Smoking rates have gone up in parts of England, according to new research—something that hadn’t been seen in almost 20 years. The country has been regarded as a tobacco harm reduction success story, so what’s going on?
In a big regional divide, smoking rates declined by nearly 10 percent in the North of England from 2020-2024, the study found—but rose 10 percent in the South. The national average, which stood at 16.5 percent in 2024, essentially didn’t budge during that period.
The study, authored by researchers at University College London and published in the Addiction journal in March, looked at data from over 350,000 people aged 16 and up. Examining trends over time, it found that the national smoking rate had fallen substantially since 2006, when it was 25.3 percent, but that progress has stalled alarmingly since the COVID-19 pandemic.
The researchers noted that “certain regions in England (particularly in the North) coordinate regional tobacco control programs.” This, they concluded, “likely contributed” to the North’s faster decline in smoking over two decades.
“It’s vital that stop smoking services are made easily and equally available across the country, so that everyone—wherever they live—can access the right tools to quit for good,” lead author Dr. Sarah Jackson told the Guardian.
Nationally, as the Guardian report noted, other research has shown recent increases in quit attempts and smoking cessation, while youth smoking has declined. It all points to regional increases in smoking being driven significantly by people who had quit smoking, but then returned to cigarettes.
When most successful quit attempts in the United Kingdom involve vapes, this group is sure to include some people who are switching back from vaping to smoking.
“Demand for nicotine is much more resilient than any particular way of taking it, so it is quite possible to see a rebound in smoking if people lose confidence in the safer alternatives.”
Commenting on the new data, British tobacco control expert Clive Bates, of Counterfactual Consulting, told Filter that it’s “a common but lazy assumption that smoking rates will always fall, and that smoking is entering its final death spiral.”
“We know the demand for nicotine is much more resilient than any particular way of taking it,” he continued, “so it is quite possible to see a rebound in smoking if people lose confidence in the safer alternatives.”
In the UK, the last few years have seen media-driven outcry against vapes. This has fueled some anti-vape policies, in what had been a very pro-vape country. A ban on disposable vapes is set to take effect in June, and a government bill to restrict flavors, among other measures, is advancing.
As all this unfolds, most people who smoke—in the country that commissioned a landmark 2015 review, estimating vapes to be 95 percent safer than cigarettes—believe that vapes are as harmful as cigarettes, or worse.
“The government, media and some tobacco control activists have been ramping up false alarms and moral panic about vaping,” Bates said, “and it’s not surprising that we are seeing the numbers go the wrong way in some places.”
Sairah Salim-Sartoni, a health psychologist and smoking cessation expert in the UK, is also concerned about a mismatch in messaging.
“Stopping smoking is difficult in itself,” she told Filter, “so imagine when there are no mass media campaigns motivating you to think about stopping, or you don’t really know about local support services which provide you the opportunity to have a go.”
“It is evident that the North of England have walked the walk when it comes to tobacco control, and that is due to consistent funding since 2005.”
The new study highlights the importance of investing in such smoking cessation programs, which offer people a range of tools, advice and support.
“Funding for regional tobacco control programs is not uniform across the country and hence the difference in smoking rates,” Salim-Sartoni said. “It is evident that the North of England have walked the walk when it comes to tobacco control, and that is due to consistent funding since 2005.”
“We need to make it easier for people to get the support they deserve and that will only come with funded, coordinated programs that are dedicated to leave no smoker behind,” she added, also emphasizing the capacity of media campaigns to “educate and motivate smokers to embark on a [smoking cessation] journey.”
Richard Pruen, a tobacco harm reduction advocate who himself quit smoking with vapes, was involved in setting up smoking cessation programs for Avon and Wiltshire National Health Service Trust. That informed government policy and resulted in vapes being made available in mental health clinics.
“When you show people a range of alternatives, from NRT options to vapes, and explain the pros and cons of each, then people feel empowered to try a healthier option,” he told Filter.
“To sum it up, carrot and stick seems to work better than stick and more stick.”
Recently, Public Health Dorset, which covers an area in the South of England, announced that its local “Swap 2 Stop” initiative—which offers free vapes to people who smoke under a UK-wide scheme—has helped 3,562 people quit cigarettes completely.
Pruen said that patient feedback from the smoking cessation program he was involved in overwhelmingly showed the importance of “feeling supported, not pressured.”
“To sum it up,” he said, “carrot and stick seems to work better than stick and more stick.”
Bates agrees. “The best public health approach is to acknowledge that some people will use nicotine because it makes them feel better,” he said.
To maximize smoking cessation—through people buying safer options independently, as well as through dedicated programs—he called for government regulation, tax policy and communication designed to encourage people to switch.
As the disposable vapes ban approaches, there are fears that an estimated 1.2 million British adults who use them, many from disadvantaged populations, risk returning to smoking.
“We need a renewed focus on adults who have been smoking for decades,” Bates said, “and preventing former smokers from drifting back into the habit in response to the stresses of modern life.”
Photograph (adapted) by Philippa Willitts via Flickr/Creative Commons 2.0
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