Your logo here Your Logo here THE CASE

Your logo here Your Logo here THE CASE FOR ACTION on TOBACCO USE & SMOKING Harms caused by tobacco use & an overview of local tobacco policies to aid commissioning Author: Add name

Your logo here 1. Scale of the challenge

Harms caused by tobacco use Each year smoking causes the greatest number of preventable deaths Alcohol: 6, 541 Smoking: 81, 400 Obesity: 34, 100 Traffic: 2, 502 Suicide: 5, 377 References: 1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 ( http: //ash. org. uk/files/documents/ASH_107. pdf ) NB area represents value HIV: 529 Drug misuse: 1, 738 3

Harms caused by tobacco use National children’s rates of smoking (age 11 – 15) References: 1. Smoking, drinking and drug use among young people in England in 2009. National Centre for Social Research, 2010: NHS Information Centre for Health and Social Care. 4

Harms caused by tobacco use The majority of smokers are from manual and routine occupations Number of smokers by occupation (millions, 2010) References: 1. Smoking, drinking and drug use among young people in England in 2009. National Centre for Social Research, 2010: NHS Information Centre for Health and Social Care. 5

Harms caused by tobacco use Smoking-related diseases Smoking attributable deaths from major diseases (2009) References: 1. NHS Information Centre (2009), Statistics on smoking: England 2009 available at www. ic. nhs. uk/webfiles/publications/smoking 09/statistics_on_smoking_england_2009. pdf 6

Harms caused by tobacco use The annual cost of smoking to smokers (compared to additional costs to Chelmsford’s community) Annual estimated costs of smoking to the individual and society References: 1. Cough Up, Policy Exchange, 2010, 2. HMRC, 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011) 7

Harms caused by tobacco use Smoking costs the local economy millions every year The annual cost of smoking in this local area (£millions) References: 1. Cough Up, Policy Exchange, 2010 2. 'Reckoner' spreadsheet 8

Harms caused by tobacco use Local smoking rates differ greatly References: 1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http: //www. cdph. ca. gov/Pages/NR 11 -031. aspx 9

Harms caused by tobacco use 2. Smoking attitudes & behaviours 10

Harms caused by tobacco use Actions to break the ‘cycle of smoking’ Protect families & communities Reduce the appeal and supply of tobacco Encourage more quit attempts each year Support quit attempts 11

Harms caused by tobacco use Children not adults start smoking Age smokers start smoking: 90% of smokers started before the age of 19 18 is the age at which you can legally buy tobacco References: 1. Smoking Attitudes & Behaviours, ONS 2011 12

Harms caused by tobacco use Children are three times as likely to start smoking if their parents smoke 1 99% of 16 year old regular smokers live in a household with at least one other smoker 1 Smoking prevalence in 11 -15 year olds by number of smokers they live with 1 References: 1. Smoking, drinking and drug use among young people in England in 2010, ONS 13

Harms caused by tobacco use Women in low-paid work are 3 times more likely to smoke during pregnancy Socio-economic group: % who smoked before or during pregnancy References: 1. Infant Feeding Survey, ONS 2011 14

Harms caused by tobacco use Teenagers are almost 4 times more likely to smoke whilst pregnant compared with those over 35 References: 1. Infant Feeding Survey, ONS 2011 15

Harms caused by tobacco use Each year nearly 10, 000 children are treated in hospital for exposure to second-hand smoke References: 1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010 16

Harms caused by tobacco use The poorer you are the more likely you are to smoke References: 1. General Lifestyle Survey, ONS, 2010 17

3. 50 Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class 3. 00 Relative mortality Harms caused by tobacco use Smoking not social status is the greatest cause of health inequalities 2. 50 The life expectancy between rich and poor smokers is similar 2. 00 Richer smokers have a lower life expectancy than poorer nonsmokers 1. 50 1. 00 0. 50 0. 00 I+II Highest IV+V Social Class Male non-smokers Lowest Male smokers References: 1. Gruer L et al. BMJ 2009; 338; bmj. b 480 ( Relative mortality assessed at 2 nd 14 year follow-up between male smokers & non-smokers of highest & lowest social class) 18

Harms caused by tobacco use Certain minority groups & ethnic groups smoke at higher than average rates References: 1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010 19

Harms caused by tobacco use Quitting is the best way for smokers to improve their life expectancy Years of life gained by stopping smoking at different ages, 30 to 60 Age at which stopped smoking Years of life gained 30 10 40 9 50 6 60 3 References: 1. Doll R, Mortality in relation to smoking, BMJ 2004 20

Harms caused by tobacco use Benefits of quitting bring improvements in wellbeing regardless of age 20 Minutes Your blood pressure & pulse return to normal. Circulation improves – especially in your hands and feet. 8 Hours Your blood oxygen levels return to normal and your chance of having a heart attack falls 24 Hours Carbon monoxide leaves your body. Your lungs start to clear out mucus and debris. 2 -12 Weeks Circulation is now improved throughout your body. It’s easier to exercise. 3 -9 Months Lung efficiency is up by 5 -10%. Breathing problems are gone. 5 Years You have half the chance of getting a heart attack than a smoker. References: 1. West R. Shiffman S. S Fast Facts, 2 nd Ed. Oxford Health Press, 2007 21

Harms caused by tobacco use Packs are ‘silent salesmen’ for tobacco brands The Government has consulted on requiring plain packaging for tobacco products and has now decided to wait before making a decision on plain packaging. However, research shows that plain packs are • Less attractive to young people • Less likely to mislead smokers into thinking “mild” brands are safer • Give greater impact to health warnings This is an example of the ‘plain pack’ the Australian national government is using. 22

Harms caused by tobacco use The majority of children who smoke get their cigarettes from a ‘friend’ Usual sources of cigarettes for 11 -15 year olds in England References: 1. Smoking, drinking and drug use among young people in England in 2006 23

Harms caused by tobacco use Smokers from lower social classes are more likely to provide an immediate and tangible reason for making a quit attempt References: 1. E Vangeli, R West, Sociodemographic differences in triggers to quit smoking: findings from a national survey, Tobacco Control 2008 24

Harms caused by tobacco use Using NHS support is nearly 4 times more successful than going ‘cold turkey’ References: 1. West R, Smoking Toolkit, UCL www. smokinginengland. org 25

Harms caused by tobacco use Smoking & public opinion (You. Gov 2011, East of England) References: 1. You. Gov Survey 2011, East of England 26

Harms caused by tobacco use Poorer smokers are as likely to want to quit and try to quit but half as likely to succeed Success rate in quitting by socio-economic class References: 1. West R, Smoking Toolkit, UCL www. smokinginengland. org 27

Harms caused by tobacco use 3. Tobacco policies 28

Harms caused by tobacco use The World Bank has developed a ‘ 6 strand’ strategy for reducing tobacco use 1. stopping the promotion of tobacco; 2. making tobacco less affordable; 3. effective regulation of tobacco products; 4. helping tobacco users to quit; 5. reducing exposure to secondhand smoke; and 6. effective communications for tobacco control. References: 1. World Bank, ‘ 6 -Strand’ Tobacco Control Strategy (found at http: //web. worldbank. org) 29

Harms caused by tobacco use Local action: County Councils enforce tobacco laws • Age of Sales • Smuggled and Counterfeit Tobacco • Advertising ban 30

Harms caused by tobacco use Local action: County Councils now commission stop smoking services NHS Stop Smoking Services are the most successful route to quit and the most cost effective NHS treatment there is Data from www. smokinginengland. info; based on smokers who tried to stop in the past year who report still not smoking at the survey adjusting for other predictors of success (age, dependence, time since quit attempt, social grade, recent prior quit attempts, abrupt vs gradual cessation): N=7, 939 31

Harms caused by tobacco use Working together councils can mount effective local campaigns 32

Harms caused by tobacco use Local action: District, Borough & City Councils Smokefree environments enjoy increasing public support Percentage of adults reporting that their homes are smokefree 33

Harms caused by tobacco use Local action cont: Smokefree Play Parks enjoy increasing public support De-normalising smoking: • Young people have a right to a clean & healthy environment to play in • Most adults agree that smoking should be banned in outdoor play areas – 76% (You. Gov 2011) • Young people over estimate the amount of smoking & think it is the norm because they see it around them • No smoking signs in play areas help people to challenge someone who lights up Environmental Impact: • Play areas can be spoiled by some form of smoking related litter • Cigarette butts can take up to 12 yrs to biodegrade 34

Harms caused by tobacco use Local action: District, Borough & City Councils Role of Environmental Health Officer: • Enforce Smokefree Legislation – Responsible for monitoring compliance & enforcement. Work closely with local business to provide education, advice and support to ensure compliance is achieved • Environmental Protection – Litter & Workplace health and safety 35

Harms caused by tobacco use 4. Delivery 36

Harms caused by tobacco use Effective communications will direct smokers to the most effective route of quitting 37

Harms caused by tobacco use Working together for better health 1. Local Government, inc. Police & Fire Brigade 2. Local Health Services 3. Organisations that work across neighbouring localities within a region 4. Employers 5. Voluntary sector organisations 6. Smokers (particularly, groups with high rates of smoking e. g. routine & manual smokers) 38

Harms caused by tobacco use Key messages 1. Local Authorities have a key & important role to play; no agency alone can reduce smoking rates 2. Smoking is the single biggest preventable cause of health inequalities; reducing rates will bring general improvements in health & cost savings in other areas 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 39

Harms caused by tobacco use Next Steps • Tobacco Control group • Smokefree Environments inc. Parks, Workplace, Homes & Cars • Illicit Tobacco • Staff Training 40