Understanding long‐term trends in smoking in England, 1972‐2019 : an age‐period‐cohort approach

Background and aims

Smoking prevalence has been falling in England for over 50 years but remains a prevalent and major public health problem. This study used an Age-Period-Cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.

Design

APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys.

Setting

England (1972 – 2019).

Participants

Individuals aged 18 to 90 years old.

Measurements

We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-1973 to 2018-2019), and 20 groups of 5-year birth cohorts (1907-1911 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18 to 25 years and those aged over 25 years.

Findings

Relative to age 18, the odds of current smoking increased with age until around age 25 (odds ratio (OR): 1.48; 95% confidence interval (CI):1.41 to 1.56) and then decreased progressively to age 90 (OR: 0.06; 95% CI: 0.04 to 0.08). They also decreased almost linearly with period relative to 1972-1973 (for 2018-2019 OR: 0.30; 95% CI: 0.26 to 0.34) and with birth cohort relative to 1902-1906, with the largest decreased observed for birth cohort 1992-1996 (OR: 0.44; 95% CI: 0.35 to 0.46) and 1997-2001 (OR: 0.35; 95% CI: 0.74 to 0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods, and by an average of 5% in those aged over 25.

Conclusions

Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.