BACKGROUND AND AIM In addition to national policies and interventions, certain regions in England (particularly in the North) coordinate regional tobacco control programmes. This study aimed to (i) examine trends in tobacco smoking prevalence and socioeconomic inequalities in smoking across regions and (ii) explore how trends in smoking prevalence have differed between regions with and without dedicated regional tobacco control activity.

DESIGN Observational study using data drawn from nationally representative monthly cross-sectional household surveys, conducted between November 2006 and July 2024.

SETTING England.

PARTICIPANTS 368 057 adults (≥16 years old).

MEASUREMENTS We used logistic regression to estimate time trends in current smoking by region, and tested interactions with occupational social grade to explore differences between more and less advantaged groups.

FINDINGS Smoking prevalence declined most in the North [28.8% to 15.8%; -12.9 percentage points (95% confidence interval -14.4 to -11.5)], similar to the national average in the Midlands [25.2% to 16.0%; -9.2 (-10.6 to -7.9)], and least in the South [22.7% to 17.3%; -5.3 (-6.5 to -4.0)], reducing regional disparities such that prevalence was similar across regions in 2024. Socioeconomic inequalities in smoking prevalence between more and less advantaged social grades fell most in Yorkshire and the Humber [from 17.9 percentage points (14.1-21.8) to 3.7 (0.4-7.0)] and the West Midlands [from 16.1 (12.8-19.6) to 3.0 (-0.03 to 6.0)]. Regions with sustained regional tobacco control activity saw greater declines in smoking prevalence [-13.3 (-15.3 to -11.3)] than regions with none [-9.3 (-10.0 to -8.5)].

CONCLUSIONS Between 2006 and 2024, smoking rates in the North of England fell faster than the national average, narrowing the geographic inequalities in smoking prevalence and bringing the North of England into alignment with other regions by 2024. Regional tobacco control programmes appeared to contribute to this progress.