Trends in motives for trying to stop smoking: a population study in England, 2018-2023.

Introduction: Since 2020, people in England have lived through a global pandemic and national cost-of-living and healthcare crises, each of which might have affected motivations to stop smoking. Objective: To examine changes in the factors motivating people to stop smoking over this period. Methods: Data were drawn from a nationally representative monthly cross-sectional survey in England, 2018-2023. Participants were 5777 past-year smokers who made one or more serious attempt to quit in the past year. Participants reported factors contributing to their most recent attempt to quit. We estimated time trends in the proportion of attempts to quit that were motivated by (i) health concerns, (ii) cost, (iii) social factors and (iv) health professional advice, and calculated prevalence ratios (PRs) for the change in prevalence across the whole time series (May 2023 vs March 2018). Results: Up to 2020, one in two attempts to quit were motivated by health concerns (mean monthly proportion 51.0%), one in five by social factors (20.2%) and cost (19.9%) and one in six by health professional advice (16.5%). In 2020, the proportion of attempts to quit motivated by health concerns, social factors and cost increased-to high levels of 56.2%, 23.9% and 25.8%, respectively-and those motivated by health professional advice fell to 8.0%. Rises in health-related and social motives soon returned to baseline levels (52.0% in May 2023 vs 52.5% in March 2018; PR=0.99, 95% CI 0.86 to 1.14) or below baseline (16.0% vs 21.6%; PR=0.74, 95% CI 0.54 to 1.01), respectively. However, attempts to quit motivated by cost increased further during 2022-2023 (reaching 25.4% in May 2023 vs 19.1% in March 2019; PR=1.33, 95% CI 1.01 to 1.76) and those motivated by health professional advice remained suppressed (8.5% vs 14.2%; PR=0.60, 95% CI 0.40 to 0.89). Conclusions: Health concerns are the most common motive for trying to stop smoking. The relative importance of other motives has shifted since 2020, with cost motivating a greater proportion of attempts to quit, and social factors and health professional advice motivating a smaller proportion.