone with no qualifications was a smoker was similar to that of someone with a GCSE (D-G).

Unemployed people were twice as likely to be cigarette smokers as employed people who shared similar characteristics.

Those with higher incomes were less likely than others to be cigarette smokers, Figure 9. This can be explained by the fact that those with higher incomes are more likely to be employed, working in managerial and professional occupations and to have high levels of educational achievement.

The tobacco control plans for England, Wales and Scotland provide separate targets for each of the countries of GB. In England the aim is to reduce the proportion of the population that smokes cigarettes to 18.5% by 2015. In Wales the target is 20% by 2016, and 16% by 2020, whereas in Scotland the target is 17% by 2016, with a longer term goal of 5% (or ‘smoke-free’) by 2034.

The proportion who smoked cigarettes was highest in 2013 in northern regions of England, and in Scotland and Wales, as shown by data from the Integrated Household Survey (IHS), Figure 10. These are generally the areas that have higher unemployment levels, lower average income and lower levels of educational achievement. IHS data have been used as the larger sample size provides more precise comparisons at this level of geography.

The debate around use of e-cigarettes

E-cigarettes have been sold since 2004, and in Europe since 2006. Their popularity and availability has increased, which has led to debate around their use. Some feel that e-cigarettes could renormalise smoking, or could be a gateway to smoking by introducing non-smokers to nicotine. Others feel that they could be a useful tool in the effort to reduce tobacco consumption. To date, e-cigarettes have mainly been marketed as a cheaper and healthier alternative to smoking. However, the long-term health effects of using e-cigarettes have yet to be established. This has led to a World Health Organisation call for tighter controls on e-cigarettes.

ONS has chosen to publish preliminary findings on e-cigarette use in response to the emerging need for more information. These data were collected between January and March 2014. Complete 2014 findings are planned for publication as part of the next Adult Smoking Habits in GB publication in 2015.

Our preliminary findings

E-cigarettes were almost exclusively used by smokers and ex-smokers, Fig 11. More than 1 in 10 (12%) of cigarette smokers also used e-cigarettes, compared with 1 in 20 (5%) ex-smokers and almost none of those who had never smoked. These findings reflect those from a YouGov survey commissioned by Action on Smoking and Health (ASH). Data on e-cigarette use have also been collected as part of the Smoking Toolkit Study.

E-cigarettes were found to be used mainly as smoking cessation aids and for the perceived health benefits (compared with smoking tobacco). Over half of e-cigarette users said that their main reason for using e-cigarettes was to stop smoking, and about one in five said the main reason for their use was because they thought they were less harmful than cigarettes.