Tobacco and Smoking

Healthy Lives

Behavioural Risk Factors

Smoking

Tobacco

Asthma

COPD

Cancer

Hypertension

CVD

Cardiovascular Disease

High blood pressure

Introduction

Tobacco control is an umbrella term for the science, policy, and practice mobilised towards reducing tobacco use and its associated harms. Tobacco is a harmful legal substance and impacts the health of the user and when smoked, people around them. Tobacco smoking is the leading cause of preventable morbidity and premature mortality in England.

The Framework Convention on Tobacco Control (FCTC) developed by the World Health Organisation (WHO) defines Tobacco Control as: “a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke”.

Why is it important to Population Health?

Smoking represents the most important cause of preventable morbidity and mortality. In 2021 it was estimated that smoking accounted for approximately 74,600 deaths a year in England, and huge inequalities can be seen in smoking-related deaths. Tobacco accounts for the largest proportion of the gap in life expectancy between the most and least deprived areas for men (9.4 years) and women (7.6 years). Smoking is the single most important driver of health inequalities: a larger contributor to inequalities than social position.

The Derbyshire Population Health Approach

The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.

When considering the topic of tobacco and smoking within The Derbyshire Population Health Approach:

Working to ensure that the residents of Derbyshire are aware of the potential harms that come with smoking tobacco through various preventative elements that are in place across the system, including the implementation of the East Midlands Tobacco Control policy, information sharing, training (Very Brief Advice or ‘VBA’), all with the aim of preventing and reducing tobacco usage amongst children and adults in Derbyshire. A specific focus of the work is to identify those harder to reach smoking groups to alleviate unfair and unjust differences in health outcomes.

A significant part of the work includes education to partners and stakeholders that smoking is not a simple personal lifestyle choice but a serious addiction (dependency), requiring tough regulation.

In addition to the generic VBA session, specific maternity stop smoking VBA sessions are delivered to partners who support this harder to engage target population.

Alongside this, the recent England wide policy announcements including raise the age of sale and the goal of becoming smoke free will reduce the impact and uptake of smoking over time supporting the goal of moving to a smoke free Derbyshire.

There are considerable inequalities in smoking rates, for example the rate for routine and manual workers compared to professional workers is much higher, both nationally and locally. Similarly, rates are much higher in those with serious mental illness compared to average rates, and in other groups such as care leavers and offenders. Rates of smoking in pregnancy are significantly higher in Derbyshire than in England. There are also inequalities within Derbyshire, broadly following deprivation, where those more affluent areas have lower smoking prevalence than more deprived areas which have higher smoking prevalence.

As well as the inequalities in smoking rates by specific groups including those described above, smoking causes significant health inequalities in its own right being the leading cause of preventable illness and death.

International priorities To support tobacco control policies at country-level WHO has defined six ‘MPOWER’¹ measures:

Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco.

In Building Blocks for Tobacco Control, the WHO emphasised that tobacco control policies should not be pursued in isolation and that effective multi-layered strategies are required². An economic evaluation of tobacco control policies published in 2008 by two US-based academics found indications of multiplicative effects between four types of restrictions³ aligning with the emphasis on comprehensive policy approaches. A Tobacco Control Scale scoring the implementation of these policies has been applied to European countries as part of work by the European Network for Smoking Prevention⁴.

In the most recent report (2021), the UK ranked highly, scoring second of the 37 included nations. Commentators have suggested moving towards a tobacco ‘endgame’, usually defined as a smoking prevalence rate of 5% or below⁵.

Achieving this will require ongoing consensus around harm reduction and eradication approaches within the tobacco control movement, alongside cessation measures. UK health organisations and charities including the British Medical Association and Cancer Research UK have promoted the ambition of a smoke free UK by 2030, where less than 5% of the adult population are smokers.

There was an announcement on 4th October 2023 of the English Government’s intention to introduce an historic new law to protect future generations of young people from the harms of smoking. It covers the following:

Smoking is the UK’s biggest preventable killer – causing around 1 in 4 cancer deaths and 64,000 in England alone – costing the economy and wider society £17 billion each year.
The Government plan to create the first smokefree generation by bringing forward legislation so that children turning 14 this year or younger will never be legally sold tobacco products. This will prevent future generations from ever taking up smoking, as there is no safe age to smoke.
Move would be the most significant public health intervention in a generation, saving tens of thousands of lives and saving the NHS billions of pounds.
Additional money for stop smoking services and enforcement agencies.
Further crackdown on youth vaping will see government consult on restricting disposable vapes and regulating flavours and packaging to reduce their appeal to children.

A detailed policy paper ‘Stopping the Start: our new plan to create a smokefree generation’ has been published⁶.

1.1.4 National policy and guidance: There are resources from National Institute for Health and Care Excellence (NICE), Office for Health Improvement and Disparities (OHID) and public health charities and organisations to advise and inform local tobacco control work.

NICE guidance: NICE Guidance NG209 Tobacco: preventing uptake, promoting quitting and treating dependence, published in November 2021, brought together and updated NICE’s previous guidelines on using tobacco, including smokeless tobacco and covers:

Support to stop smoking for everyone aged 12 and over.
Help to reduce people’s harm from smoking if they are not ready to stop in one go.
Ways to prevent children, young people and young adults aged 24 and under from taking up smoking.
Nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking.

It does not cover using tobacco products such as ‘heat not burn’ tobacco including e-cigarettes/vapes.

Office for Health Improvement and Disparities (OHID) resources: CLeaR: CLeaR is an evidence-based approach to tobacco developed from NICE Guidance and the Tobacco Control Plan for England⁷. The CLeaR model offers a self-assessment tool, and an optional peer-assessment process. It is designed to be implemented through discussion with local partners and to provide the opportunity to benchmark local work on tobacco control in comparison with other areas, and over time.

Additional resources are available in toolkits for deep dive work (standalone or combined) on stopping smoking in acute settings and maternity; stopping smoking in mental health settings; stopping smoking during and after pregnancy; illegal tobacco and compliance with regulations.

Public health charities and organisations: Action on Smoking and Health (ASH)⁸ have compiled a local resource toolkit with other partners, which includes resources to make the case effectively for tobacco control. The resources include guidance on development and implementation of policy and tools to gather and record local opinion and estimate local impact and costs of smoking.

Cancer Research UK issued a Tobacco Control Local Policy Statement in December 2017⁹ stating that local authorities should develop a comprehensive tobacco control strategy that includes:

Prioritisation and sustained funding for tobacco control
Provision of evidence-based Stop Smoking Services
Coordinated tobacco control alliance to provide: mass media campaigns, measures to target illicit trade, an acceleration in progress to reduce health inequalities, and recognition of the WHO Framework Convention on Tobacco Control.

The risk factors for higher smoking prevalence rates are primarily linked to socioeconomic deprivation. Higher prevalence is observed in routine and manual groups, more deprived areas and those with serious mental illness as well as groups including care leavers and offenders.

The reasons for the link between smoking and deprivation are complex and include different perceptions of smoking, being more likely to experience peer pressure and to be influenced by those that smoke. These factors can then create a cycle of smoking which is difficult to break leading to higher, entrenched smoking rates in more deprived areas¹⁰.

There is a national strategy and target to achieve a Smokefree 2030, where smoking prevalence is below 5% across all demographic groups. The East Midlands Tobacco Control Community of Improvement is a network of professionals who aim to reduce smoking prevalence across the East Midlands through regional collaboration. Tobacco Control representatives from the East Midland’s Public Health teams, Trading Standards and OHID came together in response to the rapidly changing evidence, growing rates of youth vaping and increasing public interest in the use of electronic cigarettes and similar products.

The Derbyshire and Derby City tobacco control group brings together stakeholders and partners in driving the ambition to reduce smoking prevalence. The existing tobacco dependency treatment programme delivered across the county and in Derby city is delivered in partnership by Derbyshire County Council, Public Health, Live Life Better Derbyshire (LLBD) and Derby and Derbyshire ICB on behalf of Joined Up Care Integrated Care Board. This agreement supports the NHS Long Term Plan Prevention Programme.

Latest Derbyshire Data

Trend Data

Derbyshire Quilt

Smoking Prevalence
Smoking Prevalence in Priority populations

Prevalence Maps of Derbyshire

The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.

LSOA
MSOA

In the top right of the map, you’ll find the ‘Layer Control’ icon. This is an easy way to customise what you see on the map visualisation. Click the ‘Layer Control’ to choose which information is displayed on the map. Pick the indicator that interests you the most, and the map will transform accordingly.

Slope Index

This chart illustrates the differences in health and lifestyle factors across areas in Derbyshire, from the most deprived (decile 1, red) to the least deprived (decile 10, green). As you move from left to right on the chart (from more deprived to less deprived areas), the line shows whether these factors are becoming more or less common. Essentially, it’s a way to see how living in wealthier or poorer areas affects the prevalence of these factors.

Further Analysis & Assessments

Derbyshire Joint Strategic Needs Assessment (JSNA) involves a thorough examination of a specific health problem, exploring its causes, consequences, and underlying factors. It combines various data sources, collaboration with stakeholders, and rigorous analysis to generate insights for evidence-informed interventions and policy changes.

Tobacco Control in Derbyshire: Health Needs Assessment - 2023 Update

More Information & Resources

Here is a list of useful resources and information with regard to tobacco and smoking. These materials are meant to provide individuals, healthcare professionals, and communities with the knowledge and tools they need as part of efforts to address tobacco and smoking as a population health topic.

The following free local services are available to the people of Derbyshire to support a stop smoking quit attempt.

Livewell is the stop smoking service for Derby City residents aged 12 and over. They provide the following:

Free Nicotine Replacement Therapy (patches, gum, mouth spray) for 10 weeks.
Behavioural support to quit smoking tobacco. This includes users who have their own e-cigarette/vape.
Personalised telephone/online support for up to 12 months.
Stop smoking drop-in clinics for extra support, Carbon Monoxide testing and collecting treatments.
Invaluable tips and guidance to beat cravings and prevent setbacks.

Live Life Better Derbyshire provides support to smokers aged 12 and over living in Derbyshire.

What is offered?

telephone support sessions
one-to-one support
Face to face group sessions
access to free nicotine replacement therapy including patches, mouth spray, gum, inhalators and lozenges
advice on stop smoking medications
useful tools to help you quit - free vape starter kits for 12 weeks for adults only (>18 yrs old). Vapes are not currently provided to pregnant women

Who can take part?

To take part in the LLBD free stop smoking programme participants must:

be over 12 years old and live in Derbyshire (excluding Derby)
want to stop smoking completely
be willing to meet with the stop smoking adviser at agreed dates and times

Tobacco dependency treatment (TDT) services are provided by Live Life Better Derbyshire in both Chesterfield Royal Hospital and Royal Derby Hospital.

TDT services are available to:

Patients who are admitted to an inpatient setting
Pregnant women and their partners (family members are referred to the community stop smoking service)
Mental health inpatients

Pharmacy

Some pharmacies in Derbyshire may offer stop smoking advice and access to nicotine replacement therapy including patches, mouth spray, gum, inhalators and lozenges
Pharmacies can provide signposting to existing stop smoking services within the county and city

Action on Smoking and Health Local Toolkit: materials for local public health professionals and Councillors involved in tobacco control.

Contributors

Louise Noon, Public Health Lead, Health Improvement

Alex Carlow, Service Manager, Public Health