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THE CASE FOR ACTION
on TOBACCO USE & SMOKING
Harms caused by tobacco use & an overview of local tobacco policies to aid
commissioning
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1. Scale of the challenge
Harms caused by tobacco use
Each year smoking causes the greatest
number of preventable deaths
Alcohol:
6,541
Smoking:
81,400
Obesity:
34,100
Traffic:
2,502
Suicide:
5,377
References:
1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 (http://ash.org.uk/files/documents/ASH_107.pdf) NB area represents value
HIV:
529
Drug misuse:
1,738
3
Harms caused by tobacco use
National children’s rates of smoking
(age 11 – 15)
14%
12%
10%
8%
6%
4%
2%
0%
1982 1986 1990 1994 1998 2002 2004 2006 2008 2009 2010
Boys
Girls
Total
References:
1. Smoking, drinking and drug use among young people in England in 2009. National Centre for Social Research, 2010: NHS Information Centre for Health and
Social Care.
4
Harms caused by tobacco use
The majority of smokers are from manual
and routine occupations
Number of smokers by occupation (millions, 2010)
Unclassified, 0.66,
8%
Managerial &
professional, 2.55,
29%
Routine & manual,
4.09, 47%
Intermediate, 1.37,
16%
References:
1. Smoking, drinking and drug use among young people in England in 2009. National Centre for Social Research, 2010: NHS Information Centre for Health and
Social Care.
5
Harms caused by tobacco use
Smoking-related diseases
Smoking attributable deaths from major diseases (2009)
1277, 2%
20616, 25%
37539, 46%
22017, 27%
Cancers
Respiratory
Cardiovascular
References:
1. NHS Information Centre (2009), Statistics on smoking: England 2009 available at
www.ic.nhs.uk/webfiles/publications/smoking09/statistics_on_smoking_england_2009.pdf
Digestive
6
Harms caused by tobacco use
The annual cost of smoking to smokers
(compared to additional costs to Tendring’s
community)
Annual estimated costs of smoking to the individual and society
Estimated cost to smokers and society in your area (£millions)
Smokers' spending on tobacco
£43.7m
Tendring
Total costs to society
£40.8m
0
5
10
15
20
25
30
35
40
45
50
Millions (£)
References:
1. Cough Up, Policy Exchange, 2010, 2. HMRC, 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011)
7
Harms caused by tobacco use
Smoking costs the local economy millions
every year
The annual cost of smoking in this local area (£millions)
References:
1. Cough Up, Policy Exchange, 2010 2. 'Reckoner' spreadsheet
8
Harms caused by tobacco use
Local smoking rates differ greatly
References:
1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http://www.cdph.ca.gov/Pages/NR11-031.aspx
9
Harms caused by tobacco use
2. Smoking attitudes & behaviours
10
Harms caused by tobacco use
Actions to break the ‘cycle of smoking’
Protect families
& communities

Take-up
smoking
Relapse
Reduce the
appeal and
supply of
tobacco


Quitting
attempt




Encourage
more quit
attempts each
year
Decision
to quit
Support quit
attempts
11
Harms caused by tobacco use
Children not adults start smoking
Age smokers start smoking: 90% of smokers started before the
age of 19
18 is the age at
40%
Under 16, 38%
which you can
legally buy
tobacco
35%
30%
16-17, 27%
25%
20%
18-19, 17%
15%
20-24, 11%
10%
25 and over, 6%
5%
0%
Under 16
References:
1. Smoking Attitudes & Behaviours, ONS 2011
16-17
18-19
20-24
25 and over
12
Harms caused by tobacco use
Children are three times as likely to start
smoking if their parents smoke1
99% of 16 year old regular smokers live in a household with at least one
other smoker1
Smoking prevalence in 11-15 year olds by number of smokers they live with1
30%
25%
25%
20%
16%
15%
10%
10%
5%
4%
0%
None
One
Two
Three or more
References:
1. Smoking, drinking and drug use among young people in England in 2010, ONS
13
Harms caused by tobacco use
Women in low-paid work are 3 times more
likely to smoke during pregnancy
Socio-economic group: % who smoked before or during pregnancy
45%
40%
40%
35%
30%
26%
25%
20%
15%
14%
10%
5%
0%
Managerial &
professional
References:
1. Infant Feeding Survey, ONS 2011
Intermediate
occupations
Routine & manual
14
Harms caused by tobacco use
Teenagers are almost 4 times more likely to
smoke whilst pregnant compared with those
over 35
Age: % who smoked before or during pregnancy
70
60
58
50
44
40
26
30
17
20
15
10
0
Under 20
References:
1. Infant Feeding Survey, ONS 2011
20 – 24
25 – 29
30 – 34
35 or over
15
Harms caused by tobacco use
Each year nearly 10,000 children are treated in
hospital for exposure to second-hand smoke
References:
1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010
16
Harms caused by tobacco use
The poorer you are the more likely you are to
smoke
30
Smoking rates by socio-economic group
(England 2009)
25
28
20
15
10
19
15
5
0
Managerial and
Professional
References:
1. General Lifestyle Survey, ONS, 2010
Intermediate
Routine and
Manual
17
3.50
Smokers from the highest social class have a lower life expectancy than
non-smokers in the lowest social class
3.00
Relative mortality
Harms caused by tobacco use
Smoking not social status is the greatest
cause of health inequalities
2.50
The life
expectancy
between rich and
poor smokers is
similar
2.00
Richer smokers
have a lower life
expectancy than
poorer nonsmokers
1.50
1.00
0.50
0.00
I+II
Highest
IV+V
Social Class
Male non-smokers
Lowest
Male smokers
References:
1. Gruer L et al. BMJ 2009;338;bmj.b480 (Relative mortality assessed at 2nd 14 year follow-up between male smokers & non-smokers of highest & lowest social
class)
18
Harms caused by tobacco use
Certain minority groups & ethnic groups
smoke at higher than average rates
45%
40%
40%
35%
30%
30%
29%
25%
25%
20%
15%
10%
5%
0%
Bangladeshi
Irish
Pakistani
Black Caribbean
References:
1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010
19
Harms caused by tobacco use
Quitting is the best way for smokers to
improve their life expectancy
Years of life gained by stopping smoking at different ages, 30 to 60
Age at which stopped
smoking
Years of life gained
30
10
40
9
50
6
60
3
References:
1. Doll R, Mortality in relation to smoking, BMJ 2004
20
Harms caused by tobacco use
Benefits of quitting bring improvements in
wellbeing regardless of age
20 Minutes
Your blood pressure & pulse return to normal. Circulation improves –
especially in your hands and feet.
8 Hours
Your blood oxygen levels return to normal and your chance of having
a heart attack falls
24 Hours
Carbon monoxide leaves your body. Your lungs start to clear out
mucus and debris.
2-12 Weeks
Circulation is now improved throughout your body. It’s easier to
exercise.
3-9 Months
Lung efficiency is up by 5-10%. Breathing problems are gone.
5 Years
You have half the chance of getting a heart attack than a smoker.
References:
1. West R. Shiffman S. S Fast Facts, 2nd Ed. Oxford Health Press, 2007
21
Harms caused by tobacco use
Packs are ‘silent salesmen’ for tobacco
brands
The Government has consulted on requiring plain packaging for
tobacco products and has now decided to wait before making a
decision on plain packaging. However, research shows that plain
packs are
•Less attractive to young people
•Less likely to mislead smokers into thinking “mild” brands are
safer
•Give greater impact to health warnings
This is an
example of the
‘plain pack’ the
Australian
national
government is
using.
22
Harms caused by tobacco use
The majority of children who smoke get their
cigarettes from a ‘friend’
Usual sources of cigarettes for 11-15 year olds in England
70%
58%
60%
50%
37%
40%
30%
24%
20%
20%
11%
10%
10%
10%
0%
en
iv
G
by
ds
n
e
fri
gh
u
Bo
m
ro
f
t
en
g
sa
w
ne
t
es
it v
la
re
…
m
so
…
References:
1. Smoking, drinking and drug use among young people in England in 2006
n
eo
e
se
el
ge
a
ar
.. g
su
…
rm
e
p
et
k
ar
g
en
iv
G
by
lin
b
si
23
Harms caused by tobacco use
Smokers from lower social classes are more
likely to provide an immediate and tangible
reason for making a quit attempt
Knew someone w ho w as
ill or died (from smoking)
Health problems at the time
Concern about future
health problems
0
5
10
15
20
Socioeconomic Group 'A'
25
30
35
40
45
Socioeconomic Group 'E'
References:
1. E Vangeli, R West, Sociodemographic differences in triggers to quit smoking: findings from a national survey, Tobacco Control 2008
24
Harms caused by tobacco use
Using NHS support is nearly 4 times more
successful than going ‘cold turkey’
NHS support and
medication
3.8
Medication on
prescription
1.6
1.02
NRT over-the-counter
No medication or
support (reference)
1
0
0.5
1
1.5
2
2.5
3
3.5
4
Odds ratio (relative to no aid)
References:
1. West R, Smoking Toolkit, UCL www.smokinginengland.org
25
Harms caused by tobacco use
Smoking & public opinion (YouGov 2011, East of England)
Requiring plain packaging with standard lettering for
tobacco products
24
21
Putting tobacco products out of sight in shops
55
Smoking should be banned in cars carrying children
under the age of 18
Government policy should be protected from the
influence of tobacco industry and its representatives
9
80
4
77
Smoking should be banned in outdoor children's play
areas
12
76
The law banning smoking in public places is good for
my health
6
The law banning smoking in public places is good for
the health of the general public
6
References:
1. YouGov Survey 2011, East of England
Disagree
Agree
50
79
84
26
Success rate in quitting by socio-economic class
60
50
40
Percent
Harms caused by tobacco use
Poorer smokers are as likely to want to quit
and try to quit but half as likely to succeed
30
20
10
0
Tried to quit in past year
AB
References:
1. West R, Smoking Toolkit, UCL www.smokinginengland.org
Success rate
C1
C2
D
E
27
Harms caused by tobacco use
3. Tobacco policies
28
Harms caused by tobacco use
The World Bank has developed a ‘6 strand’
strategy for reducing tobacco use
1. stopping the promotion of tobacco;
2. making tobacco less affordable;
3. effective regulation of tobacco products;
4. helping tobacco users to quit;
5. reducing exposure to secondhand smoke;
and
6. effective communications for tobacco control.
References:
1. World Bank, ‘6-Strand’ Tobacco Control Strategy (found at http://web.worldbank.org)
29
Harms caused by tobacco use
Local action: County Councils enforce
tobacco laws
• Age of Sales
• Smuggled and
Counterfeit
Tobacco
• Advertising ban
30
Harms caused by tobacco use
Local action: County Councils now
commission stop smoking services
NHS support and
medication
Medication on
prescription
NHS Stop Smoking
Services are the most
successful route to quit
and the most cost
effective NHS treatment
there is
NRT over-the-counter
No medication or
support (reference)
0
0.5
1
1.5
2
2.5
3
3.5
4
Odds ratio (relative to no aid)
Data from www.smokinginengland.info; based on smokers who tried to stop in the past year who report still not smoking at the
survey adjusting for other predictors of success (age, dependence, time since quit attempt, social grade, recent prior quit attempts,
abrupt vs gradual cessation): N=7,939
31
Harms caused by tobacco use
Working together councils can mount
effective local campaigns
32
Harms caused by tobacco use
Local action: District, Borough & City Councils
Smokefree environments enjoy increasing public
support
Percentage of adults reporting that their homes are smokefree
100%
80%
13%
12%
10%
26%
21%
20%
61%
67%
69%
ONS 2006
ONS 2007
ONS 2008
8%
14%
60%
40%
78%
20%
0%
YouGov 2009
Smoking permitted throughout
Partial restrictions
Smoking prohibited throughout
33
Harms caused by tobacco use
Local action cont: Smokefree Play Parks enjoy
increasing public support
De-normalising smoking:
• Young people have a right to a clean & healthy
environment to play in
• Most adults agree that smoking should be banned in
outdoor play areas – 76% (YouGov 2011)
• Young people over estimate the amount of smoking &
think it is the norm because they see it around them
• No smoking signs in play areas help people to
challenge someone who lights up
Environmental Impact:
• Play areas can be spoiled by some form of smoking
related litter
• Cigarette butts can take up to 12 yrs to biodegrade
34
Harms caused by tobacco use
Local action: District, Borough & City Councils
Role of Environmental Health Officer:
• Enforce Smokefree Legislation – Responsible for
monitoring compliance & enforcement. Work closely
with local business to provide education, advice and
support to ensure compliance is achieved
• Environmental Protection – Litter & Workplace
health and safety
35
Harms caused by tobacco use
4. Delivery
36
Harms caused by tobacco use
Effective communications will direct smokers
to the most effective route of quitting
37
Harms caused by tobacco use
Working together for better health
1. Local Government, inc. Police & Fire Brigade
2. Local Health Services
3. Organisations that work across neighbouring
localities within a region
4. Employers
5. Voluntary sector organisations
6. Smokers
(particularly, groups with high rates of smoking
e.g. routine & manual smokers)
38
Harms caused by tobacco use
Key messages
1. Local Authorities have a key & important
role to play; no agency alone can reduce
smoking rates
2. Smoking is the single biggest preventable
cause of health inequalities; reducing rates
will bring general improvements in health &
cost savings in other areas
3. To reduce smoking we need to increase
the number of quit attempts & the success
of each attempt; we should target the
poorest smokers to narrow the gap in life
expectancy between the richest & poorest
and improve the health of the poorest, fastest
39
Harms caused by tobacco use
Next Steps
• Tobacco Control group
• Smokefree Environments inc. Parks,
Workplace, Homes & Cars
• Illicit Tobacco
• Staff Training
40