Health Survey for England, 2021 part 1

Smoking is estimated to be the leading cause of preventable illness and premature death in England. Nicotine contained in tobacco is highly addictive, and tobacco use is a major risk factor for cardiovascular and respiratory diseases, over 20 different types or sub-types of cancer, and many other debilitating health conditions (Source: World Health Organization).

Actions to reduce the prevalence of smoking have been laid out in the government’s Tobacco Control Plan, published in 2017.

This analysis categorises participants in one of three ways:

• Current smokers, who answered yes to the question: ‘Do you smoke cigarettes at all nowadays?’
• Ex-regular smokers, who did not currently smoke but who reported that they had smoked cigarettes, and that they used to smoke regularly (at least once a day)
• Never regular smokers, who did not currently smoke, and had either smoked in the past, but only occasionally, or had never smoked cigarettes

These questions were asked as part of the interview. In 2019, all young adults aged between 16 and 24 answered questions about smoking cigarettes in a computer-assisted self-completion interview (CASI) which guaranteed that their answers were confidential. In 2021, young adults were asked about smoking as part of the telephone interview.

In 2021, 12% of adults were current smokers. More men (13%) than women (10%) reported that they currently smoked cigarettes.  

The proportions of adults who currently smoked cigarettes varied with age. It was highest among those aged 24 and 34 (18%), lowest among those aged 75 and over (4%). 

For more information: Table 1.

Cigarette smoking estimates by region are shown in the tables as both observed and age-standardised. Observed estimates show the actual levels of smoking in each region. Comparisons between regions should be based on the age-standardised data, which account for the different regional age profiles.

The prevalence of smoking was similar across regions.

For more information: Table 2.

The HSE uses the measure of equivalised household income, which accounts for the number of adults and dependent children in the household as well as overall household income. Households are divided into quintiles (fifths) based on this measure. The age profile of the income quintiles has been age-standardised to account for differences in age profiles between households. For information about how equivalised income is calculated, see the Methods report. 

 Adults in lower income households were more likely to smoke. The proportions of current smokers broadly increased from 8% of adults in the highest income quintile to 17% in the lowest income quintile.      

For more information: Table 3.

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see Methods report. 

In 2021, the proportions of adults who currently smoked varied across areas, with those from more deprived areas being more likely to be current smokers. Smoking prevalence in the least deprived quintile was 6% compared with 19% in the most deprived quintile.

For more information: Table 4.

Between 1993 and 2019, the proportion of adults who smoked declined from 27% to 16% in 2019. The proportion of adults who have never regularly smoked increased from 46% in 1993 to 60% in 2019. 

The Health Survey for England 2020/2021 Feasibility Study, completed online or by post, recorded current smoking prevalence among adults in 2020 as 10%, with 69% reporting that they had never smoked regularly. Because of methodological changes, findings from the 2020 Feasibility Study and the 2021 HSE are not directly comparable with previous HSEs. The Scottish Health Survey (SHeS) reported similar differences in smoking prevalence between 2019 and 2021 surveys. The SHeS data collection methodology changed in 2021 in the same way as the 2021 HSE.

The apparent decline in the reported prevalence of smoking in 2021 was greatest among younger age groups. In particular, the proportions of young people aged between 16 and 24 who said that they currently smoked fell from 21% in 2019 to 10% in 2021.  It is not possible to determine whether these findings represent real behaviour change within this age group. In addition to the methodological changes relevant to all age groups, questions about smoking cigarettes were asked in different ways, using self-completion questionnaires in 2019 and a telephone interview in 2021, which may have been perceived as less confidential. There were also differences in survey response rates.

For more information: Table 6.

In 2021, current smokers smoked an average (median) of nine cigarettes a day. (The median is the mid-point from the lowest to the highest number of cigarettes, so that half of smokers smoke fewer cigarettes and half smoke more.)

In 1993, the daily median was 15, and this fell gradually until 2011, after which it remained at 10 cigarettes a day until 2019.

In 2021, 2% of current smokers reported they smoked over 20 cigarettes per day. The proportion of current smokers who reported that they smoked over 20 cigarettes per day fell from 9% in 1993 to 3% in 2019.

For more information: Table 5.