Rising costs fuel quit-smoking surge in England amid health advice dip

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In a recent study published in BMJ Public Health, researchers investigate the factors that motivate smokers to quit smoking between 2018 and 2023.

Study: Trends in motives for trying to stop smoking: a population study in England, 2018–2023. Image Credit: fongbeerredhot / Shutterstock.com

How did COVID-19 affect smoking habits?

People attempt to quit smoking for various reasons including health concerns, social issues, expenses, and health expert guidance. Like many other people throughout the world, England residents have experienced the global COVID-19 pandemic with national-level healthcare and financial problems, which may have influenced their motives to quit smoking.

Understanding time-based and demographic differences in variables that motivate individuals to quit smoking is critical for developing treatments to support smoking cessation.

About the study

In the present study, researchers examine changes in smoking cessation attempts over the last five years while focusing on health concerns, cost, social factors, and medical expert guidance. The influence of age, sex, socioeconomic level, vaping status, and number of offspring on these changes was also assessed.

Data were obtained from the Smoking Toolkit Study, a national-scale cross-sectional-type survey of adult residents in England between 2018 and 2023. The study comprised 5,777 previous-year cigarette smokers who attempted to quit smoking at least once in the previous year. 

Changes in the percentage of quitting attempts prompted by health-related concerns, social characteristics, expenses, and health practitioner advice were determined and used to produce prevalence ratios to account for variations in the prevalences across the study period.

These data were obtained using computer-aided interviews before the start of the COVID-19 pandemic and telephonically following the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Descriptive data on quitting motivations averaged during the study period were provided. Moreover, log-binomial regressions were used to analyze the data while also considering possible mediating factors such as age, sex, occupational social grade, number of family children, and vaping status.

A sensitivity analysis examining current health concerns and prospective health problems was also conducted to identify differences.

Study findings

Of the 101,919 individuals included in the study, 96% provided information on past-year smoking cessation attempts, with 34% reporting seriously trying at least once. Health-related concerns were the most often mentioned motivation among 52% of the study cohort, particularly future health-related concerns at 36%.

Financial concerns were the second most common motivator, followed by societal considerations and medical expert recommendations at 23%, 19%, and 12%, respectively, whereas 0.6-3.7% of individuals supported other motivations.

By 2020, the percentages of efforts to quit cigarette smoking prompted by health-related concerns, social considerations, and costs increased to 56%, 24%, and 26%, respectively. The percentage of health professionals providing guidance declined to 8%; however, health-associated and social motive rates significantly reduced to baseline levels or less from over 50% to 16% and 22%, respectively.

Health problems were consistently noted to be the most common reason for attempting to quit smoking, as these factors were expressed by 48-56% of individuals across all demographics. These factors were more frequently reported by individuals 35 years and older, as well as those who did not have children at home.

Older individuals, women, and those of a lower socioeconomic status were more likely to indicate current health difficulties as a motivating factor. Those who did not have children at home were also more likely to be motivated by present and future health problems.

Individuals from middle socioeconomic classes and those who actively vaped were more likely to report cost as a motivating factor to quit smoking. Younger individuals from middle-class families, those with children, and those currently vaping were more likely to report social motives. Older women from lower socioeconomic classes were more likely to quit smoking following health practitioner advice.

There were minimal overall changes in quit attempts prompted by health problems throughout the study period. However, the percentage of individuals expressing health problems as a reason for their recent efforts to stop increased in 2020, with a peak at 56% during October 2020 before reverting to baseline rates by December 2021.

This tendency was primarily influenced by forthcoming health problems, with slight changes over time in smoking cessation attempts prompted by present health issues.


Health concerns continue to be the most frequent reason to quit smoking. However, after 2020, the emphasis shifted to cost rather than societal considerations, and healthcare provider recommendations.

These changes likely resulted from the COVID-19 pandemic, which increased health concerns, particularly among older individuals and those in lower occupational and social categories. The rising expense of smoking is also a critical motivation for quitting, thus emphasizing that prospective savings could encourage quitting efforts.

Future studies are needed to explore the reasons for inhibited efforts based on health professional guidance and develop improved solutions.

Journal reference:
  • Jackson, S. E., Cox, S., Buss, V., et al. (2024). Trends in motives for trying to stop smoking: a population study in England, 2018–2023. BMJ Public Health. doi:10.1136/bmjph-2023-000420
Pooja Toshniwal Paharia

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.


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