Smoking rates have fallen more quickly in the north of England compared to other regions, according to a new study led by UCL researchers.

This has helped to narrow significant gaps in smoking prevalence between different areas of the country, with the study suggesting that rates in the north of England are now as low as in the south.

Researchers analyzed Smoking Toolkit Study data from 368,057 adults in England between 2006 and 2024. Spanning nearly two decades, the study aimed to examine how smoking rates differed across regions—including areas with and without dedicated tobacco control activity.

The study, published in Addiction, also found that smoking decline had slowed more recently, between 2020 and 2024, and that smoking even appeared to be on the rise in some regions including the South of England.

Over the past 18 years, the study found that:

• The largest—and fastest—fall in smoking was in the north of England where rates nearly halved (28.8% to 15.8%), compared to a fall of around a quarter in the south (22.7% to 17.3%).
• In the region defined as having sustained tobacco control activity (the north east), smoking prevalence fell by -13.3%, compared with -9.3% in regions with none. Researchers note other factors could have also contributed to this difference, including demographic shifts such as changing levels of deprivation.
• Smoking rates fell more in areas with historically higher smoking rates, helping to narrow differences between regions.

Lead author Dr. Sarah Jackson (UCL Institute of Epidemiology & Health Care) said, “Until recently, smoking rates were highest in the north of England, but our study shows that regional differences have narrowed considerably over the past 18 years. Smoking rates fell most in northern regions, where dedicated regional tobacco control programs have been largely concentrated.

“But across England progress has stalled in recent years, and in some regions smoking rates appear to be increasing. 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.”

Dr. Ian Walker, Cancer Research UK’s executive director of policy and information, said, “A future free from the harms of tobacco is in sight, but we can’t afford to lose any momentum. Budget pressures and changes to NHS England can’t compromise funding for programs that help people quit—tackling smoking must be a key priority as our health services evolve.

“The world-leading Tobacco and Vapes Bill is a crucial opportunity for the UK Government to shield society from the devastating effects of smoking. We urge all MPs and Lords to vote to protect the health of the nation, or more lives will be at stake.”

Researchers consulted with key stakeholders, including Action on Smoking and Health (ASH), to categorize regions as areas with or without sustained tobacco control activity over the study period. Regional tobacco control varies over time and between areas, but involves activities such as mass media campaigns, local amplification of national campaigns, advocacy work, enhanced stop smoking support, and interventions targeting priority population groups.

The northeast was identified as a region with sustained tobacco control, while the East Midlands, West Midlands, east of England, and southeast had no dedicated tobacco control activity across the study period.