Breastfeeding

Action on Smoking and Health (ASH) identifies that smoking is the biggest preventable cause of death and disease. About half of all lifelong smokers will die early, losing on average about 10 years of life. Most smoking-related deaths arise from one of three diseases: lung cancer, chronic obstructive pulmonary disease (COPD) or coronary heart disease (CHD). Tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers exposed to second-hand smoke (Source: WHO). Smoking rates have fallen, although around 5.3 million people in the UK (10.6% of adults) still smoke (Source: ASH).

Smoking is the leading cause of health inequalities and accounts for half of the difference in life expectancy between the most and least deprived communities in England. Smoking is associated with most indicators of disadvantage. Smoking prevalence in England continues to decline each year, but the gap in prevalence between the most and least deprived has increased. This means prevalence is reducing slower in more deprived communities than more affluent communities (Source: Department for Health and Social Care (DHSC)).

There is a strong link between cigarette smoking and socio-economic groups. In 2024, 18.6% of adults in the UK in routine and manual occupations smoked, compared with 6.6% in managerial and professional occupations (Source: ASH).

Smoking during pregnancy remains the leading factor in poor birth outcomes. Stopping smoking before or during pregnancy will reduce risks to a child’s health and development (Source: RCPCH). 

In children, second-hand smoke exposure can cause ill health. Children who are exposed to second-hand smoke are at an increased risk for acute respiratory infections and other conditions. In babies, second-hand smoke can contribute to sudden infant death syndrome (SIDS) (Source: ASH). 

Research has shown that children with parents, siblings or friends who smoke are about three times more likely to start smoking themselves (Source: ASH).

The emergence of novel tobacco and nicotine products, including heated tobacco products (HTPs) and nicotine pouches, presents a developing challenge for tobacco control and smoking prevention. These products are increasingly marketed as alternatives to smoking and often perceived by consumers as less harmful than cigarettes. However, while some products may expose users to fewer harmful substances than combustible tobacco, they are not risk-free and continue to expose users to nicotine, maintaining addiction and potentially perpetuating long-term nicotine dependence. A further challenge is the appeal of these products to younger populations. Research shows increasing awareness and use of nicotine pouches among young people, with factors such as discreet use, flavourings, product design, marketing, and perceptions of reduced harm potentially contributing to uptake (Source: Reid et al, 2025). This creates a risk that individuals who may never have used tobacco products could become nicotine dependent.

Smoking has a profound impact on health, the economy, and society. Beyond the harm caused to individuals and communities, smoking generates substantial costs for public services, households, and the wider economy that significantly exceed revenue raised through tobacco taxation (Reed, 2025). These impacts are experienced most acutely by disadvantaged communities, where smoking prevalence remains higher and smoking-related illness and premature mortality contribute disproportionately to health inequalities and gaps in healthy life expectancy (Source: ONS, 2023; ASH, 2019). ASH estimates that smoking costs Lincolnshire’s Integrated Care Board (ICB) £709 million each year (Source: ASH Ready Reckoner, 2026). Despite these impacts, stopping smoking delivers immediate and long-term benefits regardless of how long an individual has smoked, improving health and life expectancy while reducing financial hardship and helping to address health inequalities across communities. 

The NHS 10-Year Plan sets out a bold ambition to create the first smoke-free generation in the UK, building on existing pledges and going further to address the harms of tobacco and vaping. Central to the plan is the Tobacco and Vapes Act 2026, which bans tobacco sales to anyone born on or after 1st January 2009, and introduces stricter regulations on vaping products to protect children. This and other measures in the legislation are expected to significantly reduce smoking-related illness, narrow health inequalities, and deliver major savings to the NHS and wider economy. Guidance, which supports understanding of initial measure in the 2026 Act: 

Selling tobacco, herbal smoking products and cigarette papers 
Selling vaping and nicotine products

The Tobacco and Vapes Act 2026 operationalises and extends the ambitions of previous government tobacco control strategies. Whilst the Tobacco Control Delivery Plan (2017-2022) was the last formal strategy document, the 2023 legislation and policy paper (Stopping the Start) effectively replaced its function and set a new direction for tobacco control in England.

Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities (HI) at both national and system level. The framework will help focus targeted support and action for specific population groups who experience poorer-than-average access to, experience of and/or outcomes of their healthcare and treatment. The approach identifies 5 clinical areas requiring accelerated improvement (Maternity, Serious Mental Illness (SMI), Chronic Respiratory Disease, Early Cancer Diagnosis, Hypertension). Smoking impacts on each of the Core20PLUS5 clinical areas (Source: ASH).

The ‘Better Births’ report sets out a five-year plan for transforming maternity services implemented by Local Maternity Systems supported by NHS resource packs.

NHS England, Saving Babies’ Lives – A care bundle for reducing stillbirth, and the follow-up in 2019, Saving Babies’ Lives Version Two, aims to reduce the number of women smoking during pregnancy. Smoking is a key factor linked to pre-term birth, low birth weight, stillbirth and sudden infant death syndrome (SIDS).

The WHO Framework Convention on Tobacco Control (WHO FCTC) and its guidelines provide the foundation for countries to implement and manage tobacco control. To help make this a reality, WHO introduced the MPOWER measures which are intended to assist in the country-level implementation of effective interventions to reduce the demand for tobacco.

NICE updated their guidance in 2025. Preventing uptake, promoting quitting and treating dependence [NG209] covers support to stop smoking and help reduce people’s harm from smoking.

DHSC Public Health data shows that smoking prevalence in Lincolnshire is declining, but at a slower rate than the national average. Despite overall improvement, inequalities remain a concern, with smoking increasingly concentrated among disadvantaged groups. These inequalities reinforce the need for continued, targeted local interventions to support those at greater risk (Source: DHSC).

Pregnancy  

Historically, Lincolnshire has a high smoking status at time of delivery (SATOD) rate, above the England and Midlands averages. The rate fell from 12.1% in 2023/24 to 8.4% in 2024/25, a reduction of 3.7 percentage points; in the same period, the Midlands rate fell by 2.0 and in England by 1.3 (Source: DHSC).

As smoking prevalence has declined nationally, rates of smoking have become increasingly concentrated among disadvantaged communities and groups. There are big variations in maternal smoking rates affected by age, geography, socio-economic status, and ethnicity. During and before pregnancy, women from disadvantaged backgrounds are more likely to smoke, less likely to quit, and those who do quit are more likely to start again after giving birth. Mothers in unskilled jobs are more likely to have smoked before or during pregnancy than those in managerial and professional roles. Pregnant women are more likely to smoke if they have lower qualifications, live in communities with higher levels of smoking, are single, or have a partner who smokes (Source: ASH).

Mental Health 

People with long-term mental health conditions are substantially more likely to smoke than the general population, nationally around 30.0% of smokers have a mental health condition. Those with SMI have some of the highest smoking rates, and 40.1% of adults with SMI smoke, often more heavily, with higher nicotine dependency and find it more difficult to quit despite being just as likely to want to stop. Smoking is the single largest contributor to the 10-20-year reduced life expectancy in this population, making targeted support essential (Source: ASH). In Lincolnshire, prevalence of adults with a long-term mental health condition is 25.4% which is similar to the England rate (24.0%) but higher than the East Midlands rate (23.5%) (Source: DHSC).

LGBTQ++ 

While specific data is not available for Lincolnshire, LGBTQ++ people are more likely to smoke than heterosexual people (Source: ASH).

Ethnic Minorities  

Black, Asian, and Chinese people are less likely to smoke, but people with mixed ethnicity are more likely to smoke than white people. Ethnic minorities in the UK have a higher risk than White British people of some long-term conditions that can be caused by smoking (Source: ASH). Particularly high smoking rates, due to cultural norms, are reported among Eastern European populations (Source: Health Inequalities Lincolnshire). Gypsy, Roma and Irish Traveller (GRT) Communities have the highest reported smoking rates among all ethnic groups (Source: Office for Health Improvement and Disparities (OHID)).

Data from the local stop smoking service shows that most users are White British (89%), with low representation from minority ethnic groups and some incomplete data (including 6% ‘prefer not to say’) (Source: Lincolnshire County Council, 2026). This may indicate underrepresentation of some communities, particularly those facing language or cultural barriers (e.g. Eastern European communities).

Homeless Communities 

Nationally, smoking is considerably more prevalent among people experiencing homelessness compared to the general population. In 2014, around 77% without stable housing were smokers, compared to 17% of the general population (Source: Homeless Link 2022). Tobacco use is also heavier in this group. A report found that many people experiencing homelessness smoked more than 20 cigarettes a day, whereas the average in the general population was about 11 (Source: Groundswell 2016).

Widespread and heavy smoking contributes to serious health disparities. Individuals experiencing homelessness are three times more likely to die from chronic lower respiratory diseases, mainly caused by smoking. Of this population, 80% face an increased risk of lung cancer due to tobacco use; their average age of death is approximately 30 years lower than the general population (Source: ASH).

Young People 

In 2023, 11% of 11–15-year-olds in England had tried smoking, 3% were currently smoking, and 1% smoked regularly. This means around 400,000 11 to 15-year-olds in England have tried smoking and 120,000 currently smoke. Children whose parents smoke are approximately three times more likely to start smoking, and more likely to smoke if they have siblings or friends who smoke. The number of 11 to 15-year-olds who smoke has halved in the past ten years. This change could be attributed to new legislation such as banning cigarette displays in shops and requirements for plain packaging (Source: ASH). Emerging evidence suggests that young people who vape have a much higher probability of taking up smoking tobacco. A recent study found that among adolescents, the predicted probability of smoking was 1% among those who had never used e-cigarettes, compared to 33% among current e-cigarette users; highlighting a concerning link between vaping and future smoking uptake (Source: Mongilio et al., 2025). 

In support of the government’s ambition to create a smoke-free generation, an additional £70 million per year has been allocated from April 2024 to reinforce local authority-led stop smoking services (Source: DHSC). This funding nearly doubles previous investments and is part of a broader public health strategy that includes measures such as the Tobacco and Vapes Act 2026, aiming to reduce smoking initiation and regulate vape marketing. Funding allocations are based on smoking prevalence data from 2021 to 2023, so resources are directed to areas with the highest need. In 2024/25, Lincolnshire received £1,076,632, and in 2025/26 received £1,140,181. Funding is ring-fenced for public health and must meet specific grant criteria. This empowers local authorities to enhance local stop smoking services and reduce health inequalities (Source: ASH).

In December 2025, the DHSC announced a new smoking cessation ring-fence for community-based services. This combines three previously separate strands of funding which will be merged over 3 years (2026-2029) to improve simplicity, planning and impact. Flexibility for community-based service delivery is now devolved to local areas according to local need. National expectations are that funding on local service delivery will be used to increase set quit dates. A common goal and a new target to reduce smoking prevalence, as measured by achieving a minimum of 5% set quit dates of the local smoking population has been created.

Across Lincolnshire, a multi-agency Tobacco Control Delivery Plan is being drafted to reduce smoking prevalence, address health inequalities, and support individuals to quit. This co-ordinated approach spans healthcare settings, enforcement, education and public engagement, ensuring interventions are not only evidence-based, but also tailored to the local context.

The key components of Lincolnshire’s tobacco control efforts include:

Supporting Behaviour Change through One You Lincolnshire 

One You Lincolnshire (OYL) is a countywide integrated lifestyle service offering a 12-week community stop smoking programme combining behavioural support and medication; operating as a hybrid model of telephone and online sessions. The flexible delivery has received positive feedback from clients; in 2025/26 One You Lincolnshire helped 3,075 people to quit smoking (Source: Local Data).

Expanding Access through System Level Investment 

The Integrated Care System (ICS), comprising the Integrated Care Board (ICB) and Integrated Care Partnership (ICP), has committed funding from the national Health Inequalities budget to establish in-house tobacco treatment services across all hospital trusts. This investment aims to ensure a consistent, system-wide approach to reducing tobacco-related harm.

Helping Expectant Mothers through Maternity Services  

Launched in early 2023 as part of maternity care provided by United Lincolnshire Teaching Hospital NHS Trust, the NHS specialist tobacco dependency programme now supports all pregnant women who smoke. This integrated approach encourages quit attempts through behavioural support, pharmacotherapy, and access to vapes for up to 12 months. Significant others of the pregnant mother are signposted to OYL in support of smoke-free homes. Carbon Monoxide (CO) monitoring at every contact reinforces the risks associated with high CO levels and smoking, embedding tobacco dependency care into the maternity pathway. Since early 2025, the programme has implemented the national smoke-free incentive scheme, currently funded until March 2026 and awaiting national direction for 2026/27. All these initiatives align with the NHS 10-Year Plan and the Saving Babies’ Lives Care Bundle, underpinning Lincolnshire’s in-house model for smoking in pregnancy. They also support the Lincolnshire Maternity Equity and Equality Strategy, which sets out key goals such as reducing stillbirths, neonatal deaths, maternal deaths, and brain injury. The Smoking at Time of Delivery (SATOD) rate in Lincolnshire fell from 16.2% in 2019/20 to 5.9% in 2025/26, compared with 4.2% nationally, narrowing the gap with England from 5.8 to 1.7 percentage points. 

Addressing Inequalities through Mental Health Services  

Lincolnshire Partnership Foundation NHS Trust (LPFT), which provides mental health services across the county, has signed the NHS Smoke Free Pledge. This public commitment underlines the Trust’s dedication to implementing the NICE guidance on smoking cessation across healthcare settings.

LPFT has set up a tobacco dependency treatment service to deliver the above and support those suffering from poor mental ill health who want to quit smoking tobacco as much as anyone else.

Acute Tobacco Dependency Services 

United Lincolnshire Teaching Hospital NHS Trust is committed to helping patients manage tobacco dependency during hospital stays. In line with national smoke-free policies, all Trust sites maintain smoke-free environments to promote health and recovery.

Smoking significantly increases the risk of complications following surgery and delays wound healing. To support better outcomes, patients who smoke are encouraged to access tailored advice and nicotine replacement options through the ULTH Service. Evidence shows that combining behavioural support with alternative nicotine products makes quitting up to three times more successful than relying on willpower alone.

The Acute Tobacco Dependency Service launched at Lincoln County Hospital in March 2024 and Boston Pilgrim Hospital in March 2025. As part of an Opt-Out service, all patients are routinely referred to the Service on admission. Ward teams ask about smoking status, and those staying overnight or longer are offered nicotine replacement therapy promptly to reduce withdrawal symptoms and cravings. This ensures that patients receive compassionate, practical support to improve recovery and long-term health (Source: United Lincolnshire Hospitals). 

Enforcing the Law and Disrupting Illicit Trade 

Tobacco control in Lincolnshire is supported by a multi-agency partnership involving the fire service, police, public health, trading standards, the NHS, and Lincolnshire County Council’s commissioned stop smoking service. Trading Standards officers lead efforts to reduce the availability of illegal and unsafe tobacco products through an intelligence-led enforcement strategy. Their activities include multi-agency raids, closure orders, prosecutions, and providing regulatory advice to businesses. 
Police intelligence in certain areas of Lincolnshire has identified direct links between the illicit tobacco trade and other forms of serious crime. In parallel, Trading Standards deliver programmes aimed at preventing underage sales of tobacco, including test purchasing, market surveillance, and educating local businesses.

Stopping the Start: Educating and Protecting Young People to Prevent Uptake 

Lincolnshire County Council Trading Standards Specialist Tobacco Control Officers offer a comprehensive tobacco and vaping education programme designed to inform and protect young people, to prevent them from starting smoking or vaping, particularly those considered vulnerable. Two interactive workshops, ‘Tobacco and Young People’ and ‘Vaping: Have a BLAST?’, are delivered free to schools, colleges, and pupil referral units. These can be tailored for individual needs and offer accessible and engaging education without the need for formal qualifications.

For those needing more structured support, a Smoking and Vaping Awareness course is also available. This covers health risks, passive smoking, quitting benefits, illicit tobacco and vape products, and legal considerations, concluding with an assessment. This course is targeted at groups identified as high risk.

To support these interventions, schools can access free educational resource kits including visual aids such as tar jars and Clem’s Phlegm (COPD).

Together, these initiatives aim to empower young people across Lincolnshire to make informed, health-conscious choices and reduce the likelihood of smoking or vaping uptake. There are plans to develop online communications for these programmes and self-guided resources for teachers. 

Raising Awareness 

Public-facing tobacco control activities raise awareness of the fire risks associated with cigarette smoking and the dangers of using illegal, unregulated tobacco products. These activities form part of a broader national and local strategy to reduce smoking prevalence and related harms through education, enforcement, and support. Lincolnshire Fire and Rescue carry out Home Safety Visits, providing tailored advice to vulnerable residents, including smokers who may be at increased risk of fire. This approach helps to protect vulnerable populations, prevent smoking-related fires, and improve health outcomes across the county. In recent years, smoking materials have remained a significant cause of accidental dwelling fires in Lincolnshire, highlighting the continued importance of prevention, education, and targeted intervention.

This JSNA includes information from the following organisations: 

• Lincolnshire Community Health Group (Acute and Maternity) 
• Lincolnshire Integrated Care Board (ICB) 
• Lincolnshire Fire and Rescue 
• Lincolnshire Partnership Foundation NHS Trust (LPFT) 
• Lincolnshire Public Health 
• Lincolnshire Trading Standards 
• One You Lincolnshire 

Local Stop Smoking Service Feedback 

Between January and June 2026, the local Stop Smoking Service conducted a service user survey to gather feedback on customer satisfaction with their service. There were a small number of responses (93), which cannot be taken as indicative of all users of the service.

Overall, feedback was extremely positive. Respondents rated the booking process, practitioner support, overall service quality, and likelihood of recommending the service very highly. Most attended 10-12 sessions, and almost all reported achieving all or some of their quit goals. Just over half of respondents reported having a long-term condition.

Qualitative comments were positive, with respondents particularly valuing the support, encouragement, and regular contact provided by practitioners. Many reported that the service helped build their confidence and motivation to quit smoking, and several specifically praised individual advisers. Most other comments indicated that no improvements were needed. The main suggestion for improvement related to the iCOquit app, which some users found difficult to use, that it was less suited to rolling tobacco users, and that it lacked flexibility to amend quit dates retrospectively.

Key Population Groups with Unmet Needs: 

• Deprived Communities: Smoking prevalence increases significantly in more deprived areas across England (Source: ONS). These communities also face compounded health inequalities, such as poor healthcare access, lower income, and higher unemployment (Source: NHS England). 
• Routine and Manual Workers: Smoking rates are consistently higher among individuals employed in this type of work (Source: ASH). In Lincolnshire, prevalence in this group exceeds both national and regional averages. 
• Pregnant Women: Lincolnshire continues to report high rates of smoking at the time of delivery, above both national and regional levels (Source: DHSC) 
• Adults with Severe Mental Illness (SMI): Around 40.1% of individuals with SMI in Lincolnshire smoke – above the general population average for Lincolnshire (14.4%) and matching the regional rate (Source: DHSC). 
• Homeless Populations: Nationally, 77% of homeless people smoke (Source: ASH; Homeless Link). There is limited local data available in Lincolnshire. 
• Ethnic Minority Populations: Particularly high smoking rates are reported among Eastern European populations, often due to cultural norms (Source: Health Inequalities Lincolnshire). 
• Gypsy, Roma and Irish Traveller (GRT) Communities: This population have the highest reported smoking rates of all ethnic groups (Source: Office for Health Improvement and Disparities). 
• Historically, smoking prevalence has been higher among LGBTQ++ communities. National data from 2017 showed higher rates among lesbian, gay and bisexual adults than in heterosexual adults; however, limited recent and local data, particularly for trans and non-binary people, restrict understanding of current inequalities and support needs (Source: Adult smoking habits in the UK – Office for National Statistics). 
• Other gaps may also exist around the criminal justice system. 
• Smoke-free policies: These are in place across a number of healthcare and public sector settings, however, consistent implementation and enforcement remain challenging. Smoking continues to occur in some smoke-free environments such as hospitals and healthcare facilities, highlighting the need for a coordinated system-wide approach that goes beyond policy development alone. Further work is required to strengthen cross-organisational leadership, improve the visibility and promotion of smoke-free messages, support consistent enforcement, and embed tobacco dependence treatment pathways across healthcare, local authority, community, and voluntary sector services. A system-wide approach would help create consistent smoke-free environments, support behaviour change, and contribute to reducing smoking-related health inequalities.

Health Inequalities and response 

Causes of Inequalities Identified: 

• Socioeconomic deprivation  
• Routine and manual work 
• Pregnancy  
• Mental health status 
• Substance use 
• Ethnicity (Eastern European communities) 
• Housing status (e.g. homelessness)  

Local Actions to Address Inequalities: Lincolnshire’s response aligns with the Core20PLUS5 model, targeting the most deprived 20% of the population and key vulnerable groups. Key interventions include: 

• Targeted Campaigns: Delivered through One You Lincolnshire in wards with the highest smoking rates. 
• Maternity Services: Use of CO-monitoring and opt-out referrals for smoking cessation support during pregnancy (Source: ULTH NHS). Signposting for partners and significant others who also smoke tobacco to the local stop smoking services. 
• Integrated Mental Health Support: Smoking cessation support is being incorporated into mental health pathways to ensure a holistic approach to care and wellbeing (Source: LPFT NHS).

Additional Gaps and Evidence 

Unaddressed or Underexplored Areas: 

• Homeless Populations: There is little local information on smoking cessation support for homeless individuals (Source: Health matters: rough sleeping). However, local provision is not entirely absent. One You Lincolnshire currently delivers face to face smoking cessation clinics within a homeless centre in Boston, providing direct support to individuals who may otherwise struggle to access services. 
• Ethnic Minorities (White-Other/Eastern European): Engagement with health services (e.g. vaccinations) has been low in this group due to language barriers and cultural differences. Smoking rates are high, but targeted interventions are in place through One You Lincolnshire who employ a Polish worker (Source: Statement of Information on Health Inequalities, Lincolnshire ICB). 
• Gypsy, Roma, and Irish Traveller Communities (GRT): While national data exists, there is little up-to-date or local data specifically about smoking prevalence or tailored interventions in Lincolnshire (Source: NHS East of England).

Plans to Address These Gaps 

Current and Planned Responses: 

• Ethnic Minority Groups: The ICB has acknowledged service uptake issues among White-Other communities such as Eastern Europeans, and plans to improve engagement. This includes addressing language barriers, which should help improve smoking cessation outcomes. A website and app that works in all languages would improve service uptake and support given to individuals. This is planned within the new stop smoking service contract from April 2027 onwards. 
• Homeless Populations: The local stop smoking service started to deliver targeted smoking cessation support to people experiencing homelessness and rough sleeping through a range of tailored outreach interventions from 2026. This support includes a monthly walk-in clinic delivered in partnership with the Lincolnshire Recovery Partnership’s Rough Sleeper Team, and weekly drop-in clinics at the Salvation Army and Restore Foodbank. By embedding support within trusted community settings already accessed by this group, the service is improving accessibility and engagement among individuals who may face significant barriers to accessing conventional healthcare services. 
• Early engagement has been encouraging, with 11 people experiencing homelessness and three staff members from participating venues enrolling in stop-smoking support during the first week of delivery. Building on this success, there are plans to expand the model to additional locations across Lincolnshire, working with established community and voluntary sector organisations to further increase reach and reduce smoking-related health inequalities among homeless and rough sleeping populations. 
• Gypsy, Roma and Irish Traveller (GRT) Communities: The local stop smoking service has established relationships with GRT communities and the organisations that support them, to build trust and opportunities for service take-up, this needs to continue and develop further where possible. 
• Ensuring joined-up service delivery for whole family support to pregnant smokers to help them in achieving a smoke-free home. 
• Routine and Manual Workers: Working with employers and health champions to promote work culture change. Enhancing telephone and app-based support as well as onsite pop-up clinics for those with limited free time to engage with clinic support or come to the local stop smoking service.

Addressing the Three National Shifts 

1. Hospital to Community: Lincolnshire is expanding its community-based stop smoking services; strengthening pathways and ensuring smooth transitions from acute treatment to community services, as well as working as a whole system to support smoke-free healthcare settings. Community pharmacies, primary care, social prescribers, and neighbourhood hubs now play a growing role in prevention and support. 
2. Analogue to Digital: Adoption of digital tools such as the NHS Quit Smoking App and integration with GP systems for referral and tracking. However, gaps remain in digital reach in rural Lincolnshire. 
3. Treatment to Prevention: Shifting towards prevention-first by embedding smoking cessation within primary and community healthcare services and making opt-out models standard in maternity, primary and secondary care following NICE guidelines. 

 
Gaps in Evidence and Planned Action 

Current Evidence Gaps: 

• Despite national data on smoking prevalence, there remain significant gaps in localised evidence, particularly relating to vulnerable groups such as people experiencing homelessness and ethnically diverse communities. Addressing these gaps is essential for developing equitable and effective tobacco control strategies.
   

Planned Steps to Address Gaps: 

• Partnering with Voluntary and Community Sector (VCS) groups to collect insights that reflect lived experience, to provide local context and to co-design acceptable forms of service delivery. 
• Using existing community insights about what works to expand service delivery. 
• Community engagement events to explore cultural, structural, and social drivers of smoking behaviours to inform new approaches to support. 
• Research to fill knowledge gaps about smoking prevalence and habits across under-represented groups in Lincolnshire and what works in addressing these. 

Lincolnshire’s integrated model of healthy lifestyle support (ILS), which includes smoking cessation as a key pathway, was independently evaluated and found to outperform national benchmarks as well as offering high returns of investment of £4.26 for every £1 spent. From March 2027, a new smoking cessation service will be commissioned, designed to build on these strengths.

To support the Smokefree Generation ambitions, the government has ring‑fenced funding for smoking cessation services for three years, providing financial stability for local delivery.

The Public Health Smoking Cessation Grant enables local community support services to expand and enhance their offer, with success measured through progress towards a 5% reduction in smoking prevalence. In Lincolnshire, this means increasing outreach and engagement activities and delivering tailored quit support to reduce smoking rates and tackle health inequalities. 

 The priorities of the local Tobacco Control Board, which includes all key partners, are to: 

• Continue to reduce smoking rates in Lincolnshire, with a focus on high-prevalence groups in line with: 
  • National Smokefree 2030 ambitions. 
  • The NHS England » Fit for the Future: 10 Year Health Plan for England, which commits to offering NHS funded tobacco treatment services to all inpatients, pregnant women, and people with mental health needs. 
  • Core20PLUS5, targeting the most deprived 20% of the population, local groups and five clinical priorities, where smoking is a shared risk factor. 
  • Critical Six: Smoking cessation is one of the 6 regional priorities. The Regional Director of Public Health (RDPH) Midlands Report 2026 requires local areas to strengthen and integrate clinical and priority group cessation pathways across NHS, Local Authority and VCSE partners. 
• Successfully address and tackle gaps and unmet needs in key groups such as: 
  • Pregnant women and participation in national smoke-free pregnancy incentive schemes. 
  • Routine and Manual Workers: consider implementing smoking cessation interventions tailored to their unique needs. 
  • People with a Serious Mental Illness (SMI) (via delivery of the NHS smoke-free pledge by Lincolnshire Partnership NHS Foundation Trust). 
  • Local group populations with high smoking prevalence such as Homeless, Eastern European, routine and manual agricultural and seasonal workers, and Gypsy Roma Traveller (GRT) communities, by improving outreach data collection and cultural relevant interventions. 
• Strengthen data and intelligence gathering, especially: 
  • On homeless populations and underrepresented ethnic groups and smoking populations (e.g., LGBTQ++, smokers in social housing, those in drug and alcohol treatment, individuals involved in the criminal justice system), where local data is limited. 
  • Partnering with voluntary and community sector (VCS) organisations and conducting community engagement events. 
• Improve system-wide coordination and governance: 
  • Oversight by Lincolnshire’s Tobacco Control Board to align services across primary care, hospitals, maternity, and mental health settings. 
  • Shared performance tracking through dynamic dashboards and regular JSNA content refreshes. 
  • Implement and scale up opt-out tobacco dependence treatment across all relevant NHS care settings, including acute inpatient, maternity, mental health (inpatient and outpatient), and high-risk outpatient pathways. 
• Expand digital and community-based support: 
  • Wider use of digital tools (e.g. NHS Quit Smoking App) while addressing rural digital exclusion. 
• Deliver education and enforcement aligned with: 
  • NICE guidance. 
  • The Tobacco and Vapes Act 2026. 
  • Local multi-agency efforts to enforce illicit tobacco laws and deliver youth education workshops (e.g. ‘Have a BLAST’).