Understanding the impact of the recession on smoking Robert West University College London June 2009

Outline Why might the recession influence smoking cessation? Is the recession influencing smoking and if so how?

Why might the recession influence smoking? Unemployment Increased smoking More idle time Reduced salaries Anxiety Reduced motivation to stop Depression Insecurity about job/business Greater difficulty stopping Lose sense of purpose Unemployment in close relatives Less disposable income Increased motivation to stop

What would one expect? Balance of forces Rise in real cost of smoking leading to reduced smoking Vs Financial stress deterring quit attempts and making it harder to stop Actual income reduction in early phase of the recession is limited to minority of smokers while increased stress would be more widespread Prediction smokers would delay quitting and focus on immediate priorities smokers who try to stop would find it harder smoking prevalence would rise or fail more slowly

Smoking prevalence: trends Smoking prevalence declined rapidly for the first 9 months following the ban on smoking in indoor public areas in July 2007 There was a rebound at the start of the recession (2nd quarter of 2008) and prevalence has remained static since then Total population Pre-ban Post-ban Recession By social grade Refs: 1) www.smokinginengland.info; 2) Financialadvice.co.uk. When did the UK recession officially start?. URL:http://www.financialadvice.co.uk/news/12/ukeconomy/9795/When-did-the-UK-recession-officially-start-to-kick-in.html. Accessed: 2009-05-31. (Archived by WebCite® at http://www.webcitation.org/5hBmp6M4c)

Attempts to stop in past month Monthly rate of attempts varies from 5 to 14% of smokers The major peaks are at New Year with minor peaks in March-April and at the time of ‘smoke-free’ Refs: www.smokinginengland.info

Attempts to stop: 2007 vs 2008 Fewer attempts to stop in 2008 compared with 2007 At least partly due to extra peak due to ‘smoke-free’ No obvious decline since start of recession Refs: www.smokinginengland.info

Tentative conclusion … Recession may be making it harder to stop rather than reducing number of quit attempts

Key findings from McNeil survey … Stress is a major perceived barrier to quitting Cost of smoking is less of a barrier because smokers cut back on other spending instead Almost half of smokers do not believe that NRT is helpful Almost one-third of smokers do not know NRT is available on prescription

Addressing the problem Greater efforts to educate smokers NRT greatly increases chances of quitting It is available on prescription Makes it cheaper Provides opportunity for professional support from GP or stop smoking service Higher dose forms and safe and effective Combining patch plus an acute form is better than using either alone Ref: Stead, L.F., et al., Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev, 2008(1): p. CD000146.

Discussion points What can health professionals do? Emphasise potential value of prescriptions Put efficient system in place for obtaining NRT Make smokers are aware of benefits of newer ways of using NRT Specifically address issue of stress arising from economic situation