Trends in smoking prevalence and socioeconomic inequalities across regions in England: a population study, 2006 to 2024

BackgroundIn addition to national policies and interventions, certain regions in England (particularly in the North) coordinate regional tobacco control programmes. This study examined trends in tobacco smoking prevalence and socioeconomic inequalities in smoking across regions. MethodsData were obtained from monthly household surveys of adults ([≥]16y) in England, conducted between November 2006 and July 2024 (total n=368,057). We used logistic regression to estimate time trends in current smoking by region, and tested interactions with occupational social grade to explore differences between more and less advantaged groups. ResultsSmoking prevalence declined most in the North (28.8% to 15.8%; -12.9 percentage points [95%CI -14.4; -11.5]), similar to the national average in the Midlands (25.2% to 16.0%; -9.2 [-10.6; -7.9]), and least in the South (22.7% to 17.3%; -5.3 [-6.5; -4.0]), reducing regional disparities such that prevalence was similar across regions in 2024. Socioeconomic inequalities in smoking prevalence between more and less advantaged social grades fell most in Yorkshire and the Humber (from 17.9 percentage points [14.1; 21.8] to 3.7 [0.4; 7.0]) and the West Midlands (from 16.1 [12.8; 19.6] to 3.0 [-0.03; 6.0]). Regions with sustained regional tobacco control activity saw greater declines in smoking prevalence (-18.1 [-21.4; - 14.7]) than regions with none (-12.8 [-13.9; -11.6]). ConclusionsBetween 2006 and 2024, smoking rates in the North of England fell faster than the national average, aligning with other regions. Regional tobacco control programmes appeared to contribute to this progress.