Leave no one behind

Addressing the challenges of smoking and inequalities

Sarah WilliamsTobacco Control Programme Manager, Public Health England

Overview

• Smoking and health inequalities

• Opportunities for tackling these inequalities

• The challenges ahead

• Suggestions for the way forward

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Smoking and health inequalities

Smoking is the greatest cause of health

inequalities

4 Tobacco Control in England: Reducing Inequalities

Smoking prevalence in different groups

• 40.5% of people with severe mental illness smoke

• Mothers in routine and manual occupations are five times more

likely to have smoked throughout pregnancy than mothers in

managerial and professional occupations

• 80% of the prison population smoke

• Many of the most deprived authorities also have the highest rates of

smoking

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Smoking at time of delivery (2016/17)

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0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

2016/17 rate of SATOD by CCG

10.1% national average6% 2022 target

Opportunities for tackling these inequalities

Towards a smokefree generation

• Reduce adult smoking rates from 15.5% down to 12% or less.

• Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less

• Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3%

or less.

• Reduce the inequality gap in smoking prevalence between those in routine

and manual occupations and the general population.

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Golden Threads…

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Reducing Inequalities

• Targeting priority populations

NHS Sustainability

• Emphasis on smokers in the healthcare system

Maternity transformation

programme

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Smoking and mental health

Leading Change Adding Value - Smoking and Mental Health Programme

Smokefree prisons

• 86 out of 103 prisons smokefree

• The final phase is now underway

• Roll out has been largely without incident

• Rechargeable vaping devices are popular

• Vigilance and support levels remain high

• Support for prisoners on release is a priority

• Probation services must be linked to cessation

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More people stopping successfully

• Better and more quitting aid options, with e-cigarettes now the most

popular. Combining the most effective (stop smoking services) with

the most popular (e-cigarettes) has strong results

• More restrictions on smoking

• Banning the use of attractive brand imagery on tobacco packaging

• Developing a strong smokefree ethos, especially through healthcare

systems

• Effective stop smoking campaigns such as Stoptober

• Increase in rates of quitting in smokers from lower socio-economic

groups

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Challenges

Limited resources

Stop smoking services and wider tobacco control have seen

some of the largest reductions in public health budgets

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Source: David Buck, The King’s Fund, 2017

Suggestions for the way forward

Evidence of effectiveness

Rank Component Boosts quit rates

by*…

1 Face–to-face group support with

pharmacotherapy

300%

2 Face-to-face individual support with

pharmacotherapy

200-300%

3 Supported use of pharmacotherapy 50-100%

4 Telephone support 50-100%

5 Text message support 40-80%

6 Websites Unknown

7 Mobile digital applications Unknown

* Quit rates boosted if intervention is run properly

Pool your resources

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Use available tools and resources

• Stop smoking services: models of delivery

• Commissioning support pack: principles and indicators

• Commissioning support pack: key data

• CLeaR

• Use of e-cigarettes in public places and workplaces

• NICE ROI tool

• NCSCT briefings: Integrated health behaviour services briefing;

Prevention v cessation: effectiveness and cost-effectiveness

• NCSCT on-line training: Specialist practitioner; Very Brief Advice; E-

cigarettes: a guide for healthcare professionals.

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Any questions?

Sarah Williams

sarah.williams@phe.gov.uk