Trends in daily cigarette consumption among smokers: a population study in England, 2008-2023

Objectives To estimate time trends in cigarette consumption among smokers in England between 2008 and 2023, and explore differences by key potential moderators. Methods We used data from 57,778 adult cigarette smokers participating in a nationally-representative monthly cross-sectional survey between January-2008 and September-2023. We estimated monthly time trends in mean daily consumption of (i) any, (ii) manufactured, and (iii) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. Results Overall cigarette consumption fell from 13.6 [95%CI=13.3-13.9] to 10.6 [10.5-10.8] per day between January-2008 and October-2019 (a 22% decrease), then remained stable up to September-2023. Over this period, the proportion mainly/exclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1-32.1%] in 2008 to 52.1% [49.7-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January-2008 to 5.0 [4.7-5.3] in September-2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9]. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. Conclusions Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October-2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco.