JSNA topic report : healthy lifestyles - smoking and tobacco control

The Buckinghamshire Council Public Health team commissioned a Health Needs Assessment (HNA) in 2021 to look at healthy lifestyle services with a key focus on stop smoking services. The HNA was completed by Therapeutic Solutions/ The Centre for Public Innovation. The HNA involved a detailed data assessment looking at local, regional, national and international data. The HNA aimed to understand which key groups have higher smoking rates, which areas of Buckinghamshire have the highest prevalence, and which key groups are not accessing local services. Additional questions included looking at what makes people want to quit smoking, why some people don’t quit smoking, and how effective ‘cut down to quit’ approaches are.

In addition to a literature review, the HNA provider also conducted a range of consultations. These included an online survey and 1:1 interviews with:

• Previous stop smoking service clients (77 responses to survey)
• Current stop smoking service staff
• Professional stakeholders
• Residents (including those that have never used the stop smoking service) (857 responses to survey)

The survey and interviews aimed to understand what people would like to see as part of stop smoking services, what are the motivators for quitting and how do people want to access this type of support. Several themes came out of the different consultations, and recommendations for current and future service provision were given in a final report.

The review found that the main reasons for quitting are often health related, guilt at the impact smoking was having on their health and the health of others, peer pressure, financial reasons or accidental circumstances which have resulted in someone quitting smoking. There is also a complex relationship between smoking and poverty. Whilst financial insecurity can increase the desire to quit for financial reasons, financial stress is commonly cited as a barrier to quitting smoking and a reason for continuing. There is also some evidence to suggest that digital interventions for smoking cessation are more effective than brief in-person advice (source:'Trends in and factors associated with the adoption of digital aids for smoking cessation and alcohol reduction: A population survey in England,' Drug and Alcohol Dependence).

The data shown within the HNA indicated that there is scope to increase the number of successful quitters. Looking at differentials in quit rates however, tends to suggest that there are a number of distinct “pockets” of groups who are not benefiting from smoking cessation services. These would appear to be:

• older smokers (those aged 60 plus) and the retired
• ethnic minority groups – and those of Asian heritage in particular
• those who are sick and disabled
• residents in areas of deprivation

Consultations with previous service users showed that the ‘text to quit service’ was easy to use and clients valued having professional support to quit, often having tried on their own before. The flexibility that telephone appointments provided was welcomed with appointments scheduled around work and other commitments.

The resident survey showed that some of the barriers in accessing a service are worries that they would have to pay for the service and not having enough time. Surveys with professional stakeholders showed that over half (56.1%) did not currently make referrals into the healthy lifestyle service, with reasons such as not having heard of the service, or not knowing how to refer. A clear feedback loop would encourage professionals to make referrals. Only 40.5% of respondents would be comfortable referring residents for support to use a free e-cigarette.

The Global Burden of Disease (GBD) study assesses the scale of health lost (death and ill-health) from diseases and injuries, as well as looking at the impact of risk factors (e.g. smoking). The variation in ill-health and death, and the opportunity to address and prevent this burden, is strongly associated with deprivation (source: 'Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016,' The Lancet).

In Buckinghamshire in 2019:

• second-hand smoking ranked 11th highest for 5 to 14 year olds as a risk factor for ill-health and death
• smoking ranked 3rd highest for 15 to 49 year olds as a risk factor for ill-health and death
• smoking ranked the highest for 50 to 69 year olds as a risk factor for ill-health and death
• smoking ranked the highest for those aged 70 years and over as a risk factor for ill-health and death (source: GBD data visualizations)

There are an estimated 45,104 smokers in Buckinghamshire which is around 10.5% of all adults (2021). This is lower than the South East average (11.9%) and significantly below the England average (13%).

Source: Office for Health Improvement and Disparities (OHID), accessed through Fingertips.

Although there had been a steady downward trend in smoking prevalence for Buckinghamshire, there has been a slight annual increase since 2017 (Figure 3).

Source: Office for Health Improvement and Disparities (OHID), accessed through Fingertips.

One in five (21%) of routine and manual workers in Buckinghamshire smoke, which is significantly similar compared to the England average of 24.5% and the South East average of 24.5% (2020).

Source: Office for Health Improvement and Disparities (OHID), accessed through Fingertips.

Further work is required to understand the level of smoking for different ethnicities within Buckinghamshire as data is currently not collected by ethnicity.

In 2021 to 2022 6.6% of pregnant women were smokers at time of delivery, which is 345 women. This is lower than the South East average of 8.2% and the England average of 9.1%. 6.8% of babies in Buckinghamshire are born with a low birth weight, which is similar to the England average (6.9%) (source: Local tobacco profiles, OHID).

Substance misuse in 2019/20, 51.8% of adults admitted to treatment for non-opiate misuse in Buckinghamshire are smokers compared to the England average of 62% (source: Local tobacco profiles, OHID).

In Buckinghamshire in 2016/17, 22.6% of adults with anxiety or depression were smokers, compared to the England average of 25.8%. According to the GP Patient Survey smoking prevalence in those with a long-term mental health condition in Buckinghamshire in 2020/21 was 20.9%, significantly below England (26.3%) and South East (25.2%). The trend for Buckinghamshire shows a significant reduction since 2013/14 (32.8%), and a reduction observed each year as part of the survey, the prevalence was 22.1% in 2019/20.

In Buckinghamshire, those recorded in 2022 with depression had a smoking prevalence of 23.9% and those recorded with a serious mental illness (schizophrenia, bipolar affective disorder or other psychoses) had a smoking prevalence of 34%.

The 2014 What About YOUth survey of 15 year olds found that in Buckinghamshire, 5.1% of the sample reported being current smokers, 2.9% regular smokers, 2.2% occasional smokers and 10.8% reported having tried e-cigarettes.

These percentages are significantly lower than the England averages, apart from the proportion of occasional smokers, which is similar to England.

Of those aged 15 to 19 years old with a smoking status recorded in Buckinghamshire in 2022 (~25% of the age group have a smoking status recorded), 7.3% are recorded as current smokers.