Smoking

Smoking is the number one cause of preventable death in the country (Global Burden of Disease Study). A wide range of diseases and conditions are caused by smoking, such as cancers, lung (respiratory) diseases and heart (cardiovascular) diseases (CVD). Though most often associated with lung disease, smoking is an important risk factor in development of heart disease, alongside more well-known factors such as high cholesterol.

Exposure to second hand smoke (passive smoking) also increases the risk of a number of conditions, with children being most vulnerable to these effects. Asthma, chest infections and ear infections and sudden infant death (also known as ‘cot death’) are all associated with exposure to smoking.

Smoking is also the greatest contributor to health inequalities in the country. Half of the difference in life expectancy between the richest and the poorest in the UK is due to smoking (Smoking and health inequalities).

In recognition of the huge impact on life expectancy stopping smoking can have, in recent years there has been concerted effort by the government to control tobacco. Interventions have ranged from legislative (including fiscal measures) to ensuring the availability of a personalised local stop smoking service (Smokefree NHS).

This chapter focuses broadly on smoking in adults, more specific issues of smoking in pregnancy and smoking in children and young people will be considered separately.

What do we know?

Smoking causes approximately 100,000 deaths a year in the UK. Most deaths attributed to smoking are related to three types of disease; lung cancer, chronic obstructive pulmonary disease (COPD, also known as emphysema and chronic bronchitis) and coronary heart disease (including angina and heart attacks)(source: ASH).

The health risks of smoking are related to both how much you smoke, but also importantly how long you smoke for. The greatest risk is for those who start young and carry on.

Stopping smoking has significant health benefits whenever you do it, health benefits are seen even in long-term smokers, older smokers, and smokers who quit after lung cancer diagnosis (source: Cancer Research UK).

Why people start/continue to smoke and when

Children and young people’s beliefs about smoking behaviour depends on their own smoking behaviour with smokers believing that young people smoke because of its effects (including stress relief and to stay slim)

What helps prevent people from taking up smoking

Studies show that although knowledge about the risks of smoking is an important component of preventing children to take up smoking, on its own it does not deter children from eventually smoking, though it may delay their uptake. Changing price of cigarettes, however, has been seen to have a significant effect on children.

What helps them stop

The evidence suggests that you’re four times more likely to quit if you have help.

Facts, figures, trends

It is estimated that approximately one in five adults in Slough still smoke (Integrated Household Survey 2014). While the rate of hospital admissions related to smoking in Slough was lower than the national average at 1,436 per 100,000 aged over 35 (2013/14), the rate of deaths caused by smoking was higher than the England average with a total number of 407 deaths between 2011 and 2013 attributable to smoking.

Smoking is also responsible for a significant burden of ill-health in Slough. Over 2010-2012 there were 150 new lung cancer cases and 28 new oral cancer cases in the borough. Adult smoking also has an impact on health of children.

Mothers smoking during pregnancy can affect health of the foetus (discussed in the chapter smoking in pregnancy), and parents smoking around young children can increase risk of ear infections, chest infections and asthma.The rate of hospital admissions for asthma was slightly higher in Slough (211 per 100,000) than that for England (197 per 100,000)

Over 2014/15 there were 1,686 adults that set a quit date using the local stop smoking service. This represents just over 7% of current smokers in the borough. Though this represents a lower rate than had taken up the service in the previous year, it is still higher than the national average.

Of those that set a quit date 998 had successfully stopped smoking at 4 weeks. When carbon monoxide detector tests were used to validate this result, however, the figure drops to 531 which is approximately a third of all those attempting to quit with the service.

The total number of 4-week quitters from black and minority ethnic (BME) communities in 2014/15 was 530 which represents 52% of the total quitters which is a marked improvement in uptake from minority groups.

(Source: Smoke Free Life Berkshire).

National and local strategies (current best practices)

National

The Department of Health’s National Tobacco Plan is wide ranging and described in the strategies section later in this chapter. It has informed local priorities to date.

  • Priorities 1 and 2 were at national level and have not been agreed by parliament. The remainder are set out below:
  • Priority 3: continue to defend tobacco legislation against legal challenges by the tobacco industry, including legislation to stop tobacco sales from vending machines from October 2011
  • Priority 4: continue to follow a policy of using tax to maintain the high price of tobacco products at levels that impact on smoking prevalence
  • Priority 5: promote effective local enforcement of tobacco legislation, particularly on the age of sale of tobacco
  • Priority 6: encourage more smokers to quit by using the most effective forms of support, through local stop smoking services
  • Priority 7: publish a 3-year marketing strategy for tobacco control

CLeaR self-assessment: excellence in local tobacco control (Action on Smoking and Health (ASH) and Public Health England (PHE) is an evidence-based self-assessment toolkit developed to help local authorities and wellbeing boards evaluate the effectiveness of local action to address tobacco.

Local

As a response to national priorities and local consultation six areas have been developed to focus on in order to improve outcomes. These are:

  • Local Priority Area 1: “Bringing partners together"
    The development of an integrated tobacco control programme.
  • Local Priority Area 2 “Reduce the number of young people taking up smoking”
    Actions include reinstating school based Personal, Social and Health Education (PSHE) and other programmes, outreach from smoking cessation advisors, advertising on local radio and implementing school surveys. Prevention of the normalisation of Shisha. Test purchasing of under age sales of tobacco.
  • Local Priority Area 3: “Encourage & support existing smokers to quit”
    This is the core work of the smoking cessation services which focus on 4 and 12 week quitters and support to schools.
  • Local Priority Area 4: “Work with businesses to take up cessation plans for staff and provide Smoke Free advice”
    Ensuring compliance with smoke free legislation.
    Develop a directory of services for local businesses via links with the regional Chances for Change hub.
  • Local Priority Area 5: Protect communities and families from tobacco related harm.
    Promoting recognition of illicit tobacco products throughout Primary Health Care Services.
    Undertake smoke free litter surveys to inform action.
    Train traders on smokefree legislation.
    Enforce Smokefree legislation.

What is this telling us?

Smoking remains an important cause of morbidity, mortality and health inequality in Slough though work to reduce this burden is continuing and successes are being recorded.

The representation of BME groups among smoking cessation service users has improved . Specific targeted campaigns across Slough which have included working with religious and BME community groups in Sikh Temples, Hindu Temples, Mosques, Polish Churches, Roma Community Church and groups, Polish shops and Pakistani, Indian and Polish community centres.

There remain challenges in targeting some vulnerable groups such as those with mental health problems.

What are the key inequalities?

As previously stated, smoking is the greatest contributor to health inequalities in the UK (Smoking and health inequalities).

Deprivation

Slough is ranked as the 79th most deprived out of 236 local authorities in England. Despite a reduction in the overall prevalence of smoking in the UK over the past 30 years, there has been little change in smoking rates among those living on low incomes and those who are least advantaged. Among those living in greatest hardship smoking rates are over 70% ( Source: Smoking and health inequalities).

Minority Ethnic groups

The 2011 census shows that 54.3% of the resident population of Slough is from a Black and Minority Ethnic (BME) group. Smoking levels vary considerably among minority ethnic communities living in Britain. There are some groups for whom tobacco use is a major concern. Cigarette smoking may not be a good guide to tobacco use in all instances, as in some groups, for example Bangladeshi women, there are high levels of use of oral tobacco products. (Source: Smoking and health inequalities).

Mental health

It is estimated that just under 1 in 10 adults in Slough feel moderately to severely anxious or depressed (Source: Public Health England Fingertips). Smoking prevalence is significantly higher among people with mental health problems than among the general population. Moreover, people with depression are more likely to have difficulty when they try to stop smoking.

Studies have shown smoking rates to be as high as 80% among schizophrenics. There is concern that the smoking needs of people with mental health needs are not addressed adequately. (Source: Smoking and health inequalities).

What are the unmet needs/service gaps?

Though data systems for estimating prevalence of cigarette smoking are well established, there is fairly little known about other sources of tobacco including chewing tobacco which may be prevalent in diverse populations such as Slough’s.

Success rates in terms of stopping smoking for those with mental health remains poor. There is little intelligence locally in terms of the mental health of stop smoking users.

Recommendations for consideration by other key organisations

  • tackle health inequalities in a more targeted way using sociodemographic mapping
  • improve access to 12 week quit support services
  • improve availability of advice and information in schools
  • deliver smoking cessation support to mothers in pregnancy
  • develop locally based smoking cessation support linked to the Healthchecks programme
  • work with mental health services to help reduce smoking rates among those with mental health conditions.
  • CLeaR self-assessment undertaken for Slough

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