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Smoking

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  • 1. Smoking Overview This is the most important preventable risk factor for death from cancer and cardiovascular disease.i,ii (It is also important to remember that, in addition to the unequivocal evidence that smoking damages the smoker’s health, there is also substantial evidence that exposure to second-hand tobacco smoke (e.g. smoke from other people’s cigarettes) harms non- smokers.iii,iv,v,vi,vii ) Figure 1 shows the estimated prevalence in different London boroughs. Even though Barnet’s smoking prevalence overall is estimated to be only 17.9% and is one of the lowest in London, this still means that there are some 60,000 smokers in the borough. Figure 1: The estimated prevalence of smoking in different parts of London 35 Estimated smoking prevalence (%) 30 25 20 15 10 5 0 Ha row db m ea ley Ea n sm ch E n g Ha h a eac ld en B et ne Cam ey Te ham Ch ton lli ng Ne ham ac n w th mn w Me k un n an lin w ke e er ut am tm rth W F ts om g W dsw st H ng al Ha on ge Fu ng Ba am ng a oy g ar lin do ic idg Te de La sto Ho gdo Br in Ki lse Is lo T fi e Re ha rn Cr in Le be am le e st l Hi eri t T ex hi er rt es o rin nd hi tto So nh a hw g an or ch nh s ar h th m in l w is Tw r e ac v n ge T o nd Da d y y d n er w i an Br on d W ck it mn an gt m ree ng Su Ha in d ki Ha G on d ns ar an hm Ke B ity ic C R Source: Health Surveys for England 2003-2005viii The risk we face Tobacco use is the most important preventable risk factor for death from cancer and cardiovascular disease.ix,x About 2,600 people die in Barnet each year. Of these, about 440 die from smoking-related diseases.xi This is more than from any other cause and these deaths are all preventable. Smoking tobacco causes diseases that affect nearly every part of the body. Smoking is especially damaging to the lining of blood vessels and leads to a reduced blood supply to various parts of the body. It is therefore a leading and avoidable cause of heart attack, kidney failure, intermittent claudication and impotence. For the same reason, people who are smokers when they have operations are more likely to suffer from wound breakdown and to have delayed bone healing. Among many other conditions caused by smoking are chronic obstructive pulmonary disease (COPD), coronary heart disease, osteoporosis, insulin resistance in diabetes, infertility, age-related macular degeneration (the most common cause of blindness in older people), premature menopause, Crohn’s disease, gastro-oesophageal reflux and peptic ulcers, bone resorbtion and tooth loss, multiple sclerosis, thyroid disease, hearing loss, and liver disease. Women who smoke when pregnant damage the placenta and this leads
  • 2. to a reduced blood supply to their baby. Smoking is also a cause of premature hair loss and premature skin ageing (so children are right: smoking does make you look older). In addition to the unequivocal evidence that smoking damages the smoker’s health, there is now substantial evidence that passive exposure to tobacco smoke harms non- smokers.xii,xiii,xiv,xv,xvi Second-hand smoke causes lung cancer, coronary heart disease, stroke, asthma attacks, reduced growth of babies in the womb and premature birth, and in children it causes cot death, middle ear diseases, respiratory infections, the development of asthma in those previously unaffected and asthma attacks in those already affected.xvii The relationship between diversity and deprivation and smoking-related disease There are differences in smoking habits between the sexes and between people in different ethnic groups. This is shown in Figure 1. Principally, this is important when planning smoking cessation services. It is important that promotion and provision of such services are culturally appropriate and that smokers see them as relevant to them and not just to others. Figure 1: Current cigarette smoking by ethnic group and sex in England in 1999 General population White Irish Indian Pakistani Bangladeshi Black Caribbean Men Chinese Women 0 10 20 30 40 50 Proportion of smokers in different ethnic groups (%) Source: Office for National Statisticsxviii Smoking is more prevalent amongst people who live in deprived areas. Figure 2 shows the differences in smoking habits between people from different social classes; people in routine and manual occupations (and those who are unemployed) are more likely to live in deprived areas than those in managerial and professional occupations.
  • 3. Figure 2: Cigarette smoking by sex and socio-economic classification, adults aged 16 and over, 2006, Great Britain 35 Men 30 Women 25 20 15 10 5 0 Managerial & Professional Intermediate Routine & Manual xix Source: British Heart Foundation As smoking is the cause of so many deaths, and it is more common amongst people living in more deprived areas, an important cause of the differences in death rates between affluent and deprived areas is likely to be smoking. Seeking to increase the proportion and the absolute number of smoking quitters in deprived areas will thus contribute to reducing health inequalities. Finally, deaths from COPD – principally a disease caused by smoking – in Barnet are now higher amongst women than men, and deaths from lung cancer in women will soon become more common than deaths from breast cancer. This is simply because an increasing number of women took up smoking in the 1940s and 1950s: they are now reaping the longer-term consequences of this. Local targets Figure 3 shows how the number of people quitting smoking through NHS services has increased over the last few years. In 2005/06, Barnet PCT exceeded its target for smoking quitters for the first time and did so again last year. Currently, the PCT is ahead of our quarterly target and should exceed the target for 2008/09. The PCT also has a ‘stretch target’ to enable a higher proportion of smokers in the seven most deprived electoral wards in Barnet to quit smoking. This target was achieved last year and, again, the PCT is ahead of its quarterly target and should exceed the annual one. Figure 3: The number of people quitting smoking through NHS services in Barnet 3500 Number of smoking quitters 3000 2500 2000 1500 1000 500 0 2002/03 2003/04 2004/05 2005/06 2007/08 Source: Barnet PCT Stop Smoking Service data returns to Department of Health
  • 4. Key things that need to be done The key activities required are: maintaining current performance on smoking cessation;  identifying greater numbers of quitters in more deprived areas and enabling them to quit (see  also section ); introducing techniques, such as measuring ‘lung age’ to increase quit rates; and  raising awareness amongst health and social care personnel and the public of the risks of  being a smoker when a surgical procedure is required to encourage and facilitate more smokers to quit.
  • 5. i Bartecchi CE, MacKenzie TD, Schrier R. The human costs of tobacco use (I).New NEJM 1994;330:907-12 ii Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors.Br Med J 1994;309:901-911 iii Eriksen MP, Gottlieb NH. A review of the health impact of smoking control at the workplace. Am J Hlth Prom 1998;13:83-104 iv Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. Br Med J 1997;315:980-988 v Zaridze DG, Peto R, (eds). IARC Scientific Publications No. 74. International Agency for Research on Cancer. Lyon, 1986 vi Morris PD. Lifetime excess risk of death from lung cancer for a U. S. Female never-smoker exposed to environmental tobacco smoke. Environmental Research 1995;68:3-9 vii Siegel MS. Involuntary smoking in the restaurant workplace. JAMA 1993;270(4):490-493 viii http://www.ic.nhs.uk/webfiles/Popgeog/Model%20Based%20Estimates%20of%20Smoking%20%28adults %29%20for%20PCOs%20in%20England%2C%202003-2005.xls (accessed 14 October 2008) ix Bartecchi CE, MacKenzie TD, Schrier R. The human costs of tobacco use (I).New NEJM 1994;330:907-12 x Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors.Br Med J 1994;309:901-911 xi Callum C, White P. Tobacco in London: the preventable burden. London Health Observatory. London. 2004 xii Eriksen MP, Gottlieb NH. A review of the health impact of smoking control at the workplace. Am J Hlth Prom 1998;13:83-104 xiii Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. Br Med J 1997;315:980-988 xiv Zaridze DG, Peto R, (eds). IARC Scientific Publications No. 74. International Agency for Research on Cancer. Lyon, 1986 xv Morris PD. Lifetime excess risk of death from lung cancer for a U. S. Female never-smoker exposed to environmental tobacco smoke. Environmental Research 1995;68:3-9 xvi Siegel MS. Involuntary smoking in the restaurant workplace. JAMA 1993;270(4):490-493 xvii British Medical Association. Tobacco – passive smoking British Medical Association. London, 2003 xviii http://www.statistics.gov.uk/cci/nugget.asp?id=466 (accessed 14 October 2008) xix http://www.heartstats.org/temp/Figsp4.8spweb08.xls (accessed 14 October 2008)

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