Aim: To examine changes in smoking, drinking, and quitting/reduction behaviour following the Covid-19 lockdown in England. Design/setting: Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019 through February 2020) versus after (April 2020) the lockdown.

Participants: 20,558 adults (≥16y). Measurements: The independent variable was the timing of the Covid-19 lockdown in England (before vs. after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking; past-year cessation and quit attempts (among past-year smokers); past-year attempts to reduce alcohol consumption (among high-risk drinkers); and use of evidence-based (e.g., prescription medication/face-to-face behavioural support) and remote support (telephone support/websites/apps) for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region, and level of nicotine and alcohol dependence (as relevant).

Findings: The Covid-19 lockdown was not associated with a significant change in smoking prevalence (17.0% (after) vs. 15.9% (before), OR=1.09[95%CI 0.95-1.24]), but was associated with increases in the rate of quit attempts (39.6% vs. 29.1%, ORadj=1.56[1.23-1.98]) and cessation (8.8% vs. 4.1%, ORadj=2.63[1.69-4.09]) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0% vs. 51.5%, ORadj=1.10[0.72-1.68]) but use of remote support increased (10.9% vs. 2.7%, ORadj=3.59[1.56-8.23]). Lockdown was associated with increases in the prevalence of high-risk drinking (38.3% vs. 25.1%, OR=1.85[1.67-2.06]) but also alcohol reduction attempts by high-risk drinkers (28.5% vs. 15.3%, ORadj=2.16[1.77-2.64]). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2% vs. 4.0%, ORadj=0.23[0.05-0.97]) and there was no significant change in use of remote support (6.9% vs. 6.1%, ORadj=1.32[0.64-2.75]).

Conclusions: In England, prevalence of high-risk drinking but not smoking has increased since the Covid-19 lockdown. Smokers and high-risk drinkers are more likely than before lockdown to report trying to quit smoking or reduce their alcohol consumption, and rates of smoking cessation are higher. Smokers are no less likely than before lockdown to use cessation support, with increased uptake of remote support. However, use of evidence-based support for alcohol reduction by high-risk drinkers has decreased, with no compensatory increase in use of remote support.