Research and analysis

Smoking prevalence in adults commentary: current smokers aged over 18 years by wellbeing group and region

Published 8 March 2021

Applies to England

Introduction

This publication presents data on the relationship between smoking and wellbeing and shows that low wellbeing is associated with higher smoking prevalence, with increasing levels of low wellbeing between 2019 and 2020.

These analyses were undertaken by Public Health England (PHE) on data from the Annual Population Survey (2019) and the Opinions and Lifestyle Survey 2020. More data on smoking prevalence can be found in the Local Tobacco Control Profiles.

Background

People with mental health conditions are more likely to smoke than the general public and smoking rates increase with the severity of illness. In addition, those smoking more than 15 cigarettes a day are more likely to experience a common mental health disorder than those who smoke fewer cigarettes or do not smoke at all, and 40% of cigarettes smoked in England are smoked by people with a mental health problem.

The Annual Population Survey (APS) is a large continuous household survey run by the Office for National Statistics, questioning around 320,000 people (160,000 in England) per year.

The Opinions and Lifestyle Survey (OPN) was transformed in 2020 and adapted for COVID-19 specific questions, increasing the sample size to around 2,000 respondents per week. Both surveys ask the same 4 wellbeing questions and respondents provide a score between 0 and 10 for each question. These can be used as a proxy for low wellbeing:

• overall, how satisfied are you with your life nowadays?
• overall, to what extent do you feel the things you do in your life are worthwhile?
• overall, how happy did you feel yesterday?
• overall, how anxious did you feel yesterday?

Smoking and wellbeing

Low wellbeing and smoking in England, 2019

In 2019, an estimated 4.7% of the population reported low life-satisfaction, 3.7% reported low self-worth, 8.3% reported low happiness and 20.7% reported high anxiety.

Whilst smoking prevalence was around 13% in people who did not experience low wellbeing, smoking prevalence was significantly higher in people who did. Around 30% of people in England reporting low life-satisfaction and low self-worth were current smokers, along with almost a quarter of people reporting low happiness and 18% of those with high anxiety.

Looking at low wellbeing in smokers, more than a quarter of smokers in England reported having high anxiety in 2019, estimated to be around 1.6 million people. Fourteen per cent of smokers reported low happiness, 10% low life-satisfaction and 8% low self-worth.

Low wellbeing and smoking during the coronavirus pandemic, 2020

In 2020, levels of low wellbeing increased, with double the number of people reporting low life-satisfaction (9.8%) and self-worth (7.5%) compared with 2019 and more than a third (34.3%) reporting high anxiety.

Smoking prevalence remained at around 13% in those people who did not experience low wellbeing, with around 24% of people reporting low self-worth and life-satisfaction being current smokers, along with 23% of those reporting low happiness and 16% of those reporting high anxiety.

In 2020, 38% of smokers (an estimated 2.4 million people) reported high anxiety, 21% of smokers reported low levels of happiness, 17% reported low life-satisfaction and 13% reported low self-worth.

Low wellbeing and smoking by region

Some variation was seen between regions, though in all areas higher smoking prevalence was reported amongst those who experienced low wellbeing.

The 2020 data shows that:

• more than 40% of smokers in the North East, North West, East Midlands and East of England reported high anxiety compared with around a third of non-smokers in the same regions
• more than 20% of smokers in the majority of regions reported low happiness, with the highest being 25% of smokers the North East – this compares to a high of 13% in non-smokers
• around 20% of smokers in London, the North East and East Midlands reported low life-satisfaction compared to less than 10% in non-smokers
• the percentage of smokers reporting low self-worth ranged from 20% in the North East to 11% in the South East, compared to 8% and 6% respectively in non-smokers