Local Tobacco Control Profiles and Adult Smoking Habits 2018 The webinar will start at 13:00 July 2019 update https://fingertips.phe.org.uk/profile/tobacco-control

Published 2nd July Local Tobacco Control Profiles Adult Smoking Habits in the UK – (PHE & ONS) NHS Digital Statistics on Smoking, 2019 Smoking at time of delivery (SATOD) annual statistics 2018/19 On 2nd July various publications went out from PHE, ONS and NHS Digital and this is something that we have been working together on for the last few years in order to harmonise outputs for our users. We updated the tobacco profiles available on the fingertips platform, published the adult smoking habits in the UK bulletin which is a collaborative piece of work between PHE and ONS but published on the ONS website. Also NHS Digital published their statistics on smoking report which contains some of the data from the adult smoking habits and other statistics for example smoking attributable hospital admissions, and then they also published their annual smoking at time of delivery stats for the 2018/19 period. Local Tobacco Control Profiles – July 2019 update

Today’s LTCP update: New data for 14 indicators: Inequalities data Smoking prevalence in adults (current/ex/never smoked) 2018 Smoking prevalence in adults in routine & manual occupations (current/ex/never smoked) 2018 Gap in smoking prevalence Cancer registrations 2015-17 Illicit tobacco Fires from smoking materials and resulting fatalities Inequalities data Added new geographical areas Local Tobacco Control Profiles – July 2019 update

New LA geographies in Fingertips Firstly just to explain about the new local authority geographies. Those of you who use the public health outcomes framework may already have seen this but for those of you who are not aware, from April 2019 there were some changes to local authority boundaries as per this table. The plan for including these in the profiles is that when an indicator is updated the new geographies will be calculated and the old ones will no longer be calculated. While we are in the transition period getting these updated you will notice that in the dropdown list you have two options for county & UA and district & UA as shown in this list. For areas where there haven’t been any changes which is the majority of regions, the data will display the same whichever of these you choose, though the list of indicators will only contain those where new data has been added Local Tobacco Control Profiles – July 2019 update

For example here in the smoking prevalence in adults domain, we currently only have calculated for the APS indicators so the list on the right hand side with the new county & UA doesn’t display the GPPS and QOF smoking prevalences which will be updated in due course. Local Tobacco Control Profiles – July 2019 update

Smoking prevalence trend This chart shows the trend in smoking prevalence, the red line shows data for all adults age 18 plus and the green line shows data for persons in routine and manual occupations. We can see that both groups show a downward trend, which has continued since 2011. However there is also a clear difference between the two lines which in 2018 shows that those in routine and manual occupations had a smoking rate 11 percentage points higher. Local Tobacco Control Profiles – July 2019 update

Smoking prevalence 2018 Current smokers Ex smokers Never Smoked Persons 14.4% 25.8% 59.7% Male 16.4% 28.1% 55.5% Female 12.6% 23.7% 63.8% The estimated prevalence of current smokers in 2018 in England is 14.4%. There remains clear differences between males and females, with estimated prevalence of 16.4% compared to 12.6%. This map also clearly shows that there are regional differences in smoking rates. The map is RAG rated and shows that the north east of England has higher smoking prevalence compared to the south. The map is taken from the profiles – where the values for the regions can be displayed by clicking on the map. Included alongside the prevalence values is an estimated smoking population for each area. This is also available for local authorities. Local Tobacco Control Profiles – July 2019 update

Inequalities in smoking prevalence As well as the variation in smoking prevalence between regions, there also remain other inequalities in the estimates for current smokers. Looking at age, the estimates are higher within the younger age groups, with those age 25 to 29 having the highest prevalence at 20.1%, meanwhile all age groups from 60 years and above have a smoking prevalence significantly lower than the England average. As well as age, inequality is also seen by deprivation decile. As shown in this chart there is a clear difference between the most deprived decile where 17.9% are estimated to be current smokers, against 9.8% in the least deprived decile. Local Tobacco Control Profiles – July 2019 update

Inequalities in smoking prevalence: Housing A further breakdown of the data by housing tenure shows that there are differences in current smoking rates. The breakdown shows there is a divide in smoking rates between persons who rent and those who own their own home. The group with the highest smoking rate of 30%, are those who rent their home from a local authority or housing association, whereas those who own their own home outright have the lowest rate, at 8.1%. We would perhaps expect this as those in local authority or housing association rented accommodation would generally be the most deprived. Local Tobacco Control Profiles – July 2019 update

Inequalities in smoking prevalence: sexual identity We also looked at smoking rates by sexual identity, although this data is only available for 2017 because ONS do not provide the data to customers until they have released their publication on sexual identity later on in the year. It shows that people who identify as gay, lesbian or bisexual have higher smoking rates than those who identify as heterosexual, other or who would prefer not to say. There is also variation within groups for males and females, with females being less likely to smoke than males in all groups except for those who identify as gay or lesbian where the female smoking rate is higher at 25% compared to 21% for males. The group with the highest smoking rate of 26.7% are males who identify as bisexual. Local Tobacco Control Profiles – July 2019 update

Inequalities in smoking prevalence: ethnicity and sex One inequality measure where we see a stark difference between men and women is ethnicity, where rates differ significantly, particularly in Asian and Chinese groups where around 14 to 15% of men are smokers compared with just 3% of women. Local Tobacco Control Profiles – July 2019 update

Gap in smoking prevalence between routine & manual and other occupations Moving onto the gap in smoking prevalence between routine and manual and other occupations. This is an indicator we added to the profile last year in response to the target in the tobacco control plan to reduce the gap as it’s well known that routine and manual workers have higher smoking rates than their managerial and professional counterparts. The difficulty faced by local authorities in assessing this was that for some they had a very small routine and manual population and therefore their overall smoking prevalence did not reflect this high risk group, whilst for others their population was much larger and it therefore increased their overall smoking prevalence rates. To combat this we calculate an odds ratio, for people aged 18-64 years, comparing the odds of someone who is a routine and manual worker being a current smoker compared with those in managerial and professional and intermediate occupations. What we see in the trend is that although we know overall smoking prevalence has reduced between 2011 and 2018, the gap between these groups has actually significantly increased, which is somewhat of a concern, and we are still seeing an increase year on year albeit not a significant one. Local Tobacco Control Profiles – July 2019 update

Smoking related ill health in the smoking related ill health domain the three cancer registration indicators have been updated. We include these because smoking has a well established link with all three of these cancers, probably most well-known of them being lung cancer and therefore we would hope that by decreasing smoking prevalence after some time we would also see a decrease in the registrations of these cancers though we do of course note that there is much of a time lag between smoking and developing them in most cases. Positively we see here that there has been a significant reduction in the lung cancer registrations between 2014-16 and 2015-17, and that oral cancer and oesophageal cancer registrations have remained stable in recent years. Local Tobacco Control Profiles – July 2019 update

Impact of smoking Looking at the impact of smoking domain, which you will need to select the England area type in order to view as these indicators are only available at the England level. HMRC published their tax gap report which states that “Trends in the cigarette and hand-rolling tobacco market appear to be diverging. UK taxpaid consumption of cigarettes continues to fall whereas the UK tax-paid consumption of hand-rolling tobacco has steadily increased since 2005-06, levelling off in recent years. There may be a number of reasons for this difference, including consumer preference, price, and policy initiatives". Local Tobacco Control Profiles – July 2019 update

Smoking related fires Looking at the trends in fires caused by smoking related materials we see that there has been an increase from last year although there are many year-on-year fluctuations. One thing to note about the fatalities figure is that it is significantly lower than previous years at 28% compared with 45% last year and we believe that this is due to the fatalities from the Grenfell tower fire being included in the denominator. Local Tobacco Control Profiles – July 2019 update

Moving on to the other tables in the adult smoking habits bulletin, which can be found on the ONS website via this link here https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/he althandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018 Local Tobacco Control Profiles – July 2019 update

Adult smoking habits 2018 Changes to the OPN As part of the Census and Data Collection Transformation Programme (CDCTP), in ONS, the method for collecting Opinions and Lifestyle Survey (OPN) questionnaire responses is being transformed from a face-to-face interview to online with telephone follow up (mixed-mode). The first thing to note is that there have been changes made to the opinions and lifestyle survey as part of the Census and Data Collection Transformation Programme (CDCTP), in ONS, the method for collecting Opinions and Lifestyle Survey (OPN) questionnaire responses is being transformed. Previously the question were asked face-to-face but from April last year they moved to asking via the telephone and later on this year they will move to mixed mode which will invite people to respond to the questionnaire online and then follow up with telephone if there is no response. Face-to-face Telephone (April 2018) Mixed mode (late 2019) Local Tobacco Control Profiles – July 2019 update

Adult smoking habits 2018 What does this mean for the publication? Questions had to be transformed. Most responses are comparable to previous years. Not comparable are: ex-vapers average daily cigarette consumption For further details see: https://www.ons.gov.uk/aboutus/whatwedo/paidservices/opinions/opinionsandlif estylesurveymixedmodepilotanalysis Some of the questions were transformed for the new mode as the face-to-face questioning didn’t transfer to a telephone interview well, and for the majority of questions there has been little or no affect as far as we can see. ONS have done some comparisons which can be found via this link, but there are a couple of questions that can no longer be compared to previous years. Firstly the ex-vapers. Some of you will remember that in 2016 we changed the APS smoking question which affected the proportions of ex smokers by including the word regularly, for example have you ever regularly smoked cigarettes? When previously the question was have you ever smoked? the same thing has been implemented here so now the ex-vapers shows people who have ever regularly vaped when previously it may have included people who only tried it. Secondly the average daily cigarette consumption, people are now asked each day individually so how many cigarettes to you smoke on a Monday, how many on a Tuesday etc where previously they were asked how many do you smoke on weekdays and at weekends. The effect is that the cigarette consumption figures are now much lower than in previous surveys though there is no real explanation as to why at the moment and this is been looked into further by ONS. Local Tobacco Control Profiles – July 2019 update

Taking some of the graphics out of the bulletin just to show the key points from the publication. Here we see that the smoking prevalence has been steadily decreasing since the 70’s and the smokers who have quit has been increasing. It also highlights where various pieces of legislation have come into place such as the ban on smoking in public places and plain packaging so we can see if these have had an effect. Local Tobacco Control Profiles – July 2019 update

Looking at smokers’ intention to quit, the data tells us that in England 58.5% of smokers want to quit in the next 3 months and this chart shows that these people typically wait longer to have their first cigarette of the day from waking up which is generally a positive move towards quitting. Local Tobacco Control Profiles – July 2019 update

E-cigarette use in England by age and sex Now looking at e-cigarette use, in England 6.3% of people classed themselves as current vapers in 2018, up from 5.5% last year. Breaking this down by age and sex this chart shows the current vapers as the green colour, ex vapers as orange, tried vaping but didn’t continue as grey and never vaped as red. Note that these categories are a change from previous releases, and though a back series has been produced do remember that the ex-vapers figure is not comparable to previous years. We see here that the most likely people to vape are males age 35-44 years and the least likely are women in the youngest age group. Local Tobacco Control Profiles – July 2019 update

E-cigarette use in England by smoking status A different breakdown of the same data by smoking status is shown here and notably less than 1% of people who have never smoked are current vapers compared with 13% of ex smokers and 14% of current smokers. Again looking at this by sex we can see male ex-smokers are more likely to vape than female ex-smokers though current smokers have similar rates. Just 0.1% of women who have never smoked currently vape. Local Tobacco Control Profiles – July 2019 update

E-cigarette use in England Respondents who use an e-cigarette are asked about their reasons for doing so, and more than half say their main reason was as a quitting aid. Also the perception that they are less harmful than cigarettes is consistently given as a reason though the rate is down this year which may be due to the way the question is being asked and therefore will be investigated further. Local Tobacco Control Profiles – July 2019 update

E-cigarette use in England For the first time this year we have included two new tables. Here the table shows that of people who have both vaped and smoked at any point, the overwhelming majority smoked first with around 5% saying they vaped before they smoked. Local Tobacco Control Profiles – July 2019 update

Heat-not-burn With the emerging heat-not-burn tobacco products on the market a question has also been introduced to monitor how well known and well used they are in the population and it seems that at the moment very few people have even heard of them let alone used them. Local Tobacco Control Profiles – July 2019 update

Smoking at time of delivery Finally just to touch on the smoking at time of delivery data that was published by NHS digital. Firstly to say these are not yet available in fingertips. I’m going to add them at CCG level as soon as possible but the local authority estimates require us to use the ONS births data to transform the CCG data and this is not available until later on in the year so the indicator should be updated in November. Looking at the figures for 2018/19 there has been a slight reduction to 10.6% yet still only 28 out of the 195 CCG’s met the target set by the government in the tobacco control plan to be at 6% or less so there is still some way to go. For further data on this please see the link here. 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-january-2019-to-march-2019 Local Tobacco Control Profiles – July 2019 update

Questions or feedback on the webinar tobacco.profiles@phe.gov.uk Local Tobacco Control Profiles – July 2019 update