Related to: Ill Health and Disability, Cancer, Coronary Heart Disease,Chronic Obstructive Pulmonary Disease, Lung Cancer, Stroke, Wellbeing, Night Time Economy, Electronic Cigarettes and vaping, Child Health and Wellbeing Survey , Voicebox Resident Survey
- Smoking is the primary cause of preventable illness and death in the UK.
- Nationally, the proportion of children and young people who report they have ever smoked continues to fall (to 23% of girls and 20% of boys in 2013), and are at their lowest levels since at least 1982.1
- There were 43,776 people in 2012/13 (financial year) on the smoking register in GP practises in Bath and North East Somerset, a rate of 22% of the registered population.
- The proportion of adults smoking in B&NES is falling, and prevelence rates are lower than nationally, however rates among routine and manual work groups are higher.
- There were 158 deaths per 100,000 35+ year olds in Bath and North East Somerset attributed to smoking in 2008-10. This is significantly lower than national rates of 210.
- 10% of respondents to the 2016 Voicebox Survey said they currently smoke, this is less than in 2014 (16%), but similar to 2012 (11%).
- Only 9% of respondents to the 2016 B&NES Voicebox Survey said they had ever used an electronic cigarette.
What does the data say?
Unicef’s 2013 smoking rates in children in rich countries comparative overview 2
In Unicef’s 2013 smoking rates in children in rich countries comparative overview, Unicef compares 29 of the world’s most advanced economies.
According to Unicef’s report, in the UK, just under 6% of children aged 11, 13 and 15 smoke cigarettes at least once a week. The UK has the 7th lowest rate in the table. Canada, Iceland, Norway, Portugal and the United States are the only countries in which the smoking rate for young people is below 5%. The highest smoking rates (more than 10% of young people report smoking cigarettes at least once a week) are found in Austria, the Czech Republic, Hungary, Latvia, Lithuania, Romania and Slovakia.
It is important to note that one of the limitations of these league tables is that internationally comparable data on children’s lives is not sufficiently timely. Between the collection of data in a wide variety of different settings and their publication in quality-controlled, internationally comparable form, the time-lag is typically two to three years. This means that most of the statistics on child well-being used in this report, though based on the latest available data, apply to the period 2009–2010.
Smoking is the primary cause of preventable illness and death. Smoking causes around 80 per cent of deaths from lung cancer, around 80 per cent of deaths from bronchitis and emphysema, and about 17 per cent of deaths from heart disease. 3 Smoking results in more deaths than the next 6 causes combined 4
Inequalities highlighted by the Office of National Statistics 5
In 2009 the ONS reported that 26.6% of those in manual and routine industries smoke although these groups are highest proportion of quitters through GP services 6
The main findings from the annual ‘Smoking, Drinking and Drug Use Among Young People in England’ Survey for 2013 7 are as follows:
- In 2013, less than a quarter of pupils said that they had smoked at least once. At 22% (23% for girls and 20% for boys), this was the lowest level recorded since the survey began in 1982, and continues the decline since 2003, when 42% of pupils had tried smoking.
- 3% of pupils reported that they smoked at least one cigarette a week, the survey definition of regular smoking. This was also at the lowest level measured since 1982, and considerably below the 9% recorded in 2003.
- The prevalence of smoking increased with age. In 2013, less than 0.5% of 11 and 12 year olds said that they smoked at least one cigarette a week, compared with 4% of 14 year olds and 8% of 15 year olds.
Bath and North East Somerset
The proportion of adults smoking in B&NES is falling, and the latest prevalence rate is 14.5 per cent (21,153 smokers aged 18+), which is lower than the England rate of 18.4 per cent (2013 data). However, the rate of smoking among routine and manual groups is higher, at 21.1 per cent. 8
There were 43,776 people in 2012/13 (financial year) on the smoking register in GP practises in Bath and North East Somerset.* 9
The prevalence of people on the smoking register in the B&NES GP registered population in 2012/13 (financial year) was 22%, slightly lower than the 2012/13 (financial year) national rate of 23%.* 10
*It is important to note that the above rates are based on the GP registered population of Bath and North East Somerset and so some of these people may not be residents of Bath North East Somerset. Nevertheless, the vast majority of people will be registered with a GP in their county of residence.
B&NES compares favourably to regional and national rates for all smoking attributable outcomes including COPD, Lung disease, heart disease, stroke and overall mortality 11
The cost of smoking
Bath and North East Somerset is within average bounds on cost & prescribing compared with nationally. 12
The cost per capita of smoking attributable hospital admissions for over 35 year olds in Bath and North East Somerset in 2010-11 was £32, compared to £35 in the South West and, £37 in England. 13
For the first time, new research has estimated the cost of smoking to the social care system. It indicates that current smokers over 50 are twice as likely to need help with day-to-day living and on average need care nine years earlier than non-smokers14
The graphic below demonstrates the estimated social cost of smoking to the economy, NHS, social care and emergency services 15
Smoking in pregnancy
For the year 2013/14, 10.1% of all maternities were smokers at delivery (12% England, 13% South West). This has reduced from 14.2% in 2004/05. B&NES remains lower than national and regional rates of smoking at delivery and the trend is in line with the national and regional picture. 16
Mortality and Morbidity associated with Smoking 17
There were 158 deaths per 100,000 35+ year olds in Bath and North East Somerset attributed to smoking in 2008-10. This is significantly lower than national rates of 210 and lower than regional rates of 178.
Between 2008-10 there were 20 smoking attributable deaths from heart disease per 100,000 of the 35+ year olds population, compared with 25 per 100,000 in the South West and 30 per 100,000 in England.
There were 7 smoking attributable deaths from stroke per 100,000 35+ year olds in Bath and North East Somerset in 2008-10. This is lower than national rate of 10 and lower than regional rates of 8.
In Bath and North East Somerset there were 1108 hospital admissions per 100,000 of over 35 year olds attributed to smoking in the year 2009-10. Again, this was lower than the South West rate of 1287 per 100, 000 and the national rate of 1417 per 100,000.
Smoking remains one of the leading causes of premature death and inequalities in life expectancy. 18
What does the community say?
You Gov public opinon digest for the South West - What further tobacco control action should be taken?
Results show that respndents in the South West see a need for greater action to control tobacco, with policies that protect children and young people particularly popular. There is also strong support for banning smoking in hospital grounds. 19
The large scale Voicebox Resident Survey aims to provide an insight into Bath and North East Somerset and its local communities and to capture resident’s views and experiences of their local area and council services. The questionnaires were posted to 3,150 addresses selected randomly in the local authority area in 2010, 2012 and 2014, and to 3,650 addresses in 2016. Selected respondents also have the opportunity to complete the survey online.
The Voicebox Resident Survey carried out in 2010, 2012, 2014 and 2016 asked respondents a series of questions about smoking.
In 2010 the survey overall generated 1,310 responses, a response rate of 42%, in 2012, 850 responses, a response rate of 27%, in 2014, 975 responses, a response rate of 31%, and in 2016, 1,113 responses, a response rate of 31% (sent to 3,650 addresses).
In 2010, 2012, 2014 and 2016 respondents were asked about the following:
- Current and past levels of smoking
- Perceptions of the health impacts of smoking
- Giving up smoking
In 2014 and 2016 respondents were also asked about their use of electronic cigarettes.
Current and past levels of smoking
The Voicebox respondents were asked - Which one of the following best describes you? –
- I occasionally smoke, but not every day
- I smoke between 1 and 6 cigarettes a day
- I smoke more than 6 cigarettes a day
- I used to smoke, but never smoke now
- I have never smoked
The age group with the greatest proportion of respondents that stated that they currently smoke was the youngest age group, 18-34 year olds, with 24%.*
*It is important to note that Voicebox results have a margin of error between 1-3%, and so only differences higher than 3% should be considered significant.
Figure 1: The proportion of 2014 Voicebox Survey respondents that said they currently smoke (I occasionally smoke, but not every day, I smoke between 1 and 6 cigarettes a day, I smoke more than 6 cigarettes a day) by age.*
The proportion of respondents who said they currently smoke (I occasionally smoke, but not every day, I smoke between 1 and 6 cigarettes a day, I smoke more than 6 cigarettes a day) was similar in 2010 (15%), 2012 (11%) and 2014 (16%).*
There was also very little difference in the proportion of respondents that stated they smoked more than 6 cigarettes a day, 5% in 2010, and 6% in both 2012 and 2014.*
Figure 2: Current and past levels of smoking according to 2010, 2012, and 2014 Voicebox Survey respondents*
Perceptions of the health impacts of smoking
When those that smoked (167 in 2010, 93 in 2012, 153 in 2014) were asked - Do you think your present level of smoking is harmful to your health? – The proportion of smokers that thought it was in 2014 (74%) and 2012 (70%) was higher than in 2010 (65%).*
Giving up smoking
When those that smoked were asked - Have you made a serious attempt to give up smoking during the past 12 months? - The proportion of smokers that said they had tried to give up was slightly lower in 2014 (31%) than in 2012 (37%).*
We are not able to compare the 2010 figures because the respondents that said they were not sure were not included in the figures for 2010, and so the % is not directly comparable.
When those that smoked were asked - Would you like to give up smoking in the next 12 months? - The proportion of smokers that said they would like to give up was lower in 2014 (38%) than in 2012 (49%).*
We are not able to compare the 2010 figures because the respondents were asked whether they would like to stop smoking over the next six months, rather than twelve months. Also, the respondents that they were not sure were not included in the figures for 2010, and so the % is not directly comparable
When all the respondents in 2014 were asked – Have you ever used an electronic cigarette? – Only 9% of respondents said they had.
Of the 81 people who said they had used an electronic cigarette:
- 57% said they had done so to help them quit smoking tobacco products completely
- 20% stated they used them to reduce the number of cigarettes they would normally smoke
- 19% said they used electronic cigarettes because they can use them indoors.
2011 Household survey on smoking prevalence 27
According to a 2011 houshold survey on smoking prevalence the smoking prevalence of adults in Bath and North East Somerset is 16.4%, 37.3% ex-smokers and 46.3% never smoked (April 2011-March 2012) (compared with 20%, 33% and 47% respectively nationally) This equates to 23,269 smokers aged 18+ in Bath and North East Somerset (using 2011 mid-year estimates
This survey suggests that smoking rates have been decreasing in B&NES and nationally.
Figure 1: Change in rate of current smokers (18+) from Integrated Household Survey
Child Health and Wellbeing Survey
For the results of the Child Health and Wellbeing Survey see Child Health and Wellbeing Survey section.
Client stop smoking survey 2010 28
Nearly all (93%, 135/145) would recommend the service to other smokers who want to stop smoking
50% (72/145) of respondents reported not smoking at all
88% (127/145) of respondents said that in the event that they started smoking again they would go back to the service for help with stopping smoking
83% (121/145) thought that if they did return to the service they would be welcomed back
92% (133/145) respondents said that it was easy to contact the service when they had decided that they wanted to stop smoking. 90% of clients (130/145) when asked about whether they were given an appointment date or told how long they would have to wait to see someone replied affirmatively
The vast majority of respondents 79% (115/145) waited for their first appointment for up to and including 10 days with only 3% (5/145) having to wait for three weeks and over. 89% (129/145) of respondents said the length of time this was acceptable. 94% (136/145) of respondents found their appointment time convenient and 96% (139/145) felt likewise about the appointment venue
88% of respondents (128/145) were satisfied/very satisfied with how supportive staff were
72% (105/145) found that CO-monitoring was helpful or very helpful and 11% (16/145) said that their CO was not measured at every visit
Just under 50% (72/145) reported using NRT to aid their quit attempt and the same number (72/145) said Varenicline and under 1% (1/145) said they used no medication.
The majority of clients felt it was easy to access services and the length of time for an appointment was acceptable
Time of appointment and venue were answered positively by the respondents but most clients said they did not get contacted by the service prior to the first appointment to encourage them to attend. Some clients complained that they had been kept waiting at appointments and even had them cancelled at short notice. Nearly a third of respondents did not get offered a choice of an individual appointment or a group. This choice would be offered as a standard procedure within the Specialist Stop Smoking Team but may not be either practical or possible for community advisors to provide group support themselves. However, community advisors can refer clients to the Specialist Stop Smoking Team who will provide closed or rolling group support.
The advisors received high satisfaction levels when it came to the support they gave a client. It should be standard procedure for an advisor to do a CO reading at every appointment and this is reinforced at the two day training course for Smoking Advisors facilitated by the Specialist Service.
Nearly half of respondents had smoked since their last appointment which would indicate that a proportion of those that had been quit at four weeks were now smoking again
“I think the support given should go on for longer (More than 3 months).”
“I'm registered in Bath but work in Bristol so there were no appointments.”
“Maybe follow up calls between appointments or after completion of course would be helpful.”
“Nurse at the GP didn't always know what was available and the tablets I had at one point made me very ill and the nurse said it was a fluke. I disagree and not happy with their training.”
“It would be good to have counselling and somebody to talk to for advice”
“Extremely helpful and non-judgemental. I was given lots of encouragement, but not pressurised in any way.”
“The service was great they worked appointments around my work shift. The nurses were very polite, helpful and great support. No more cigarettes for me ever”
Are we meeting the needs?
From 2008-11, 3917 people joined the quit smoking service. 41% of these (1621) are verified as having quit smoking and an additional 15% self-reported as quit (591). 29
The percentage of people who have signed up with the stop quitting service (2008-11) and have not quit increases with deprivation quintile – 30% not quit in the least deprived quintile, 40% in the most deprived quintile.
Although there is no significant variation by deprivation with respect to the percentage who have been verified as having quit, there is still a lower percentage quitting in the lowest deprivation quintile compared with the highest. When these figures are added to the percentage who self-report that they have quit, this trend becomes significant. 30
Figure 2 : Percentage of clients using the stop smoking service who quit by deprivation quintile (2010/11) 31
Residents of isolated rural communities
Residents of small and mid-sized towns with strong local roots
Wealthy people living in the most sought after neighbourhoods
Successful professionals living in suburban or semi-rural home
Middle income families living in moderate suburban semis
Couples with young children in comfortable modern housing
Young, well-educated city dwellers
Couples and young singles in small modern starter homes
Lower income families in older or social housing
Owner occupiers in older-style housing in ex-industrial areas
Residents with sufficient incomes in right-to-buy social housing
Active elderly people living in pleasant retirement locations
Elderly people reliant on state support
Groups X and Q had the highest percentage signing up for the quitting smoking service (11% of the group population)(residents with sufficient incomes in right-to-buy social housing and middle income families in the suburbs). The lowest signup was from Group Y (1.2% sign up) (well-off and retired)
Of those who signed up a significantly high number who did not quit were likely to be from Groups U, X and Z (above 35%) (couples/young singles in small modern starter homes, those with sufficient incomes in right-to-buy social housing and the poor elderly)
Of those who signed up Groups M and O had the highest percentage of those likely to be verified as having quit (significantly high percentage) (23% and 25% respectively) (these are also the groups with the highest percentage quitting when the self-reported quitting figures have been added (70% and 65% respectively) (rural dwellers and wealthy)
Lowest percentages verified as having quit are from group Z (10%) (poor elderly) (significantly low) although when the percentage of self-reported quitters have been added to those verified those with significantly low percentages of quitters are likely to be from Groups X, V and U (those with sufficientincomes in right-to-buy social housing, those on lower incomes and couples/young singles in small modern starter homes) [i].
Figure 3: Percentage of clients in the stop smoking service who have quit by MOSAIC group
There is some evidence of success of national and local activity to reduce smoking prevalence and associated illnesses (e.g. reduction in lung cancer).
However there are more hospital admissions for smoking related conditions, considered to be a consequence of living longer with conditions.
Sirona Stop Smoking Service update 2013/1432
The service provides direct support to smokers who wish to stop on a 1-1 basis through clinic provision. The service supports and updates community stop smoking advisors working in primary care through mentoring, refresher training and network meetings. The service continues to meet new challenges such as lower footfall into the whole service (25% reduction since the previous year) and and extensive use of e-cigarettes.
For the financial year 2013/14 there were 1833 referrals into the service, of which 87% were aged 45+ ,56% were female and 41% lived in areas falling into local deprivation quintiles 4 & 5 (top 40% most deprived LSOAs in B&NES). Quit rates rose by 2% to 58% from the previous year. Quit rates for specialist services (75%) are higher than for pharmacists (59%) and GPs (52%).
What can we realistically change?
The areas that need to be addressed are as follows:
Community Stop Smoking Advisors to be informed that:
- clients should be referred to the Specialist Stop Smoking Service if they cannot be seen by the advisor within two weeks
- Appointments with clients should not be cancelled at short notice
- Prescriptions should be issued without delay
- Clients should be asked whether or not they want individual or group support. If group support is requested and is not available in the community setting then referral should be made to the Specialist Stop Smoking Service
- CO readings should be taken at every appointment. 33
- 1. HSCIC (2014), Smoking, Drinking and Drug Use Among Young People in England Survey for 2013, available from: http://www.hscic.gov.uk/catalogue/PUB14579
- 2. Unicef Research (2013) Child well-being in rich countries: A comparative overview, http://www.unicef.org.uk/Images/Campaigns/FINAL_RC11-ENG-LORES-fnl2.pdf (downloaded 31/01/14)
- 3. http://www.ash.org.uk/files/documents/ASH_94.pdf
- 4. Tobacco control: JSNA support pack 2015-16, PHE
- 5. Robinson, S. & Harris, H. (2009) Smoking and Drinking among Adults, 2009, Office for National Statistics (downloaded 02/04/2012) http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2009-report/index.html
- 6. NICE (2008) Smoking cessation services in primary care, pharmacies,local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities http://www.nice.org.uk/nicemedia/pdf/PH010guidance.pdf (downloaded 02/04/2012)
- 7. HSCIC (2014), Smoking, Drinking and Drug Use Among Young People in England Survey for 2013, available from: http://www.hscic.gov.uk/catalogue/PUB14579
- 8. http://www.tobaccoprofiles.info/tobacco-control
- 9. HSCIC (Health and Social Care Information Centre) (2013) Quality and Outcome Framwork 2012-2013 Practice level, http://www.hscic.gov.uk/catalogue/PUB12262
- 10. HSCIC (Health and Social Care Information Centre) (2013) Quality and Outcome Framwork 2012-2013 Practice level, http://www.hscic.gov.uk/catalogue/PUB12262
- 11. Tobacco control: JSNA support pack 2015-16, PHE
- 12. London Health Observatory (downloaded 16/03/2012) Local Tobacco Control Profiles for England, Bath and North East Somerset UA http://www.lho.org.uk/lho_topics/analytic_tools/TobaccoControlProfiles/profile.aspx ? (downloaded 16/03/2012)
- 13. Public Health England (2013) Local Tobacco Control Profiles for England, Bath and North East Somerset UA, http://www.tobaccoprofiles.info/tobacco-control#gid/1000110/par/E12000009/ati/102/page/1/ (downloaded 12/02/2013)
- 14. http://ash.org.uk/information/ash-local-toolkit
- 15. Tobacco control: JSNA support pack 2015-16, PHE
- 16. Public Health Outcomes Framework indicator 2.03 - Smoking status at time of delivery
- 17. Public Health England (2013) Local Tobacco Control Profiles for England, Bath and North East Somerset UA, http://www.tobaccoprofiles.info/tobacco-control#gid/1000110/par/E12000009/ati/102/page/1/ (downloaded 09/01/20134)
- 18. Mulliss, R. (2008) What a waste: Premature deathsdue to smoking, the picture in the South West, SWPHO (downloaded 04/04/2012) http://www.swpho.nhs.uk/resource/item.aspx?RID=41894
- 19. Tobacco control: JSNA support pack 2015-16, PHE
- 20. Bath and North East Somerset Council (2010) Voicebox18 Weighted Cross-tabs
- 21. RMG:Clarity (2013) Bath & North East Somerset Council – Voicebox 21, Health and Wellbeing, Bath and North East Somerset Council
- 22. Marketing Means (2015) Voicebox 23, Results weighted by Age and Gender, Bath and North East Somerset Council, November 2014 – January 2015
- 23. Marketing Means (2016) Voicebox 24, Results weighted by Age and Gender, Bath and North East Somerset Council, November 2015 – January 2016
- 24. Marketing Means (2017) Voicebox 25, Individual results with Age and Gender weighting, Bath and North East Somerset Council, November 2016 – January 2017
- 25. Marketing Means (2015) Voicebox 23, Results weighted by Age and Gender, Bath and North East Somerset Council, November 2014 – January 2015
- 26. Marketing Means (2016) Voicebox 24, Results weighted by Age and Gender, Bath and North East Somerset Council, November 2015 – January 2016
- 27. London Health Observatory (2011) Smoking prevalence among adults aged 18+ by region and local authority: Datafrom the integrated household survey on smoking prevalence, updated as at 24 November 2011 http://www.lho.org.uk/viewResource.aspx?id=16678 (downloaded 16/3/2012)
- 28. Bath and North East Somerset NHS (2010) Stop Smoking Quitting Service, client stop smoking survey
- 29. Bath and North East Somerset NHS (2010/11) Stop Smoking Quitting Service in-house analysis
- 30. Sirona (2008-11) Stop smoking database, in-house analysis
- 31. Sirona (2008-11) Stop smoking database, in-house analysis
- 32. Sirona Healthy Lifestyle Service 2013-14 demographic report
- 33. Bath and North East Somerset NHS (2010) Stop Smoking Quitting Service, client stop smoking survey