We are family:
Delivering more smokefree families
in England
Executive summary
Smoking rates in England and across the UK have fallen sharply over recent decades. The smoking ban, increased taxation, regulation and alternative products have all played an important role.
However there are still 5.3 million adults smoking in England1. Smoking costs the public finances £17 billion, significantly more than it raises in taxes through duties and VAT2. Direct NHS costs are £2.4 billion3.
In October 2023 Prime Minister Rt Hon Rishi Sunak MP announced that the Government would ban smoking for all those born after 1 January 2009, starting in January 2027, creating a ‘smokefree generation’4. The announcement also included £70 million a year for local authority stop smoking services and £15 million for national anti-smoking campaigns5. Such moves followed previous announcements on a new national ‘Swap to Stop’ scheme supporting 1 million smokers to swap cigarettes for vapes and up to £10 million over two years for financial incentives to support all pregnant smokers to quit6.
Such investments and actions will significantly support efforts to deliver the ambition of less than 5% of people smoking in England by 2030. However to reach this target an estimated 3.2 million fewer people will be smoking by the turn of the decade – representing a challenging reduction rate of 60%.
One area for concerted action to deliver on this is increasing the number of smokefree families with children. This report finds that there are an estimated 1.8 million households in England with children where someone smokes. The highest proportion of these households are in the East and North East of England.
The impacts of second hand smoke in the home have been known for decades7. In the early 2000s the Royal College of Physicians published a set of papers8 which found that over 20,000 cases of lower respiratory tract infection, 120,000 cases of middle ear disease, and at least 22,000 new cases of wheeze and asthma were all caused by passive smoking in children each year in the UK9. Women with partners who smoke are less likely to quit smoking and to relapse after pregnancy10. Children who grow up in smokefree homes are less likely to smoke11.
To date policy in this area has often focused on supporting the woman during pregnancy to quit. Smoking in pregnancy rates have fallen, but not at the rate desired12. The age group with the highest smoking rate is the 25–34 year old group and there is evidence from the pandemic that smoking rates amongst younger age groups could be on the rise13.
This report advocates new immediate action for delivering more smokefree families in England. This includes bringing in measures before 2027 to increase the age of sale from 18 to 21, using a tobacco levy to further improve access to stop smoking services and investing in improving broader public health14.
It also calls for new public health campaigns to improve awareness on the harms of smoking particularly targeted at younger generations, using plans for pack inserts to communicate messages on the importance of families for going smokefree and extending planned financial incentives for pregnant women to their partners in areas with higher rates of smoking. There is much good practice locally, such as that in Manchester and Newcastle, as well as internationally in Canada that should be learnt from and scaled.
Ambitions for creating a smokefree generation are right and have rightly been applauded.
However more work here and now is needed to combat smoking. Too many children are growing up in homes where someone smokes. More support is needed for pregnant women and their partners to quit smoking.
More smokefree families will have wider benefits, helping to tackle health inequalities, improve child and maternal health, reduce NHS pressures and cut the economic costs of smoking.
Summary of recommendations
To support more families in going smokefree, this report makes the following
recommendations:
- All political parties should use their election manifestos to commit to increase the number of smokefree families
- Number 10 and the Department for Health and Social Care (DHSC) should increase the age of sale for tobacco to 21 before 2027 and the planned introduction of plans to incrementally phase out smoking. Doing so will support efforts at reducing the number of women smoking during pregnancy and increasing the numbers of smokefree families
- HM Treasury should introduce a tobacco levy at the next Budget that caps tobacco company profits and reinvests the funds in further expanding access to stop smoking services and wider public health services
- The DHSC should use increased funding for public health campaigns to specifically support more families in going smokefree and running such campaigns year-round
- The DHSC should ensure plans for pack inserts include messages that support pregnant women, mothers with young children and their partners in quitting smoking
- The DHSC should consider opportunities for expanding the planned incentive programme for pregnant women to quit smoking to their partners. Initially this could be done through a targeted approach in local authorities with higher smoking rates as part of efforts to address wider health inequalities
- The National Institute for Health Research (NIHR) should fund a new set of evidence collection on models and approaches for increasing the number of smokefree partners of pregnant women and women with children in England. This research should be channelled into regions of the country with the highest proportions of families with children where someone smokes
- NHS England’s Workforce, Education and Training Directorate and the Office for Health Improvement and Disparities (OHID) should work with the medical colleges and relevant charities on new evidence based material for engaging with young families on the benefits of going smokefree
- Both the Government and Opposition should include the necessary increases in the community health workforce, including health visitors and district nurses, in their upcoming manifestos
7 https://www.ncbi.nlm.nih.gov/books/NBK44330/#:~:text=In%201981%2C%20the%20first%20major,1981
9 https://shop.rcplondon.ac.uk/products/passive-smoking-and-children?variant=6634905477
13 https://smokinginengland.info/graphs/top-line-findings
14 https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete
This research report from Future Health has been commissioned and funded by Kenvue*. The report was authored by Future Health and the final content is editorially indpendent.