The Scottish Health Survey 2024 - volume 1: main report

8. Smoking

Hannah Biggs

8.1     Introduction

Tobacco is recognised internationally as a major public health threat. More than seven million deaths worldwide each year are a direct result of tobacco use, including an estimated 1.6 million non-smokers exposed to second-hand smoke[i].

Smoking is the cause of around one in five deaths annually and a leading cause of premature death and ill health in Scotland[ii]. Evidence of differences by deprivation in smoking rates and the likelihood that children will grow up in a smoking household/family or have a mother who smoked during pregnancy mean that smoking also remains an ongoing health inequality challenge[ii],[iii]. Smoking-related health risks increase over time but can be substantially reduced following smoking cessation interventions - cost-effective interventions that help to reduce the economic and human cost of smoking-related illnesses and conditions[iv]. Examples include pharmacotherapy, such as nicotine replacement therapy (NRT) or Varenicline.

Less is known about the long-term impact of Nicotine Vapour Products (NVPs). However, these practices and devices are not deemed to be risk-free, particularly where there is dual use alongside tobacco products[v,vi]. Further research to evaluate the long-term effects of NVPs is needed. Whilst NVPs are deemed lower risk than tobacco products, and can serve as a cessation aid, they should not be used by non-smokers or young people. They can cause addiction to nicotine and health harms, such as exposure to toxicants in non-smokers, to which they would not otherwise have been exposed[vii].

8.1.1     Policy background

The overall strategic objective for health in the Scottish Government’s National Outcomes Framework is ‘We are healthy and active’[viii]. This framework is currently being revised. One of the National Indicators monitored by the Scottish Health Survey (SHeS) data is the proportion of adults with two or more of the following health risks: currently smoking, harmful/hazardous drinking, low physical activity and living with obesity[ix].

Scottish Government’s Tobacco and Vaping Framework[x], launched in November 2023, sets out a roadmap to the 2034 target of a Tobacco Free Scotland, reducing smoking prevalence in communities to 5% or less.

Taking forward actions from the Tobacco and Vaping Framework, the Scottish Government has worked with the UK Government and devolved Governments on the development of the Tobacco and Vapes Bill. The Bill, once passed, will ensure that children born after 1 January 2009 can never be sold tobacco and it bans vapes and nicotine products from being deliberately promoted and advertised to children, stopping the next generation from becoming addicted to nicotine. The Bill will also provide powers to extend the indoor smoking ban to certain outdoor settings and create vape and heated tobacco free spaces, subject to full impact assessment and consultation.

8.1.2     Reporting on smoking in the Scottish Health Survey

In this chapter the following data are presented for adults:

• cigarette smoking and e-cigarette or vaping device use
• smoking prevalence estimates without and with saliva cotinine adjustment
• cotinine validated non-smokers’ exposure to second-hand smoke
• use of nicotine replacement therapy and other products that helped successful smoking cessation
• attempts to quit smoking

Figures are reported by age, sex, and area deprivation.

An interactive data dashboard is also available presenting key indicators for Scotland, NHS Boards and local authority areas.

The area deprivation data are presented in Scottish Index of Multiple Deprivation (SIMD) quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised. For a detailed description of both SIMD and age-standardisation, as well as definitions of other terminology used in this chapter and further details on the data collection methods for smoking, please refer to the Scottish Health Survey 2024 - Volume 2: Technical Report.

8.1.3     Comparability with other UK statistics

The Health Survey for England[xi], Health Survey Northern Ireland[xii] and the National Survey for Wales[xiii] provide estimates of smoking prevalence in the other UK countries. The surveys are conducted separately and have different sampling methodologies, so smoking prevalence estimates across the surveys are only partially comparable.

Smoking prevalence estimates from the UK-wide Annual Population Survey (UK) and the Opinions and Lifestyle Survey GB provide fully comparable data for Scotland, England, Wales and Northern Ireland[xiv].

Further breakdowns for smoking can be found in the Scottish Survey Core Questions, which asks harmonised questions across the three major Scottish Government household surveys.

​​​8.2     Results

Summary points

In 2024:

• Fourteen per cent of adults were current smokers, the same level as in 2023, maintaining the overall downward trend in prevalence recorded since 2003 (28%).
• Smoking prevalence was much higher among adults living in the most deprived areas in Scotland (23%), than among those living in the least deprived areas (7%).
• Current use of e-cigarette or vaping devices has increased from the range 5%-7% between 2014 and 2021, to 10%-12% since 2022 (10% in 2024).
• E-cigarette or vaping device use was most prevalent among young adults aged 16-24 (18%), decreasing by age to 2% among those aged 75 and over.
• Around half (52%) of current adult smokers would like to give up smoking.

In 2022/2023/2024 combined:

• Thirteen per cent of adults with a valid saliva cotinine measure self-reported as a current cigarette smoker, which increased to 17% when adjusted for cotinine levels. (Note: the use of products containing nicotine other than NRT or vapes – such as nicotine pouches – may be impacting these results).
• A significantly higher proportion of non-smokers who did not vape had detectable levels of cotinine in their saliva (26%) indicating potential exposure to second-hand smoke. This compares with 21% in 2018/2019 combined, and is similar to the levels recorded in 2012/2013 combined to 2016/2017 combined (24%-26%). (Note: the use of products containing nicotine other than vapes and NRT – such as nicotine pouches – and, potentially, exposure to second-hand vapour, may be impacting these results).

8.2.1     Following a period of decline, smoking prevalence among adults has remained relatively stable at around one in seven since 2022

In 2024, 14% of adults were current smokers, the same level as in 2023, maintaining the overall downward trend in prevalence recorded since 2003 (28%).

Differences in the prevalence of current smokers by sex have been variable across the timeseries, however, a higher proportion of males were current smokers (16%) compared with females (12%) in 2024.

Figure 8A, Table 8.1

8.2.2     Smoking was least prevalent among adults aged 75 and over

In 2024, current smoking was least prevalent among adults aged 75 and over (5%) while for all other age groups prevalence was in the range 12%-17%.

The mean number of cigarettes smoked per day was 11.3 for adult smokers, with no significant difference between males and females (11.6 and 10.9 respectively).

The highest mean number of cigarettes consumed per day was recorded among smokers aged 65-74 (14.8 per day), however, small base sizes for some age groups mean that data by age should be treated with caution.

Figure 8B, Table 8.2

8.2.3     Smoking prevalence continues to be highest among adults living in the most deprived areas in Scotland

As in previous years, the smoking prevalence (age-standardised) was much higher in 2024 among adults living in the most deprived areas in Scotland (23%), than among those living in the least deprived areas (7%).

The findings were indicative of an increase in the mean number of cigarettes smoked per day as deprivation increased, with the highest mean recorded among current smokers living in the two most deprived areas (13.2 and 12.6 per day) and lowest among those living in the least deprived areas (7.5 per day). However, small base sizes for some deprivation groups mean that mean cigarettes smoked per day data by deprivation should be treated with caution.

Figure 8C, Table 8.3

8.2.4     One in ten adults currently use e-cigarettes or vaping devices, with prevalence relatively stable over recent years

Across the timeseries, current use of e-cigarette or vaping devices has increased from a range of 5%-7%, between 2014 and 2021, to 10%-12% since 2022 (10% in 2024).

No significant variations were recorded by sex for current e-cigarette or vaping device use in 2024.

Table 8.4

8.2.5     E-cigarette or vaping device use was most prevalent among young adults

In 2024, e-cigarette or vaping device use was most prevalent among adults aged 16-24 (18%), decreasing by age to 2% among those aged 75 and over.

There was no significant difference in e-cigarette or vaping device use by age and sex.         

Table 8.5

8.2.6     Smoking prevalence estimates with saliva cotinine adjustment were significantly higher than unadjusted rates for 2022/2023/2024 combined

In 2022/2023/2024 combined, 13% of adults with a valid saliva cotinine measure self-reported as a current cigarette smoker, which increased to 17% when adjusted for cotinine levels. While males recorded higher prevalence of both self-reported and cotinine-adjusted smoking levels (16% and 19% respectively) compared with females (11% and 15% respectively), these differences were not significant.

The difference between the self-reported and cotinine-adjusted levels was highest among those aged 16-24 (seven percentage points) and those aged 35-44 (six percentage points) compared with between two and four percentage points for the other age groups.

Although those who reported vaping or using NRT products in the past 7 days were excluded from this analysis, use of other products containing nicotine (such as nicotine pouches) could be impacting these results. 

Table 8.6

8.2.7     Around a quarter of non-smokers who did not vape had a detectable level of cotinine in their saliva indicating potential exposure to second-hand smoke in 2022/2023/2024 combined, a significant increase from 2018/2019

Adult non-smokers’ (who did not vape) geometric mean cotinine levels have been in the range 0.02 – 0.03 since 2012/2013 combined, with the 2022/2023/2024 combined level (0.03) at the top end of this range. This represents an overall decrease from 0.40 in 2003. Differences by sex were not significant.

In 2022/2023/2024 combined, just over a quarter (26%) of non-smokers who did not vape had a detectable level of cotinine in their saliva. This is a significant increase from 21% in 2018/2019 combined and a return to similar levels to those recorded in 2012/2013 combined to 2016/2017 combined (24%-26%). However, the 2022/2023/2024 combined proportion remains below the prevalence in 2003 (85%), 2008/2009 combined (38%) and 2010/2011combined  (38%). The difference between males and females was not significant.

Although those who reported vaping or using NRT products in the past 7 days were excluded from this analysis, use of other products containing nicotine (such as nicotine pouches) and, potentially, exposure to second-hand vapour, could be impacting these results. 

Table 8.7

8.2.8     The products adults most frequently used in attempts to stop smoking were nicotine NRT products and vaping devices

In 2023/2024 combined, 39% of adult ex-smokers and current smokers who had ever attempted to quit smoking, had used some form of Nicotine Replacement Therapy (NRT) or other products in their most recent quit attempt.   

The most frequently used products were nicotine NRT products (including gum, patches, sprays/inhalers and lozenges/microtabs) (23%) followed by e-cigarettes or vaping devices (19%).

Nicotine NRT products were more likely to be used by those aged 35-74 (23%-32%) than by those aged 16-34 (11%-15%) and those aged 75 and over (15%).

Younger people were more likely to have used e-cigarettes or vaping devices as part of their most recent attempt to quit smoking with 41% of those aged 16-24 using e-cigarettes/vapes, declining to 3% of those aged 75 and over. 

Table 8.8

8.2.9     Around half of current adult smokers would like to give up smoking

In 2023/2024 combined, just over half of current adult smokers indicated that they would like to give up smoking (52%). Desire to give up smoking was highest amongst those aged 35-64 (58%-60%) and lowest amongst those aged 75 or over (28%).  There was no significant difference by sex.

The majority of current smokers in 2023/2024 combined had tried to stop smoking at least once, with 35% having tried once or twice and 35% having tried three times or more. Of those who had tried to quit smoking 42% managed to stop for 6 months or more.

Table 8.9

Table List

Table 8.1 Cigarette smoking status, 2003 to 2024, by sex

Table 8.2  Cigarette smoking status, 2024, by age and sex

Table 8.3  Cigarette smoking status (age-standardised), 2024, by area deprivation and sex

Table 8.4  E-cigarette or vaping device use, 2014 to 2024, by sex

Table 8.5  E-cigarette or vaping device use, 2024, by age and sex

Table 8.6  Smoking prevalence estimates without and with saliva cotinine adjustment, 2022/2023/2024 combined, by age and sex

Table 8.7  Self-reported, cotinine validated non-smokers' exposure to second-hand smoke, 2003 to 2022/2023/2024 combined, by sex

Table 8.8  Use of NRT and other products in the most recent attempt to quit smoking, 2023/2024 combined, by age and sex

Table 8.9  Attempts to quit smoking, 2023/2024 combined, by age and sex

References and notes