Smoking

Introduction

Smoking is the primary cause of preventable illness and death. Every year smoking causes around 100,000 deaths in the UK.

Smoking is a major risk factor for many diseases and causes around 80% of deaths from lung cancer, around 80% of deaths from bronchitis and emphysema, and about 14% of deaths from heart disease. More than one quarter of all cancer deaths can be attributed to smoking. These include cancer of the lung, mouth, lip, throat, bladder, kidney, pancreas, stomach, liver and cervix.

Secondhand smoke exposure also harms babies and children, with an increased risk of respiratory infections, increased severity of asthma symptoms, more frequent occurrence of chronic coughs, phlegm and wheezing, and increased risk of cot death and glue ear.

The benefits of quitting smoking and how to go about it are outlined in the short video on the council’s YouTube channel.

Key inequalities and risk factors

A number of inequalities are set out in the Public Health Outcomes Framework where prevalence is higher than the England average:

  • Gender - Men are more likely to be smokers than women
  • Age - Smoking prevalence in people aged 55 is less than the England average compared to adults aged 18-54 and younger adults aged 18-34 are most likely to be smokers
  • Ethnicity - People from white and mixed backgrounds are more likely to smoke than other ethnic groups
  • Religion or belief - Those with a religion or belief are less likely to smoke than those people with no religion or belief
  • Sexual orientation - is a factor in smoking prevalence with bisexual people are more likely to smoke than lesbian or gay men, and all three categories are more likely to smoke than heterosexual people
  • Occupation - Managerial, professional and intermediate populations are less likely to smoke than routine manual or unemployed people
  • Deprivation - People from economically deprived areas are twice as likely to smoke compared with the affluent and to have started and to be more heavily addicted (Office for National Statistics General Lifestyle Survey, 2009)
  • Mental health - Smoking prevalence among people with a mental health disorder are significantly higher than in the general population, ranging from 40-50% among people with depressive and anxiety disorders to 70% or higher among patients with schizophrenia

In addition, the 2016 ASH report on Health Inequalities and Smoking state that compared to the population as a whole, smoking is also more common among people who are unemployed, homeless, incarcerated, in receipt of welfare benefits, have no qualifications or are lone parents.

It is estimated that globally 600,000 deaths a year are caused by secondhand smoke which is invisible and odourless. Most of these deaths are among women and children.  A video from the NHS SmokeFree campaign highlights the hidden dangers:

Facts, figures and trends

Smoking prevalence in adults aged 18+ has been slowly decreasing in Bracknell Forest and has fallen from 19.2% in 2010 to 16.9% in 2014.  The 2014 figure is similar rate to the South East average of 16.6% and lower than the England average of 18%, however this is not statistically significant.

Research identified that the greatest number of smokers are in the routine and manual worker population. The number of persons aged 18+ who are self-reported smokers in the Integrated Household Survey is reported in the Public Health Outcomes Framework:

The prevalence of smoking in routine and manual professions in Bracknell Forest was 23.5% in 2014. This is statistically similar to the England average of 28% and below the regional average of 26.4%.  The CancerData dashboard is also a useful source of data connected to smoking.

Smoking up to the time of any surgery increases cardiac and pulmonary complications, impairs tissue healing, and is associated with more infections and other complications at the surgical site (Peters, 2010). Abstinence from smoking for even a short time prior to surgery leads to significant improvements in clinical outcomes. For example, Moller et al (2002) found the overall surgical complication rate was nearly 3 times lower among smokers assigned to smoking cessation support compared to those not assigned.

The link between smoking status and other illnesses is made clear using a measure in the NHS Quality and Outcomes Framework (reported in the Public Health England Inhale - INteractive Health Atlas of Lung conditions in England portal):

This chart shows the high percentage of patients presenting with any or any combination of the following conditions: coronary heart disease, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are also smokers. 

Cessation, treatment and support services

Smoking is a modifiable lifestyle risk factor; effective tobacco control measures can reduce the prevalence of smoking in the population

There is evidence that when doctors and other health professionals advise on smoking cessation, and particularly when they offer support and treatment, that people are more likely to quit. Around four per cent of patients who quit without using either pharmacotherapy or behavioural support will remain abstinent at 12 months. With pharmacotherapy and brief supervision from a GP or other clinician, this would be about eight per cent.

This chart shows the high level of smoking cessation and treatment support being offered to the same patients:

If a patient takes up the offer of referral to an NHS Stop Smoking Service or a specially trained member of practice staff, such as a practice nurse, providing regular weekly support, the 1-year continuous abstinence rate doubles to about 15 per cent. 

Smoking cessation

Stop smoking service provide intensive support through group therapy or one-to-one support. The support is designed to be widely accessible within the local community and is provided by trained personnel, such as specialist smoking cessation advisors and trained nurses and pharmacists.

The local Stop Smoking Service has a quit success significantly higher than the national average and the cost per quitter is significantly lower - referral of smokers to this service is therefore a high priority:

These figures are an underestimate as they do not include residents who either go elsewhere or stop smoking on their own.

Reducing harm

It is recognised that some people cannot or may not wish to give up smoking but never the less wish to reduce the harm caused by smoking.  This requires a slightly different approach which is documented in Smoking: harm reduction (NICE, 2013).

Mortality

Despite a slight rise since 2011/13, the estimated proportion of smoking related deaths in Bracknell Forest has been in general decline since 2007/08 when the rate was estimated at 281.2 per 100,000 population.

The actual changes in the number of deaths has been very small.

Mortality statistics relating to a range of diseases and illnesses can be found separate cancer, COPD and cardiovascular disease chapters of the JSNA.

Costs

In 2008/09, some 463,000 hospital admissions in England among adults aged 35 and over were attributable to smoking, or some 5 per cent of all hospital admissions for this age group (NHS Information Centre (2010).

Costs relating to a range of diseases and illnesses related to smoking can be found separate cancer, COPD and cardiovascular disease chapters of the JSNA.

Want to know more?

2010 to 2015 government policy: smoking (Department of Health, 2015) – underpins the delivery of government strategy sets out the government position in relation to tobacco control.

Action on Smoking and Health - detailed referenced information and statistics on a variety of smoking and tobacco topics at individual and societal levels.

A Smoke free future – A Comprehensive Tobacco Control Strategy for England (Department of Health, February 2011)  - sets out three overarching objectives to make significant progress towards a smokefree society concentrating reducing uptake in young people, motivating and assisting smokers to quit and wider measures to protect families and communities.

CancerData dashboard (Public Health England) – an aggregate of annual data at Bracknell Forest CCG and NHS Trust level on all cancers, breast, lung, colorectal (bowel) and prostate cancers covering incidence, mortality, survival, experience of care, diagnosis rates and operational performance.

Healthy Lives, Healthy People: a tobacco control plan for England (Department of Health, 2011) sets out what the government plans to do over 2011 to 2015. It includes details of plans on stopping tobacco promotion, making smoking less affordable, regulating tobacco products, helping smokers to quit and reducing exposure to secondhand smoke.

NHS Smoke free – a range of video resources from the NHS Smoke Free YouTube channel

NICE Tobacco ROI Tool - Estimating Return on Investment of Tobacco Control (external link):- a tool to estimate the return on investment of tobacco control interventions.

Smoking (General Lifestyle Survey Overview) 2011 (Office for National Statistics, 2011) – A summary of General Household Survey (GHS) and General Lifestyle Survey (GLF) data following monitoring of smoking prevalence for over 35 years. The 2011 survey included questions on cigarette consumption, type of cigarette smoked, how old respondents were when they started smoking, and dependence on cigarettes.

Smoking Cessation Services (NICE, 2008 updated 2013) – guidance for service commissioners on the range of services that should be available for everyone who smokes or uses tobacco in any form. In particular, this includes pregnant women, those aged under 20, manual workers and people who are on a low income or income support. It also gives advice on the training and education that managers and staff in stop smoking services need.

Smokefree marketing and campaigning resource centre (Public Health England) – useful resources for smoking cessation campaigning.

Smoking: harm reduction (NICE, 2013) - harm-reduction approaches which may or may not include temporary or long-term use of licensed nicotine-containing products for people who struggle to quit smoking but nevertheless wish to reduce the impact of their habit.

Tackling health Inequalities - Targeting routine and manual smokers – (Department of Health, 2009) - rationale as to why targeting routine and manual smokers will in turn help reduce smoking prevalence.

Tobacco Marketing and Communications (National Social Marketing Centre, 2010) – a showcase document assessing the effectiveness and making recommendations on behavioural change campaigning to trigger interest, inform and re-inforce long-term behavioural change in smoking prevalence groups.

 

This page was created on 27 February 2014 and updated on 10 June 2016. Next review date May 2017.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Smoking. Available at: jsna.bracknell-forest.gov.uk/living-working-well/healthy-lifestyles/smoking (Accessed: dd Mmmm yyyy)

 

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