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

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

Smoking prevalence in Britain Data from General Household Survey 2006 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

Smoking prevalence in England, Scotland and Wales Data from GHS 2006; data from 2000 onwards are reported every year 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

Smoking prevalence by occupational group in England Data from General Household Survey 2006 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

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;

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

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

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;

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;

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;

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

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

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

Future strategies: a personal view 1.Increase the cost of smoking by tax increases and bearing down harder on smuggling and counterfeit cigarettes Will deter uptake and promote cessation 2.Increase the budget for innovative communications campaigns Will increase the rate at which smokers try to stop and use effective methods 3.Ensure easy accessibility of high quality smoking cessation assistance through the NHS Will increase the success rates of smokers trying to stop 4.Remove remaining opportunities for tobacco promotion Will reduce appeal of smoking to young people and cues to smoking in those trying to stop 5.Encourage development of more effective, cheap, safe methods of stopping Will provide smokers who want to stop with greater opportunities to do so

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