Smoking

Smoking

Smoking is the leading cause of preventable death and disease in the UK and the leading factor for disability-adjusted life years. Every year around 78,000 people in the UK, die from smoking, with many more living with debilitating smoking-related illnesses. Smoking increases the risk of developing more than 50 serious health conditions including cancer, heart disease, other vascular diseases and Chronic Obstructive Pulmonary Disease (COPD). Ischemic Heart Disease, COPD, cancer and a stroke are 4 of the top 6 conditions causing the greatest disease burden with smoking as an upstream factor. In addition, one in nine pregnant women still smoke nationally with the associated risks of miscarriage, premature birth, still birth, low birth weight and neonatal complications. Tobacco is the largest contribution to years of life lost for both males and females.

Action on Smoking and Health (ASH) estimates that smoking in Southampton costs society approximately £230.2m per year. This is a combination of £7.6m to the NHS, £164.8m potential wealth lost from the local economy as a result of lost productivity, £56.8m in additional social care costs from smokers and £1.0m in costs to fire and rescue services responding to house fires caused by cigarettes (ASH ready reckoner 2023).

We are more aware today that smoking is bad for our health. Smoking is restricted or banned in almost all public places and cigarette companies are not allowed to advertise on TV, radio, or in magazines and newspapers. Smoking used to be commonplace and the effects of smoking were less known and evidenced. Smoking affects a person’s own physical health as well as the health of those around them (passive smoking).

People who smoke find it hard to stop because of addiction to nicotine in tobacco. Tobacco can be smoked in pre-rolled or hand rolled cigarettes. Some people smoke shisha, a special tobacco smoked in a hookah. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer (OHID - E-cigarettes and heated tobacco products: evidence review 2018).

More information can be found in the dashboard below and in the resources section.

E-cigarettes

E-cigarettes or vapes are electronic devices that let you inhale nicotine in a vapour instead of smoke. This is done by heating a solution (e-liquid) that typically contains propylene glycol, vegetable glycerine, flavourings and nicotine. Nicotine has been used safely for many years in medicines to help people stop smoking. E‑cigarettes can have disposable/ single use cartridges or a refill container and a tank which can be recharged.

Nicotine vaping is substantially less harmful than smoking. It's also one of the most effective tools for quitting smoking and recommended by NICE. There are also other types of Nicotine Replacement Therapy, like patches or gum; medication (currently unavailable due to supply issues), and behavioural support, which are also very effective and have been used safely for a long time.

Vaping has not been around for long enough to know the risks of long-term use. Vaping nicotine is not completely harmless and only recommended for adult smokers, to support short-term quitting smoking and to stay quit (Cochrane Library - Electronic cigarettes for smoking cessation by Hartmann-Boyce, J, et al. - 2022). The Chief Medical Officer for England has given very clear advice that if people who do not smoke, should not vape. Tobacco products and e-cigarettes are a significant source of wider health harms, including litter, fire and environmental pollution.

Action on Smoking and Health (ASH) monitors the use of e-cigarettes in Britain through the ASH Smokefree GB Survey of 11-18 year olds and ASH Smokefree GB Adult Survey (for ages 18+). In 2023, the proportion of adults 18+ using e-cigarettes is 9.1% amounting to 4.7 million people in Great Britain, the highest rate ever and has grown by 10% since 2022. Assuming the prevalence is the same in Southampton, we can estimate 20,700 people aged 18+ use e-cigarettes in the city. In Great Britain, 56.0% of e-cigarette users are ex-smokers, dropping 1.0 percentage point from 2022 and 37% are smokers (dual use). 7% of people using e-cigarettes have never smoked, which means that 1.1% of the general population vape but have never smoked. 6% of the general population has ever tried vaping but has never smoked. Adults reported using e-cigarettes to cut down on smoking, stop smoking and prevent a relapse. The use of disposable electronic cigarettes (non-rechargeable) has increased from 2.3% in 2021 to 31.0% in 2023 with adults aged 18-24 driving this rise. (ASH - Use of e-cigarettes (vapes) among adults in Great Britain)

Among young people in 2023, 79.0% of 11-17 year olds reported they have never tried or are unaware of e-cigarettes or vaping. Young people who have tried vaping once or twice has grown significantly from 7.7% in 2022 to 11.6% in 2023. Under 16 year olds are least likely to try an e-cigarette, however the percentage who have has doubled from 6.5% in 2021 to 15.0% in 2023. A much higher percentage of 18 year olds reported having tried one, 38.0%, and this is likely due to being able to buy them or being confident to report use. The current use of e-cigarettes made a steep increase in ages 16-17 in between 2021 and 2022 from 5.9% to 14.0% however only increased by 1 percentage point to 15.0% in 2023. Again, assuming the prevalence is the same in Southampton, an estimated 705 people aged 16-17 are using e-cigarettes in the city.

The information below summarises some of the key issues relating to smoking prevalence and smoking ill-health in Southampton. More detail is available in the Southampton Smoking Needs Assessment, Smoking dashboard and Smoking presentation available in the resources section.

Who is at risk and why?

Smoking and smoking harm contributes to health inequalities. People in more deprived areas, people living with severe mental illness, people who are homeless and people who are drug or alcohol dependent are more likely to smoke and are more likely to smoke heavily.

The Department for Health and Social Care produced the Tobacco Control Plan (2017), that sets out the Government’s strategy to reduce smoking prevalence among adults and young people, reduce the inequality gap in smoking prevalence where those people are more at risk;

• Between those in routine and manual occupations and the general population: there are nearly 1.7x more smokers who are lower earners, compared to higher earners
• Reduce smoking during pregnancy: smoking in pregnancy increases the risks of miscarriage, stillbirth or having a sick baby, and is a major cause of child health inequalities. Nationally 1 in 9 pregnant women smoke
• Smoking is twice as common in people with long-standing mental health problems: the plan aims to give equal priority to people with mental ill health as much as those with physical ill health

In 2019, the Department of Health and Social Care set an ambition for England to be smokefree by 2030, meaning no more than 5% of the population would smoke. The government commissioned an independent report on achieving the ambition. The subsequent Khan Review: making smoking obsolete in June 2022 reported that “without further action, England will miss the smokefree 2030 target by at least 7 years, and the poorest areas in society will not meet it until 2044”. The report suggested 15 recommendations with 4 “critical must dos”.

In 2023 the Department of Health and Social Care announced that they will:

• run a “Swap to Stop” scheme, providing vapes to 1 million adult smokers nationally
• set up a national vaping enforcement “squad” to reduce illegal vape sales to young people and illegal vape products.
• offer financial motivation to pregnant people to stop smoking, in line with NICE guidance
• consult on putting more information in inserts in tobacco products
• call for evidence on young people and vaping

More information can be found in the dashboard below and in the resources section.

Why tackling smoking is important

Smoking is the leading cause of preventable death and disease in the UK. 78,000 people die in the UK every year from smoking. Smoking also increases your risk of developing more than 50 serious health conditions. It causes about 70% of lung cancers and can cause cancer in other parts of the body including lip, mouth, throat, bladder, kidney, stomach, liver and cervix. Smoking damages the heart and circulation, increases the risk of heart disease and other vascular diseases. It also damages your lungs, leading to conditions such as COPD and pneumonia and can cause impotence and reduce fertility (NHS website).

Smoking also negatively affects earnings and employment prospects with a total productivity loss of £164.8 million split by: smoking related lost earnings (£48.3 million or 29.3%), smoking related unemployment (£45.6 million or 27.7%), smoking related early deaths (£8.2 million or 5.0%) and reduced GVA due to expenditure on tobacco (£62.7 million or 38.0%). (ASH 2023)

Smoking is a modifiable lifestyle risk factor; it can be tackled with effective tobacco control measures to reduce the prevalence of smoking in the population.

More information can be found in the dashboard below and in the resources section. 

People who smoke in the city

In 2022 around 1 in 8 people (13.2%) in Southampton smoke, equivalent to 28,000 people. Compared with 12.7% in England and 10.5% in Hampshire. Southampton is the 6th highest in our ONS comparator group. This is an increase from 2021 and is now higher than England, but not significantly.

In 2021, more males smoke than females and they are more likely to smoke between the ages of 30 and 39 years. Smoking amongst men peaks between the ages of 35 and 39 years (3,530 registered patients). Whereas for females smoking peaks between the ages of 30 and 34 years (2,579 registered patients).

In Southampton by England deprivation quintile, just over 25.3% (17,483 people) of registered patients who smoke live in the 20% most deprived areas, compared to just 11.1% (731 people) of registered patients in the 20% least deprived areas. By Southampton deprivation quintile this is 26.5% (12,186 people) and 14.7% (6,387) respectively.

In terms of wards, Thornhill has more than 1 in 4 registered patients who smoke (25.8%). Freemantle is the 2nd highest ward with 24.2% of patients who smoke and Woolston is 3^rd (23.9%). Some parts of these wards are also the more deprived areas of Southampton. Whereas Shirley, Bassett and Bitterne Park (which have parts of the least deprived areas in Southampton) have the 3 lowest prevalence.

In Southampton, 24.0% of adults with a long-term mental health condition smoke, lower, but not significantly, than England (25.1%) and compared to comparators the 4^th lowest. As there is a very strong relationship between depression and deprivation, with the prevalence of depression 1.8 times higher for those living in the most deprived England deprivation quintile compared to the least deprived, this can explain a higher smoking prevalence in the most deprived areas of Southampton. Tobacco dependency also exacerbates low mood and anxiety. Southampton has a high prevalence of adults who smoke admitted to treatment for substance use. Of adults admitted for alcohol, 62.5% smoke, and for non-opiates, 82.1% smoke, both significantly worse than England (43.9% and 62.0% respectively) and the worst amongst comparators. We do not know how good the quality of data was across the country when this was measured.

In Southampton, smokers are more likely to:

• Live in single households than married households
• Live in terraced houses or flats and/or renting
• Have lower household incomes
• Have ‘difficult’ or ‘very difficult’ financial stresses
• Have a high use of social networks (Facebook and Twitter are most popular)
• People who identify as gay and male, gay and female and bisexual and female are more likely to smoke than other heterosexual gender groups
• Identify as being Eastern European (over 50% smoking prevalence among people who are Latvian, Lithuanian or Slovakian); Gypsy or Traveller, or Bangladeshi or Pakistani and male.

More information can be found in the dashboard below and in the resources section.

Smoking and maternity

Supporting people who are pregnant to be smokefree is important as protecting an unborn baby from tobacco smoke is one of the best ways to give a child a healthy start in life. Smoking when pregnant increases the risk of complications in pregnancy and birth such as stillbirth, premature birth, miscarriages, low birth weight and sudden infant death syndrome (NHS England – smoking in pregnancy).

In Southampton, 8.9% of pregnant people are smoking at time of delivery. This percentage gives Southampton the 6^th highest prevalence amongst its comparators and is similar to England (8.8%). Southampton has always been significantly higher than England until 2020/21 where Southampton made a significant decrease and continues to do so. Looking at 2023 ward level, in 2018/19 to 2020/21 pooled, Thornhill (which is one of the more deprived areas) had the highest prevalence of smoking at delivery with 22.7% while Bassett (one of the least deprived areas) had the lowest of 4.4% pregnant people being smokers at the time of delivery.

More information can be found on the Births page and in the resources section below.

Adult smoking cessation and quit rates

In 2022/23, 5,788 per 100,000 smokers in Southampton aged 16+ set a quite date, significantly higher than England (2,998 per 100,000). The (self-reported) quit rate in Southampton for the same year is 2,388 per 100,000 smokers and is significantly higher than the England average (1,620 per 100,000 smokers). This compares with 2,674 per 100,000 smokers in 2013/14.

The Experian Mosaic data indicates people who have tried to quit smoking through services in the last 12 months are more likely to be single, council tenants, unemployed, have school aged children and very low income. Many others will have quit smoking without using services.

More information can be found in the dashboard below and in the resources section.

Smoking ill-health and mortality

Smoking accounts for 1 in 6 of all deaths in England and smoking is responsible for over 70% of lung cancer cases (the most common type of cancer related death - 1 in 5 cancer deaths). In 2022, 100 Southampton deaths were from lung cancer, out of a total of 508 cancer deaths (19.7%). Three million people in the UK suffer from COPD, for which smoking is the biggest preventable risk factor. COPD is the third biggest killer in the UK and 86% of these deaths are caused by smoking.

In England in 2022/23, there was estimated to be 408,700 hospital admissions attributable to smoking (4% of all hospital admissions), a drop of 8% from a peak in hospital admissions in 2019/20 (446,400). 25% of admissions for respiratory diseases that can be caused by smoking, and 19% of admissions for cancers that can be caused by smoking, were estimated to be attributable to smoking. Southampton had 1,901 per 100,000 smoking attributable hospital admissions in 2019/20 which is a 26% increase since 2017/18 and significantly higher than England (1,398 per 100,000). COPD hospital admissions in the city are significantly higher than the England average. Analysis of GP data at LSOA (neighbourhood level) shows a high correlation between areas with high smoking or ex-smoker prevalence and those areas with a high prevalence of COPD. Looking specifically at those diagnosed with COPD, 94.6% were ex or current smokers further highlighting the impact of smoking on COPD.

In 2019, 15% of all deaths were estimated to be attributable to smoking in England. This is made up by 52% of cancer deaths, 47% of respiratory diseases deaths and 43% of deaths for diseases of the digestive system which were estimated to be attributable to smoking. By sex, more smoking attributable deaths occur for males compared to females. (NHS England - statistics on smoking) In Southampton, the smoking attributable mortality in 2017-19 was 260.6 per 100,000, significantly higher than England and the 4^th worst amongst comparators. Deaths from COPD, lung cancer and smoking attributable conditions have all remained significantly higher than the England average since 2010-11. More information can be found on the Mortality page.

Additionally, nationally people with a diagnosis of severe mental illness have a life expectancy up to 20 years less than people who do not. Most of this difference is attributable to smoking (Smoking and Mental Health - ASH). There is a paucity of information about the rates or impacts of smoking for people who are neurodiverse.

More information can be found in the resources section.