Objectives To determine whether the European Commission Eurobarometer survey of 27 European Union (EU) member states produces reliable smoking prevalence estimates when compared to national prevalence survey data, and to identify approaches to standardising the measurement of smoking prevalence in the EU. Methods This was a direct comparison of questions, sampling methods and smoking prevalence estimates, between the 2006 Eurobarometer study and contemporaneous national surveys. All 27 EU member states were included. Participants were people surveyed in the 2006 Eurobarometer study and in various national surveys in the closest year to 2006 for which data were available. The main outcome measures were the mean and range of differences in prevalence estimates between the Eurobarometer and national surveys. Results Most national surveys used similar multistage sampling methods and involved sample sizes of 3000 or more, but the phrasing of the questions used to define smoking, the inclusion or exclusion of occasional smokers, the age ranges of participants and the frequency of national surveys varied substantially between countries. The Eurobarometer study used the same questions in all countries but in sample sizes of 1000, or in 3 countries, 500. Eurobarometer 2006 smoking prevalence estimates were on average 0.37 percentage points higher than those in national surveys, but with a 95% range from −10.49 to +11.23 percentage points. At the extremes, the equivalent national prevalence estimate for Slovakia was 13.0% higher and for the UK 10.0% lower than the Eurobarometer figure. Conclusions Measurements of the prevalence of smoking, the biggest avoidable public health threat in the European Union, are highly discrepant within countries between national and European Commission survey estimates. Monitoring national smoking prevalence on a regular basis, using standardised methods in representative population samples, is an urgent priority for the EU.

Background and aims: Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age–period–cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.Design: APC analysis of repeated cross‐sectional smoking prevalence data obtained from three nationally representative surveys.Setting: England (1972–2019).Participants: Individuals aged 18–90 years.Measurements: We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2‐year survey periods (1972–73 to 2018–19) and 20 groups of 5‐year birth cohorts (1907–11 to 1997–2001). Age and period rates were studied for two groups of birth cohorts: those aged 18–25 years and those aged over 25 years.Findings: Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41–1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04–0.08). They also decreased almost linearly with period relative to 1972–73 (for 2018–19: OR = 0.30, 95% CI = 0.26–0.34) and with birth cohort relative to 1902–06, with the largest decreased observed for birth cohort 1992–96 (OR = 0.44, 95% CI = 0.35–0.46) and 1997–2001 (OR = 0.35, 95% CI = 0.74–0.88). Smoking declined in the 18–25 age group by an average of 7% over successive 2‐year periods and by an average of 5% in those aged over 25.Conclusions: Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

Aims: To investigate the association between frequency of visiting shops and noticing of tobacco point‐of‐sale (PoS) displays and the development of susceptibility to smoking, or smoking uptake, in secondary school students. Design: Two surveys of a school based cohort study carried out in 2011 and 2012. Settings: Nottinghamshire, UK. Participants: A total of 2270 children aged 11–16 years from eight schools in Nottinghamshire. Measurements: We investigated changes in susceptibility to smoking and smoking status in relation to frequency of visiting shops and noticing PoS displays and number of tobacco brands recognized, controlling for a range of potential confounders. Susceptibility to smoking was defined using a set of three questions covering intentions to try smoking, to smoke within the next year and likelihood of smoking if a best friend offered a cigarette. For the analysis we used multinomial logistic regression. Findings: Among non‐susceptible never smokers, noticing PoS displays more frequently was associated independently with an increased risk of becoming susceptible to smoking [adjusted relative risk ratio (RRR) = 1.74; 99% confidence interval (CI) = 1.13–2.69], but was not associated with smoking uptake. Recognizing a higher number of brands among non‐susceptible never smokers doubled the risk of becoming susceptible to smoking and of becoming a smoker, but this did not have a significant effect on transition to smoking among susceptible never smokers. Frequency of noticing tobacco PoS displays was not associated significantly with smoking uptake among those who were susceptible never smokers at baseline. Conclusions: Noticing tobacco point‐of‐sale displays more often and recognizing a higher number of tobacco brands is associated with an increased risk of becoming susceptible to smoking among adolescents in the United Kingdom, and recognizing a higher number of brands is associated positively with an increased risk of smoking uptake.

Objectives Cigarette price increases reduce smoking prevalence but as a tobacco control policy are undermined by the availability of lower cost alternatives such as hand-rolling tobacco. The aim of this descriptive study is to explore time trends in the price of manufactured cigarettes and hand-rolling tobacco, and in the numbers of people who smoke these products, over recent years in the UK. Settings and participants UK. Outcome measures Trends in the most popular price category (MPPC) data for cigarettes and hand-rolling tobacco from 1983 to 2012 adjusted for inflation using the Retail Price Index, and trends in smoking prevalence and the proportion of smokers using hand-rolling tobacco from 1974 to 2010. Results After adjustment for inflation, there was an increase in prices of manufactured cigarettes and hand-rolling tobacco between 1983 and 2012. Between 1974 and 2010, the prevalence of smoking fell from 45% to 20%, and the estimated total number of smokers from 25.3 to 12.4 million. However the number of people smoking hand-rolling tobacco increased from 1.4 to 3.2 million, and MPPC cigarette price was strongly correlated with number of people smoking hand-rolling tobacco. Conclusions Although the ecological study design precludes conclusions on causality, the association between increases in manufactured cigarette price and the number of people smoking hand-rolling tobacco suggests that the lower cost of smoking hand-rolling tobacco encourages downtrading when cigarette prices rise. The magnitude of this association indicates that the lower cost of hand-rolling tobacco seriously undermines the use of price as a tobacco control measure.