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Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking
  1. Emma Beard1,2,
  2. Jamie Brown1,2,
  3. Robert West2,
  4. Colin Angus3,
  5. Eileen Kaner4,
  6. Susan Michie1
  1. 1Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  3. 3ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
  4. 4Institute of Health and Society, Newcastle University, Newcastle, UK
  1. Correspondence to Dr Emma Beard; e.beard{at}


Objectives This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Conclusions In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

  • Alcohol
  • Tobacco
  • Regional

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  • Twitter Emma Beard @DrEVBeard

  • Contributors EB, JB, SM and RW all designed the study and contributed to the writing of the paper. EB conducted the analyses and wrote the first draft. All authors contributed to the final draft.

  • Funding The ATS is funded by the National Institute for Health Research (NIHR)'s School for Public Health Research (SPHR). SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. The Smoking Toolkit Study is currently primarily funded by Cancer Research UK (C1417/A14135; C36048/A11654; C44576/A19501), and has previously also been funded by Pfizer, GlaxoSmithKline and the Department of Health.

  • Disclaimer The views are those of the authors(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests EB's salary is funded by the NIHR SPHR and Cancer Research UK (CRUK); JB is funded by CRUK and the Society for the Study of Addiction; RW and SM are funded by CRUK. EB and JB have received unrestricted research funding from Pfizer for the Smoking Toolkit Study (a sister survey of the ATS). RW has received travel funds and hospitality from, and undertaken research and consultancy for, pharmaceutical companies that manufacture and/or research products aimed at helping smokers to stop. CA is funded by NIHR SPHR, and has received funding from CRUK. CA has also received funding related to commissioned research from Systembolaget, the Swedish government-owned alcohol retail monopoly.

  • Ethics approval UCL ETHICS.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement For access data to the set, contact the lead author or JB (

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