Health behaviours: tobacco
- Tobacco use remains the UK’s single greatest cause of preventable illness and avoidable death, with 100,000 people dying each year from smoking-related diseases. In Suffolk, smoking-related illnesses cause over 1,100 deaths every year, which equates to three people dying every day in the County. (2 Why is tobacco use important?)
- Just as the links between smoking and poor health are irrefutable, there are proven short and medium term benefits of stopping smoking. Within three months of quitting, blood circulation improves and lung function increases. After a year, the risk of coronary heart disease has halved compared with a person who continues smoking. Five years after quitting, the risk of developing many cancers has halved and the risk of cervical cancer and stroke fall to that of a non-smoker. (2 Why is tobacco use important?)
- Smoking prevalence is decreasing both locally and nationally, with rates reducing over the last 5 years by around a quarter. In 2017, 1 in 7 (13.9%) Suffolk residents aged 18+ were smokers. (3.2 Smoking prevalence)
- Smoking while pregnant can cause a range of problems for the baby. In 2017/18, 1 in 10 Suffolk mothers were current smokers during their pregnancy. Although this rate has decreased over the last decade, it still represents more than 750 Suffolk mothers smoking while pregnant each year. (3.4 Smoking while pregnant)
- Smoking prevalence is higher among some groups, such as routine and manual workers, people living in areas of higher deprivation and people with mental ill health. (3.3 Smoking prevalence among routine and manual workers)
Cigarette smoke contains more than 7,000 chemicals. Repeated inhalation of this complex mixture of toxicants, often over the course of many years, causes a range of short term and long term health effects that affect most major organ systems. In the short term, smoking damages health by increasing susceptibility to acute illnesses and respiratory symptoms whilst also increasing the likelihood of absence from school/work and lower self-reported health. The long term health effects of smoking are the major causes of death in middle and upper income nations: coronary heart disease, cancer and chronic obstructive pulmonary disease (COPD).
Tobacco use remains the UK’s single greatest cause of preventable illness and avoidable death, with 100,000 people dying each year from smoking-related diseases. In Suffolk, smoking-related illnesses cause over 1,100 deaths every year, which equates to three people dying every day. Every year, more than 7,500 people are admitted to hospital for reasons which are directly attributable to smoking. The wider costs to the Suffolk economy are estimated to be £163 million each year through NHS costs, social care, lost productivity, smoking-related fires, and smoking-related litter. In Suffolk, around £182 million is spent on tobacco products annually.
In Suffolk, smoking is the single biggest risk factor for both the number of years of life lost to disease (YLL) and the number of years lived with disability as a result of disease (YLD). Smoking is also the largest cause of inequalities in death rates between the richest and poorest in our communities: smoking attributable death rates are three times higher in the most deprived areas than the least deprived areas. Smoking prevalence is higher among groups such as routine and manual workers, people living in areas of higher deprivation, and people with mental ill health.
Just as the links between smoking and poor health are irrefutable, there are proven short and medium term benefits of stopping smoking. Within three months of quitting, blood circulation improves and lung function increases. After a year, the risk of coronary heart disease has halved compared with a person who continues smoking. Five years after quitting, the risk of developing many cancers has halved and the risk of cervical cancer and stroke fall to that of a non-smoker.
Both locally and nationally, smokers are increasingly using e-cigarettes to help them move away from tobacco products. Among ex-smokers who successfully stopped smoking ten or more years ago, less than 1 in 200 used e-cigarettes as an aid, whereas 4 in 10 (38.5%) ex-smokers who quit in the last year used e-cigarettes to help them quit. Although e-cigarettes are not completely risk free, they carry only a small fraction of the health risk of tobacco cigarettes. Public Health England’s evidence review suggests that e-cigarettes are 95% safer than tobacco cigarettes, although the long term effects of e-cigarette use has not yet been determined. Research suggests that, when combined with expert face-to-face support, people who used e-cigarettes to quit smoking were twice as likely to succeed as people who used other nicotine replacement products, such as patches or gum.
In Suffolk, smoking is the single biggest risk factor for the number of years of life lost (YLL) to disease (the difference between actual and expected length of life among the resident population). Among people aged 35-74 years old in 2015-17, smoking accounted for 1,144 YLL per 100,000 residents. This is significantly lower than the East of England (1,217 YLL per 100,000 residents) and England (1,365 YLL per 100,000 residents).
Certain districts/boroughs have historically had comparatively high numbers of potential years of life lost due to smoking, particularly in more deprived areas of Suffolk. The most recent data published at district level, for 2013-15, showed that Ipswich stood out as having significantly higher rates of YLL due to smoking than England, and Waveney had rates of YLL comparable to England. All other districts/boroughs had rates of YLL that were lower than England.
Smoking prevalence is decreasing both locally and nationally, with rates reducing over the last 5 years by around a quarter. In 2017, smoking prevalence among residents aged 18+ was 13.9% in Suffolk, which is comparable to the East of England (14.2%) and England (14.9%). Smoking prevalence in Suffolk varies between districts/boroughs, with lower rates in the more affluent districts of Babergh, Mid Suffolk and Suffolk Coastal (7.3%, 7.4% and 9.3%, respectively). Comparatively higher rates were found in the less affluent areas of Waveney, Ipswich and Forest Heath (18.3%, 20% and 22.5%, respectively). Within most districts/boroughs there are deprived communities where smoking prevalence is higher than average. These are generally located in and around the main urban settlements (Figure 1).
Source: Experian Ltd. Mosaic Consumer Classification System.
Smoking prevalence is significantly higher among routine and manual workers compared to the overall population. However, like smoking prevalence in the population as a whole, smoking prevalence among routine and manual workers is on the decrease both locally and nationally, with rates reducing by around a quarter over the last 5 years.
Nearly one in four (23.6%) routine and manual workers in Suffolk smoke, which is comparable to the East of England (24%) and England rate (25.7%). Within Suffolk, the range of smoking prevalence amongst routine and manual workers varies from 13.9% in Suffolk Coastal to 41.9% in Forest Heath. This difference may be partially explained by the smoking prevalence figures being based on survey data, and partly by Forest Heath being relatively more deprived than Suffolk Coastal.
In 2017/18, 1 in 10 (10.6%) Suffolk mothers were current smokers during pregnancy, which is comparable to the prevalence across both the East of England (10.3%) and England (10.8%). Although this rate has decreased considerably since 2010/11, when the prevalence was 16.1%, it still represents over 750 Suffolk mothers smoking while pregnant each year.
Every year, more than 7,500 people are admitted to hospital in Suffolk for reasons directly attributable to smoking. In 2016/17, this corresponded to a rate of smoking attributable hospital admissions of 1,557 admissions per 100,000 residents aged 35 and over, which is significantly lower than both East of England and England (1,642 and 1,685 admissions per 100,000 residents aged 35 and over, respectively). This rate has remained relatively stable over the last decade.
Within Suffolk’s districts/boroughs, the lowest rates of smoking attributable hospital admissions were recorded in the more affluent districts of Babergh, Mid Suffolk and Suffolk Coastal. Significantly higher admission rates than England were found in areas with higher smoking prevalence of Ipswich and Forest Heath.
Smoking-related illnesses have consistently accounted for over 1,100 deaths every year in Suffolk, which equates to three people dying every day. The smoking attributable mortality rate for Suffolk in 2015-17 was 220.3 per 100,000 Suffolk residents aged 35 and over, which was significantly lower than both the East of England and England rates (240.7 and 262.6 per 100,000 population aged 35 and over).
The long term trend in smoking attributable mortality rates have decreased both locally and nationally over the last decade. Between 2007-09 and 2015-17 there was a 14% reduction in the rate of smoking attributable deaths in Suffolk.
Suffolk's mortality rate for deaths from Chronic Obstructive Pulmonary Disease (COPD) has consistently been significantly higher among males than females. There is evidence nationally that deaths from COPD are higher among more deprived communities.
The NHS Long Term Plan sets out how the NHS will tackle smoking as a route to reducing ill health. By 2023/24, all people admitted to hospital who smoke will be offered NHS-funded tobacco treatment services. As part of a new smoke-free pregnancy pathway, this service will be adapted for expectant mothers and their partners. A new universal service to help people quit smoking will also be available as part of specialist mental health services for long term users of specialist mental health services, and in learning disability services. Following the advice of Public Health England, this will include the option to switch to e-cigarettes while in inpatient settings.
Smoking is a modifiable lifestyle risk factor and effective tobacco control measures can reduce the prevalence of smoking in the population. The UK Government document Towards a Smokefree Generation: A Tobacco Control Plan for England (published July 2017) set out the national strategy to reduce smoking prevalence, aiming to achieve the following objectives by the end of 2022:
- reduce the number of 15-year-olds who regularly smoke from 8% to 3% or less (Suffolk: 8.6% in 2015)
- reduce smoking among adults in England from 15.5% to 12% or less (Suffolk: 13.9% in 2017)
- reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population (Suffolk figure: 9.7% in 2017)
- reduce the prevalence of smoking in pregnancy from 10.5% to 6% or less (Suffolk: 10.6% in 2015)
The Suffolk Tobacco Control Alliance are a group of professionals who are committed to tackling smoking in Suffolk through good promotional work, changing policies, supporting people to quit smoking and disrupting the illicit tobacco trade. As endorsed by the Suffolk Health and Wellbeing Board, the Suffolk Tobacco Control Alliance are working towards the vision of a smoke-free Suffolk, with the following objectives:, 
- reduce smoking during pregnancy
- support the reduction of smoking among people with a mental health diagnosis
- identify and support routine and manual workers to quit smoking
- prevent uptake of smoking among under 18s
- target high prevalence smoking areas
Published in July 2017, the UK Government document Towards a Smokefree Generation: A Tobacco Control Plan for England set out the national strategy to reduce smoking prevalence: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf
The report Aspiring to a tobacco free Suffolk: Moving towards a tobacco free generation outlined a new approach to drive down the numbers of people smoking in Suffolk: Aspiring to a tobacco free Suffolk: Moving towards a tobacco free generation
NICE produce a comprehensive range of guidance, advice and quality standards about smoking. These include specific guidance related to smoking prevention in schools, and young people more generally, and smoking interventions in pregnancy and after childbirth: www.nice.org.uk/guidance/lifestyle-and-wellbeing/smoking-and-tobacco
The Suffolk Tobacco Control Alliance are a group of professionals who are committed to tackling smoking in Suffolk through good promotional work, changing policies, supporting people to quit smoking and disrupting the illicit tobacco trade: www.healthysuffolk.org.uk/advice-services/adults/smoking/i-am-a-professional/suffolk-tobacco-control-alliance
The Local Tobacco Control Profiles for England provides a snapshot of the extent of tobacco use, tobacco related harm, and measures being taken to reduce this harm at a local level. These profiles have been designed to help local government and health services to assess the effect of tobacco use on their local populations. They will inform commissioning and planning decisions to tackle tobacco use and improve the health of local communities: fingertips.phe.org.uk/profile/tobacco-control
NHS Digital publish an annual report titled Statistics on Smoking. This report presents a range of information on smoking which is drawn together from a variety of sources. The report aims to present a broad picture of health issues relating to smoking in England and covers topics such as smoking prevalence, habits, behaviours and attitudes among adults and school children, smoking-related ill health and mortality and smoking-related costs.digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking
Action on Smoking and Health (ASH) is a public health charity that works to eliminate the harm caused by tobacco. ASH produces a wide range of information and resources including factsheets, briefings and a Local Toolkit for local public health professionals involved in tobacco control. ash.org.uk/category/information-and-resources/ and a tool to calculate the local costs of tobacco use (2019).
OneLife Suffolk is Suffolk’s integrated healthy lifestyle service which offers effective weight management, physical activity, smoking cessation and health improvement programmes. The Stop Smoking service is accessible for everyone who has smoked a tobacco product in the last 48 hours and available for all ages. onelifesuffolk.co.uk/stop-smoking/
Saving Babies’ Lives is a care bundle designed to support providers, commissioners and professionals take action to reduce stillbirths. The guidance was developed with clinicians, commissioners, charities and royal colleges and is based on the best available evidence. It supports the delivery of safer maternity care, as described by the National Maternity Review, in Better Births. www.england.nhs.uk/mat-transformation/saving-babies/
 Board on Population Health and Public Health Practice, Committee on the Public Health Implications of Raising the Minimum Age for Purchasing Tobacco Products. 2015. Available at: https://www.nap.edu/read/18997/chapter/1
 D. M. Parkin, “Tobacco-attributable cancer burden in the UK in 2010,” Br. J. Cancer, vol. 105 Suppl, no. Suppl 2, pp. S6–S13, Dec. 2011.
 Public Health England, “Local Tobacco Control Profiles.” [Online]. Available: https://fingertips.phe.org.uk/profile/tobacco-control
 Action on Smoking and Health (ASH), “The Local Costs of Tobacco: ASH Ready Reckoner 2018.” [Online].
 World Health Organisation, “Fact sheet about health benefits of smoking cessation,” 2013. .
 Office for National Statistics, “Adult smoking habits in the UK: 2017,” 2018. [Online]. Available: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017
 NHS, “Using e-cigarettes to stop smoking,” 2019. [Online]. Available: https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/.
 Public Health England, “Evidence review of e-cigarettes and heated tobacco products 2018,” 2018. [Online]. Available: https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review/evidence-review-of-e-cigarettes-and-heated-tobacco-products-2018-executive-summary
 P. Hajek et al., “A randomized trial of e-cigarettes versus nicotine-replacement therapy,” N. Engl. J. Med., 2019.
 Experian Ltd, “Mosaic consumer classification system.”
 Department of Health and Social Care, “Smoke-free generation: tobacco control plan for England,” 2017. [Online]. Available: https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england
 Suffolk County Council, “Aspiring to a tobacco free Suffolk : Moving towards a tobacco free generation,” 2015.
 Suffolk County Council, “Suffolk Tobacco Control Alliance.” Available at: https://www.healthysuffolk.org.uk/advice-services/adults/smoking/i-am-a-professional/suffolk-tobacco-control-alliance
 NHS England, “Saving Babies’ Lives A care bundle for reducing stillbirth,” 2016. Available at: www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf