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Smoking

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Introduction

Smoking continues to kill almost 80,000 people in England every year and is the number one cause of preventable death in the country, resulting in more deaths than the next six causes combined. Tobacco use is also a powerful driver of health inequalities and is perhaps the most significant public health challenge that we face today.

Facts and Figures

Smoking prevalence in Blackpool

In England there has been steady decline in smoking prevalence in the adult population since 2010 with a reduction from 20.8% in 2010 to 18% in 2014. The picture in the North West as a whole is similar with smoking prevalence showing a similar decline. However in Blackpool, whilst there was a small decline from 2010 (29.5%) to 2013 (26.5%), prevalence has seen a slight increase again in 2014 to 26.9%, as seen in Figure 1.

Figure 1: Trend in smoking prevalence in adults aged 16+, Blackpool and England

Smoking prevalence
Source: PHE, Local Tobacco Control Profiles for England

Smoking prevalence and health inequalities

Smoking is the biggest cause of health inequalities in the UK accounting for half the difference in life expectancy between richest and poorest. More people in disadvantaged communities smoke, where smoking is more socially accepted. Poorer smokers are usually more addicted and smoke more each day. On average, all smokers make similar numbers of quit attempts each year but, well-off smokers are much more likely to succeed. To reduce health inequalities it is vital that support to quit is tailored to the needs of poorer and more disadvantaged smokers, who find it harder to quit.

Approximately half of all smokers in England work in routine and manual occupations. Workers in manual and routine jobs are twice as likely to smoke as those in managerial and professional roles and unemployed people are twice as likely to smoke that those in employment.

For smoking prevalence amongst the routine and manual workers section of the population, England shows a gradual downward trend up to 2014 and smoking prevalence is currently 28%. However, in Blackpool, although there has been a decline, since a worryingly sharp rise in prevalence amongst this group in 2012 (44.3%), the prevalence amongst this group still remains significantly higher than the national average at 35.7%, as seen in Figure 2.

Figure 2: Trend in smoking prevalence in adults in routine and maual occupations, adults aged 16+, Blackpool and England

 

Smoking prevalence-manual
Source: PHE, Local Tobacco Control Profiles for England

Smoking prevalence by ward

Figure 3 shows the breakdown of smoking prevalence by ward. All wards have significantly higher smoking rates than the national average and rates range from almost 30% in Bloomfield to 24% in Norbreck.

Figure 3: Estimates of adult (18+) smoking prevalence by ward, 2016

 Smoking prevalence-ward
Source: ASH Local Toolkit - Ready Reckoner

Smoking prevalence versus deprivation index

Smoking rates are much higher within certain groups and deprived communities. Smoking is around twice as common amongst people with mental health disorders, and more so in those with more severe diseases. Estimates vary significantly between 37% and 56%1.  Lesbian, gay and transgender communities are also significantly more likely to smoke, as are long-term unemployed, and some minority ethnic groups, which also have gender disparities. Helping disadvantaged smokers quit is the best way to reduce health inequalities. Figure 4 which shows local smoking prevalence against the deprivation index, indicating that the higher up the Indices of Multiple Deprivation scale, the higher the estimated smoking prevalence there is.

Figure 4: Smoking prevalence by deprivation indices

Figure 4: Prevalence by deprivation

 

Smoking status at time of delivery (SATOD)

The Smoking at Time of Delivery (SATOD) rate in Blackpool has been the highest in the country since 2010 with rates over double that of the rest of England as whole. Whilst England has shown a gradual decline in the rate from 13.5% in 2010/11 to 11.4% in 2014/15, and the North West region shows a similar trend with the rate falling from 17.7% in 2010/11 to 14.7% in 2014/15, the trends in Blackpool are very different. In 2011/12 the rate fell to 29.7% from 33.2% the previous year. However, in 2012/13 there was a rise to 30.8%. In 2013/14 this rate fell again to 27.5% and very slightly fell again in 2014/15 to 27.2%. However, although there has been a decline since 2012/13, this rate still remains worryingly higher than the national and regional averages, as seen in Figure 5.

Figure 5: Smoking status at time of delivery, Blackpool and England

Smoking SATOD
Source: PHE, Local Tobacco Control Profiles for England

Health costs of tobacco in Blackpool

Smoking related mortality

Figure 6 shows the number of estimated deaths per 100,000 of the population aged 35+ in the period 2012-2014, which equates to 1,094 deaths in Blackpool that are smoking related. Figure 6 also shows the number of smoking related deaths attributed to lung cancer, chronic obstructive pulmonary disease, smoking attributable deaths from heart disease and smoking attributable deaths from stroke. Smoking related mortality in Blackpool is significantly higher than the natiional average.

Figure 6 - Smoking related mortality

Smoking mortality
Source: PHE, Local Tobacco Control Profiles for England

Smoking related ill-health and smoking attributable hospital admissions

There are a number of indicators which define smoking related ill health. Figure 7 shows this range of indicators and how Blackpool compares to the England average for each of these indicators. Blackpool has a significantly higher number of smoking attributable hospital admissions when compared to the England average. This indicator aims to present the size of preventable smoking related conditions on inpatient hospital services as well as inequalities between local authorities in England. High smoking attributable admission rates are indicative of poor population health and high smoking prevalence. Since 2011, Blackpool has seen a sharp rise in smoking attributable hospital admissions from 1,836 in 2011/12 up to 2,414 in 2014/15.

Figure 7: Smoking related ill health

Smoking ill health
Source: PHE, Local Tobacco Control Profiles for England

 

Societal costs of smoking in Blackpool

Tobacco use imposes a significant economic burden on society. In addition to the direct medical costs of treating tobacco-induced illnesses there are other indirect costs including loss of productivity, fire damage and environmental harm from cigarette litter and destructive farming practices. The total burden caused by tobacco products more than outweighs any economic benefit from their manufacture and sale2. Action on Smoking and Health (ASH) provide estimates of the cost of smoking to Blackpool (figure 8) which shows the cost of smoking is almost twice the local revenue the town gets from tobacco duty.

 

Figure 8: Estimated cost of smoking in Blackpool

smoking costs
Source: ASH Local Toolkit - Ready Reckoner

 

Electronic cigarettes

Electronic cigarettes - more commonly known as e-cigarettes - are novel nicotine delivery devices that were developed in China more than 10 years ago (also known as vapourisers or electronic nicotine delivery systems). E-cigarettes are battery operated devices that aim to simulate combustible cigarettes. They do not contain tobacco but operate by heating nicotine and other chemicals, including propylene glycol and glycerol, into a vapour that is inhaled.

There are three main types of electronic cigarettes or vapourisers:

    • Disposable products (non-rechargeable)
    • An electronic cigarette kit that is rechargeable with replaceable pre-filled cartridges
    • An electronic cigarette that is rechargeable and has a tank or reservoir which has to be filled with liquid, often containing nicotine

Nationally, an estimated 2.6 million adults in Great Britain currently use e-cigarettes, nearly two out of five users are ex-smokers and three out of five are current smokers. The main reason for use by smokers who currently use e-cigarettesis to reduce the amount they smoke while ex-smokers report using electronic cigarettes to help them stop smoking3.

There is very little local data on e-cigarette use but information from the What abour YOUth? Profile found Blackpool has the highest proportion of 15-year-olds who have ever used e-cigarettes, 33.9% compared to the England average of 18.4%.

Data from the survey, Health Behaviours in Blackpool, found that 8% of survey responders said they use e-cigarettes, while a further 8% said they used to use them but don't any more.  The survey found people aged 25-44 years were significantly more likely to use e-cigarettes and young people aged 16-24 years were more likely to have used e-cigarettes but don't any more.

Figure 9: The use of e-cigarettes in Blackpool, adults aged 16+, 2015

Use of e-cigarettes
Source: Health Behaviours in Blackpool, 2015

 

National and local policies

Local strategies

Tobacco FREE Lancashire: Towards a Smokefree Generation 2018-2023  pdf  (1887Kb)

The Tobacco Free Lancashire strategy has the overarching framework of ‘smokefree’ – to reduce the damaging impact of tobacco by helping people to quit smoking, reducing the availability of illicit tobacco and challenging the social norm of smoking. It is seeking to create more smokefree environments and spaces across communities and challenge the norm of smoking.This

Tobacco Free Lancashire strategy has been developed in-line with the new Tobacco Control Plan for England which sets out the ambition to achieve a smokefree generation by:

    • preventing children from taking up smoking in the first place
    • stamping out inequality for example smoking in pregnancy
    • supporting smokers to quit

The strategy has prioritised the following areas based on detailed local intelligence at an individual level in order to reduce health inequalities and improve quality of life by reducing smoking prevalence in the following groups:

    • pregnancy
    • people with mental health conditions
    • people with long-term conditions

The Blackpool Joint Health and Wellbeing Strategy 2013-15 sets a local framework for commissioning health, social care and broader wellbeing services. It will be a key driver towards meeting the overarching health and wellbeing outcomes of Blackpool Council and Blackpool Clinical Commissioning Group (CCG).

The Blackpool CCG Prospectus discusses how the CCG is working to improve the health and wellbeing of the local community. The CCG has identified three local priority areas - heart disease and stroke; respiratory disease; and dementia - which they will focus on during the next 12 months. Doing this will help to deliver change and make a real impact on improving health and quality of life and preventing people from dying prematurely.

National strategies

Towards a Smokefree Generation: A Tobacco Control Plan for England (July 2017). The vision is to create a smokefree generation. This will have been achieved when smoking prevalence is at 5% or below. To deliver this, the government sets out the following national ambitions which will help focus tobacco control across the whole system:

    • preventing children from taking up smoking in the first place
    • stamping out inequality for example smoking in pregnancy
    • supporting smokers to quit

Smoking Still Kills produced by the charity, Action on Smoking and Health (ASH), proposes new targets for a renewed national strategy to accelerate the decline in smoking prevalence over the next decade. A key recommendation of Smoking Still Kills is for the Government to impose an annual levy on tobacco companies and for the money raised to be used to pay for measures such as mass media campaigns and stop smoking services.

NICE guidance on smoking and tobacco provides advice, quality standards and information services for health, public health and social care. Also contains resources to help maximise use of evidence and guidance. 

 

Services

Smoking and Nicotine Addiction Prevention and Treatment Service

Smokefreelife Blackpool is a free stop smoking service, commissioned by Public Health, Blackpool Council, supporting Blackpool residents to stop smoking and other forms of nicotine addiction and lead a healthier smokefree life.

GP Practice Led Smoking Cessation Service

The GP Practice led Smoking Cessation Service is an additional model for delivery of effective smoking cessation treatments. GP practices will recruit smokers opportunistically during routine medical care, removing the need for direct marketing. The success rate is expected to be about half that of the specialist service but the reach could easily be double. It does not replace the specialist service nor alter the ideal pathway for a smoker.

 

Recommendations

The Blackpool Tobacco Control Strategy identifies the following aims to deal specifically with the very unique problems faced by the town:

  1. Reduce the promotion of tobacco
  2. Make tobacco less accessible by considering licensing sales/local initiatives and reduce the flow of illicit and illegal tobacco products into Blackpool
  3. Effectively regulate tobacco/nicotine containing products
  4. Help tobacco users to quit
  5. Reduce exposure to SHS
  6. Effectively communicate for tobacco control
  7. Protect tobacco control policy from industry influence
  8. Reduce health inequalities through reduced tobacco consumption
  9. Ensure that tobacco control is prioritised in cross-cutting policies, education, guidance and funding
  10. Work with communities to change the cultural norms around smoking

 


[1] RCP and RCPsych, Smoking and mental health, 2013

[2] Eriksen M, Mackay J & Ross H. The Tobacco Atlas. 4th Ed. American Cancer Society, 2012

[3] ASH, Fact Sheet-Use of electronic cigarettes (vapourisers) among adults in Great Britain, May 2015