Health Survey for England, 2022 Part 1

This report includes results from the 2022 Health Survey for England describing cigarette smoking, e-cigarette use, physical activity, and fruit and vegetable consumption. Adult drinking is covered in a separate topic report for 2022.

Detailed tables accompanying this report can be accessed here.

• Current cigarette smoking has declined steadily from 27% in 1993 to 13% in 2022.
• Adults living in the most deprived areas were more likely to smoke cigarettes (21%) than those living in the least deprived areas (9%). 
• In 2022, 9% of adults currently used e-cigarettes. Current cigarette smokers were more likely to use e-cigarettes compared with those who have never smoked cigarettes (26% and 2%, respectively).
• 22% of adults participated in less than 30 minutes of moderate or vigorous physical activity (MVPA) a week. 
• 29% of adults ate 5 or more portions of fruit and vegetables per day, and 7% ate no fruit or vegetables. 

Smoking is estimated to be one of the leading causes of preventable illness and premature deaths in England. It is highly addictive due to the nicotine contained in tobacco. Tobacco use is a major risk factor for cardiovascular and respiratory diseases, several different types of cancer and many other debilitating health conditions (Source: World Health Organization).

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 during the interview. In 2022, young adults aged 16 to 17, and some aged 18 to 24, answered these questions in a computer-assisted self-completion interview (CASI) to ensure confidentiality. 

In 2022, 13% of adults reported currently smoking cigarettes. Current smoking among adults varied by age, from 18% among those aged 25 to 34 years to 5% among those aged 75 years and over. 

Men (14%) were more likely than women (11%) to be current cigarette smokers.

In 2022, an estimated 5.8 million adults were current smokers, including 3.2 million men and 2.6 million women.

For more information: Table 1, Table 2 and Table B1

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 proportion of adults who smoked cigarettes was similar across regions.

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 the HSE 2022 Methods documentation, available on the first page.

The proportions of adults reporting they currently smoked varied by area deprivation. Smoking prevalence in the most deprived areas was 21% compared with 9% in the least deprived areas.

For more information: Table 4

Prevalence of current cigarette smoking has declined from 27% in 1993 to 13% in 2022. The proportion of adults reporting never regularly smoking cigarettes has increased from 46% to 64% in the same period. 

The decline in current smoking is observed for both men and women since 1993. The proportion of men who never regularly smoke increased from 39% in 1993 to 60% in 2022. For women, prevalence of never regularly smoking increased from 52% to 68% between 1993 and 2022. 

For more information: Table 1 and Table 2

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.

In 2022, current smokers smoked an average (median) of 10 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.)

Between 1993 and 2011, the median number of cigarettes smoked per day by current smokers gradually decreased from 15 to 10, where it has remained since. 

In 2022, 3% of current smokers reported they smoked over 20 cigarettes per day. The proportion of adults smoking 20 or more cigarettes a day has decreased gradually over time, from 9% in 1993 to 3% in 2014 where it has remained since. 

For more information: Table 1

Electronic cigarettes (e-cigarettes) and other vaping devices use a range of methods that allow their users to inhale nicotine as a vapour rather than via tobacco smoke. Their use in Britain has increased in recent years (Source: ASH: Use of e-cigarettes among adults in Great Britain).

There are strict regulations on the kind of e-cigarettes and vaping devices that can be sold, and how much nicotine they can contain (Source: GOV.uk).

This report uses the term e-cigarette to refer to all vaping devices.

The current questions about e-cigarette use were asked between 2016 and 2022. Participants were asked whether they had ‘ever used an electronic cigarette (e-cigarette), or any other vaping device?’ Interviewers offered further clarification if necessary. Those who said that they had ever used e-cigarettes were asked whether they used e-cigarettes or vaping devices at all nowadays.

In 2022, 9% of adults aged 16 and over reported currently using e-cigarettes. 79% had never tried e-cigarettes and 12% reported that they had tried using e-cigarettes, but were not currently using them.

The prevalence of adults using e-cigarettes decreased with age. It was highest among those aged 16 to 24 (15%) and lowest among those aged 75 and over (1%). Current e-cigarette use did not differ between men and women (10% and 8%, respectively).

For more information: Table 5

In 2022, 26% of current cigarette smokers also currently used e-cigarettes, as did 17% of ex-regular smokers and 2% of those who had never smoked cigarettes.

Women who currently smoke cigarettes were more likely to use e-cigarettes (28%) compared with men (24%).

For more information: Table 6

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

E-cigarette use varied across regions, with the highest prevalence in Yorkshire and the Humber (13%), and the lowest prevalence in London and the West Midlands (both 6%).

For more information: Table 7

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 the HSE 2022 Methods documentation, available on the first page.

The proportion of adults who currently used e-cigarettes varied by area deprivation. Current e-cigarette use in the most deprived areas was 13% compared with 7% in the least deprived areas.

For more information: Table 8

Current e-cigarette use remained stable at 6% between 2016 and 2019, and increased to 9% in 2022. This upward trend occurred in both men (6% to 8% between 2016 and 2019 and 10% in 2022) and women (5% between 2016 and 2019 and 8% in 2022).

Prevalence of adults who had never used an e-cigarette decreased from 82% in 2016 to 79% in 2022.

For more information: Table 5

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.

Physical activity is important for both physical and mental health. Physical inactivity is linked to increased risk of premature deaths, particularly deaths from coronary heart disease (CHD) (Source: The Lancet). Physical activity also helps with developing and maintaining physical and mental function (Source: (Sporting Future (publishing.service.gov.uk)).

In 2011, the Chief Medical Officers for the four UK countries published revised guidelines for physical activity, outlining the levels of activity and type of activity needed to benefit health. Updates to these guidelines were published in 2019 with differing recommendations for each age group, for muscle strengthening activities, aerobic activity and balance activities (Source: UK Chief Medical Officers' Physical Activity Guidelines (publishing.service.gov.uk)). The recommendations indicated that the overall volume of physical activity is more important for health than specific types of activities or frequency of sessions.

In HSE 2022, information on physical activity was collected using the Short-Form International Physical Activity Questionnaire (IPAQ). This questionnaire defines activity levels based on reported moderate or vigorous physical activity (MVPA). Participants reporting below 30 minutes MVPA per week were defined as ‘inactive’ whereas those reporting 30 minutes or more MVPA per week were defined as ‘active’.

Note that this definition differs from the UK Chief Medical Officers' Physical Activity Guidelines for sufficient levels of aerobic activity (at least 150 minutes/week of MVPA) which cannot be calculated from the IPAQ.

In 2022, 22% of adults were classified as ‘inactive’, reporting participating in less than 30 minutes of moderate or vigorous physical activity (MVPA) per week.

The proportions of ‘inactive’ men (22%) and women (23%) were similar.

Overall, inactivity was lowest for younger adults (16 to 44 years) and increased with age after 35 to 44 years. For men, inactivity increased with age, with those aged 16 to 24 least likely to be inactive (14%) and those aged 75 and older the most likely to be inactive (35%). For women, those aged 35 to 44 were least likely to be inactive (17%) and inactivity increased with age thereafter, with those aged 75 and older most likely to be inactive (43%).

For more information: Table 9

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 the HSE 2022 Methods documentation, available on the first page.

Inactivity among adults increased with area deprivation, from 18% in the least deprived areas to 30% in the most deprived areas.

For more information: Table 10

The 5 A Day fruit and vegetable campaign was created with guidance from the World Health Organisation, who recommended that eating 400g of fruit and vegetables a day can reduce the risks of illnesses like heart disease, strokes, and some cancers (Source: World Health Organisation).

Participants were asked about the amount of fruit and vegetables they had consumed in the last 24 hours, including salads, pulses, dried and fresh fruit, fresh and frozen vegetables, tinned fruit and vegetables, and fruit juices.

These amounts were collated and assessed as a portion size, which is roughly equivalent to 80g of fruit and/or vegetables.

In 2022, the average (mean) consumption of fruit and vegetables was 3.9 portions a day. 29% of adults ate 5 or more portions of fruit and vegetables per day, and 7% ate no fruit or vegetables.

Women reported higher levels of fruit and vegetable consumption than men (an average (mean) of 4.0 and 3.7 portions a day, respectively). Similarly, women were more likely than men to eat 5 or more portions of fruit and vegetables (30% and 28%, respectively).

Fruit and vegetable consumption varied by age. Adults aged 16 to 24 were least likely to eat 5 or more portions of fruit and vegetables per day (25%) and those aged 65 to 74 most likely to do so (34%). The average (mean) consumption per day was 3.5 portions among those aged 16-24 compared with 4.2 portions among those aged 65 to 74.

In 2022, an estimated 13.5 million adults consumed 5 or more portions of fruit and vegetables per day, including 6.4 million men and 7.1 million women.

For more information: Table 11 and Table B2

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 the HSE 2022 Methods documentation, available on the first page.

Fruit and vegetable consumption varied by area deprivation. Adults in the most deprived areas were less likely to eat 5 portions of fruit and vegetables. The proportion of adults who ate 5 portions of fruit and vegetables a day was 23% in the most deprived areas compared with 34% in the least deprived areas.

The average (mean) portions of fruit and vegetables consumed in the most deprived area was 3.3 portions a day, compared to 4.4 portions a day in the least deprived area.

For more information: Table 12

In 2022, 29% of adults reported eating 5 or more portions of fruit and vegetables a day. From 2009 to 2016, the proportion of adults consuming more than 5 portions of fruit and vegetables a day remained stable (between 26% and 27%) and then increased to 29% in 2017 and has remained similar since then (28% in 2018 and 29% in 2022).

For more information: Table 11