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Tobacco Control Northern Ireland Tobacco Control Northern Ireland ‘Smoking has been identified as the single greatest cause of preventable illness and premature death in Northern Ireland.’ Gilmore G. Wilmot E. Tobacco Control Northern Ireland. 2015 Public Health Agency: Belfast, 2015. 2 Tobacco Control Northern Ireland, produced by Health Intelligence, Public Health Agency, 2015. 8 Contents The impact of smoking in NI ........................................................................................ 5 Deaths attributable to smoking ......................................................................... 5 Inequality and smoking related mortality .......................................................... 5 The costs of smoking .................................................................................................. 6 The extent of smoking in Northern Ireland .................................................................. 7 Disadvantaged adults who smoke .................................................................... 7 Pregnant smokers ............................................................................................ 9 Children and young people (11-16 year olds) ................................................... 9 Prevalence of E-cigarette use ................................................................................... 10 Second hand smoke exposure .................................................................................. 10 Tobacco control vs the tobacco industry ................................................................... 11 Key advertising strategies .............................................................................. 11 Point of sale advertising ....................................................................... 13 Packaging as advertising ..................................................................... 13 Taxation/illicit tobacco .................................................................................... 13 Stop Smoking Services .................................................................................. 14 Conclusion ................................................................................................................ 15 References ................................................................................................................ 16 3 Tobacco Control Northern Ireland, produced by Health Intelligence, Public Health Agency, 2015. 8 4 Tobacco Control Northern Ireland, produced by Health Intelligence, Public Health Agency, 2015. 8 The impact of smoking Nevertheless, the ‘standardised death rate due to smoking related causes in ii Deaths attributable to smoking the most deprived areas was 54% Smoking has been identified as the higher than the overall regional rate single greatest cause of preventable and 129% higher than the standardised death rate in the least illness and premature death in 5iii Northern Ireland with 2014 data deprived areas’ . revealing approximately 16% or 1 in 6 of all deaths in Northern Ireland (NI) Furthermore, over the past decade, were attributable to smoking.1,2 there is now a widening inequality gap between the standardized death rate in the most deprived and the least deprived areas of NI (see Figure 1).5 Figure 1: Inequality gap in the Indeed smoking has been shown to standardized death rate due to contribute to deaths from a wide smoking in NI (2004/08-2009/13) 5 variety of causes and is thought to 2i 140 127 129 account for: 117 120 119 120 110 86% of all deaths from lung cancer; 100 85% of all deaths from Chronic Obstructive Lung Disease; 80 52 53 54 Over half the deaths from 60 47 48 51 Stomach/Duodenum ulcers; causes related 40 1 in 4 of all cancer deaths and; smoking to due (SDR) rate % gap in standardised death death standardised in gap % 1 in 10 of all circulatory disease 20 deaths. 0 During the past decade the number of Year deaths attributable to smoking has been estimated to be between 2,300- % gap in the SDR from smoking related 2,400 per year, equating to causes between the most deprived areas 1 and NI average approximately 6 deaths a day. % gap in the SDR from smoking related causes between the most deprived areas and least deprived areas. Moreover, research has shown a smoker’s life span is shortened by about five minutes for each cigarette Smoking related mortality among smoked and on average, those killed males is twice that of females (244 vs. by smoking have lost 10-15 years of 115 deaths per 100,000 population) life.3 Inequality and smoking related ii Deprivation level is assessed in Northern Ireland by the use of the Northern Ireland Multiple Deprivation Measure mortality (NIMDM) 2010. This measure examines 7 areas of The regional standardised death rate deprivation which are given individual weights to produce an overall combined measure of deprivation. The small due to smoking related causes in NI geographical area used for the NIMDM is the super output was 168 per 100,000 in the period area (SOA). Northern Ireland consists of 890 SOA areas, each with an average population of 2,000 people. These 2009-13, a decline from previous 890 areas are divided into 5 equal quintiles representing a years.4,5 measure of the diversity of deprivation in the population. iii Smoking related death rate in most deprived areas: 258 per 100,000, regional average 168 per 100,000 and in i Deaths relate to deaths registered in the 2012 year. least deprived areas 113 per 100,000. 5 Tobacco Control Northern Ireland, produced by Health Intelligence, Public Health Agency, 2015. 8 (see Figure 2). Moreover, the care, premature death, excess inequality divide is strongly evident sickness absence, smoke breaks, within the genders. The standardised second hand smoke (early deaths), smoking related litter and fire in the death rate due to smoking related business place or home. The costs of causes is highest among males in the smoking have been estimated to be 20% most deprived areas, more than £790m per year in Wales, £1.1 billion twice that of males in the 20% least in Scotland and £12.9 billion in deprived areas and almost five times England with an additional one billion that of females in the 20% least pounds required for social care costs 9,10,11,12 deprived areas.6 in England alone. Based on the economic studies above, Figure 2: Standardised death rate per (and accounting for the number of 100,000 (2009-13) from smoking smokers within the Northern Ireland related causes by gender and population) it is estimated that smoking deprivation6 costs the Northern Ireland economy around £450 million per year. Given the economic costs outlined above, it is estimated the total cost of smoking to the UK as a whole could substantially outweigh the tax generated through cigarettes by an excess of £5 billion a year.13iv Moreover, nationally it has been Smoking not only causes death but reported a 1% decrease in the reduced quality of life through illness. prevalence of smoking could be While it is difficult to quantify the extent estimated to produce a net revenue and impact of these illnesses, it has gain of £240 million pounds per year in been estimated 17,889 people were the UK.14 admitted to hospitals in NI due to 7 smoking related causes in 2013. Asides from the societal costs of tobacco, the financial burden to The costs of smoking individual smokers is considerable. In 2014, a 20-a-day smoker would spend In Northern Ireland it has been on average, over £3,000 a year on estimated the costs of treating cigarettes with lower income groups in smoking related illness in NI hospitals the UK spending twice as much of alone is around £164m a year.8 their total income on cigarettes compared to the more affluent groups However, hospital costs are only one (4% vs 2%).15,16 of the many financial outlays associated with smoking. Several studies conducted within the UK have examined the overarching costs of iv Total costs exclude any social care costs in Northern smoking to society. These studies Ireland, Scotland and Wales. £5 billion is calculated as the have accounted for a wide range of total costs of tobacco throughout the UK (minus tax revenue) plus an additional one billion lost through illicit smoking related costs including health tobacco. Note: additional pension costs or costs of quitter’s health care gained through extra life years are not included in the calculation. 6 Tobacco Control Northern Ireland, produced by Health Intelligence, Public Health Agency, 2015. 8 The extent of smoking in The Northern Ireland Ten Year Tobacco Control Strategy for Northern Northern Ireland Ireland identifies a number of priority groups for targeted action owing to the Population prevalence high prevalence of smoking or the Twenty two percent of the NI particularly detrimental health impact population currently smoke, a figure smoking can cause within these which has declined from 24% in 2012 groups. These priority groups have but still remains the highest prevalence been identified as: disadvantaged rate (equal to Scotland, 22%), within adults who smoke, pregnant women the UK and Republic of Ireland (ROI), 17,18,19,20,21 who smoke and children and young (Figure 3). 23 people (11-16 years old). Figure 3: Smoking prevalence Disadvantaged adults who smoke throughout the UK and ROI Smoking prevalence analysis by 29 deprivation quintile (see page 5, 27 footnote ii for further information on 25 deprivation quintiles) shows a strong 23 gradient exists. The most recent NI 21 data for 2014/15 shows three times as 19 (non zero axis) axis) zero (non
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