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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
for Directors of Public Health
NORTH West
Version 12.0
5th October 2012
Your logo
here
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, June 2011 (http://ash.org.uk/files/documents/ASH_107.pdf)
(http://www.ash.org.uk/files/documents/ASH_107.pdf)
NB area
NB represents
area represents
value value
HIV:
529
Drug misuse:
1,738
3
Harms caused by tobacco use
The decline in smoking rates has stalled
35%
30%
29%
25%
22%
Note to customise this chart:
20%
21%
1. Save this presentation to your computer
15% 2. Double click the chart to enter values for your region
and your locality
10%
3. Local data can be found at
5%
http://www.lho.org.uk/viewResource.aspx?id=16649
4. Delete these instructions
0%
5. Save the revised presentation.
1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
England
Your region
Your locality
References:
1. Integrated Household Survey 2010 (mid-point estimate for locality given small sample size and large confidence interval)
4
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.
5
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.
6
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
7
Note to customise this chart:
(compared to additional costs to our community)
1.
Annual estimated costs of smoking to
£64
£63.1
Double click on the chart to open
the data sheet to input values for
your locality. The example of
theBlackpool
individual
and
society
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.
£54.3
£62
£60
Cost in millions
Harms caused by tobacco use
The annual cost of smoking to smokers
£58
£56
£54
The spreadsheet also allows you to
print off a handout to use with this
presentation.
£52
£50
£48
Total cost to smoker (amount spent on
tobacco)
Total cost of smoking to community
References:
1. Cough Up, Policy Exchange, 2010, 2. HMRC, 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011)
8
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
Harms caused by tobacco use
Smoking costs the local economy millions
every year
£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
References:
1. Cough Up, Policy Exchange, 2010 2. 'Reckoner' spreadsheet
presentation.
9
Harms caused by tobacco use
If we do nothing…
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
References:
1.Monthly survey for smoking rate in England, Smoking Toolkit, UCL 2011l’, smokinginengland.co.uk
10
Harms caused by tobacco use
Local smoking rates differ greatly
22
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
22
23
19
19
22
18
22
19
References:
1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http://www.cdph.ca.gov/Pages/NR11-031.aspx
11
Harms caused by tobacco use
2. Smoking attitudes & behaviours
12
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
13
Harms caused by tobacco use
Children not adults start smoking
Age smokers start smoking: 90% of smokers started before the age of
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
References:
1. Smoking Attitudes & Behaviours, ONS 2011
16-17
18-19
20-24
25 and over
14
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
15
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
16
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
17
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
18
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
19
15
10
5
0
Managerial and
Professional
References:
1. General Lifestyle Survey, ONS, 2010
Intermediate
Routine and
Manual
19
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)
20
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
21
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
22
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
23
Harms caused by tobacco use
The tobacco industry uses pseudo economic
arguments to divert attention from health
issues
Claims on the economic impact of
policies to reduce smoking:
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
24
Harms caused by tobacco use
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.
25
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
26
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
27
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
28
Harms caused by tobacco use
Smoking & public opinion (YouGov 2011)
Requiring plain packaging with standard lettering for
tobacco products
23
Agree
21
56
Smoking should be banned in cars carrying children
under the age of 18
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
References:
1. YouGov Survey 2011
Disagree
47
Putting tobacco products out of sight in shops
Government policy should be protected from the
influence of tobacco industry and its representatives
NB You can replace
this chart with
regional data
produced with this
toolkit.
80
82
29
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
30
Harms caused by tobacco use
3. Tobacco policies
31
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)
32
Harms caused by tobacco use
Local action: councils enforce tobacco laws
33
Harms caused by tobacco use
Local action: Councils will 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
34
Harms caused by tobacco use
Working together councils can mount
effective local campaigns
35
Harms caused by tobacco use
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
36
Harms caused by tobacco use
Effective communications will direct smokers
to the most effective route of quitting
37
37
Poorer smokers are much more likely to buy illicit tobacco
Social classes & illicit tobacco consumed
(Smoking Toolkit)
15
12
10
7
%
Harms caused by tobacco use
Helping poorer smokers to quit is the most
effective way of reducing health inequalities
5
0
AB to C1
References:
1. West R, Smoking Toolkit, www.smokinginengland.org.uk
C2 to E
38
Harms caused by tobacco use
4. Delivery
39
Harms caused by tobacco use
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.
40
Harms caused by tobacco use
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.
41
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)
42
Harms caused by tobacco use
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
43
Harms caused by tobacco use
Make Smoking History for our children’
a collaborative approach
• Tobacco Free Futures has worked since 2008
as a collaborative specialised programme to
tackle tobacco harm
• NW Primary Care Organisations commission
Tobacco Free Futures to provide multiple
components of work, delivered in partnership
with localities and key sub-regional groups
(e.g. public health networks) and national
agencies (e.g. Smokefree Action Coalition)
• Small dedicated office; NW wide strategy; long
term campaign ‘make smoking history for
children’
44
Harms caused by tobacco use
Role of Tobacco Free Futures
• Providing strategic leadership, expertise,
guidance, training and development to all
localities and their alliances around effective
tobacco control delivery
• Developing, delivering and evaluating
integrated mass media campaigns, including
ongoing public relations (over £4m earned
media to date) and public engagement (inc.
60,000 NW responses to national consultation
on future tobacco control)
• Tailored support to commissioners and
providers of stop smoking services
• Advocacy around the evidence base and
making sure that the North West can influence
key legislative and policy decision making
45
Harms caused by tobacco use
North West and pan-regional programmes
46
Harms caused by tobacco use
Good progress in North West
Beginning to make smoking history for children…
•
•
•
Smoking rates at age 14 halved from 2009 to 2011 –down
from 18% to 9% (Trading Standards NW young people
surveys)
Adult prevalence held at 23% (General Household Survey
2009) despite recession and highest levels in England of
routine & manual groups in NW
NW had highest numbers nationally setting quit date &
successful quitters in 2009/10 (1,038 per 100,000 compared
to England average of 895)
47
Harms caused by tobacco use
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
48