Smoking appears to be on the rise once more in some parts of England, warn researchers who have been tracking trends over two decades.
An analysis of the effectiveness of regional tobacco control strategies also found that a large North-South divide in smoking prevalence seems to have disappeared.
But data from 2006 to 2024 shows that progress in smoking cessation seems to have stalled in recent years with indications of rising rates in some areas.
The UK Government target for smoking prevalence to be below 5% by 2030 is unlikely to be met, the figures suggest.
Yet the study points to the success of sustained dedicated regional tobacco control programmes.
Smoking Toolkit Study data from 368,057 adults in England over the 18-year period showed the greatest drops in smoking prevalence in areas with regional tobacco control programmes which were largely concentrated in the North, including Yorkshire and the Humber, Greater Manchester and the North East.
Overall 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%), they reported in Addiction.
In the North East which had the longest and most consistent tobacco-control programme, smoking prevalence fell by 13.3%, compared with 9.3% in regions with none, the researchers from University College London said.
Socioeconomic inequalities in smoking prevalence between more and less advantaged social grades fell most in Yorkshire and the Humber from 17.9 percentage points to 3.7 they found.
The East Midlands, West Midlands, east of England, and south east had no dedicated tobacco control activity across the study period, they noted.
It has meant the narrowing of significant gaps in smoking prevalence between different areas of the country, they concluded.
Lead author Dr Sarah Jackson, principal research fellow at the UCL Institute of Epidemiology and 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 programmes have been largely concentrated.’
But she added: ‘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 programmes that help people quit – tackling smoking must be a key priority as our health services evolve.’
RCGP chair Professor Kamila Hawthorne said general practice had played a major part in encouraging millions of people to quit the habit.
‘It’s really encouraging to see that smoking rates have dropped across England and that differences between regions are beginning to narrow. But it’s concerning to see rates stagnate and even rise in some areas.’
In February, NICE recommended GPs could prescribe cytisine as another option to help people stop smoking.
