Tobacco Control Strategy 2024 to 2029

Smoking prevalence is associated with levels of deprivation, with one-third of smokers residing in the 20% most deprived areas in England. In Buckinghamshire, data from GP systems (EMIS web) reveals a contrast in smoking prevalence between the least deprived areas (10%) and the most deprived areas (20.1%). This work compliments the ‘Opportunity Bucks’ programme, our local response to the government’s Levelling Up White Paper published in February 2022. The programme focuses on 10 wards in Buckinghamshire across three areas where people are experiencing the most hardship, and several of our tobacco control initiatives are focussed in these areas.

Lower-income individuals face higher smoking rates, often encountering difficulties in quitting due to factors such as limited social support or stress. Those in social housing are three times more likely to smoke than mortgage holders39. The UK is facing a cost-of-living crisis (as of October 2022) that will hit the most deprived hardest, yet it is often those who cannot afford to smoke who spend the most on their smoking addiction15. In Buckinghamshire, an estimated £110 million is spent on tobacco annually, with each smoker averaging £2,451 in spending. Nearly all this money goes straight out of the local economy as tobacco industry profits or tax40.

Smoking is more prevalent in men, with 15.5% (around 3.7 million) smoking compared to 12.1% of women (around 3 million) in 202141. This gender difference, observed since 2011, may result from various physiological, cultural, and behavioural factors39. Men are also more likely to vape daily (9.7% compared to 5.7% of women)42. In Buckinghamshire in 2022, more women (54%) set a quit date than men (46%), but ultimately, more men successfully quit (61% compared to 59% for women)43.

Smoking prevalence varies among ethnic groups, with higher rates in Mixed (19.5%) and White (14.4%) groups, and lower rates in Chinese (6.7%), Asian (8.3%), and Black (9.7%) groups in 201944. Significant gender differences are observed, particularly in Asian (13.9% in men, 2.9% in women), Chinese (12.6% in men, 4.0% in women), and Black (12.9% in men, 6.9% in women) ethnic group45.

Research on smokeless tobacco use in the UK is limited. Chewing tobacco, primarily betel quid or paan, is common among South Asian communities, with a 2004 survey finding 9% of Bangladeshi women using it. Water pipe smoking (shisha) use in the UK remains low, however we know that it is more commonly used in Black and Asian populations47. Like cigarettes, shisha contains nicotine, tar and carbon monoxide. A single shisha session equals inhaling smoke equivalent to over 100 cigarettes48. Tobacco-free shisha is not a safe alternative.

More research is needed to understand the effects of shisha and chewed tobacco, especially among ethnic minorities.

Smoking prevalence in England is linked to employment status. In 2021, 25.7% of unemployed adults were current smokers, while only 13.3% of employed adults smoked49. Unemployment is associated with higher smoking rates, with one in four unemployed individuals smoking compared to one in eight employed individuals. In 2019, 23.4% of those in routine and manual occupations smoked, approximately 2.5 times higher than those in managerial and professional roles (9.3%)50.

Government policy emphasises the necessity of ensuring that the LGBT populations receive necessary care, especially to address health inequalities51. Smoking rates among lesbian, gay, bisexual, and transgender (LGBT) individuals exceed the national average52.

= chart

The chart illustrates significantly higher smoking prevalence in the gay/lesbian groups (17.3%) and bisexuals (23.23%) compared to heterosexual groups (15.9%), based on 2018 data. Young LGBT individuals are more prone to starting smoking earlier and smoking more heavily52. LGBT communities often face barriers in accessing medical treatment, and they are disproportionately affected by social inequalities, increasing the risk of smoking initiation and addiction.

While research on smoking among transgender people is limited, surveys indicate a higher likelihood of smoking53.

NICE guidelines from 2018 emphasise the importance of targeting and prioritising LGBT smokers in cessation initiatives and services54. Stop smoking services should ensure accessibility for the LGBT community, demonstrating inclusivity in equality policies and health promotion campaigns, as seen in examples like the Greater Manchester Health and Social Partnership’s ‘You Can’ campaign55,56.

Approximately one third of adult tobacco consumption is by people with a current mental health condition, with smoking rates more than double the general population57. People with mental health conditions die 10 to 20 years earlier, and the biggest preventable factor for this is smoking58.

Research from the Royal College of Physicians indicates that people with depression are 1.7 times more likely to smoke, while those with schizophrenia are over twice as likely compared to those without a mental health condition. People with a mental health condition are also more likely to be heavy smokers, despite a more frequent desire to quit compared to the general population59.

The severity of the mental health condition correlates with higher rates of smoking, smoking dependence, and a greater likelihood of relapse60.

+ chart

Smokers are more prone to long-term illnesses, and many of these conditions are either caused or worsened by smoking. Smoking significantly heightens the risk of heart-related issues, including heart attack and stroke. Smokers have a 30% to 40% increased likelihood of developing diabetes, leading to complications like kidney disease, nerve damage, circulatory problems, and non-healing sores61.

For individuals with asthma who smoke, hospitalisation rates, symptom severity, and lung function decline are higher compared to non-smoking asthmatics62. Chronic Obstructive Pulmonary Disease (COPD) results in 30,000 deaths annually in England, with smoking responsible for up to 80% of COPD-related deaths63.

Smokers have a 30 to 40% increased likelihood of developing diabetes.