The prevalence of tobacco use Tobacco and health in Wales June 2012 Tobacco and health in Wales 1 A technical guide explaining the data sources and methods used in this report, plus interactive spreadsheets containing additional data at health board and local authority level, are available at: www.publichealthwalesobservatory.wales.nhs.uk/tobaccoandhealth Project team (analysis and writing): Hugo Cosh, Gareth Davies, Ioan Francis, Elinor Griffiths, Leon May, Cath Roberts, Claire Tiffany, Margaret Webber Project board: Mererid Bowley, Nathan Lester, Cindy Marsh, Cath Roberts, Jane Wilkinson Acknowledgements Thanks to the following people for their contribution to this report: Rose Allgeier, Joanna Arthur, Susan Belfourd, Lloyd Evans, Deirdre Hickey, Ciarán Humphreys, Louise Megrath, Isabel Puscas, Salah Sharif (NHS Information Centre) Contact details Public Health Wales Observatory 14 Cathedral Rd Cardiff CF11 9LJ Email: [email protected] Website: www.publichealthwalesobservatory.wales.nhs.uk For further information or to request printed copies of this report, please contact us. Publication details / copyright statement Title: Tobacco and health in Wales Publisher: Public Health Wales NHS Trust / Welsh Government Date: June 2012 ISBN: 978-0-9572759-0-4 All tables, charts and maps were produced by the Public Health Wales Observatory and Welsh Government. Data sources are shown under each graphic. Material contained in this report may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Typographical copyright lies with Public Health Wales NHS Trust. Contents Key messages 5 1 Introduction 6 2 The prevalence of tobacco use 7 2.1 Adults 7 2.1.1 Adults with mental health problems 15 2.2 Maternity, children and young people 16 3 Exposure to second-hand smoke 20 3.1 Adults 20 3.2 Children 22 4 Prevention and cessation 24 4.1 National prevention initiatives 24 4.2 How many smokers would like to quit, and why? 25 4.3 People using Stop Smoking Wales to help them quit 25 4.4 Use of medicines to help people stop smoking 28 5 Impact of tobacco use on health and health services 30 5.1 Maternity, children and young people 30 5.1.1 Hospital admissions in children attributable to second-hand smoke 31 5.2 Adults 33 5.2.1 Smoking-attributable mortality 33 5.2.2 Contribution of smoking to overall inequality in mortality rates 38 5.2.3 Mortality from specific causes of death related to smoking 40 5.2.4 Smoking-attributable hospital admissions 42 6 Affordability 48 7 Examples of successful tobacco control policy from California 49 and Singapore 8 Implications for public health 51 References 52 Tobacco andand healthhealth in WalesWales 1 Figures and tables Figure 1 Estimated annual consumption of Figure 13 Percentage of mothers in Wales, by tobacco products in UK males and individual National Statistics Socio- females aged 15+, kilograms per adult, economic Classification, who: a) smoked 1905-1987 page 6 throughout pregnancy and b) were smokers but gave up before or during Figure 2 Percentage of adults who reported pregnancy page 17 smoking daily, OECD countries, 2009 page 8 Figure 14 Percentage of mothers in Wales, by age, Figure 3 Percentage of adults who reported who: a) smoked throughout pregnancy smoking daily or occasionally, by country, and b) were smokers but gave up before 2010 page 8 or during pregnancy page 17 Figure 4 Percentage of adults who reported Figure 15 Percentage of 15 year-olds who smoke smoking daily or occasionally, Wales, at least once a week by country and sex, 1978-2010 page 9 2009/10 page 18 Figure 5 Percentage of adults who reported Figure 16 Percentage of 11-16 year-olds who smoking daily or occasionally, Wales, smoke at least once a week by health 2003/04-2010 page 10 board, 2009 page 19 Figure 6 Percentage of adults who reported Figure 17 Percentage of 15 years-olds in Wales who smoking daily or occasionally, Wales, smoke at least once a week by sex, by age and sex, 2003/04 and 2010 1990-2009 page 19 page 10 Figure 18 Percentage of non-smoking adults who Figure 7 Percentage of adults reporting specific reported being regularly exposed to other smoking status, by sex, 2010 page 11 people’s tobacco smoke, 2010 page 20 Figure 8 Percentage of adults who reported Figure 19 Percentage of non-smoking adults who smoking daily or occasionally, by local reported being regularly exposed to other authority and health board, age- people’s tobacco smoke, 2003/04-2010 standardised, 2009-10 page 12 page 21 Figure 9 Percentage of adults who reported Figure 20 Percentage of children living in smoking daily or occasionally, by Upper households where adults smoke, by Super Output Area (USOA), age- household National Statistics Socio- standardised, 2003/04-2009 page 13 economic Classification, 2009-10 page 22 Figure 10 Percentage of adults who reported smoking daily or occasionally, by Figure 21 Percentage of 11-16 year-olds exposed deprivation fifth (Welsh Index of Multiple to smoke in cars by health board, 2009 Deprivation 2008), age-standardised, page 23 2003/04-2010 page 14 Figure 22 Percentage of adult smokers citing Figure 11 Percentage of adults who reported specific reasons for wanting to give up smoking daily or occasionally, smoking, 2010 page 25 by household National Statistics Figure 23 Use of Stop Smoking Wales: i) given an Socio-economic Classification, age- appointment, ii) attended assessment, iii) standardised, 2003/04-2010 page 14 attended treatment, iv) quit at four weeks Figure 12 Percentage of mothers, by UK nation, (self-reported), 2005/06-2010/11 page 26 who: a) smoked throughout pregnancy Figure 24 Quit rate after four weeks (self-reported), and b) were smokers but gave up before percentage of all smokers attending at or during pregnancy page 16 least one treatment session, 2005/06- 2010/11 page 26 2 Tobacco and health in Wales Figure 25 Smokers who contacted Stop Smoking Figure 33 Smoking-attributable mortality, age 35 and Wales in 2011 and a) were given an over, Upper Super Output Areas (USOAs), appointment, and b) attended treatment, age-standardised rate per 100,000, age-standardised rate per 1,000 estimated 2008-10 page 38 smokers in Wales, by deprivation fifth Figure 34 Percentage of inequality in mortality (Welsh Index of Multiple Deprivation 2011) attributable to smoking, age 35 and over, page 27 2001-03 to 2008-10 page 39 Figure 26 Quit rate after four weeks, 2011, a) Figure 35 Mortality from key causes of death, age self-reported and b) CO-validated, age- under 75, UK, Wales and most/least standardised percentage of all smokers deprived fifth (Welsh Index of Multiple attending at least one treatment session, by Deprivation 2011), age-standardised rate per deprivation fifth (Welsh Index of Multiple 100,000, 2001-03 to 2008-10 page 41 Deprivation 2011) page 28 Figure 36 Counts of hospital admissions attributable Figure 27 Annual NHS primary care prescribing to smoking for selected causes, age 35 and expenditure in Wales on pharmacotherapy over, 2010 page 43 for smoking cessation, 2006-2011 page 28 Figure 37 Smoking-attributable hospital admissions, Figure 28 Age-specific hospital admission rates per age 35 and over, age-standardised rate per 100,000 for selected childhood diseases 100,000, English Regions (2009/10), Wales attributable to second-hand smoke (2009) page 44 exposure, Wales residents by deprivation fifth (Welsh Index of Multiple Deprivation Figure 38 Smoking-attributable hospital admissions, 2011), 2008-10 page 32 age 35 and over, Wales and most/least deprived fifth (Welsh Index of Multiple Figure 29 Breakdown of deaths attributable to Deprivation 2011), age-standardised rate per smoking for selected causes, age 35 and 100,000, 2001-03 to 2008-10 page 45 over, 2010 page 34 Figure 39 Smoking-attributable hospital admissions, Figure 30 Smoking-attributable mortality, age 35 and age 35 and over, local authorities and health over, age-standardised rate per 100,000, all boards, age-standardised rate per 100,000, persons, English Regions and Wales, 2008-10 page 46 2007-09 page 35 Figure 40 Smoking-attributable hospital admissions, Figure 31 Smoking-attributable mortality, age 35 and age 35 and over, Upper Super Output Areas over, Wales and most/least deprived fifth (USOAs), age-standardised rate per 100,000, (Welsh Index of Multiple Deprivation 2011), 2008-10 page 47 age-standardised rate per 100,000, 2001-03 to 2008-10 page 36 Figure 41 Change in affordability of tobacco over time, UK, 1980-2010 page 48 Figure 32 Smoking-attributable mortality, age 35 and over, local authorities and health boards, age-standardised rate per 100,000, 2008-10 page 37 Table 1 Number of peer supporters trained by Table 4 Counts and percentages of deaths ASSIST programme, 2008/09-2010/11 attributable to smoking, age 35 and over, by page 24 cause and deprivation fifth (Welsh Index of Multiple Deprivation (WIMD) 2011), 2010 Table 2 Number of community pharmacies providing page 33 smoking cessation services by health board, 2011 page 29 Table 5 Counts and percentages of hospital admissions attributable to smoking, age Table 3 Hospital admissions in children aged 0-14 35 and over, by cause and deprivation fifth for selected childhood diseases attributable (Welsh Index of Multiple Deprivation (WIMD) to second-hand smoke exposure, Wales 2011), 2010 page 42 residents, 2010 page 31 Tobacco and health in Wales 3 Foreword This report lays bare the impact of tobacco on health in Wales. Over half a century since Doll and Hill demonstrated the harmful effect of smoking on health, smoking continues to be the single greatest avoidable cause of death causing almost one in five deaths in Wales.