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THE CASE FOR ACTIONon TOBACCO USE & SMOKING
Harms caused by tobacco use & an overview of local tobacco policies to aid commissioning
for Directors of Public Health
Common
Version 11.2
12th October 2011
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1. Scale of the challenge
3 Harm
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se Each year smoking causes the greatest number of preventable deaths
References:1. ASH Factsheet, Smoking Statistics: illness & death, June 2011 (http://www.ash.org.uk/files/documents/ASH_107.pdf) NB area represents value
Obesity: 34,000
Smoking: 81,400
Alcohol: 8,724
Suicide:5,377
Murder:648
HIV: 529
Traffic: 2,946
4 Harm
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se The decline in smoking rates has stalled
References:1. Integrated Household Survey 2010 (mid-point estimate for locality given small sample size and large confidence interval)
Note to customise this chart:
1. Save this presentation to your computer
2. Double click the chart to enter values for your region and your locality
3. Local data can be found at http://www.lho.org.uk/viewResource.aspx?id=16649
4. Delete these instructions
5. Save the revised presentation.
5 Harm
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se National children’s rates of smoking(age 11 – 15)
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.
0%
2%
4%
6%
8%
10%
12%
14%
1982 1986 1990 1994 1998 2002 2004 2006 2008 2009 2010
Boys Girls Total
6 Harm
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seThe majority of smokers are from manual and routine occupations
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.
Number of smokers by occupation (millions, 2010)
7 Harm
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se Smoking-related diseases
Smoking attributable deaths from major diseases (2009)
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
8 Harm
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se The annual cost of smoking to smokers(compared to additional costs to our community)
References:1. Cough Up, Policy Exchange, 2010, 2. HMRC, 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011)
Annual estimated costs of smoking to the individual and society
Note to customise this chart:
1. Double click on the chart to open the data sheet to input values for your locality. The example of Blackpool is used in this illustration.
2. Open the Local Costs of Smoking spreadsheet to calculate the costs in your locality – instructions on how to use the spreadsheet' are contained within it.
3. Paste the chart from the spreadsheet into this presentation.
The spreadsheet also allows you to print off a handout to use with this presentation.
9 Harm
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se Smoking costs the local economy millions every year
References:1. Cough Up, Policy Exchange, 2010 2. 'Reckoner' spreadsheet
The annual cost of smoking in this local area (£millions)
Note to customise this chart:
1. Save this presentation on your computer
2. Delete the sample chart
3. Open the Local Costs of Smoking spreadsheet to calculate the costs in your locality – instructions on how to use the spreadsheet are contained within it
4. Select a chart and paste it into this document
5. The spreadsheet also allows you to print off a handout to use with this presentation.
10 Harm
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se If we do nothing…
References:1.Monthly survey for smoking rate in England, Smoking Toolkit, UCL 2011l’, smokinginengland.co.uk
Evidence and experience show that when anti-smoking campaigns cease: Fewer adults are prompted to quit, more children start smoking, the effect is heaviest on the poorest
Following Ireland’s smokefree legislation (2004) smoking rates declined sharply.
When smoking was allowed to become more affordable and support for smokers to quit diminished smoking rates began to rise again.
The decline in smoking resumed following above inflation tax increases in 2008
11 Harm
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23
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All across England there is more room for progress...
… and international experience shows more can be achieved: in Smoking rates in New York City has fallen from 21% in 2001 to a historic low of 14% within a decade
References:1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http://www.cdph.ca.gov/Pages/NR11-031.aspx
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2. Smoking attitudes & behaviours
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se Actions to break the ‘cycle of smoking’
Take-up smoking
Quitting attempt
Relapse
Decision to quit
Take-up smoking
Quitting attempt
Relapse
Decision to quit
Take-up smoking
Quitting attempt
Relapse
Decision to quit
Reduce the appeal and supply of tobacco
Protect families &
communities
Encourage more quit
attempts each year
Support quit attempts
14 Harm
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seChildren not adults start smoking
References:1. Smoking Attitudes & Behaviours, ONS 2011
Age smokers start smoking: 90% of smokers started before the age of 19
18 is the age at which you can legally buy tobacco
15 Harm
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seChildren 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
References:1. Smoking, drinking and drug use among young people in England in 2010, ONS
4%
10%
16%
25%
0%
5%
10%
15%
20%
25%
30%
None One Two Three or more
Smoking prevalence in 11-15 year olds by number of smokers they live with1
16 Harm
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seWomen in low-paid work are 3 times more likely to smoke during pregnancy
References:1. Infant Feeding Survey, ONS 2011
14%
26%
40%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Managerial &professional
Intermediateoccupations
Routine & manual
Socio-economic group: % who smoked before or during pregnancy
17 Harm
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seTeenagers are almost 4 times more likely to smoke whilst pregnant compared with those over 35
Age: % who smoked before or during pregnancy58
44
26
17 15
0
10
20
30
40
50
60
70
Under 20 20 – 24 25 – 29 30 – 34 35 or over
References:1. Infant Feeding Survey, ONS 2011
18 Harm
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seEach 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
19 Harm
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se The poorer you are the more likely you are to smoke
References:1. General Lifestyle Survey, ONS, 2010
Smoking rates by socio-economic group (England 2009)
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1915
0
5
10
15
20
25
30
Managerial andProfessional
Intermediate Routine andManual
20 Harm
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seSmoking not social status is the greatest cause of health inequalities
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)
Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
I+II IV+V
Social Class
Rel
ati
ve
mo
rtal
ity
Male non-smokers Male smokers
Highest Lowest
The life expectancy
between rich and poor smokers is
similarRicher smokers have a lower life expectancy than
poorer non-smokers
21 Harm
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seCertain minority groups & ethnic groups smoke at higher than average rates
References:1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010
40%
30% 29%25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Bangladeshi Irish Pakistani Black Caribbean
22 Harm
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seQuitting is the best way for smokers to improve their life expectancy
References:1. Doll R, Mortality in relation to smoking, BMJ 2004
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
23 Harm
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seBenefits 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
24 Harm
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se The tobacco industry uses pseudo economic arguments to divert attention from health issues
1. Small businesses and workers’ jobs are lost
2. Criminal gangs profit from increases in smuggled tobacco
3. Tobacco control measures don’t work and are a waste of public money
Claims on the economic impact of policies to reduce smoking:
25 Harm
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se Packs are ‘silent salesmen’ for tobacco brands
By the end of the year the Government will consult on requiring plain packaging for tobacco products.
Research shows that 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 the suggested ‘plain
pack’ the Australian national
government is considering.
26 Harm
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seThe majority of children who smoke get their cigarettes from a ‘friend’
References:1. Smoking, drinking and drug use among young people in England in 2006
Usual sources of cigarettes for 11-15 year olds in England
58%
37%
24%20%
11% 10% 10%
0%
10%
20%
30%
40%
50%
60%
70%
Given
by
frien
ds
Bought fro
m n
ewsa
gent
…re
lativ
es
…so
meo
ne el
se
..gar
age
…su
perm
arket
Given
by
sibl
ing
27 Harm
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se Smokers from lower social classes are more likely to provide an immediate and tangible reason for making a quit attempt
References:1. E Vangeli, R West, Sociodemographic differences in triggers to quit smoking: findings from a national survey, Tobacco Control 2008
0 5 10 15 20 25 30 35 40 45
Concern about futurehealth problems
Health problems at the time
Knew someone w ho w asill or died (from smoking)
Socioeconomic Group 'A' Socioeconomic Group 'E'
28 Harm
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se Using NHS support is nearly 4 times more successful than going ‘cold turkey’
1
1.02
1.6
3.8
0 0.5 1 1.5 2 2.5 3 3.5 4
No medication orsupport (reference)
NRT over-the-counter
Medication onprescription
NHS support andmedication
Odds ratio (relative to no aid)
References:1. West R, Smoking Toolkit, UCL www.smokinginengland.org
29 Harm
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se Smoking & public opinion (YouGov 2011)NB You can replace
this chart with regional data
produced with this toolkit.
82
80
76
74
78
56
47
7
6
12
4
10
21
23
The law banning smoking in public places is good forthe health of the general public
The law banning smoking in public places is good formy health
Smoking should be banned in outdoor children's playareas
Government policy should be protected from theinfluence of tobacco industry and its representatives
Smoking should be banned in cars carrying childrenunder the age of 18
Putting tobacco products out of sight in shops
Requiring plain packaging with standard lettering fortobacco products
Disagree
Agree
References:1. YouGov Survey 2011
30 Harm
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se Poorer smokers are as likely to want to quit and try to quit but half as likely to succeed
0
10
20
30
40
50
60
Tried to quit in past year Success rate
Per
cent
AB C1 C2 D E
Success rate in quitting by socio-economic class
References:1. West R, Smoking Toolkit, UCL www.smokinginengland.org
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3. Tobacco policies
32 Harm
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seThe World Bank has developed a ‘6 strand’ strategy for reducing tobacco use
References:1. World Bank, ‘6-Strand’ Tobacco Control Strategy (found at http://web.worldbank.org)
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.
33 Harm
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se Local action: councils enforce tobacco laws
34 Harm
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se Local action: Councils will commission stop smoking services
0 0.5 1 1.5 2 2.5 3 3.5 4
No medication orsupport (reference)
NRT over-the-counter
Medication onprescription
NHS support andmedication
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
NHS Stop Smoking Services are the most
successful route to quit and the most cost
effective NHS treatment there is
35 Harm
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36 Harm
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se Smokefree environments enjoy increasing public support
61% 67% 69% 78%
26% 21% 20%14%
13% 12% 10% 8%
0%
20%
40%
60%
80%
100%
ONS 2006 ONS 2007 ONS 2008 YouGov 2009
Smoking permitted throughout
Partial restrictions
Smoking prohibited throughout
Percentage of adults reporting that their homes are smokefree
37 Harm
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seEffective communications will direct smokers to the most effective route of quitting
38 Harm
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se Helping poorer smokers to quit is the most effective way of reducing health inequalities
Poorer smokers are much more likely to buy illicit tobacco
7
12
0
5
10
15
AB to C1 C2 to E
%
Social classes & illicit tobacco consumed (Smoking Toolkit)
References:1. West R, Smoking Toolkit, www.smokinginengland.org.uk
39 Harm
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4. Delivery
40 Harm
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se Significant & growing role for Local Authorities
LA responsibilities include enforcement on:
Age-of-sale
'Smokefree' places
Smuggled & counterfeit tobacco
Advertising ban
From 2013, Local Authorities will take on responsibility to commission services to motivate & support smokers to quit their habit.
41 Harm
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se Health cost of smoking in your area
Note to customise this chart:
1. Values for your locality are calculated in the 'Local Tobacco Profiles'
2. Copy from the ‘pdf’ as this provides the clearest image.
3. Due to the amount of detail on this slide, a printed “handout” will probably be necessary for your audience.
42 Harm
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se 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)
43 Harm
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se Benefits of working across local boundaries
• Marketing & mass media – to ensure ‘health messages’ are supportive, clear & do not conflict
• Tackling smuggling – criminal gangs don’t pay heed to local government boundaries
• Surveys, research & data collection – cost savings can be had from collectively commissioning research & surveys, & sharing the results
44 Harm
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se Key messages
1.Local Authorities have a key & important role to play; the NHS alone cannot 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
