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THE CASE FOR ACTION
on SMOKING &TOBACCO USE
2014
1. Scale of the challenge
2. Smoking attitudes and behaviour
3. How do we reduce tobacco use?
4. Delivery at local level
2
1. Scale of the challenge
3
Smoking is the leading cause of preventable death
Alcohol:
6,669
Smoking:
79,100
Obesity:
34,100
Traffic:
1,850
Suicide:
5,377
HIV:
504
Illegal drugs:
1,605
4
Deaths from the most common
smoking-related diseases
Total annual deaths = 79,100
5
Smoking prevalence in England
21
o Prevalence was 19% in 2013.
o Peaked at 45% in 1974.
o Prevalence is substantially
higher amongst lower socioeconomic groups, people with a
mental illness and certain ethnic
groups.
o Prevalence is lowest amongst
higher income groups and those
with higher levels of education.
23
22
16
19
21
17
17
19
6
The decline in smoking prevalence has stalled
35%
30%
29%
Note to customise this chart:
25%
20%
15%
10%
1. Save this presentation to your computer
22%
21%
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%
5. Save the revised presentation.
0%
1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
England
Your region
Your locality
7
The financial cost of smoking
Annual estimated costs of smoking to the individual and society
£20
£18.3
£18
Cost in billions
£16
£13.7
£14
£12
£10
£8
£6
£4
£2
£0
Cost to smoker
Cost to society
This figures is the highest estimate
and includes £9.5 billion in tax.
8
The local cost of smoking
Annual estimated costs of smoking to the individual and the community
Note to customise this chart:
£64
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
£54.3 – instructions on
how to use the spreadsheet' are
contained within it.
3.
Paste the chart from the
spreadsheet into this presentation.
£63.1
£62
Cost in millions
£60
£58
£56
£54
£52
£50
£48
Total cost to smoker (amount spent on tobacco)
cost of smoking to community
TheTotal
spreadsheet
also allows you to
print off a handout to use with this
presentation.
9
Smoking costs the local
economy millions every year
The annual cost of smoking in this local area (£millions)
Note to customise this chart:
1.
Save this presentation on your
£16.6
computer
2.
Delete the sample chart
£18
£16
Cost in £ millions
£14
£12
£10.1
£10.9
3.
£10
£8
£6
£4
£2
£1.4
£2.1
£2.8
£11.7
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.
£0
Smoking
litter
Domestic
fire
Passive
smoking
Sick days
Select a chart and paste it into
document Output
NHS carethis
Smoking
breaks
5.
loss from
The spreadsheetearly
also allows you
death
to print off a handout to use with
Type of cost associated with smokingthis
presentation.
10
Smoking not social status is the leading
cause of health inequalities
3.50
Smokers from the highest social class have a lower life expectancy than
non-smokers in the lowest social class
Relative mortality
3.00
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
11
If we do nothing…
Evidence and experience show that when
anti-smoking campaigns cease, fewer
adults are prompted to quit and more
children start smoking.
The impact is greatest amongst those on
low incomes……
12
2. Smoking attitudes & behaviours
13
It is children not adults
who take up smoking
90% of smokers started before the age of 19
40%
18 is the age at
which you can
legally buy
tobacco
Under 16, 38%
35%
30%
16-17, 27%
25%
20%
18-19, 17%
15%
20-24, 11%
10%
25 and over, 6%
5%
0%
Under 16
16-17
18-19
20-24
25 and over
14
Smoking Prevalence: Young People (11-15)
463 children take up smoking every day in England.
15
Children are three times more likely to
start smoking if their parents smoke
99% of 16 year old regular smokers live in a
household with at least one other smoker
Smoking prevalence in 11-15 year olds by number of smokers they live with.
30%
25%
25%
20%
16%
15%
10%
10%
5%
4%
0%
None
One
Two
Three or more
16
Where do children get their cigarettes from?
Usual sources of cigarettes for 11-15 year olds in England
17
Smoking rates amongst pregnant teenagers are
substantially higher than in other age groups
Age: % who smoked during pregnancy
40
35
35
30
25
22
20
15
11
10
7
6
5
0
Under 20
20 – 24
25 – 29
30 – 34
35 or over
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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
Intermediate
occupations
Routine & manual
19
Every year nearly 10,000 children are treated in
hospital for exposure to second-hand smoke
20
Smoking prevalence is higher in
routine and manual groups
21
Smokers from lower socioeconomic groups are
more likely to purchase illicit tobacco
Illicit tobacco consumed by social group
15
12
10
%
7
5
0
AB to C1
C2 to E
22
How do we 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
23
3. How do we reduce tobacco use?
24
The World Bank has developed a ‘six strand’
approach for reducing tobacco use
1. Stop the promotion of tobacco;
2. Make tobacco less affordable;
3. Effective regulation of tobacco products;
4. Help tobacco users to quit;
5. Reduce exposure to secondhand smoke;
6. Effective communications for tobacco control.
25
Local action: councils enforce tobacco laws
26
Local Authorities’ enforcement
responsibilities include:
Purchase of tobacco by under 18s
Proxy sales
Chewing and smokeless tobacco sales
Smokefree legislation
Illicit tobacco
Shisha cafes
Advertising ban
27
Local Authorities 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)
28
Smokers are nearly 4 times more likely to quit
using NHS support 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)
29
Poorer smokers want to quit
but are only half as likely to succeed
Success rate in quitting by socio-economic class
60
50
Percent
40
30
20
10
0
Tried to quit in past year
AB
Success rate
C1
C2
D
E
30
Harm Reduction
Nicotine is highly addictive. Some smokers are highly
dependent on nicotine and:
• may not be able (or want) to stop smoking in one
step
• may want to stop smoking but are unable to give up
nicotine
• may not be ready to stop smoking but want to reduce
the amount they smoke.
However it is the toxins in the tobacco smoke – not the
nicotine – that cause illness and death.
31
The NICE approach to harm reduction
For highly addicted smokers, NICE recommends a
“harm reduction” approach which advocates either
temporary or long-term substitution of tobacco with safer
forms of nicotine:
• Stopping smoking, but using NRT to prevent
relapse.
• Cutting down prior to stopping smoking with or
without the help of NRT.
• Smoking reduction with or without the use of NRT.
• Temporary abstinence from smoking with or
without the use of NRT.
32
Since the introduction of smokefree legislation,
more people are making their homes smokefree
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
There is strong public support for
tobacco control measures
Requiring plain packaging with standard lettering for
tobacco products
23
21
Putting tobacco products out of sight in shops
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
Disagree
47
Agree
NB You can replace
this chart with
regional data
56
produced
with this
toolkit.
10
78
4
74
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
7
80
82
34
Effective communication is essential
35
4. Delivery at local level
36
Local Authorities can
mount effective local campaigns
37
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.
38
Tobacco industry attempts to
influence policy at local level.
• The tobacco industry has a long history of using front
groups to influence the policy process and undermine
tobacco control measures.
• The Tobacco Control Plan for England states explicitly that
local government should take action to protect their public
health policies from the interests of the tobacco industry.
• Front groups may claim to represent shopkeepers, retailers
and publicans but in fact promote the interests of the
tobacco industry.
• Now that Local Authorities are responsible for public
health, it is likely that the tobacco industry representations
to Councils via these groups will increase.
39
Things to look out for….
• In 2013 the tobacco industry subsidiary “Nicoventures”
attempted to meet with local authorities to discuss the
implementation of the NICE guidance on harm reduction.
• Planting stories with exaggerated claims about the
impact of illicit tobacco sales in local press.
• “Responsible Retailer” programmes purporting to
address underage sales.
• Offers to fund sniffer dogs, scanners and other
“resources” for combating illicit tobacco.
• Funding conferences for local government officers.
40
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. Children’s and youth groups
7. Smokers (particularly, groups with high rates of
smoking e.g. routine & manual smokers)
8. Health commissioners
41
Benefits of working across
local boundaries
• Marketing – would it be more cost effective to split
marketing costs with other Local Authorities?
• Tackling illicit tobacco – criminal gangs don’t pay
attention to local government boundaries.
• Surveys, research & data collection – cost savings
can be had from collectively commissioning
research & surveys, and sharing the results.
42
Key messages
1. Local Authorities have a key role to play: the NHS
cannot reduce smoking rates alone.
2. Smoking is the single biggest preventable cause of
health inequalities: reducing rates will bring significant
improvements in health as well as cost savings.
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
43