Local Tobacco Control Profiles The webinar will start at 1:00pm December 2018 update www.tobaccoprofiles.info

4th December LTCP update: NEW smoking and mental health indicators Updated data for GPPS and QOF indicators Updated data for SATOD Updated data for smoking attributable mortality and deaths from smoking related illnesses Updated data for quitters domain Revised back series where applicable using the revised ONS mid-year population estimates Local Tobacco Control Profiles – December 2018 update

Smoking prevalence in adults domain New layout using subheadings New data for 5 indicators Smoking prevalence in adults – current smokers (GPPS) Smoking prevalence in adults – current smokers (QOF) Smoking prevalence in adults – ex-smokers (GPPS) Smoking prevalence in adults – never smoked (GPPS) Smoking at time of delivery Two NEW indicators Smoking prevalence in adults with a long term mental health condition Smoking prevalence in adults with anxiety or depression Local Tobacco Control Profiles – December 2018 update

Current smokers This is a screenshot from the top of the smoking prevalence in adults domain - they are now arranged so all the estimates for current smokers are together, to hopefully make it easier for people to compare them. We welcome feedback on whether this is more user friendly than previously now that the subheadings have been added. You will notice that the APS says new data as well because I have updated the smoking populations for 2017 using the ONS population estimates which were not available in July when we published the rates so we used the 2016 population for 2017 at that point – rates have not changed. Comparing the three different estimates, the latest figures calculated from the GPPS are 14.7% for England and you will notice that the QOF estimates are all generally higher than the other surveys with the England value at 17.2%. A previous webinar about the differences in the sample and sampling methods can be found in the further resources of the tobacco profiles. Local Tobacco Control Profiles – December 2018 update

Mental heath indicators Towards a smoke-free generation: a tobacco control plan for England (2017) https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england The tobacco control plan recognises that smoking prevalence in people with mental health conditions is significantly higher than the general population and also that people with a mental health condition die on average 10-20 years earlier which could be linked to the higher rates of smoking. It also recognises that we need to improve the data collected on these individuals so that we can monitor whether smoking prevalence here is seeing the same decline as other groups. This led us to look around at what survey data is available, and from the GP patient survey we were able to calculate two indicators. Local Tobacco Control Profiles – December 2018 update

Mental heath indicators Smoking prevalence in adults with a long term mental health condition The first is the smoking prevalence in adults with a long term mental health condition. The question appears on the GPPS questionnaire as shown. The trend in the data, (with the grey line showing the figures for persons, blue males and red females) shows that there has been a decline from around 35% in persons in 2013/14 to 28% in 2017/18, however if you look at this compared to the overall smoking prevalence in the general population you can see there are still vast differences. Local Tobacco Control Profiles – December 2018 update

Mental heath indicators Smoking prevalence in adults with anxiety or depression The second indicator is smoking prevalence in people with anxiety or depression. Again the question is asked as shown and appears in the section of state of your health today, where people are about various things such as mobility and pain. The people included in the calculation of this indicator are those who responded they were moderately, severely or extremely anxious or depressed. Unfortunately this question was removed from the questionnaire in the latest wave so we only have data up to 2016/17 but looking at the trend, similarly to the last chart you can see that there has been a decrease in recent years but the latest figures were still significantly higher than the prevalence from the general population. Local Tobacco Control Profiles – December 2018 update

Long term mental health condition: inequalities in smoking prevalence 17.2 This chart downloaded from the profiles shows the long term mental health condition indicator by sex. As with overall smoking prevalence more males smoke than females, however when you add on the figures from the general population you can see to what extent it is greater with 15% difference in males and 12% in females. 12.4 Local Tobacco Control Profiles – December 2018 update

Long term mental health condition: inequalities in smoking prevalence 14.5 23.1 26.3 17.8 Next looking at sexual identity, most noticably here more than half of the group that would prefer not to say their sexual identity were smokers, when in the general population this group have the lowest smoking prevalence shown here by the black bars. 14.5 Local Tobacco Control Profiles – December 2018 update

Anxiety or depression: inequalities in smoking prevalence 19.1 19.2 16.5 15.9 14.1 10.0 6.5 Now switching to the anxiety and depression indicator, looking at the figures by age, around 30% of people age 25-54 with anxiety or depression were smokers. When we add in the figures for the general population, you see that the biggest difference in seen in those age 45-54 years where the prevalence is almost double in people with anxiety and depression. 3.5 Local Tobacco Control Profiles – December 2018 update

Anxiety or depression: inequalities in smoking prevalence 18.2 17.0 17.2 15.9 15.5 14.9 14.2 13.0 12.7 Finally by deprivation, we see the same pattern as we would expect, however again when you add in the general population figures you see that in each decile there is around a 10-11% difference between these and those with anxiety or depression. 12.2 Local Tobacco Control Profiles – December 2018 update

Smoking related mortality Now moving on to the smoking related mortality domain, seven indicators have been updated in this domain as shown here. The next few slides will briefly go through the calculation of the smoking attributable mortality indicators as we sometimes get questions about these and they are quite complex. Local Tobacco Control Profiles – December 2018 update

Smoking attributable fractions Current smokers Ex-smokers Relative risk for diseases such as: Malignant neoplasms Cardiovascular Diseases: Respiratory Diseases Diseases of the digestive system Age Groups The first thing needed for the calculations are the smoking attributable fractions. To calculate these we look at the relative risks of various diseases so for example a males smoker over 35 has 23 times the risk of getting lung cancer compared to a non-smoker, an ex-smoker has nearly 9 times the risk etc. This is then multiplied by the smoking prevalence for the corresponding value for current smokers or ex-smokers, for males or females and then for the affected age groups. We then extract the deaths for these same diseases and apply the fractions to them before calculating the age standardised rate. Males and females separately Local Tobacco Control Profiles – December 2018 update

Smoking attributable mortality Here the chart shows the trend in smoking attributable mortality for people aged over 35. The red dashed line here represents where there was a change in the method to calculating this indicator so the trend across this time period should be treated with caution. The latest figures for overall smoking attributable mortality show that around 263 people in every 100,000 population age 35+ years die from smoking related diseases which is a slight decrease on last year. Variation remains across the country and this map which can be seen on the profiles clearly shows that there is higher smoking attributable mortality in the North compared with the South which we would perhaps expect given smoking prevalence is also generally higher. Local Tobacco Control Profiles – December 2018 update

Smoking attributable mortality: inequalities This chart shows the magnitude of the difference by deprivation, so in the most deprived areas there are 165 more deaths per 100,000 people aged over 35 than there are in the least deprived areas. Local Tobacco Control Profiles – December 2018 update

Smoking related deaths Of the smoking attributable mortality, 24.7 per 100,000 deaths were related to heart disease and 8.2 per 100,000 to stroke. Deaths from other smoking related diseases that are shown in the profiles are oral cancer and chronic obstructive pulmonary disease, rates in both of which have remained relatively stable over recent years. Lung cancer deaths however have continued to decrease. Note that all these have been revised from 2012 with the new ONS mid-year populations so you may notice some slight changes in the back series if you look at the trends. Local Tobacco Control Profiles – December 2018 update

Quitters New CI method Finally the quitters indicators which have all been updated. The first thing you might notice is that the names of the top three indicators have been slightly changed. We recently had to take these indicators through the indicator methodology review group in order to have agreed the new confidence interval method which is now able to take into account the fact that the denominator is calculated using the smoking prevalence which itself has confidence intervals around it. In this process it was noted that the names of the indicators did not necessarily explain very well what the indicator was showing, particularly if taken out of context of our profile, so we have updated these accordingly. Local Tobacco Control Profiles – December 2018 update

Quitters Looking at the trends we see that the smokers setting a quit date has decreased so it’s perhaps not surprising that the number of successful quitters has also decreased. In England in 2017/18, 4,097 per 100,000 smokers set a quit date , with 2,070 successful quitters at 4 weeks per 100,000 smokers in 2017/18, 71% of whom were CO validated. Local Tobacco Control Profiles – December 2018 update

And please complete our user survey (see recent updates on front page of profiles for the link) Local Tobacco Control Profiles – December 2018 update

Feedback on the webinar tobacco.profiles@phe.gov.uk Local Tobacco Control Profiles – December 2018 update