Beard, E;
West, R;
Jarvis, M;
Michie, S;
Brown, J;
(2019)
'S'-shaped curve: modelling trends in smoking prevalence, uptake and cessation in Great Britain from 1973 to 2016.
Thorax
, 74
(9)
pp. 875-881.
10.1136/thoraxjnl-2018-212740.
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Abstract
Background: It is widely believed that the long-term to declining smoking prevalence naturally slows as the smoking population ‘hardens’ and that progress in prevalence reduction has come primarily from reducing uptake rather than increasing cessation. To address these issues, we undertook the first formal attempt to model the trajectory of smoking prevalence and indices of uptake and cessation in Great Britain from 1973 to 2016. Methods: Data from the General Lifestyle Survey (1973-2010), Integrated Household Survey (2009-2014) and Annual Population Survey (2015-2016) were used to model year-on-year changes in cigarette smoking prevalence in people aged 18+, ever-smoking in 18-24 year olds as an index of uptake, and the quit ratio (proportion of ever smokers who do not currently smoke) as an index of cessation. We used a pre-specified plan (https://osf.io/8gsk7/) aiming for the most parsimonious models that fitted the series. Findings: For all three outcomes, changes over time were best fitted by what may be broadly characterised as ‘S’-shaped curves: segmented functions characterised by initial rapid progress, a slowing or reversal, then renewed progress. Smoking prevalence in Great Britain showed a decelerating decline over time between 1973 and 2000, but then, after the introduction of the national ‘Smoking Kills’ tobacco control plan, the decline accelerated again and has remained nearly linear at -0.67 percentage points per year. Ever-smoking in young adults showed a decelerating decline which eventually ceased and began increasing around 1994 but then declined again after 2000. Quit ratios rose rapidly then slowed and then accelerated around 2000 and again more recently in 2013. Interpretation: Long-term trends in smoking prevalence, uptake and cessation in Great Britain have followed a broadly ‘S’-shaped trend suggesting that it is responsive to major tobacco control initiatives. The decline in prevalence has resulted both from reductions in uptake and increases in cessation.
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