In this article, our CEO, Kelly Evans shares her insights from over 20 years working to reduce smoking prevalence in the UK.
Kelly spent the early part of her career inside the NHS and working for national government shaping policy and communications around tobacco control before setting up Social Change – an agency dedicated to using behavioural science to deliver positive social and environmental change. Over the last decade, Kelly has continued to work on many briefs to reduce smoking prevalence in England and Wales. Here are some of the insights from her work.
I’ve examined changes in smoking behaviour in the UK over the last 20 years through the lens of behavioural science, and believe me, it provides valuable insights into what drives individual, societal, and cultural shifts in behaviour.
The biggest by far is the shift in social norms and the move towards conformity which in the behavioural science field, is known as ‘Social Cogitative Theory’. This is when people conform to behaviours they perceive as socially acceptable. Through much of our work, we looked at Bandura’s Social Cognitive Theory which highlights the role of observational learning and social models in shaping behaviour.
Smoking became socially unacceptable in the UK due to shifting social norms and the de-normalisation of smoking largely in public spaces. Smoking bans in public places and workplaces – and even in cars (e.g., the 2007 UK smoking ban) have reinforced the idea that smoking is not a socially acceptable behaviour. This has been complemented by public health campaigns portraying smoking as undesirable or harmful.
The environment around us shapes our behaviour and changes in this environment, such as the removal of branding on cigarette packs (plain packaging laws introduced in 2016), did reduce smoking's appeal.
We saw how Behavioural nudges, such as the placement of graphic health warnings and hiding tobacco products behind counters, discouraged impulse purchasing. We tested loads of ‘nudges’ over the last 20 years and Nudge Theory (Thaler & Sunstein) was a ‘go to’ in our work because we understood the power of subtle environmental changes to "nudge" individuals toward healthier choices without restricting freedom.
There is no doubt that increasing the cost of smoking through taxation has been a key deterrent.
Cigarettes in the UK have become significantly more expensive over the past 20 years. This economic barrier particularly affects young people and lower-income groups, who are more price-sensitive. Beyond financial cost, we have used Rational Choice Theory in our campaigns to help smokers weigh up the costs and benefits of smoking – and we are not just talking about the financial costs and benefits. We have focused on other costs and benefits that connect people emotionally with the behaviour – such as the impact on children and families and we found this really resonated with people where financial cost was not the number one deterrent.
Breaking smoking habits remains challenging due to its addictive nature, but interventions like nicotine replacement therapy (NRT) and vaping have provided alternatives for smokers.
Behavioural Economics highlights how "substitutes" can help break habits, as quitting smoking involves overcoming both physiological addiction and behavioural routines. The rise of e-cigarettes in the UK as a harm-reduction tool shows a shift in behaviour among smokers looking for less harmful habits and the Government’s endorsement of vaping as a safer alternative has further reinforced this trend. Unfortunately, by jumping to make vaping a ’desirable’ alternative [and not a medicine or treatment] has led to vaping becoming a lifestyle ‘feel good’ product – and even a treat and trend [especially with young people] which present a new problem for public health.
A question I am asked a lot is ‘do shock tactics work’?
I know many people are disappointed when I say ‘it depends’ as it feels like a politicians answer but it really does depend on who you are trying to shock and how. Yes, it can work. Fear-based campaigns, such as graphic anti-smoking ads, play on loss aversion by emphasising the health risks of smoking (e.g., cancer, emphysema) and this worked with some segments of the population – in particular the most educated. For example, when smoking ads started to ‘shock people’ in the 90’s, the first people to give up were doctors. Studies show that fear appeals are more effective when combined with clear instructions on how to quit. It worked for smoking in the UK because there was a lot of support for people who wanted to kick the habit - helplines, mobile apps, and cessation programmes delivered in every community. Without this, it is unlikely shock tactics on its own would have moved the nation towards smokefree.
In the early days, shock tactics worked to bring attention to smoking – and its harms.
But time went on, and people became desensitised, it was time to try something different so we saw a notable shift towards motivation. We started to look at Self-Determination Theory and how it could move people towards stop smoking services. This is the idea that intrinsic motivation, supported by external facilitators, leads to sustainable behaviour change. What we found is that smokers are more likely to quit when they feel autonomous and supported rather than coerced. The growth of personalszed quit-smoking plans and supportive measures, such as workplace cessation programmes, align with this principle. These kinds of programmes increase our motivation to quit.
Smoking rates have declined significantly in the UK, with prevalence dropping from 27% in 2002 to around 12.9% in 2023.
This is a fantastic achievement. The primary drivers have been a mix of regulatory measures, cultural shifts, economic disincentives, and health promotion campaigns. It needed a mix of all of these things, and one alone would not have got us to this place. The key challenge now is how to move the final 12% to a smoke free life.
New technologies (e.g., vaping) and tailored interventions have made quitting more accessible and appealing – but I think we have made some mistakes on the positioning and presentation of vaping that now need to be addressed, especially in young people. Using the same approach we have adopted over the last 20 years to smoking – but accelerating it – we can be both smoke and vape free.
By combining behavioural science insights with empirical data, it’s clear that policies and interventions targeting smoking must address social norms, environmental cues, economic incentives, and individual motivation to sustain progress. If you need some help getting your local population to smokefree, please get in touch with our team.
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