What is tobacco?
Tobacco is the dried leaves of plants from the Nicotiana genus that grow in many parts of the world. Around 70 species of tobacco are known, but the species grown commercially is usually N. tabacum. The main active ingredient is nicotine.
Most tobacco used in this country comes from America and is sold as cigarettes. Cigars and pipe tobacco are made from stronger, darker tobacco. Snuff is powdered tobacco that is sniffed up the nose.
Tobacco is often used when making cannabis cigarettes or joints. Both rolling tobacco and tobacco removed from packet cigarettes are mixed with resin or herbal cannabis and rolled into cigarette papers.
Tobacco smoking involves the inhalation of tar, nicotine, carbon monoxide and other gases. Nicotine is a stimulant drug which increases pulse rate and blood pressure. Regular smokers often find smoking combats anxiety and stress, helps concentration and alleviates boredom. Some also find it suppresses appetite. First time users often feel sick, dizzy and suffer headaches.
Tolerance develops quickly to the effects of nicotine so more is needed to get an effect. Most people who smoke become dependent and feel restless and anxious if they try to stop. Very few people find they can just have the occasional cigarette. They tend to either smoke a number a day or not smoke at all.
Regular, long term smoking greatly increases the risk of a number of serious diseases including lung and other cancers, heart diseases, bronchitis, bad circulation and ulcers. In 2019, 74,600 deaths were attributed to smoking in the UK. However, the number of deaths caused by smoking has been decreasing: in 2018 there were 77,000, in 2009 there were 82,000 (NHS Digital’s Statistics on Smoking, England 2020). In 2020 there were 26,935 deaths due to lung cancer in England. The mortality rate for lung cancer in England was 49.6 per 100,000. This continues the general downward trend for lung cancer mortality (Official Statistics Local tobacco control profiles for England: short statistical commentary, December 2021).
Women who smoke cigarettes during pregnancy tend to give birth to babies of smaller birth weight. Smoking whilst taking oral contraceptives (‘the pill’) increases the risk of heart and circulatory problems.
Exposure to second hand tobacco smoke also damages health. According to the Health Survey for England 2015 referenced in NHS Digital’s 2018 statistics, of those aged 16+, 31% of men and 26% of women self-reported at least some exposure to secondhand smoke. Those aged 16-24 were most likely to report exposure to secondhand smoke with over half of this group reporting some exposure.
Electronic cigarette (e-cigarettes) are devices that enable the user to inhale nicotine. They work by heating and vaporising a solution that contains nicotine, glycerine and sometimes flavourings. Since there is no burning involved, there is no smoke and there is no tar or carbon monoxide produced – two of the most harmful products of smoking. Inhaling nicotine from an e-cigarette is referred to as vaping.
During the last five years e-cigarettes have become increasingly widely available and popular. While there are some public health concerns over the uptake of e-cigarettes by non-smokers, many doctors believe that they can help smokers quit or reduce their tobacco consumption. In fact, they may begin to be prescribed on the NHS to help people stop smoking. If so, it would be the first country in the world to do so.
According to the annual survey, Smokefree GB, carried out for ASH by YouGov in 2021:
- 7.1% of the adult population in Great Britain are e-cigarette smokers. That’s 3.6 million people.
- Nearly two thirds of current vapers are ex-smokers (64.6%)
- The proportion of adult smokers who have never tried e-cigarettes is continuing to decline slowly to 30.1% in 2021
- Fewer than 1% of never smokers are current vapers (amounting to 4.9% of vapers).
- As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%).
This suggests that very few non-smokers have taken up using e-cigarettes. However an NHS report Smoking, Drinking and Drug Use among Young People in England, 2021 (2022) found that e-cigarette use (vaping) among pupils has increased to 9%, up from 6% in 2018. Around 1 in 5 (21%) 15-year old girls were classified as current e-cigarette users.
New rules for e-cigarettes and their refill containers came into effect in the UK on May 20 2016. These rules ensure that there are minimum standards for the safety and quality of all e-cigarettes and refill containers.
For more information see our e-cigarettes DrugSearch page.
Heated tobacco products are electronic devices that contain tobacco leaf, also known as ‘non-combustible cigarettes’ or ‘heat not burn cigarettes’ . The device uses electricity to heat the tobacco leaf to a high temperature without burning it, creating a vapour that can be breathed in.
Prevalence of cigarette use
- In the UK, in 2021, 13.3% of people aged 18 years and over smoked cigarettes, which equates to around 6.6 million people in the population; this is the lowest proportion of current smokers since records started in 2011.
- Of the constituent countries, the highest proportion of current smokers in 2021 was in Scotland (14.8%) and the lowest was in England (13.0%); Wales and Northern Ireland reported 14.1% and 13.8% current smokers, respectively.
- In 2021, 15.1% of men smoked compared with 11.5% of women in the UK; this trend has been consistent since 2011.
- In the UK, those aged 25 to 34 years had the highest proportion of current smokers (15.8%), compared with those aged 65 years and over who had the lowest (8.0%) in 2021.
- In the UK, those who had no qualifications were more likely to be current smokers (28.2%) than those whose highest level of education was a degree or equivalent (6.6%) in 2021.
The publication Local tobacco control profiles for England: short statistical commentary, December 2021 from gov.uk reveals that:
- The prevalence of current smokers in the routine and manual occupation group (18 to 64) for 2020 (April to December) was 21.4%.
- The prevalence of current smokers was highest in the North East (13.6%) and the North West (13.4%) and lowest in the South West (10.9%).
- Smoking prevalence and smoking-related mortality rates were highest in the most deprived areas.
- The prevalence of ex-smoking among adults (18+) in 2020 was 26.3% and of those who have never smoked was 61.6%.
And according the the NHS report Smoking, Drinking and Drug Use among Young People in England, 2021 there has been a decrease in the prevalence of smoking cigarettes among young people, 12% of pupils had ever smoked (16% in 2018), 3% were current smokers (5% in 2018), and 1% were regular smokers (2% in 2018).
The COVID-19 pandemic’s effect on smoking
A new Public Health England survey of 2,000 smokers in September 2021 has revealed that 45% of smokers have been smoking more since the first lockdown began. Reported reasoning is due to being bored in the lockdowns (43%) or the COVID-19 pandemic making them more anxious (42%). The full survey results can be seen on Gov.uk.
Epidemiological studies suggest that 1.1 billion people smoke globally and there are 68 million vapers. This suggests a considerable uptake of e-cigarettes given that they have only been available for around a decade and that there is opposition to vaping in many countries.
Charred tobacco seeds recently discovered by archeologists in an ancient Utah fireplace suggest that humans have used tobacco for over 12,300 years. Tobacco was first brought to England in the second part of the 16th century by Sir Walter Raleigh. By the early 1600s it was sold in specialist tobacconist shops, grocers and drapers. Many Europeans made extravagant claims about the use of tobacco to cure a variety of diseases and ailments. Initially smoking tobacco for pleasure was confined to the wealthy classes but its use gradually spread.
In the early 1600s King James and the clergy came out strongly against smoking tobacco and regarded it as a risk to morals and health. Rather than attempting to completely ban it the King raised the duty on its importation. Other countries took a more draconian view. Tobacco smoking could be punished by death in Persia or China.
From the late 17th century to early 19th century snuff replaced pipe smoking as the main way tobacco was used in England. Cigar smoking also became more common.
Cigarettes were first introduced to England by troops returning from the Crimean War (1854-86) who had seen French and Turkish soldiers smoking them. At this time cigarettes were of the roll-your-own variety. By the 1870s English companies started making ready rolled cigarettes but it was not till the 1880s, with the development of automatic machinery, that cigarettes as we know them today became widely available. Filter tip cigarettes were first introduced in the 1950s.
During the 1960s tobacco smoking became associated with health problems. Until that time tobacco products were often seen as health enhancing and a good way or relaxing. Smoking was even advertised by famous sportsmen.
Health warnings led to a fall in tobacco consumption in developed countries, increased tax on tobacco products, controls on advertising, low tar varieties and bans on smoking in public places. Concerns over health also led to new products and schemes to help people stop smoking, including smoking cessation groups, nicotine patches, chewing gums and e-cigarettes.
It has been revealed that the tobacco companies knew for many years before it became public knowledge that regular smoking was closely linked to cancer. This has led to a number of court cases in the USA from those seeking compensation.
It is not illegal to buy, possess or use tobacco products.
Since 2003, tobacco advertising and promotion are banned in the UK, following the passage of the Tobacco Advertising and Promotion Act in December 2002.
New tobacco product stock was required to display pictorial warnings from October 2008. And in May 2016 the warnings were required to cover the top 65% of the front and back of the packet. As of May 2017, all tobacco products must be sold in plain, standardised packaging with no logos or promotional images or text.
Since 1st July 2007, smoking in virtually all enclosed public places and workplaces has been banned throughout the UK and from the 1st October 2007 the cigarette buying age was raised from 16 to 18. In October 2015 it was also made illegal to smoke in a car (or other vehicle) with someone under 18.
UK smokers spend around £15.6bn a year on legal and illicit tobacco.
In the UK, a packet of 20 cigarettes costs between £13.60 for the most expensive cigarettes and £9.73 for the cheapest.
The future: a smoke free Britain
Every October the NHS run a prevention campaign called Stoptober which aims to support people in quitting smoking.
A new report published in June 2021 sets out the All Party Parliamentary Group on Smoking and Health’s recommendations for the Tobacco Control Plan to deliver a Smokefree UK by 2030. They note how Government action to end smoking is both needed and wanted, with three quarters of the public supporting both the ambition and Government action to deliver it.
The Government’s goal for the UK to be smoke free by 2030 has since been independently reviewed (published June 2022) by Dr Javed Khan OBE in The Khan review: making smoking obsolete. 15 recommendations were made in the review including four ‘critical’ recommendations:
- Urgently invest £125 million per year in a comprehensive smoke free 2030 programme. Options to fund this include a ‘polluter pays’ levy.
- Increase the age of sale by one year, every year.
- Offer vaping as a substitute for smoking, alongside accurate information on the benefits of switching, including to healthcare professionals.
- For the NHS to prioritise further action to stop people from smoking, by providing support and treatment across all of its services, including primary care.
In April 2023 the government announced a new ‘Swap to stop’ scheme and other measures informed by the recommendations in the Khan review. As part of the scheme 1 in 5 smokers in England will be given a vape starter kit and behavioural support to help them quit. At the same time the government also plans to prevent children and non-smokers from taking up vaping by cracking down on illicit vape sales.
As another measure, the government will also consult on introducing mandatory cigarette pack inserts with positive messages and information to help people to quit smoking.
Further, the press release also states that all pregnant women who smoke will also be offered financial incentives to give up smoking and behavioural support by the end of the year.
As well as helping smokers quit, the government also aims to stop children from starting to smoke. In October 2023 the government announced it would be introducing new legislation to create ‘the first smokefree generation’. The proposed legislation would make it illegal to sell tobacco products to children turning 14 this year or younger so they would never be legally sold tobacco products. Anyone who can legally buy cigarettes now would not be prevented from doing so in future but the sale of cigarettes will be phased out over time.
Current and past trends in tobacco and e-cigarette use and the impact of control measures: an analysis of survey data and other evidence (2021)
Current and past trends in tobacco and e-cigarette use and the impact of legislative and regulatory controls on smoking and e-cigarette use behaviours are outlined in this multi-method research | NatCen, UK
Updated October 2023