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THE CASE FOR ACTIONon SMOKING &TOBACCO USE

2014

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1. Scale of the challenge

2. Smoking attitudes and behaviour

3. How do we reduce tobacco use?

4. Delivery at local level

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1. Scale of the challenge

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Smoking is the leading cause of preventable death

Obesity: 34,100

Smoking: 79,100

Alcohol: 6,669

Suicide:5,377

Illegal drugs: 1,605

HIV: 504

Traffic:1,850

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Deaths from the most commonsmoking-related diseases

Total annual deaths = 79,100

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Smoking prevalence in England21

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o Prevalence was 19% in 2013.

o Peaked at 45% in 1974.

o Prevalence is substantially higher amongst lower socio-economic 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.

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The decline in smoking prevalence has stalled

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.

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The financial cost of smoking

Annual estimated costs of smoking to the individual and society

This figures is the highest estimate and includes £9.5 billion in tax.

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The local cost of smoking

Annual estimated costs of smoking to the individual and the community

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.

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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 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.

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Smoking not social status is the leadingcause of health inequalities

Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class

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Social Class

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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

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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……

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2. Smoking attitudes & behaviours

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It is children not adults who take up smoking

90% of smokers started before the age of 19

18 is the age at which you can legally buy tobacco

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Smoking Prevalence: Young People (11-15)

463 children take up smoking every day in England.

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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

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Smoking prevalence in 11-15 year olds by number of smokers they live with.

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Where do children get their cigarettes from?

Usual sources of cigarettes for 11-15 year olds in England

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Smoking rates amongst pregnant teenagers are substantially higher than in other age groups

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Age: % who smoked during pregnancy

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Women in low-paid work are 3 times more likely to smoke during pregnancy

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Managerial &professional

Intermediateoccupations

Routine & manual

Socio-economic group: % who smoked before or during pregnancy

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Every year nearly 10,000 children are treated in hospital for exposure to second-hand smoke

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Smoking prevalence is higher inroutine and manual groups

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Smokers from lower socioeconomic groups are more likely to purchase illicit tobacco

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AB to C1 C2 to E

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Illicit tobacco consumed by social group

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How do we 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

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3. How do we reduce tobacco use?

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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.

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Local action: councils enforce tobacco laws

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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

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Local Authorities commission Stop Smoking Services

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No medication orsupport (reference)

NRT over-the-counter

Medication onprescription

NHS support andmedication

Odds ratio (relative to no aid)

NHS Stop Smoking Services are the most

successful route to quit and the most cost

effective NHS treatment there is

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Smokers are nearly 4 times more likely to quit using NHS support than going ‘cold turkey’

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No medication orsupport (reference)

NRT over-the-counter

Medication onprescription

NHS support andmedication

Odds ratio (relative to no aid)

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Poorer smokers want to quit but are only half as likely to succeed

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Tried to quit in past year Success rate

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Success rate in quitting by socio-economic class

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.

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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.

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Since the introduction of smokefree legislation, more people are making their homes smokefree

61% 67% 69% 78%

26% 21% 20%14%

13% 12% 10% 8%

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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

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There is strong public support for tobacco control measures

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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

AgreeNB You can replace

this chart with regional data

produced with this toolkit.

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Effective communication is essential

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4. Delivery at local level

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Local Authorities can mount effective local campaigns

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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.

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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.

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.

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Working together for better health

1. Local Government, inc. police & fire brigade2. Local Health Services3. Organisations that work across neighbouring

localities within a region4. Employers5. Voluntary sector organisations6. Children’s and youth groups7. Smokers (particularly, groups with high rates of

smoking e.g. routine & manual smokers)8. Health commissioners

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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.

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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