Tobacco Smoking: Current Status and Strategies for Reduction

1. Tobacco smoking: where are we now and what can be done to reduce prevalence? Robert West University College London Cardiff, April 2008

2. Outline • Smoking patterns • Quitting patterns • Attempts at ‘harm reduction’ • Future strategies

3. Smoking prevalence in Britain • Smoking prevalence stopped declining in the 1990s until 1998 when the UK Government introduced a comprehensive tobacco control strategy • Since then it has declined at an average of 0.4% per year Data from General Household Survey 2006

4. Smoking prevalence in England, Scotland and Wales • Smoking prevalence has declined at similar rates in England, Scotland and Wales • Greater apparent variability in data from Scotland and Wales reflects smaller sample sizes of surveys Data from GHS 2006; data from 2000 onwards are reported every year

5. Smoking prevalence by occupational group in England • Rates of decline has been broadly similar since the 1990s across the social spectrum • There is a still a very large gap between the different socio-economic groups • The same is likely to be true in other parts of Britain Data from General Household Survey 2006

6. Smoking prevalence in England: 2007 • Cigarette smoking prevalence in England in 2007 is estimated at 24% • This is higher than the GHS estimate for 2006 of 22% but that figure must be viewed with caution because it showed an apparent 2% drop in current and ever-smoking in one year • Over the past 14 months there has been a trend for a 0.09% drop per month which translates into a 1% drop over the year Data from Smoking Toolkit Study; www.smokinginengland.info

7. Daily cigarette consumption in England • Average daily consumption is 14 cigarettes per day • Smokers in lower social grades smoke more roll-your-own cigarettes but not more manufactured cigarettes • Smokers in lower social grades are much more likely to smoke exclusively roll-your-own cigarettes

8. What smokers pay for their cigarettes in England • The average smoker spends £2.80 per day on cigarettes • There is no difference across the social grades despite the fact that those in lower grades smoke more cigarettes per day • The average cost of 20 manufactured cigarettes is £4.60 compared with £1.90 for roll-your-own cigarettes

9. Quitting patterns in England • 43% of smokers report having tried to quit in the past year • There is no difference in attempts to quit across social grades • Those in social grade E are less than half as likely to succeed as those in social grades A or B • Those in social grade E are more likely to use nicotine replacement therapy on prescription Data from Smoking Toolkit Study; www.smokinginengland.info

10. Monthly rate of attempts to stop in England • There is marked variation in rate of attempts to stop with peaks at the New Year and mini-peaks in March and around the time of the smoke-free implementation • Quit attempts made around special dates such as New Year are more likely to be successful in the short-term • 8% report having tried to stop as a result of smoke-free legislation Data from Smoking Toolkit Study; www.smokinginengland.info

11. Monthly use of aids to cessation • More than 40% of quit attempts involve use of medication • Nicotine replacement therapy bought over the counter is most common • About 3% of attempts involve use of NHS services Data from Smoking Toolkit Study; www.smokinginengland.info

12. Trying to cut down in England • More than 50% of smokers report trying to cut down • There is a slight decline over the year Data from Smoking Toolkit Study; www.smokinginengland.info

13. Use of NRT by continuing smokers • Approximately 1 in 7 smokers report regularly using nicotine replacement therapy for situations in which they cannot smoke • Patch and gum are the most popular forms • About 25% of those cutting report using NRT to help • The nicotine patch is the most popular form followed by the gum

14. The continuing problem • The current strategies are working but progress is too slow, particularly among the less well-off members of the community • Smoking will continue to kill at least 70,000 people per year into the foreseeable future without faster progress • Cheap tobacco is killing the poor • Each percentage point reduction in prevalence will eventually save almost 4,000 lives per year

15. Future strategies: a personal view

16. What is being done • The WHO’s Framework Convention of Tobacco Control is acting as a spur to international and national initiatives to head off the escalating global disaster of tobacco-related deaths • Department of Health in England is consulting on development of a range of important tobacco control measures • ASH in England is preparing a blueprint for a co-ordinated national tobacco control strategy to feed into the public consultation