title: Healthier central England or North-South divide? Analysis of national survey data on smoking and high-risk drinking.
abstract: 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.
  
  
  
  Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.|Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Beard
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.|Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Brown
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Angus
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Alcohol; Regional; Tobacco