With public health being such an ongoing and important concern, we’re aware first hand of the relationship between smoking and health. It’s more complex than simply becoming an addiction for some people and it’s not just a matter of simply quitting. We also know there are other factors that play into why people pick up a cigarette for the first time (and continue to do so). Vape Superstore did some work with Smokefree Hackney to look at smoking rates and which factors were affecting the prevalence of smoking.
While, collectively, we’re quitting at a pretty impressive rate, we’re not quite on track for the 2025 “smokefree” deadline. Smoking related illnesses are still the leading cause of preventable deaths in the UK and accounts for a high number of cancer diagnoses too. It isn’t just smokers who are affected by their habit, second hand smoke also affects the children, friends and relatives around the smoker too. It’s a complex issue to unpack, so let’s start at the beginning.
THE CURRENT STATISTICS:
Smoking is currently at an all time low in the UK. While that’s great news, it doesn’t mean the issues surrounding smoking are gone.
- 15% of the UK’s adults still smoke(1) - in order to constitute as a “smokefree” society, that figure would need to drop to 5%. This equates to around 66% of smokers needing to quit in the next 6 years for the UK to reach its 2025 target.
- Smoking is responsible for 15% of the cancer diagnoses in the UK. It’s still the leading preventable cause of cancer(1).
- 25 - 34 year olds still have the highest smoking rate, with around 1 in 5 of this group being a smoker, equating to around 1.4 million of the smokers in the UK(2).
WHO’S STILL SMOKING?
Before we look at why people are smoking, it’s important to look at the demographics of the largest smoking populations. There are a number of groups who have higher smoking rates which compounds if an individual falls into more than one.
- Those with poor mental health. If someone suffers from mental health issues including but not limited to anxiety, depression, high stress levels, bipolar disorder, PTSD or Schizophrenia - they’re more likely to smoke(4).
- People who are unemployed or fall below the poverty line. Those in the most deprived areas are more than twice as likely to smoke than those who live in the least deprived areas(1). This includes factors like whether they rent or own their homes, whether they receive benefits and who they’re living with. Those who are single, divorced or in a house share are more likely to be a smoker than those who are married or in a civil partnership(4).
- Another factor relating to work is the nature of their profession. Manual and factory workers with routine jobs are significantly more likely to smoke than those in professional or managerial roles. Around 1 in 4 in manual labour will smoke compared to 1 in 10 office workers(4).
- Individuals with a lower level of educational qualification, those with no qualifications are twice as likely to smoke than those with qualifications(4).
- Sexual orientation also plays a factor, with lesbian, bisexual and gay individuals being one and a half times more likely to smoke than straight/heterosexuals(4).
- Individuals whose parents smoked. If a child has smoking parents, they’re 15 - 21% more likely to become a smoker later in life themselves(3).
BEING BORN INTO AND GROWING UP IN A POORER AREA SETS PEOPLE UP FOR BEING MORE LIKELY TO SMOKE.
If we look at income and poverty alone, financial stability has a significant impact on the quality of someone’s life. It can be affected by general economic changes as well as individual factors like family, education and where someone lives. Consider the fact that living in a lower decile area, rented accommodation or council funded accommodation can make someone twice as likely to smoke. Then, add to that the financial strain of sustaining a smoking habit to an already tight budget and breaking free of poverty is going to be even more of a challenge. To understand better why smoking is more prevalent in lower decile areas, we need to look at a number of factors:
WHERE YOU’RE FROM AND WHO YOU’RE AROUND PLAYS A BIG PART
Being born into and growing up in a poorer area sets people up for being more likely to smoke. There’s a significant impact on your environment, who you’re around and what you do that can combine to influence how likely you are to smoke. If you consider the life path of someone born into a lower decile suburb, there are a number of triggers that can result in smoking addiction.
- First of all, growing up in a smoking household makes a child significantly more likely to later take up the habit themselves. It also provides access to cigarettes they may not otherwise have(3).
- Even if a child has non-smoking parents, the added stress of living pay-check to pay-check can affect anyone’s life - even if you’re not the one paying the bills.
- A recent study from Scotland found that children in less affluent areas came into contact with shops selling cigarettes on average 149 times in a single week. For children in better off areas that number was only 23(8).
- Living in poverty has a knock on effect to education. Essentially, those from lower income neighbourhoods or those living in poverty are more likely to struggle in school. With a lower educational qualification level having a direct correlation with higher smoking rates, it’s another factor that’s amplified by living in poverty.
- A lower educational level factors into career prospects. With highly educated professionals having the lowest smoking rate in the UK with around one in 10 smoking, manual laborers and those in routine oriented jobs have a one in four chance of being a regular smoker(4).
- Adults and children living in the lowest 20% income bracket are two to three times more likely to suffer from poor mental health(10). Poor mental health is yet another contributing factor to smoking(4). With a lower average income, increased job and financial stress, things like depression and anxiety are more likely to manifest.
Quitting smoking improves #mentalhealth even in the short term; it can reduce #depression and #anxiety, improve mood and help to relieve financial stress for those on low incomes: https://t.co/RjjFIrT1iT @GM_HSC #ActOnTobacco— ASH (@ASH_LDN) September 12, 2019
WHY DOES STRESS LEAD TO SMOKING?
From this trend, we can see that stress is one of the main contributing factors to increasing someone's likelihood of being a smoker. Why is that? Stress causes the release of a hormone called cortisol. There are two kinds of stress, both release cortisol but have different triggers. One form is eustress, which is beneficial in day to day life. Small doses of cortisol boost concentration and productivity and your body will stop producing cortisol once you’ve completed the task that’s causing you stress in the first place. This is the function that helps people focus when they have a tight deadline or need to get something done in a certain timeframe.
The second kind of stress is distress. It’s where there’s no “end trigger” to tell your body to stop producing cortisol so it builds in your system over time. The end result is being in a constant state of agitation and “fight or flight” mode(11). So what’s the correlation between stress and smoking?
Smoking triggers the release of dopamine in the brain(12), the happy molecule that makes you feel calm. When there are a number of stressful factors in your life - including financial strain and mental health issues for example - smoking can become a coping mechanism. However, the more you smoke, the higher your tolerance becomes meaning you need more over time to achieve the same effect(13). Essentially, a smokers brain becomes desensitised to nicotine with more use whilst still craving the same effect. Smoking gives a perceived relaxing effect, even though the withdrawal symptoms then add more stress to their body once the nicotine has been synthesised in their brains.
THE RISING COST OF SMOKING, COMPARED TO A SLOWER INCREASE IN AVERAGE INCOME.
If these factors combine, once you start smoking, it’s that much more difficult to break free of the poverty line. Back in 2009, just a decade ago, the average cost of a 20 pack of premium cigarettes was just £5.45, compare that to an average cost in 2019 of £10.83 for the same product. Sustaining a pack a day smoking habit now costs nearly double what it did just a decade earlier(5).
In comparison the average inflation rate from 2009 to 2019 means the buying power of £1 back then equates to £1.33 now. In real terms if cigarettes had stayed in line with this price point, a standard 20 pack would cost £7.24. A pack a day smoker can stand to spend around £3952.95 a year at the current price whereas standard inflation change would cost £2642.60 - a difference of £1310.35 a year.
COST OF SMOKING INCREASING AT A GREATER RATE THAN INFLATION
The increase in price largely stems from the government raising the import tax on tobacco products. While this was done to discourage consumption, the tobacco companies respond by passing the increased cost onto consumers. For those already addicted, the options are either to cut down, switch to less premium brands or purchase counterfeit cigarettes from the illicit and illegal tobacco industry. What doesn’t change is the fact that a comparatively higher proportion of household income will still be going to fund tobacco addiction, adding to financial strain and stress in the home.
Let’s consider the average household income. In 2009 the median full-time weekly earnings were £488.50, while in 2018 they’d risen to £569(7) - a 16% increase. Bearing in mind this is the average, a 16% increase in average weekly income is still far outstripped by the 98% increase in the cost of smoking for the same period. A pack a day smoker will spend around £75.81 a week on cigarettes which - based on the average income - would be 13% of their take home pay. For households on a lower than average income, this percentage will be even more significant with sustaining a smoking habit taking a greater relative percentage of their income. According to ASH, there are 5.1 million households in England with at least one smoker. Of these, 1.4 million fall below the poverty line due to the cost of smoking which equates to more than a quarter (27%) of all households. If these smokers quit, an estimated 418,127 households would be elevated back above the poverty line(20).
Hackney’s smoking rate sits at 21%, higher than the London average of 16% and the UK average of 15%(21). Hackney is also the 11th most deprived local authority in England(14). Hackney typifies many of the factors that contribute to a higher prevalence of smoking even when compared to the rest of London. Essentially - factors like lower education level, more chance of renting, higher unemployment and lower average income are more common in Hackney than elsewhere in London. We can see a correlation between these factors and the 5% higher smoking rate in this borough.
HOW THE KEY FACTORS AFFECTING SMOKING RATE STACK UP:
IT’S ESTIMATED THE UK COLLECTIVELY LOSES £8.4BN A YEAR IN PRODUCTIVITY DUE TO SMOKING BREAKS ALONE.
COST OF SMOKING TO THE ECONOMY AND PUBLIC HEALTH:
With the ill-effects of smoking affecting someone’s health, that can have a knock on effect on their ability to work. It’s estimated the UK collectively loses £8.4bn a year in productivity due to smoking breaks alone. Add to that absences from work due to smoking related illness that affect both employer and employee and the cost is amplified.
It’s not just the smokers who are affected - pregnant mothers, children and passive smokers all have their health affected. Rates of mothers who smoke during pregnancy are still relatively high in the UK with the NHS stating an average 10.8% of women are still smoking at time of delivery. This can cause complications with birth as well as increasing the chances of things like SIDS and asthma. If the expectant mother isn’t a smoker but her partner is, second hand smoke can also have the same effect(18).
Children from families that smoke are more likely to smoke too, resulting in a self-perpetuating cycle of smoking and poverty. This in turn also contributes to more strain on the NHS and public health facilities as well as contributing to demand for the illicit cigarette trade. With smoking related illnesses costing the NHS around £2.5bn a year and an additional £760m a year on local councils for social care services(16), smoking is draining everyone’s pockets as well as their health.
THE ILLEGAL CIGARETTE TRADE:
With such high demand for cigarettes and many people struggling to afford to sustain a habit, the illegal tobacco industry is thriving in the UK. Aside from contributing to people’s addiction as well as making cigarettes more accessible to younger people, it also undermines proper taxation. For the 2015-2016 period at a mid-range level, HM Revenue and Customs estimated that 13% of all cigarettes and 32% of hand-rolling tobacco in the UK were illicit. What this translates to financially is a collective loss of £3.5bn in tobacco duties and a further £1.3bn in VAT for that period alone(17).
While it may not be possible to quickly counteract all the factors affecting smoking rates - like employment, education and living conditions - there are a few things that would make a difference. The first of which is to try and prevent a new generation from picking up cigarettes in the first place.
Typically, most people will take up smoking before they’re 20 years of age. Part of preventing a new generation of smokers is addressing the current smoker population. They directly influence the younger generation both through second hand smoke exposure and making cigarettes more readily available. Aside from offering quit services in lower income areas, reducing the accessibility and visibility of cigarettes can help. Even if a child lives in a low decile area with non-smoking parents, they’re more likely to encounter shops selling cigarettes and other tobacco products than those in higher decile areas.
However, a recent study looked at perceptions of 11 - 16 year olds regarding smoking since legislation changed regarding how cigarettes can be displayed. Displaying cigarettes was banned in larger stores in 2012 and the full ban including smaller stores like off-licenses came into effect in 2015. Since then, smoking has become less appealing to teenagers. The study interviewed 3,791 young people, including 2,953 who had never smoked and tracked their perceptions of smoking before, during and after the legislation change. The results showed a drop in susceptibility to smoking - going from 28% pre-ban to 23% mid-ban and 18% post ban. Noticing cigarettes at all dropped significantly from 81% pre-ban to just 28% post-pan(19). It also made smoking unappealing to 70% of the participants interviewed.
When it comes to addressing the adult population, in recent years we’ve seen a significant increase in quit smoking services for current smokers. Things like Stoptober, Vapril and quit services provided by the NHS and local organisations including the likes of Smokefree Hackney are all offering people the support they need. NHS hospitals are set to start offering quit assistance for all patients who come through their facilities - regardless of whether it’s for a smoking related illness or not. While smoking is still prevalent in the UK, the volume of cigarettes people are smoking is dropping and the number of quit attempts is rising all the time.
A new study from Cancer Research UK indicates the UK is smoking a billion less cigarettes a year. Part of this is due to a smaller smoking population but can also be attributed to the fact that those who continue to smoke are smoking less cigarettes on average a day. Smokers trying to quit are in good company as on average, someone makes a quit attempt every 80 seconds in the UK(22). The current smoking rate is at an all time low too. The government are predicting the existing smoking rate of 15% will have dropped to just 5% by 2030, a significant fall when as recently as 2011 it was 19.8% in England(24).
WHY QUIT SERVICES ARE IMPORTANT
The importance of quit smoking services is clear. Campaigns like Stoptober, run by Public Health England find that smokers who stop for 28 days are five times more likely to quit for good. Those who use face to face services and smoking aids like nicotine replacement therapy are four times more likely to quit(25).
Not only does quitting improve the health of the individual smoker, it also significantly impacts their quality of life, mental health, financial independence and the health of those around them. Were the existing smokers in the UK enabled to quit, many would be elevating themselves above the poverty line. This positively benefits the health and mental wellbeing of smokers children. By removing the parental influence as well as the ill-effects of living in poverty that smoking can cause, future generations stand a better chance of escaping poverty.
The talks from the #ecigsummit are now online.— Centre for Addictive Behaviours Research (@CABR_LSBU) November 17, 2018
Here is CABR's Sharon Cox delivering the keynote on 'Smoking & Poverty &...', discussing why we need a change in thinking if we are ever going to engage with the UK's most deprived smokershttps://t.co/XDD1z7xTkZ
Vape Superstore, partnered with Smokefree Hackney to support those most at risk of smoking addiction in the borough. With the launch of a quit smoking pilot scheme, Vape Superstore assisted the Smokefree team by supplying discounted e-cigarettes, vaping liquid and ongoing support to those looking to quit smoking.
WITH THANKS TO SMOKEFREE HACKNEY
- Tobacco Statistics - cancerresearchuk.org
- Turning the tide on tobacco: Smoking in England hits a new low - publichealthmatters.blog.gov.uk
- Parent and Child Cigarette Use: A Longitudinal, Multigenerational Study - ncbi.nlm.nih.gov
- Adult smoking habits in the UK: 2018 - ons.gov.uk
- RPI: Ave price - Cigarettes 20 king size filter - ons.gov.uk
- UK Inflation Calculator - in2013dollars.com
- Employee earnings in the UK: 2018 - ons.gov.uk
- Children tracked with GPS in Scottish tobacco sale study - bbc.co.uk
- Child poverty harms children’s educational opportunities - neu.org.uk
- Mental health statistics: poverty - mentalhealth.org.uk
- Recognition and Alleviation of Distress in Laboratory Animals - ncbi.nlm.nih.gov
- Measuring Cigarette Smoking-Induced Cortical Dopamine Release - ncbi.nlm.nih.gov
- Nicotine Addiction - ncbi.nlm.nih.gov
- Indices of Multiple Deprivation 2015 Briefing - hackney.gov.uk
- Smoking Costs UK Businesses £8.7bn - cebr.com
- A Tobacco Control Plan for England - gov.uk
- Illicit trade in tobacco - ash.org
- Statistics on Women’s Smoking Status at Time of Delivery - nhs.uk
- Smoking risk in children has fallen since tobacco display ban - stir.ac.uk
- Smoking and poverty calculator - ash.org.uk
- L&B: Smoking: Comparisons Hackney adults - hackneyjsna.org.uk
- One person quits smoking every 80 seconds in England - gov.uk
- More than a billion fewer cigarettes smoked each year as people ditch the cigs - cancerresearchuk.org
- Health matters: stopping smoking - what works? - gov.uk
- Stoptober - phe.gov.uk
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