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

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

3. 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

4. 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

5. 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) 2) Financialadvice.co.uk. When did the UK recession officially start?. URL: Accessed: (Archived by WebCite® at

6. 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:

7. 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:

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

9. 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

10. 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. CD

11. 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