Smoking is down to 10% – now comes the hard part

In October 2026, the Office for National Statistics (ONS) announced a historic milestone: that for the first time ever, fewer than 1 in 10 adults in the UK are smokers [1]. While this marks extraordinary progress, smoking remains the nation’s leading avoidable killer.

To unpack the importance and challenges of smoking cessation interventions, and where policy should go from here, we sat down with Chief Executive Officer Matthew Taylor and Project Director Robert Malcolm to discuss. In this blog, you can read their reflections on what this incredible landmark means and how YHEC’s work in the field has impacted public policy.

This is a massive achievement. How much of it comes down to behavioural change interventions?

Mat:
We shouldn’t downplay the shift in public behaviour, but behind that shift is decades of targeted intervention modelling. Our work in smoking cessation has probably saved more lives than anything else we’ve done. Smoking is directly linked to a huge list of fatal conditions, so every fraction of a percentage point drop represents thousands of lives saved.

Rob:
To go a step further, if you stratify the data by the Index of Multiple Deprivation (IMD), smoking prevalence remains significantly higher in areas of high deprivation. That’s where health inequalities compound. Getting someone to quit in a high-deprivation community not only means that they live longer, healthier lives, but also brings that gap in health inequalities closer together. But that means we must make sure that the right services are actually reaching them.

How does implementation science change the success rate of quitting?

Rob:
Research shows that the decision to quit smoking is often highly spontaneous. If a person decides to quit, but has to wait weeks for an appointment, that momentum evaporates. Implementation is key. For example, when cessation support was integrated directly into lung cancer screening programmes in Manchester, uptake of smoking cessation increased from around 16% to approximately 75% of people still smoking. When you capture people at the point of care, the impact is enormous. It’s really around identifying and removing the barriers to accessing treatment that is key.

Mat:
Smoking cessation doesn’t behave like typical chronic disease management. In chronic care, a treatment might fail clinically and we move onto a new treatment, whereas with smoking, people may simply drop out after a failed quit attempt. Once that happens, you don’t know if or when they’ll ever attempt to quit again. We also see huge variations in how services are delivered. Approximately half of people going through treatment do not receive pharmacological support alongside behavioural therapy. However, combining pharmacological interventions with behavioural support is far more successful than relying on behavioural therapy alone. Where we still lack robust evidence is in treatment sequencing: knowing exactly which intervention to deploy, and in what order, to help that patient succeed, assuming they don’t just drop out after a failed quit attempt.

What role does secondary care play in smoking cessation?

Mat:
Secondary care offers a massive, often overlooked opportunity. Look at oncology: Kaplan-Meier survival curves clearly show that quitting post-diagnosis significantly improves survival outcomes. It is literally never too late to quit. We even see it in acute trauma care, where nicotine patches are applied to comatose patients in intensive care due to the effects of nicotine withdrawal, while there is clear evidence smoking tobacco severely impairs tissue healing and greatly increases infection rates. Cultural shifts matter too; policies like banning NHS staff from smoking in uniform helped reframe smoking as a core clinical issue, rather than a lifestyle choice.

Rob:
Different demographics also need different mechanisms. In maternity care, our soon to be published research showed that financial incentive vouchers for pregnant women are incredibly effective and cost effective, but that is not necessarily the case for every population. Tailoring the intervention to the population is key.

Are current policy models still underestimating the true impact of smoking on health systems?

Mat:
Definitely. Years ago, health economic models typically evaluated smoking against around six primary comorbidities. Recent studies have expanded that view, proving clear causal links to Alzheimer’s disease, dementia, kidney disease, and several other systemic conditions [2].

Rob:
The broader structural hurdle is funding: who pays versus who benefits? Cessation often falls under public health budgets, but the fiscal and clinical benefits are reaped downstream by NHS acute care, oncology, or maternity units. Because the savings don’t directly return to the funder’s budget, services don’t always get adequate funding.

Mat:
We also frequently encounter the economic misconception around lost tobacco tax revenue for HMRC. From an economic standpoint, tax is a transfer payment – it isn’t a net loss to society. When people stop buying cigarettes, that money doesn’t disappear; it shifts into other goods and services across the economy.

Where do e-cigarettes fit into future strategy, and how do we maintain momentum?

Rob:
E-cigarettes, or ‘vapes’, have filled a significant harm-reduction gap, but the retail market lacks the rigorous regulation seen with traditional tobacco. However, in clinical settings where unflavoured, non-colourful nicotine vapes are prescribed as a structured cessation tool, there is a clear, evidence-based role for them [3]. It’s important to note that vapes still come with risks. They are less harmful than smoking, but still cause harm, and that is becoming a bigger concern across society. This is because people who never smoked, are now taking up vaping, with more and more evidence outlining the harms they cause.

Mat:
Moving forward, we can’t assume that the decline in smoking rates will remain linear. The easy wins are behind us. To break generational smoking cycles, where children of smokers are far more likely to take up the habit, we must continually innovate and remove barriers to quitting. Most people who smoke want to quit, but there are barriers to accessing treatment that we need to try and break. Look at models like New Zealand, where nicotine replacement therapies were made directly available through GP clinics, without any need for prescriptions or even an appointment, you could just collect them and go. If we want to reach the end game for tobacco, we need more implementation science research to break down the remaining barriers of entering cessation services.

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To read about our work in smoking cessation, you can find our publications on our website or contact us to find out more.