Have there been sustained impacts of the Covid-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022

Background: This study aimed to examine whether there have been sustained impacts of the Covid-19 pandemic on smoking patterns in England. Methods: Data were from 101,960 adults ([≥]18y) participating in a monthly representative household survey between June-2017 and August-2022. Interview were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March-2020) with current smoking, uptake, cessation, quit attempts, medium-term abstinence, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure. Findings: Before the Covid-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RR{Delta}trend=1.06, 95%CI=1.02-1.09). This slowing was evident in more but not less advantaged social grades (RR{Delta}trend=1.15, 1.08-1.21; RR{Delta}trend=1.00, 0.96-1.05). There were sustained step-level changes in different age groups: a 34.9% (95%CI=17.7-54.7%) increase in smoking prevalence among 18-24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95%CI=4.4-21.9%) decrease among 45-65-year-olds. There were sustained increases in quitting among past-year smokers, with a 120.4% (95%CI=79.4-170.9%) step-level increase in cessation and a 41.7% (95%CI=29.7-54.7%) increase in quit attempts. Interpretation: In England, the rate of decline in adult smoking prevalence stagnated during the Covid-19 pandemic. Potential reductions in smoking prevalence among middle-aged adults and sustained increases in quitting among smokers may have been offset by a sustained rise in uptake among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.