Worcestershire Health and Well-being Board
JSNA Briefing on Smoking
Commissioning Lead
Jessica Glenn
Version
V2
Information Lead
Mark Sheldon
Date
31/07/2013
Smoking amongst adults
 In England, 22% of men and 20% of women aged 16 and over were regular smokers in 2009. People who
were classified as ‘current smokers’ in 2009 smoked an average of 13 cigarettes a day. However, there are
marked differences in sections of the community in smoking prevalence and consumption, varying by
factors such as age, sex, social class and ethnicity.
 Smoking prevalence amongst adults is highest among those aged 20-24, and gradually declines with age,
through quitting or dying. In England, almost a third (28%) of people aged 20-24 were smokers in 2009.
The lowest level of smoking (14%) was among people aged 60 and over.
Smoking and young people
 Taking up smoking at an early age greatly increases the health risks of smoking, such as the risk of
developing lung cancer. Children and young people who start smoking are more likely to continue
smoking as adults, and are less likely to give up than those who start smoking in later life.
 Almost two thirds (65%) of adult smokers in England in 2009 started before they were 18 years old. Only
6% of smokers started at the age of 25 or over.
Smoking in pregnancy
 Smoking during pregnancy increases the risk of complications during pregnancy and labour, including
miscarriage. Women who smoke, or who are exposed to second-hand smoke, while pregnant are more
likely to have a baby with low birth weight than non-smoking mothers. Low birth weight is associated with
higher risks of death and disease in infancy and early childhood. Smoking during, and after, pregnancy
also increases the risk of sudden infant death (‘cot death’).
Smoking and health inequalities
 The prevalence of smoking varies markedly between socio-economic groups. People in deprived
circumstances are not only more likely to take up smoking but generally start younger, smoke more
heavily and are less likely to quit smoking , each of which increases the risk of smoking-related disease.
Smoking related ill-health and deaths
 Smoking caused an average of 82,500 estimated deaths per year of adults aged 35 and over in England
during the period 2008-10. This figure includes a yearly average of 10,800 deaths from heart disease and
3,600 deaths from stroke that were attributed to smoking in 2008-10.
 There were 28,100 deaths from lung cancer and 22,400 deaths from chronic obstructive pulmonary
disease (COPD) on average per year in England over the period 2008-10. The vast majority of these deaths
were caused by smoking.
 Smoking is responsible for a larger proportion of deaths among men than women. In England in 2009, an
estimated 23% of all deaths among men aged 35 and over were attributed to smoking, compared with
14% of all deaths among women.
JSNA Briefing on Smoking
Key Indicators;
Table 1: Worcestershire, West Midlands and England Headline Data Comparison
Key Indicators from Public Health Outcomes
West
Worcs vs.
England
Worcs
Framework:
Midlands
England
Significantly
2.3 Smoking Status at Time of Delivery 2011/121
13.2%
15.4%
16.3%
worse
2.14 Smoking prevalence – % adults (over 18)
No significant
20.0%
19.5%
18.4%
2011/122
difference
4.7 Under 75 mortality rate from respiratory
Significantly
11.7
11.8
9.1
3
diseases
better
Sources: 1Local Tobacco Profiles, 2ONS (experimental statistics), 3Public Health England Fingertips toolkit
Figure 1 – Local Tobacco Profiles Spine Chart for Worcestershire
Source: Local Tobacco Profiles
JSNA Briefing on Smoking
Figure 2 - Rate of Smoking During Pregnancy in Worcestershire Districts compared
to the National average 2010/11 and 2011/12
 Although there
4%
appears to be no
difference in the
rates for the
Worcestershire
districts, there are
differences in the
confidence intervals
for each area. Those
areas with a greater
lower level
confidence interval
can be deemed to be
performing worse
than others.
2%
 It is worth noting
2010/11
2011/12
England 2010/11
England 2011/12
20%
18%
16%
14%
16.3%
15.8%
16.3%
15.8%
16.3%
15.8%
16.3%
15.8%
16.3%
15.8%
8%
15.8%
10%
16.3%
12%
6%
0%
Malvern Hills Bromsgrove Wyre Forest
Wychavon
Redditch
Worcester
Source: Local Tobacco Profiles
Figure 3: Estimated Smoking prevalence among adults (18+) by Worcestershire
District and National average 2011/12
Current smoker
Redditch
Ex-smoker
25.2%
Worcester
33.6%
23.0%
England
16.9%
Bromsgrove
15.7%
Wyre Forest
15.5%
Malvern Hills
15.2%
0%
10%
41.1%
27.9%
20.0%
Wychavon
Never smoked
49.1%
33.2%
46.8%
36.2%
46.9%
36.4%
47.9%
34.9%
49.7%
38.3%
20%
30%
40%
46.5%
50%
60%
70%
Source: Integrated Household Survey, ONS (experimental statistics)
80%
90%
100%
that whilst the
National average has
fallen since 2010/11,
Worcestershire’s has
risen.
 Redditch has the
largest estimated
proportion of adults
that are current
smokers. Worcester
also has a higher rate
than the National
average.
 In 2009/10 only
14% of adults in
Worcester were
current smokers,
with 54% having
never smoked. This
implies that previous
efforts have been
unsustainable and
there needs to be a
greater emphasis on
persuading current
smokers not only to
quit, but to remain
abstinent.
JSNA Briefing on Smoking
Figure 4: Rate of Smoking Related Mortality per 100,000 Males for All Ages by
Worcestershire District 2006/10 and 2008/12 (5 Years pooled data)
2006/10
2008/12
Worcs 2006/10
Worcs 2008/12
200
180
160
140
120
146.0
159.8
138.6
145.5
135.9
109.9
120.9
120.6
112.6
40
107.0
60
110.3
80
129.6
100
 Each district has a
lower smoking
related mortality
rate for Males in
2008/12 than in
2006/10, although
Wychavon now has a
slightly lower rate
than Bromsgrove.
 Worcester and
Redditch have
mortality rates
significantly above
the Worcestershire
average in both time
periods.
20
0
Malvern Hills Bromsgrove
Wychavon
Wyre Forest
Redditch
Worcester
Source: Worcestershire County Council, Instant Atlas Toolkit
Figure 5: Rate of Smoking Related Mortality per 100,000 Females for All Ages by
Worcestershire District 2006/10 and 2008/12 (5 Years pooled data)
2006/10
2008/12
Worcs 2006/10
Worcs 2008/12
90
80
70
60
20
69.1
71.0
63.6
53.2
61.9
53.2
55.7
54.8
54.3
48.1
30
48.4
40
67.4
50
10
0
Malvern Hills Wychavon
Bromsgrove Wyre Forest
Source: Worcestershire County Council, Instant Atlas Toolkit
Redditch
Worcester
 Every district has a
lower smoking
related mortality
rate for Females in
2008/12 than in
2006/10, apart from
Wychavon which has
experienced a very
small increase.
 The rate for Wyre
Forest has reduced
considerably over
the two time
periods.
 Only the
Worcester district
has a significantly
higher rate than the
County average in
both time periods.
JSNA Briefing on Smoking
Figure 6: Rate of Smoking Related Deaths in Worcestershire Districts compared
to the National average 2010/11
2008-2010
England
Worcestershire
300
250
200
150
100
150.65
159.34
160.51
186.23
215.23
223.42
Redditch
Worcester
50
0
Malvern Hills Bromsgrove
Wychavon
Wyre Forest
 The
rate
of
smoking
related
deaths is significantly
lower
than
the
National average in
the
districts
of
Malvern
Hills,
Bromsgrove,
Wychavon, and Wyre
Forest.
 Although the rates
for Redditch and
Worcester are not
significantly different
to
the
National
average, they are
significantly higher
than the average for
Worcestershire as a
whole.
Source: Association of Public Health Observatories, http://www.apho.org.uk
Figure 7: COPD Emergency Hospital Admissions April 2006 to March 2011
2006/07-2010/11
England
140
120
100
80
122.3
60
87.0
40
20
49.5
54.4
65.3
67.8
0
Malvern Hills Bromsgrove Wyre Forest
Wychavon
Worcester
Source: Association of Public Health Observatories, http://www.apho.org.uk
Redditch
 The main risk
factor for COPD is
smoking, with the
risk increasing the
longer a person has
smoked.
 Not only does
Redditch have a
significantly greater
rate of emergency
hospital admissions
for COPD than the
national average, but
this is also
significantly greater
than the other five
Worcestershire
districts.