Epidemiology of Smoking Disease

• Epidemiology is the study of distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems
• Epidemiology describes disease patterns by time, place and person.
• People in the most deprived areas are more than twice as likely to smoke than people in the least deprived areas.
• The proportion of population who smoke cigarettes has decreased. The proportion of population who have never smoked cigarettes, or who have quit, has increased.
• 64% of people in mental health settings smoke
• 80% of people in prisons smoke - four times the national average
• 1 in 5 adults smoke - nearly 8 million people. Two-thirds begin before the age of 18.
• Cohort studies

  • identify a group of people and their exposure to a particular risk factor
  • follow the whole group to determine their health outcomes in terms of death or the development of diseases
  • can be prospective or retrospective
• Case control studies start with disease and measure exposures

  Cohort studies start with exposure and measure disease
• Case control studies

  • identify cases of disease
  • match cases to controls who do not have the disease in question
  • measure exposure of cases and controls to potential risk factors for the disease
  • are retrospective
• Diseases caused by Smoking

  • cancer
  • heart disease
  • peripheral vascular disease
  • chronic bronchitis and emphysema
• After the introduction of standard smoking packs Australia has seen:

  • fewer young people taking up smoking
  • a decline in children's exposure to secondhand smoke
  • an accelerated decline in smoking prevalence
  • no evidence of increases in use of illicit or contraband cigarettes
  • a decline in household expenditure on tobacco
  • a reduction in the volume of tobacco sales
• Prenatal/Neonatal Outcomes smoking

  • 20-30% low birth weight infants
  • fetal growth retardation
  • spontaneous abortion and pre-term deliveries
  • stillbirth
  • ectopic pregnancies
  • placenta praevia and placental abruption
  • Lower APGAR
• Tobacco Smoke Pollution and Children

  • sudden infant death syndrome
  • respiratory tract infections such as pneumonia and bronchitis
  • reduced lung function
  • increased severity of asthma
  • cognitive and behavioural development
  • ADHD
• Public Health England

  • provide tools and data to support local tobacco control.
  • Set out evidence to inform national policies.
• Local government

  • commission comprehensive tobacco control programmes including local stop smoking services
  • monitor and enforce tobacco control regulation
• Stop smoking services

  • respond to needs of local people and target high-prevalence groups
  • be open to people who want to use e-cigarettes to help them quit and offer them support
• Health and social care services

  • promote the physical and mental benefits of quitting
  • provide referral routes into stop smoking services
• Places with high smoking rates

  • mental health trusts: implement guidelines on smoke free estates
  • prisons: implement guidelines on managing smoking and nicotine withdrawal
• Employers

  • support colleagues who want to quit smoking
  • give employees time off to attend stop smoking services