Transcript SE Regional Public Health Group Fact Sheet Teenage

South East Regional Public Health Group
Information Series 5
Tobacco Control
This information series has been compiled by the Regional Public Health Group based in the Government Office of the South East. They aim to summarise key
public health issues based upon evidence, in order to facilitate good practice and improve health at local and regional levels. They are NOT policy documents.
Vision
To improve health, and reduce inequalities, in the South East by reducing the illness and early death associated with
tobacco consumption.
Why it’s important
5 million deaths worldwide will occur from tobacco consumption in 2006, projected to reach 10 million deaths annually
by 20201. Smoking is the single greatest cause of preventable illness and premature death in the UK with 106,000
people dying of smoking related diseases in 20022 and more than 10,000 deaths each year attributable to passive
smoking3. It is linked to over 50 diseases and serious conditions, including cancer, coronary heart disease, stroke,
circulatory diseases, chronic obstructive lung disease, asthma and osteoporosis.
Cigarette smoke has roughly 4,000 compounds, many of which are toxic and can cause damage to human cell tissue.
Tar, also known as total particulate matter, is one of three main ingredients within cigarettes. It is made up of various
chemicals, many of which are known to cause cancer. When smoked, around 70% of the tar is deposited in the
smoker’s lungs.
 Smoking kills more than 13 people a hour in the UK a year.4
 Smoking causes 84% of deaths from lung cancer, and 83% of deaths from chronic obstructive lung disease,
including bronchitis.4
 Smoking causes 46,500 deaths from cancer a year in the UK – three out of 10 cancer deaths.4
 Smoking causes one out of every seven deaths from heart disease – 40,300 deaths a year in the UK from all
circulatory disease.4
 One in two smokers will die from a smoking related disease, causing on average six-eight lost life years per
smoker.
 More than 6,000 young people in the UK under the age of 18 lose a parent to a smoking related disease each
year.
 High levels of smoking are found among people with mental health problems; nearly three quarters of people
with schizophrenia, affective psychosis and neurotic disorders are smokers5.
 Smoking kills around ten times more people in the UK than road traffic accidents (3,184), accidental falls
(4,578), murder and manslaughter (306), suicide (4,291) and HIV infection (186), all put together (12,545) (Home
Office figures, 1998).
Second Hand Smoke, why is it important?
The dangers of smoking extend beyond those who choose to smoke. The Scientific Committee on Tobacco and Health
(SCOTH) published a report6 in 1998 which concluded that exposure to second hand tobacco smoke (passive
smoking) caused lung cancer and heart disease in adult non-smokers and a variety of conditions including respiratory
disease, cot death and middle ear disease in children. They recently updated this report with further evidence that has
emerged in the last five years, stating that non-smokers have a 24% increased risk of lung cancer and a 23%
increased risk of heart disease if exposed to second hand smoke7.
Professor Konrad Jamrozik has presented a conservative estimate that suggests that in the UK, pre legislation,
second-hand smoke at work was responsible for the deaths of more than two employed people per working day
(617deaths per year), including 54 deaths in the hospitality industry each year. These calculations also indicate that
second-hand smoke in the home might account for another 2700 deaths in persons aged 20-64 years and 8000 deaths
among people aged over 65 each year8.
PROTOTYPE – SEPTEMBER 2007
National Drivers
Key National Drivers
“Smoking Kills – A White Paper on Tobacco”. DH (Dec 1998).
“Choosing Health: Making healthy choices easier” A Public Health White Paper. DH
(Nov 2004).
Health Act 2006
For both documents see: http://www.dh.gov.uk
In 1998 the Government produced its first comprehensive tobacco strategy, the White Paper Smoking Kills9.
The White Paper set targets to reduce smoking prevalence by reducing smoking in the general population,
in 11-15 year olds and in pregnant women, The Cancer Plan10 then set a further target for manual workers.
These targets are as follows:
 To reduce adult smoking from 26% in 2002 to 21% or less by 2010;
 To reduce smoking among 11-15 year olds from 13% in 1996 to 11% by 2005 and 9% 2010;
 To reduce smoking among pregnant women from 23% in 1995 to 18% by 2005 and 15% by 2010;
(Updated under the Priorities and Planning Framework 2003/06 to a 1% reduction year on year);
 To reduce smoking among manual workers from 32% in 1998 to 26% by 2010.
In 2003 the Department of Health introduced a six strand action plan, and asked for Regional Tobacco
Control Strategies to be developed involving key regional stakeholders. The six strands include:






Helping smokers to give up;
Second-hand smoke;
Education and media;
Reducing tobacco promotion;
Labelling and regulation;
Taxation and smuggling.
For a copy of the South East Regional Tobacco Control Strategy11 and the Choosing Health in the South
East: Smoking Report12 see the GOSE website at www.gose.gov.uk.
The Public Health White Paper ‘Choosing Health’
‘Choosing health- Making healthy choices easier’13, the Government’s Public Health White Paper (2004),
set out the government’s strategy for improving the public’s health through measures aimed at preventing
illness. The White Paper set out a number of priorities for achieving better health which included reducing
the numbers of people who smoke and protecting people from second-hand smoke.
A key recommendation was a staged approach to smoke-free public places and workplaces, these were:
 By the end of 2006, all government departments and the NHS will be smoke-free;
 By the end of 2007, all enclosed public places and workplaces, other than
those specifically exempted), will be smoke-free.
Smokefree Legislation was introduced in England on July 1st 2007, making virtually all work places and
public places smokefree. A very successful media campaign ensured that compliance has been very high,
with over 97% awareness amongst the general public in the South East shortly before legislation was
introduced. The Health Act 2006 also included powers to raise the age of cigarette sales from 16 to 18
years which was introduced in England and Wales on October 1st 2007.
Priority Groups
Young People
Raining the age of sales legislation has been introduced to stop young people becoming addicted to nicotine. The
younger a smoker starts the more likely they are to be killed by their addiction, and someone who starts smoking
at 15 is three times as likely to die from cancer due to smoking as someone who starts in their mid-20s.
In the UK approximately 450 young people start smoking every day. Research undertaken since the 1980’s
has revealed increasing use of tobacco by young people. The Health Education Authority in 1987 showed
that 25% of 15-year-old girls and 15% of boys of the same age were smokers. By 1990, 30% of young
people in Britain (aged 16-19 years) were identified as smokers – again higher amongst females (32%) as
opposed to males (28%). By 2000 considerable increases in young people’s smoking habits were seen.
Aldridge, Parker and Measham in 1999 found that 17.6% of 13 year olds smoked and this increased to
36.8% in 15 year olds. One year later they found that the percentages had increased to 25.6% and 40.5%
respectively.
Figure20%
1. The age at which people started smoking in the South East region, 2001-2003
18%
16%
14%
Percentage
12%
10%
8%
6%
4%
2%
0%
Source: General 7
Household
2002/03.
11 Survey.
15 2001/02
19 and23
27
31
35
39
43
47
51
55
59
63
Age s tarte d s m ok ing (ye ars )
Parental influence is also an important factor in whether or not young people smoke. Strong social class
gradients in adult smoking rates are likely therefore to have a stronger influence on young people starting or
continuing to smoke. Poor young people are more likely to misuse tobacco in the transition to adulthood.
Smoking in Pregnancy
Maternal smoking poses risks to both the pregnant woman and the unborn baby. Studies have
demonstrated that smoking in pregnancy increases risks of ectopic pregnancy; miscarriage; reduced
oxygen supply to the foetus; low birth weight; stillbirth and sudden infant death syndrome. Second hand
smoke affects fertility and endangers the health of children before birth and during childhood.
Socio Economic Difference
Rates of smoking vary between different social groups with those from lower social groups smoking more
than those in more advantaged groups (Botting 1995). 15% of men and 14% of women in the professional
groups smoke compared with 45% of men and 33% of women in the unskilled manual groups. Smoking
rates among those living in the greatest hardship are over 70%. Smoking, more than any other identifiable
factor, contributes to the gap in healthy life expectancy between those most advantaged and those most
disadvantaged. The financial burden of smoking often falls on those least able to afford it. A smoker will
spend approximately £1,600 a year if they smoke 20 cigarettes per day, disadvantaged groups spend a
much larger proportion of household income on cigarettes: more than seven times the national average
Current Situation in the South East
•Smoking prevalence in the south East is 22%, lower than the national average of 24%;
•16% of all deaths in the South East region are due to smoking related illness;
•An estimated 57,800 admissions to hospital in the South East are related to smoking;
•In 2005/06 an estimated £32m was spent on NHS outpatient attendance in the South East
attributable to smoking related illness;
•The total estimated loss of earnings from premature death due to smoking in the South East
region is £950m.
•The annual cost to business in the South East region from smoking related sickness absence
from work, is approximately £418 million;
Economic Impact of smoking in the South East
There are both economic and personal costs associated with smoking. To the individual - length and quality
of life are affected, to the NHS - costs of smoking related diseases and to business - through working days
lost through illness, hours lost at work through cigarette breaks, sickness and invalidity benefits, fires, litter
and environmental damage.
Table 1. Costs of Smoking in the South East
Cost to Regional Economy of Smoking
Hospital admissions
238.5m
Premature deaths
193m
Outpatient appointments
38m
Business cost of hospital time
6m
Second hand smoke
4m
Other sick days
370m
Working day smoking
1.2b
Spend on tobacco
14m
Stopping smoking services
5m
Prescription costs attributable to smoking
96.8m
Fires caused by smoking
15.5m
Total cost (m)
2.2b
*Estimate costs using an economic model developed by the West Midlands Public Health Group
Figure 2. Percentage of smokers by socio-economic classification in South East region, 2001-2003
Current cigarette smoker
Ex-regular cigarette smoker
70%
Percentage of Cigarette Smokers
60%
50%
40%
30%
20%
10%
0%
I-Prof essional
II-Managerial
technical
IIIN-Skilled nontechnical
IIIM-skilled manual
Source: General Household Survey, 2001/02 and 2002/03, ONS Mid Year estimates
IV-Semi-skilled
manual
V-Unskilled
manual
What Works
Helping Smokers to Give Up (Local Stop Smoking Services)
Saving Lives: Our Healthier Nation (1999)14, The National Service Framework (NSF) for Coronary Heart
Disease (2000)15, The NHS National Plan (2000)16, The Cancer Plan (2000)10 all recognised and supported
the development and setting up of NHS stop smoking services. Smoking Kills (1998)9, provided the
framework and funding for setting up services across the country and set targets for year on year
improvements in smoking cessation.
A multi-tiered approach is recommended to providing support as the best possible way to reach more
smokers, and to gain the greatest reduction in smoking prevalence. These are brief opportunistic advice to
stop; intermediate interventions (one to one support) and specialist group support.
Key statistics state that :

70% of smokers say they would like to quit;

Brief advice from a GP or other healthcare professional routinely given to all patients who
smoke leads to about 40% attempting to quit;

Intensive behavioural support (one to one or specialist group) plus NRT significantly increases
an individual’s chances of successfully quitting. You are 4X more likely to quit going to your
local stop smoking service.
There are local Stop Smoking Services, usually PCT based, covering the whole of the South East Region.
Over 46,000 smokers in the South East successfully quit in 2005/06 using local stop smoking services. Of
74,298 smokers in the region, who set a quit date between April 2005 and March 2006, almost two-thirds
had successfully given up four weeks later compared to just half nationally
Table 2: People setting a quit date and successful quitters, per 100,000 of the population,
April 2005 to March 2006, by Strategic Health Authority.
SHA
Number of
setting a quit
date
Number
successfully
quit at 4 weeks
(self-report)
% successfully
quit at 4 weeks
(self-report)
Number
successfully quit
(self-report) per
100,000 of
population aged
16 and over.
England
603,174
329,854
55
818
South East
74,298
46,197
62
705
Hampshire & Isle
of Wight
18,249
11,970
66
820
Kent & Medway
14,832
8,910
60
694
Surrey & Sussex
22,620
13,961
62
670
Thames Valley
18,597
11,356
61
658
Education and Media
Maintaining awareness and knowledge of the health risks associated with smoking is very important. Largescale media coverage of the links between smoking and ill health are strongly associated with reductions in
smoking prevalence. Media publicity has been shown to be vital in helping to shape public opinion.
Reducing Tobacco Promotion
Reducing tobacco promotion covers a whole range of issues such as introducing a comprehensive ban on
tobacco advertising and sponsorship, controls on the labelling of products, education about the health
effects of tobacco, tackling smuggling, protection of the public from the effects of second hand smoke and
measures to reduce the availability and promotion of tobacco to young people. The Tobacco Advertising
and Promotion Act (2002) was introduced to stop the advertising and promotion of tobacco and tobacco
products and introduced a comprehensive ban on tobacco advertising, promotion and sponsorship.
Labelling and Regulation
It is against the law for retailers to sell any tobacco or tobacco product to children under the age of 18.
There is some evidence that campaigns to enforce legislation and educate retailers can reduce illegal sales.
The White Paper ‘Smoking Kills’ includes action to protect children and young people as a priority.
Measures include:




Minimal tobacco advertising in shops;
Tough enforcement on under-age sales;
Proof of age card;
Strong rules on siting of cigarette vending machines.
Bigger and more direct warnings were made compulsory on cigarette packs from 30th September 2003.
The warnings include "smokers die younger", and 13 other challenging facts about smoking. The warnings
include the telephone number for the NHS smoking helpline (0800 169 0 169). The government are
introducing picture warnings alongside the word warnings from next year. Evidence from countries that
have introduced picture warnings have shown them to be effective in getting smokers to quit.
Taxation and Smuggling
Smuggled tobacco is a huge public health problem for the UK as it brings cheap tobacco onto the market
and undermines the policy of using tobacco price to discourage smoking. The UK’s chief problem is with
domestic brands, which are exported to places where there is no market for them and then smuggled back
into the country. 80% of the contraband market is supplied by container smuggling (containers of cigarettes
on which no tax has been paid). Moreover, contraband tobacco is especially targeted at low-income areas,
further increasing inequalities in health. The smuggled share of the cigarette market is currently 16% (18%
in 2002/03) with a Department of Health and Customs Public Service Agrrement target to reduce this to no
more than 13% by 2007/08. The structure of smuggling activities is something which constantly evolves as
enforcement action is taken.
Ways Forward
Tobacco Control Alliances
Region wide action is currently delivered through the nine Tobacco Control Alliances (see below). Alliances
are the partnership bodies that develop and deliver locally agreed action plans for Tobacco Control and
include Health (PCTs), Local Authorities (Trading Standards, Environmental Health), Customs and Excise,
Fire Service and other key partners. Alliance projects are developed in collaboration with priorities such as
addressing health inequalities, reducing people's exposure to second-hand smoke, supporting the work of
the NHS stop smoking services and the delivery of the recommendations made in the Public Health White
Paper.
The nine Alliances in the South East are :

Smokefree Berkshire;

Bucks Action Against Smoking (BAAS);

East Sussex Brighton & Hove Tobacco Control Alliance;

Kent Alliance on Smoking and Health (KASH);

Milton Keynes Tobacco Control Alliance;

Oxfordshire Alliance on Smoking & Health (OxASH);

Smokefree Hampshire and the Isle of Wight;

Smokefree Surrey;

Smokefree West Sussex.
Local Area Agreements
Indicators proposed in guidance and areas to consider
Smoking is a major cause of ill-health and health inequalities and is therefore a priority issue for LAAs. The
best way to reduce the increased risk of heart disease, stroke, cancer and many other fatal diseases, is for
people to give up smoking and to reduce everyone’s exposure to second-hand smoke. This can be
achieved through
•
•
•
•
•
•
•
•
Improving the way people are helped to stop smoking and stay stopped: more accessible and
responsive stop smoking services and making Nicotine Replacement Therapy much more widely
available, particularly to manual groups e.g. through pharmacies and GPs and other community
outlets, including sports clubs, hospitals, leisure centres, places of worship and shops plus targeted
support for NHS employees to stop smoking.;
Using new technology e.g. developing pilots on using the electronic booking system to trigger advice
for smokers, targeting manual groups in particular
changing public attitudes and behaviour building on national media and education campaigns
Increasing the number of accredited health trainers trained to provide practical advice, support and
motivation on stopping smoking
Smoke-free environments becoming the norm both at work and at leisure; establishing a smoke-free
NHS
Restricting and enforcing tobacco advertising;
Tough action on shops that sell cigarettes to children
Action to reduce tobacco smuggling and the availability of counterfeit tobacco
The evidence base on effective tobacco control is strong and LAAs should take this into consideration whilst
also considering any innovative approaches. Any indicator included in the LAA should be specific and
measurable and underpinned with the data flows necessary to assess performance at suitably regular
intervals.
Resources and References
HDA Evidence Briefing
The Health Development Agency (HDA)* have developed the evidence base for the reduction of smoking,
‘Smoking and public health: a review of reviews of interventions to increase smoking cessation, reduce
smoking initiation and prevent further uptake of smoking’17. This evidence briefing is a review of reviews
about the effectiveness of public health interventions to reduce smoking initiation and increase smoking
cessation. This briefing is intended to inform policy and decision makers, NHS providers, public health
specialists and is available on the NICE website at www.nice.org.uk.
HDA Guidance for smoke free NHSThe HDA* document ‘Guidance for Smoke free Hospital Trusts’19
provides help on putting a smoke free policy in NHS buildings into practice. The aim of this policy, set out in
the public health white paper, is to protect and improve the health of staff, patients, visitors and remove the
dangers of second hand smoke. It will also set an example to other large employers and workforces,
particularly in health-related locations.
The guidance aims to support hospitals to become smoke free by providing guidance on how to overcome
the difficulties by identifying the ‘Five Cs for smoke free’- the key steps needed to implement a smoke-free
policy in hospital trusts. These are:
COMMIT to the policy; CREATE the policy; ensure CESSATION support is widely available and accessible;
COMMUNICATE the policy and CONSOLIDATE the policy. Contact details for health professionals who
are willing to offer advice on the issues around setting up and implementing a policy are given in the
document. The document can be downloaded from the NICE website at www.nice.org.uk
*The National Institute for Health and Clinical Excellence was formed on 1 April 2005, when the National
References
1 Tobacco:
deadly in any form or disguise. World Health Organization 2006. www.who.int/tobacco/wntd.
of Health. Smoke-free premises and vehicles. Consultation on proposed regulations to be made under
the powers in the Health Bill.
3 Jamrozik, K. Estimate of deaths attributable to passive smoking among UK adults: database analysis. British Medical
Journal 2005;330:812.
4 Callum C. The UK smoking epidemic: deaths in 1995. London: Health Education Authority, 1998
5 Meltzer H, Gill B, Hinds K, Petticrew M. Economic activity and social functioning of residents with psychiatric
disorders. OPCS surveys of psychiatric morbidity in Great Britain Report No.6.London: Stationary Office,1996
6 The Scientific Committee on Tobacco and Health (SCOTH) Report on Second hand Smoke. 1998
7 Department of Health (2004) Scientific Committee on Tobacco and Health – Second-hand Smoke:
Review of evidence since 1998
8 Jamrozik, K (2005) Health Impacts of environmental tobacco smoke exposure in hospitality industry
employees, British Medical Journal 2 March 2005
9 Department of Health. Smoking Kills A White Paper on Tobacco. December 1998.
10 Department of Health. The NHS Cancer Plan. October 2003.
11 SEPHG. A framework for action on tobacco control in the South East. August 2005.
12 SEPHO. Choosing Health in the South East: Smoking.August 2005.
13 Department of Health. Choosing Health – Making healthy choices easier. 2004
14 Department of Health. Saving Lives: Our Healthier Nation. 1999.
15 Department of Health. The National Service Framework (NSF) for Coronary Heart Disease. 2000.
16 Department of Health. The NHS National Plan. 2000.
17 Health Development Agency. Smoking and public health: a review of reviews of interventions to increase
smoking cessation, reduce smoking initiation and prevent further uptake of smoking. 2004.
18 CIEH, ASH. Achieving Smoke Freedom Toolkit – A guide for local decision makers. September 2004.
19 Health Development Agency Guidance for smoke free Hospital Trusts. 2005
2 Department
For further information please contact:[email protected]
For additional copies of the Information Series please visit the SE Regional Public Health Group
website http://www.sepho.org.uk/viewResource.aspx?id=10297