BACKGROUND AND IMPLEMENTATION CHALLENGES: Smoking rates have declined aross England in recent decades. Adult prevalence has fallen from 25% in 2004 to 11.9% in 2023. This is due to a comprehensive tobacco control approach, building upon global, national and local tobacco control efforts. However, investment in regional (or provincial/state) tobacco control efforts has been patchy across England over this period, despite strong evidence of impact.
INTERVENTION OR RESPONSE: Several regions across England have developed coordinated regional tobacco control programmes by pooling local resources and providing leadership and economies of scale across their geographic areas. These are predominantly in the North of England where smoking rates have historically been highest (e.g. North East, North West, Humber and North Yorkshire). These programmes deliver targeted approaches to work such as tackling the illicit tobacco trade, media campaigns, advocacy, research, policy development, innovation and co-ordinated support for local action on tobacco. They aim to change social norms around smoking and tackle generational health inequalities linked to tobacco.
RESULTS AND IMPACT: Smoking rates have fallen fastest in those regions which have sustained co-ordinated tobacco control programmes. A 2024 study found that smoking rates have fallen faster in the North of England than elsewhere over the last 20 years, and that regions with sustained regional tobacco control activity saw greater declines in smoking prevalence (−18.1%) than regions with none (−12.8%). In addition, socio-economic inequalities in smoking prevalence narrowed most in Yorkshire and the Humber (-17.9%) over the same period.
CONCLUSIONS: Regional tobacco control programmes have accelerated the decline in adult smoking rates in parts of England, especially in regions with traditionally high prevalence. They also helped to narrow the socio-economic gap in smoking rates. Such programmes complement international, national and local activity. and provide insights for other countries about the role of sub-national programmes which can connect local delivery to national policy goals.