Local Tobacco Control Profiles The webinar will start at 11:30am July 2018 update www.tobaccoprofiles.info

Published today Local Tobacco Control Profiles https://fingertips.phe.org.uk/profile/tobacco-control Adult Smoking Habits in the UK – (PHE & ONS) https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healtha ndlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017 NHS Digital Statistics on Smoking https://digital.nhs.uk/data-and- information/publications/statistical/statistics-on-smoking/statistics-on-smoking- england-2018 SATOD https://digital.nhs.uk/data-and- information/publications/statistical/statistics-on-women-s-smoking-status-at-time-of- delivery-england/statistics-on-womens-smoking-status-at-time-of-delivery-england--- quarter-4-october-2017-to-december-2017 PHE Public Health Matters blog https://publichealthmatters.blog.gov.uk/2018/07/03/turning-the-tide-on- tobacco-smoking-in-england-hits-a-new-low/ Local Tobacco Control Profiles – July 2018 update

Today’s LTCP update: New confidence intervals 2017 smoking prevalence data New indicator for gap in smoking prevalence between routine and manual and other occupations Update to cancer indicators Update to fires indicators Further resources on LTCP New at-a-glance reports New functionality Local Tobacco Control Profiles – July 2018 update

Confidence intervals Using 2016 as an example Previously the normal approximation method was used, however this was not able to take into account the design of the survey and how this can affect the precision of the estimates. Latest confidence interval estimates are calculated using the linearised- Jacknife method. Using 2016 as an example We have been working with ONS to update the method so that we are able to take into account the design of the survey where previously the normal approx. which we used did not take this into account. The new method we are using is the linearised jacknife method and it has been applied to the entire time series of the indicators. Using the 2016 data to illustrate the differences between the two methods, in general the CI’s have widened with just 2 LA’s having narrower CI’s using the new method. Also looking at the RAG rating, (red if they are significantly higher than England, green if they are significantly lower and yellow if they are similar to meaning that the confidence intervals overlap the England value, 19 out of the LA’s changed their RAG rating with the method change, all of which were previously significantly different and are now not significantly different. Local Tobacco Control Profiles – July 2018 update

Smoking prevalence 2017 Current smokers The 2017 estimate for current smokers in England is 14.9%. There are clear differences between men and women, 16.8% compared with 13%. There are also regional differences which can clearly be seen on this map which shows the RAG rating. Higher smoking prevalence is seen in the north of England and lower smoking prevalence in the south. This map is taken from the profiles where the values for the different areas can be found by clicking on the interactive maps where the value and confidence intervals will then be displayed. This is also available for local authorities. In this update we have also included the estimated smoking population in the count field, which is calculated by applying the smoking prevalence for each area by the corresponding ONS mid-year populations. Local Tobacco Control Profiles – July 2018 update

Inequalities in smoking prevalence Despite the reduction in smoking prevalence there remain inequalities in the 2017 estimates for current smokers. By age, there are higher proportions of smokers in younger age groups, the highest being 20.8% in those age 25-29 years and the lowest in the older age groups where age groups including the over 60s all had rates less than 11%. A clear gradient is also seen by deprivation decile with 18.1% of the most deprived decile are current smokers compared with 10.4% of the least deprived. Local Tobacco Control Profiles – July 2018 update

Inequalities in smoking prevalence One of the inequality measures that shows differences in current smokers between men and women is religion. Here you can see the variation in male smokers by religion, the highest being in Muslim men and the lowest in Sikh men. However when we bring the smoking rates in women in we see a different picture. Muslim women have one of the lowest rates along with Sikh and Hindu women. Similar rates were seen in Jewish men and women, and those with no religion. Local Tobacco Control Profiles – July 2018 update

Inequalities in smoking prevalence We also recently added the breakdown by country of birth, which shows vast differences between the highest smoking prevalence in people born in Poland at 27% compared with less than 5% of those born in India. Local Tobacco Control Profiles – July 2018 update

Smoking prevalence trend This chart shows the trend in smoking prevalence, with the red line showing current smoking rates for all adults age 18+ and the green line showing those in routine and manual occupations. Although both are showing a downward trend, with smoking prevalence reducing almost 5% in the last 6 years, and even more in the routine and manual group, there are still differences of more than 10% between the two lines. Local Tobacco Control Profiles – July 2018 update

NEW INDICATOR: Socio-economic gap in current smokers “reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population".  ODDS RATIO CALCULATIONS a * d b * c This inequality led to one of the targets in the tobacco control plan published last year being “to reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population”. In order to help local authorities measure the extent of the problem in their area, it was important to create an indicator that looked at not only the absolute difference in smoking prevalence in the two indicators we currently have in the profiles, but also take into account the size of the relevant populations in each area. The new indicator in the profiles is labelled as the socio-economic gap in current smokers, and is restricted to age 18-64 years in employment. The values presented are odds ratios and show the likelihood of routine and manual workers being smokers compared with those working in managerial and professional and intermediate level jobs. I’ll take you through how we calculated the indicator to help explain this better. Firstly we grouped everyone into these 4 categories – respondents were classed either as a smoker or non-smoker and in routine and manual or in other professions. Odds ratios were then calculated using this formula so multiplying the smoking routine and manual worker by the non-smoking other workers and dividing that by the non-smoking routine and manual workers times the smoking others. This then gives you the odds of someone in a routine and manual job being a smoker compared with the others. What we would be aiming to see is that the odds ratio is one, which would mean no difference between the groups, and odds ratio higher than one means that the routine and manual workers have higher odds of smoking which is what we expect to see, and an odds ratio lower than one would mean they are less likely. Local Tobacco Control Profiles – July 2018 update

Socio-economic gap LA values range from 1.00 to 5.13 This chart shows the trend for England and latest figures show that the odds are 2.44 time higher in 2017. It is important to note that this is a significant increase from the odds in 2012 which were 2.27 and therefore it is an important group to target for quitting services. Rates in LA’s ranged from 1.00 to more than 5 so there is also variation across the country. LA values range from 1.00 to 5.13 Local Tobacco Control Profiles – July 2018 update

Fires indicators Accidental fires ignited by smoking related materials (%) Fatalities from accidental fires ignited by smoking related materials (%) These are indicators in the impact of smoking domain. The data comes from the Home Office and is available for England only. When we refer to smoking related materials or smoking materials – we mean cigarettes and cigarette lighters For the accidental fires indicator, there is no clear pattern but decreased compared to last year. Fatalities indicator decreased compared to 2015/16 and this was in contrast to pattern seen in previous years. It is interesting to note that although only 7% of fires ignited by smoking related materials, the fatalities from these fires was much higher at 38%. Rationale: Highlighting other potential dangers of smoking and the harm that can be caused Local Tobacco Control Profiles – July 2018 update

Cancer registration indicators Current indicators Lung cancer registrations  Oral cancer registrations  New indicator Oesophageal cancer registrations  Previously in the tobacco profiles, we had 2 indicators (lung and oral cancer registrations), now 3 indicators as we have a new indicator - oesophageal cancer registrations. In the profiles, they are presented as age standardised rates, and for all these indicators, we have added data for 2014-16. These are cancers that can be caused by smoking tobacco and when we look at the relative risks of smoking related illnesses, cancers have a high relative risk. Age standardised rates Data added for 2014-16 Local Tobacco Control Profiles – July 2018 update

Cancer registration indicators (1) Lung cancer registrations The chart is from the profiles, in the compare indicators tab on the LTCP. On the Y axis, we have smoking prevalence in upper tier local authorities and the x axis is the lung cancer registrations rate. As smoking prevalence increases we can see a clear pattern of increase in the registrations of lung cancer. Local Tobacco Control Profiles – July 2018 update

Cancer registration indicators (2) Oral cancer registrations On the Y axis, we have smoking prevalence in upper tier local authorities and x axis is the oral cancer registrations rate. This is similar to lung cancer on the previous slide where, as smoking prevalence increases, the registrations of oral cancer increase. Local Tobacco Control Profiles – July 2018 update

Cancer registration indicators (3) Oesophageal cancer registrations This is the new indicator that I mentioned a couple of slides ago. The trend for oesophageal cancers has remained around 15-16 per 100,000 registrations in a 3 year period. Local Tobacco Control Profiles – July 2018 update

Further resources https://fingertips.phe.org.uk/profile/tobacco-control/supporting-information/further-info Feedback and further link for these pages is welcome. Local Tobacco Control Profiles – July 2018 update

Further resources - example Local Tobacco Control Profiles – July 2018 update

At-a-glance reports https://fingertips.phe.org.uk/profile/tobacco-control/data#page/9/gid/1938132885/pat/6/par/E12000001/ati/102/are/E06000047 New at-a-glance reports to replace the PDF’s which were removed a few months ago. Can be found on the download tab and available for various geographical areas. Local Tobacco Control Profiles – July 2018 update

At-a-glance Local Tobacco Control Profiles – July 2018 update

At-a-glance Local Tobacco Control Profiles – July 2018 update

User defined list New functionality to define your own list of indicators across the fingertips profiles. Need to set up an account to do so. Local Tobacco Control Profiles – July 2018 update

User defined list Select the indicators you wish to see from across various profiles to create a list. Name your list (right hand side) and save list. When you next log in you will be able to select to see just these chosen indicators. Local Tobacco Control Profiles – July 2018 update

Feedback on the webinar tobacco.profiles@phe.gov.uk Local Tobacco Control Profiles – July 2018 update