1. Action on Smoking and Health The evolving fight against tobacco Clive Bates Director Action on Smoking and Health

2. ASH Action on Smoking and Health 3 layers of understanding 1.Smoking and disease 2.Impact of passive smoking 3.Addiction to nicotine

3. ASH Action on Smoking and Health Understanding of smoking 1. Smoking and disease

4. ASH Action on Smoking and Health Deaths attributable to smoking (1995) Main causes of death attributable to smoking (UK) Cancer46,500 Heart, stroke, circulation40,300 Lung diseases, COPD34,300 Digestive diseases, ulcers1,900 123,000

5. ASH Action on Smoking and Health Other conditions associated with smoking Angina risk 20 x risk Buerger’s disease Cataracts 2 x risk Crohn’s disease Depression Duodenal ulcers Chronic rhinitis Fertility 30% lower Graves’ disease Hearing loss Immune system impaired Decreased lung function Ocular Histoplasmosis Optic neuropathy 16 x risk Menopause 2 years early Sudden Infant Death syndrome Osteoporosis Peripheral vascular disease Psoriasis 2 x risk Rheumatoid arthritis Reduced sperm count Tuberculosis Macular degeneration 2 x risk Low child birth weight 4 x risk Vocal chord polyps Increased sperm abnormalities

6. ASH Action on Smoking and Health Contribution of different risks factors

7. ASH Action on Smoking and Health Smoking in overall decline

8. ASH Action on Smoking and Health Disease follows

9. ASH Action on Smoking and Health Consequences Defeats the ‘harmless pleasure’ argument –Justifies state intervention Main response –Marketing controls –Warnings –Public education –Taxation

10. ASH Action on Smoking and Health Understanding of smoking 2. Passive smoking

11. ASH Action on Smoking and Health Passive smoking – the effects Fatal risks –Several hundred lung cancers (UK) –Several thousand heart disease cases Non-fatal impacts –Lung function, cough, wheeze, phlegm –Asthma aggravation Children –SIDS, middle ear infection, lung disease –17,000 under-5s Other effects

12. ASH Action on Smoking and Health “compelling confirmation” that passive smoke is a cause of lung cancer Excess risk of lung cancer 24% Corresponds to 100s of deaths in the UK annually Passive smoking evidence – Hackshaw et al. Risk of lung cancer: non-smoking women living with smoker compared to non-smoker

13. ASH Action on Smoking and Health Attitudes to passive smoking Smoking status Percent agreeing that smoking should be restricted… Current smoker Ex- smoker Never smoked All adults …at work73889286 …in restaurants73929488 …in pubs28596553

14. ASH Action on Smoking and Health Consequences Defeats the ‘freedom’ argument –Others are harmed Justifies measures to control passive smoking –Workplace –Public places –Home

15. ASH Action on Smoking and Health Consequences Work Public Places Home Health and Safety at Work Act Charter and market forces Campaigns and culture

16. ASH Action on Smoking and Health Understanding of smoking 3. Addiction to nicotine

17. ASH Action on Smoking and Health Comparison “Nicotine is highly addictive, to a degree similar or in some respects exceeding addiction to ‘hard’ drugs such as heroin or cocaine” Royal College of Physicians of London, 2000 Nicotine Addiction in Britain

18. ASH Action on Smoking and Health 2. Addiction to nicotine Characteristics of dependence Strong desire to take substance, taking more than intended for longer  Difficulty quitting or controlling use  Considerable time spent obtaining, using and/or recovering from use  Higher priority given to the drug than other social activities  Continued use despite knowledge of harm  Tolerance develops  Withdrawal syndrome 

19. ASH Action on Smoking and Health Addiction to nicotine

20. ASH Action on Smoking and Health Addiction to nicotine Defeats the ‘choice’ argument –83% of UK smokers would not start if they had their time again Policy implications –Justifies treatment of tobacco dependence –Explains why ‘lights’ do not work –Product regulation and harm reduction

21. ASH Action on Smoking and Health UK policy

22. ASH Action on Smoking and Health UK Policy Ban tobacco advertising, sponsorship Raise tobacco taxes Tackle smuggling Fund national education programme Smoking cessation services and drugs Passive smoking at work Passive smoking in public places Consumer protection measures (labelling etc)

23. ASH Action on Smoking and Health Policy drivers 1.Smoking and disease 2.Impact of passive smoking 3.Addiction to nicotine