Intended for healthcare professionals

Clinical Review

Supporting smoking cessation

BMJ 2014; 348 doi: (Published 14 January 2014) Cite this as: BMJ 2014;348:f7535

Re: Supporting smoking cessation

The recent clinical review by Zwar and colleagues on smoking cessation provides a useful and timely update on developments since the review by Aveyard and West.1 We thought it would be useful to expand on the section of the review on ‘Who smokes’ by sharing the latest findings on smoking prevalence in England from a large ongoing national surveillance study of adults which has been tracking smoking prevalence since November 2006.2 Each month a new sample of approximately 1800 individuals aged ≥ 16 and living in England are selected using a form of random location sampling and complete a face-to-face computer-assisted survey with a trained interviewer. The prevalence data are weighted using the rim (marginal) weighting technique to match English census data on age, sex, and socioeconomic group. The full methods have been described in detail and shown to result in a sample that is nationally representative in its socio-demographic composition and proportion of smokers as compared with other large national surveys such as Health Survey for England and the General Lifestyle Survey.2 A critical advantage of the Smoking Toolkit Study is that the data are available within weeks of collection and published online at

For the first time in probably 80 years, England has seen cigarette smoking prevalence fall below 20%. In 2013, 22,167 adults aged over 16 years old were surveyed. The prevalence of cigarette smoking was 19.3% (95% CI 18.8 to 19.8). Smoking was extremely rare at the start of the 20th century but increased relentlessly until the publication of ‘Smoking and Health’ by the Royal College of Physicians in 1962 by which stage over 70% of men and 40% of women smoked tobacco.3

The decline in prevalence since the 1960s has averaged 0.6% per year, and in 2013 it was slightly above this at 0.8% ( There is much still to be done, particularly on the social gradient in smoking, which contributes substantially to health inequalities.4-6 However, we hope that breaking the 20% barrier will motivate smoking cessation efforts across the country, including making more use of our stop-smoking services.7


1. Aveyard P, West R. Managing smoking cessation. BMJ 2007;335(7609):37-41.

2. Fidler JA, Shahab L, West O, et al. 'The smoking toolkit study': a national study of smoking and smoking cessation in England. BMC Public Health 2011;11:479.

3. Royal College of Physicians. Fifty years since Smoking and health. Progress, lessons and priorities for a smoke-free UK. Report of conference proceedings. London: RCP, 2012.

4. Gruer L, Hart CL, Gordon DS, et al. Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study. BMJ 2009;338.

5. Kotz D, West R. Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding. Tob Control 2009;18(1):43-6.

6. Jarvis M, Wardle J. Social patterning of individual health behaviours: the case of cigarette smoking. In: Marmot M, Wilkinson R, eds. Social determinants of health. Oxford: Oxford University Press, 1999.

7. West R, May S, West M, et al. Performance of English stop smoking services in first 10 years: analysis of service monitoring data. BMJ 2013;347.

Competing interests: JB’s post is funded by a fellowship from the UK Society for the Study of Addiction; RW is funded by Cancer Research UK; Cancer Research UK, the Department of Health, Pfizer, GlaxoSmithKline and Johnson and Johnson have all funded data collection for the Smoking Toolkit Study; JB has received an unrestricted research grant from Pfizer; RW undertakes research and consultancy and receives fees for speaking from companies that develop and manufacture smoking cessation medications (Pfizer, J&J, McNeil, GSK, Nabi, Novartis, and Sanofi-Aventis), he also has a share of a patent for a novel nicotine delivery device. There are no other financial relationships with any organisations that might have an interest in the submitted work.

26 January 2014
Jamie Brown
Senior Research Fellow
Robert West
University College London
1-19 Torrington Place, London, WC1E 7HB