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Who is at risk and why?

Background papers: Lifestyle and wider determinants :: Smoking and tobacco control [Update in progress] :: Who is at risk and why?

Smoking prevalence rates are highest in the poorest areas of England and Wales, demonstrating the strong link between smoking and deprivation. There are also differences in prevalence between genders, socio-economic groups, ethnicities and age groups [1][2][3]

Socio-Economic Status


• Smoking is higher than average in lower socio-economic status Mosaic Groups O, N, K, and I. These groups make up 31.1% of the Medway registered population.[4]
• Smoking prevalence in routine and manual workers continues to be higher at 29% than for those in the managerial and professional socio-economic group at 14%.[2]
• Smokers in lower socio-economic groups are less likely to succeed when trying to quit smoking, due in part to a stronger addiction to nicotine.
• At least 75% of lone parents in receipt of social security benefits smoke.
• People on low incomes (the bottom 15% in terms of material deprivation) have a significantly higher rate of smoking — 45% of men and 40% of women were current smokers.[5]

Gender


• Smoking in England is slightly higher in men (21%) than women (20%), contributing to the life expectancy gap between the sexes.[2]
• However, among children and young people in the South East more girls (8%) than boys (6%) smoke (2009 data).

Ethnicity


• Irish and Bangladeshi men have higher smoking levels than the general population, with Black Caribbean, Black African, Chinese, Pakistani and Indian men having similar levels; Black Caribbean and Irish women have similar smoking levels to the general population; Black African, Chinese, Pakistani, Indian and Bangladeshi women have significantly lower levels of smoking.

Age


• Those aged 20 to 34 reported the highest prevalence of cigarette smoking (32% among 20–24 year olds and 27% among 25–34 year olds) while those aged 60 and over reported the lowest (12%).[2]
• Low Income Diet and Nutrition Survey 2007[5] found that older adults were much less likely to be current smokers than younger adults. Among men, the prevalence of current smokers was 54% for men aged 19–34, 58% for those aged 35–49, 52% for men 50–64 and 22% for men aged 65 and over. It is a similar pattern for women.

Young people and children


• Almost two thirds (65%) of current and ex-smokers who had smoked regularly at some point in their lives started smoking before they were 18.
• Across the South East Coast, 36% of girls and 33% of boys aged 11–15 will have smoked at least once. 8% of girls and 6% of boys aged 11–15 will be classed as regular smokers, defined as smoking at least once per week.[6] This is slightly higher than the national average.
• Nationally, 32% of pupils aged 11–15 have ever smoked, with a large variation by age: 55% of 15-year-olds have smoked at least once. The prevalence of regular smoking (at least once per week) also increases with age.
• The odds of being a regular smoker are higher if pupils live with other people who smoke, and also increase with the number of smokers in the household; children who live with two adult smokers are four times more likely to be regular smokers themselves than children who live with non-smokers.
• Smoking increases the risk of asthma in young people and aggravates asthma symptoms in those already diagnosed. It can also lead to impaired lung growth in children and young adults.[7]

Other groups

Pregnant women


• Prevalence of smoking in pregnancy across England is approximately 14% (Department of Health, 2010). In Medway it is higher at 20%.[8]
• Younger mothers are more likely to smoke throughout pregnancy than older mothers; 45% of mothers aged under 20 smoked throughout pregnancy compared with 9% of mothers aged 30 and over.
• Mothers classed as having 'never worked' are significantly more likely to smoke throughout pregnancy than mothers in managerial and professional occupations.

Prisoners


• Smoking prevalence among prisoners is estimated to be approximately 80%, with the 1997 psychiatric morbidity survey of prisoners in England and Wales [9] reporting 82% of male prisoners and 81% of female prisoners being current smokers.
• Smoking status should be routinely recorded in primary care records.
• Mental Health Trust staff, for example Wellbeing nurses, Occupational Therapists and Physical Activity co-ordinators should be trained to level 2 in Smoking Cessation.
• Patients who smoke should be offered referral to appropriate trained smoking cessation specialists on admission: or, if they do not wish to access this help at that time, a programme to promote readiness to quit should be agreed as soon as possible, and referral continue to be offered.
• The Medway Stop Smoking Service, the Mental Health Care provider and Medway Social Services should work together to develop plans to bring the Forensic and Secure Units, and eventually the Residential Care home environment for this patient population towards completely smoke free status. The GPCCs will be expected to actively support these plans. Commissioners of Forensic Secure Unit providers should use contract review as an opportunity to instigate change following consultation with staff, clinicians and patients/service users.

Mental Health


• Approximately 70% of people on mental health inpatient units are current smokers and 50% smoke heavily (more than 20-a-day).

• People with mental illness who are living in the community and who are less ill, smoke less, with up to 40% smoking and close to 30% smoking heavily.[10]


References

[1]   Crosier A. Smoking and health inequalities 2005; Action on Smoking and Health. http://www.ash.org.uk/files/documents/ASH_98.pdf .
[2]   Office for National Statistics. General Lifestyle Survey 2008: Smoking and drinking among adults 2010; Office for National Statistics.
[3]   The NHS Information Centre for Health and Social Care. Statistics on Smoking, England 2010 2010; http://www.ic.nhs.uk/pubs/smoking10
[4]   Experian Ltd. Area Comparison Report: Medway Unitary Authority wards 2011;
[5]   Food Standards Agency. Low Income Diet and Nutrition Survey 2007; http://food.gov.uk/science/dietarysurveys/lidnsbranch/
[6]   Spencer S, Jolley J. Health Equity Audit - Stop Smoking Service: NHS Medway 2011; Kent & Medway Public Health Observatory. http://www.kmpho.nhs.uk/lifestyle-and-behaviour/smoking/?assetdet957414=216973 .
[7]   Diment E, Harris J, Jotangia D, et al. Smoking, drinking and drug use among young people in England in 2008 2009; The NHS Information Centre. http://www.ic.nhs.uk/webfiles/publications/sdd08fullreport/SDD_08_%2809%29_%28Revised_Oct_09%29.pdf .
[8]   London Health Observatory. Local Tobacco Control Profiles for England 2010; http://www.lho.org.uk/LHO_Topics/Analytic_Tools/TobaccoControlProfiles/default.aspx
[9]   Ledar D, Singleton N, Melter H. Psychiatric Morbidity among Young Offenders in England and Wales 2000; Office for National Statistics. http://www.google.co.uk/url?q=http://www.ons.gov.uk/ons/rel/psychiatric-morbidity/psychiatric-morbidity-among-young-offenders/psychiatric-morbidity-among-young-offenders/psychiatric-morbidity---among-young-offenders.pdf&sa=U&ei=IL76T4iWNua_0QW5gdG6AQ&ved=0CBMQFjAA&sig2=FNcTvw3ut6Q3ECW8YXVH1Q&usg=AFQjCNEUyGTfisdcCS_-j6hee3hKvMpsBw .
[10]   Jochelson K, Majrowski B. Clearing the Air: Debating smoke-free policies in psychiatric units 2006; King's fund. http://www.spacetobreathe.org.uk/uploads/ClearingtheAir.pdf .