Introduction

In the UK, in 2021, 13.3% of people aged 18 years and over smoked cigarettes, which equates to around 6.6 million people in the population; this is the lowest proportion of current smokers since records started in 2011 based on estimates from the Annual Population Survey (APS). Men were more likely to smoke than women in the UK. Across the UK, 15.1% of men (around 3.7 million) and 11.5% of women (around 2.9 million) reported being current smokers.

Smoking is the most important cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix. Smoking is a modifiable behavioural risk factor; effective tobacco control measures can reduce the prevalence of smoking in the population.

Commissioned by the UK Government and conducted by Javed Khan OBE in 2022, 'The Khan Review: Making Smoking Obsolete' sets out recommendations on how the Government's ambition to reduce the national smoking rate to less than 5% by 2030 can be achieved (Figure 1). Khan concludes that: “Taken together, and if implemented in full, I believe these actions will get the government to its 2030 target and then lead to a smokefree generation.” [1].

Achieving the Smokefree 2030 ambition of adult smoking rates of 5% or less, would at a stroke deliver the Levelling Up mission to extend healthy life expectancy by 5 years [2].

Figure 1: Recommendations from The Khan Review

Data Overview

Smoking Prevalence

Figure 2 below shows the percentage of adult smokers across Oldham, Greater Manchester, the North West and England as measured by the Annual population Survey. Oldham's smoking rate is currently significantly higher than the GM, North West and England rates. The rate has taken a substantial increase compared to the last few years of data. In 2020, the rate was more comparable with Greater Manchester and North West rates. Oldham's 2021 rate is 4th highest nationally.

The decrease in the proportion of current smokers over time may be partly attributed to the increase in vaping and e-cigarette use. Data from the Opinions and Lifestyle Survey (OPN) have shown regular use of a vaping device has increased in 2021 and the highest usage was among those aged 16 to 24 years"[3]. Policies associated with the Tobacco Control Plan for England, such as increased public awareness campaigns and smokefree places, may have also contributed to decreased smoking prevalence[4].

Figure 2: Smoking prevalence in adults (18+) trend
Source: Annual population Survey (APS)

Table 1: Smoking Prevalence in Adults (18+) (%)
Year	Oldham	GM	North West	England
2011	24.5	23.9	21.9	19.8
2012	24.2	22.8	21.1	19.3
2013	21	21.1	20	18.4
2014	19.3	21.2	19.6	17.8
2015	22.3	20.0	18.6	16.9
2016	18.8	18.4	16.8	15.5
2017	16.6	17.5	16.1	14.9
2018	18	16.2	14.7	14.4
2019	17.9	16.0	14.5	13.9
2020	14.9	16.3	14.9	13.8
2021	19.3	15.4	14.4	13
Source: Annual Population Survey (APS)

Figure 3 shows Oldham's position with Greater Manchester for the most recent year of data (2021). The rate is highest across Greater Manchester and second highest across the North West. Nationally, the Local Authority with the highest percentage of smokers has a rate of 22% and the lowest rate is 6.6%, compared to Oldham's rate of 19.3%.

Figure 3: Smoking Prevalence in Adults (18+) across Greater Manchester AuthoritiesSource: Annual population Survey (APS)

The latest data from the ASH-Youth 2022 survey of 11 to 18 year olds in England show that:

• current smoking prevalence (including occasional and regular smoking) is 6% in 2022, compared with 4.1% in 2021 and 6.7% in 2020
• current vaping prevalence (including occasional and regular vaping) is 8.6% in 2022, compared with 4% in 2021 and 4.8% in 2020
• most young people who have never smoked are also not currently vaping (98.3%)
• use of disposable vaping products has increased substantially, with 52.8% of current vapers using them in 2022, compared with 7.8% in 2021 and 5.3% in 2020

Smoking Prevalence & Inequalities

Smoking is the single largest driver of health inequalities in England. Smoking is more common among people that experience higher levels of deprivation and lower incomes. The more disadvantaged someone is, the more likely they are to smoke and to suffer from smoking-related disease and premature death. Smoking is so corrosive to individual, family and community health that any success in reducing smoking in disadvantaged groups has knock on benefits for the wider determinants of health, including through a reduction in poverty [5]. Figure 4 shows the smoking prevalence in adults in England by deprivation decile (according to the IMD 2019). There is a clear correlation between higher smoking rates and the most deprived groups.

Figure 4: Smoking prevalence by deprivation decile, 2021
Source: APS

Figures 5 and 6 below display the smoking prevalence in Oldham and England by housing tenure and socioeconomic group. Patterns in smoking prevalence by housing tenure follow a fairly similar pattern for Oldham and England, with slightly higher than expected rates amongst Oldham's private renters. Oldham sees a lower level of smokers in managerial and professional occupations than the England average and a similar percentage in the unemployed and routine/manual groups, although we would expect slight increases in both rates in line with Oldham's overall percentage difference with national rates. Oldham has a much higher rate of smokers from intermediate occupations than the national average, and it appears this is where much of Oldham's increase on the national rate sits.

Figure 5: Smoking prevalence by housing tenure 2021 (APS)
Figure 6: Smoking prevalence by socioeconomic group, 2020 (APS)

Across England in 2021, 14.9% of men are recorded as current smokers compared to 11.2% of women. Both groups have seen a gradual decline in smoking rates over the last 10 years and the differences between men and women have remained fairly similar throughout. Historically within Oldham, rates for female smokers have remained below rates for male smokers. However, the latest data (2021) reveals a much smaller gap in rates (figures 7 and 8).

Figure 7: Smoking prevalence by sex, trend (APS)
Figure 8: Smoking prevalence by sex, 2021 (APS)

Smoking Related Hospital Admissions & Mortality

Smoking accounts for approximately 5.5% of the NHS budget. Admissions to hospital due to smoking related conditions represent a large demand on NHS resources.

Oldham's smoking attributable hospital admissions are similar to 2015/16 figures, with a notable dip in 2016/17 and an increase year on year since. Greater Manchester and England have seen slight reductions in their rates over the same period. Oldham's latest rate (1,648 per 100,000 DSR) is above England's rate of 1,398 per 100,000 and similar to Greater Manchester's rate of 1,684 per 100,000 (figure 9).

Figure 9: Smoking attributable hospital admissions trend
Source: Hospital Episode Statistics & Office for National Statistics

In 2019/20, Oldham ranked 5th highest across Greater Manchester for smoking attributable hospital admissions. Trafford ranks lowest, with the only rate falling below the England average in Greater Manchester, at 1,310 per 100,000. Manchester has the highest rate at 2,422 (figure 10).

Figure 10: Smoking attributable hospital admissions across Greater Manchester
Source: Hospital Episode Statistics and Office for National Statistics

Figures 11 and 12 show the smoking attributable mortality rates for those aged over 35 across Oldham, Greater Manchester and England. Rates across all three areas have steadily declined over the period shown. Oldham's rate is comparable to the Greater Manchester rate (ranks 5th highest) but is significantly higher than the national average. Although Oldham is in line with the Greater Manchester average, it is important to note the rate is still extremely high and ranks 16th highest nationally.

Figure 11: Smoking attributable mortality trend
Source: OHID Local Tobacco Control Profiles

Table 2: Smoking related mortality in Oldham, GM and England
Year	Oldham	Greater Manchester	England
2013-15	343.5	326.2	244.2
2014-16	311.6	303.6	221.4
2015-17	312.9	303.5	219.1
2016-18	294.7	286.8	211.8
2017-19	292.4	281.3	202.2
Source: OHID Local Tobacco Control Profiles

Figure 12: Smoking attributable mortality across GM
Source: OHID Local Tobacco Control Profiles

As with smoking prevalence, there is a clear and defined link between smoking attributable mortality and levels of deprivation. Figure 13 demonstrates the link at England level, with the rate of smoking related deaths in the most deprived decile more than double that in the least deprived.

Figure 13: smoking attributable mortality in EnglandSource: OHID Local Tobacco Control Profiles

Figure 14 below breaks down smoking related deaths into some of the main causes and compares these to the England rate. Oldham has a higher rate across Cancer, Heart Disease and Stroke. The rates below for Oldham represent 447 Cancer deaths, 174 deaths from Heart Disease and 42 deaths from Stroke. Oldham's rate is ranked 18th highest nationally for Cancer, 7th highest for Heart Disease and 16th highest for Stroke deaths as a result of smoking.

Figure 14: Smoking attributable deaths by cause,  2017-19
Source: OHID Local Tobacco Control Profiles

Years of life lost (YLL) is a measure of premature mortality that takes into account both the frequency of deaths and the age at which the death occurs. Figure 15 shows the directly standardised rate of YLL across Greater Manchester for smoking attributable mortality. Oldham's latest rate for 2016-18 is 1,940 per 100,000 and ranks 5th highest, slightly higher than the Greater Manchester average of 1,836 per 100,000 and significantly higher than the England rate of 1,313 per 100,000. Oldham's rate is 16th highest across England.

Figure 15: Potential years of life lost across Greater Manchester, 2016-18Source: Office for National Statistics
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Quitting

The NHS stop smoking services offer support to help people quit smoking. This can include intensive support through group therapy or one-to-one support. The support is designed to be widely accessible within the local community and is provided by trained personnel, such as specialist smoking cessation advisors and trained nurses and pharmacists.

Successful quitters are those smokers who successfully quit at the four-week follow-up. A client is counted as a ‘self-reported 4-week quitter’ when assessed four weeks after the designated quit date, if they declare that they have not smoked, even a single puff on a cigarette, in the past two weeks. This information is collected on NHS Stop Smoking returns in line with requirements from the Department of Health. 

Oldham has a similar rate of smokers setting a quit date and successful quitters compared to England, although both have been on a downward trend year on year. In 2019/20, 1,264 people set a quit date in Oldham and 582 had successfully quit at 4 weeks. Oldham has the highest rate of smokers setting a quit date across Greater Manchester and 3rd highest rate of successful quitters.

Figure 16: Smokers setting a quit date trendSource: NHS Stop Smoking Services data & APS

Figure 17: Smokers setting a quit date across GMSource: NHS Stop Smoking Services data & APS

Figure 18: Smokers that have successfully quit at 4 weeks trend
Source: Population Health Analysis Team, Public Health England 

Figure 19: Smokers that have successfully quit at 4 weeks across Greater ManchesterSource: Population Health Analysis Team, Public Health England

E-cigarettes & Vaping

Evidence from 'Nicotine vaping in England: 2022' reveals the latest data from several national studies of adults in England shows that:

• vaping prevalence in England in 2021 was between 6.9% and 7.1%, depending on the survey, which equates to between 3.1 and 3.2 million adults who vape
• vaping prevalence among adults who have never smoked remained very low, at between 0.6% and 0.7% in 2021
• the popularity of disposable vaping products has increased among adults who vape, with 15.2% using them in 2022 compared with 2.2% in 2021
• tank type products remained the most popular vaping devices (used by 64.3% of adult vapers in 2022)
• vaping products remain the most common aid used by people to help them stop smoking
• in stop smoking services in 2020 to 2021, quit attempts involving a vaping product were associated with the highest success rates (64.9% compared with 58.6% for attempts not involving a vaping product)
• Overall, there is a lack of evidence on whether flavourings affect health risks. Vaping products that contain the flavouring chemical cinnamaldehyde are a cause of concern, and regulatory bodies should review its use in e-liquids.
• There is limited evidence that some flavourings in vaping products have the potential to alter cellular responses (from animal and cell studies), but less than exposure to tobacco smoke.
• Vaping products generally provide lower nicotine levels to users than smoking does. However, people who are experienced vapers can achieve nicotine levels similar to people who smoke.
• Existing evidence suggests that the risk and severity of nicotine dependency from vaping is lower than for smoking but varies by product characteristics (like device type and nicotine concentration in e-liquids). This is consistent with evidence on nicotine exposure from biomarker and pharmacokinetic studies from the current review.
  
  

Further Information & Resources

Smoking during pregnancy Oldham JSNA page
For data relating to smoking during pregnancy, please see the dedicated JSNA page in our Starting Well section.

ONS Smoking Inequalities in England, 2016
This dataset reports statistics on smoking inequalities in England between 2012 and 2016. The dataset contains three tables:

1. Proportion of current smokers by sex and national deciles of area deprivation, England, 2012 to 2016
2. Distribution of current smokers across national deciles of area deprivation by sex, England, 2012 to 2016
3. Likelihood of smoking across several domains of inequality, England, 2016

A Tobacco Control Plan for England (Department of Health)
The objectives of the tobacco control plan are to:

• reduce the number of 15 year olds who regularly smoke from 8% to 3% or less
• reduce smoking among adults in England from 15.5% to 12% or less
• reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population
• reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less

The Khan review: making smoking obsolete, 2022
Independent review by Dr Javed Khan OBE into the government’s ambition to make England smokefree by 2030.

Action on Smoking & Health (ash) - Use of e-cigarettes (vapes) among young people in Great Britain 
Examines evolving youth use of e-cigarettes om Great Britain in the context of changes in the regulation of e-cigarettes, and use of tobacco among adults and children.

Action on Smoking & Health (ash) - Electronic Cigarettes
Provides an introduction to the function and uses of electronic cigarettes, as well as exploring the perceptions and impacts of vaping and how this can be used to support the cessation of smoking.

Delivering a Smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the Tobacco Control Plan 2021
The All Party Parliamentary Group (APPG) on Smoking and Health is a cross-party group of Peers and MPs which was founded in 1976 and is currently chaired by Bob Blackman MP. Its agreed purpose is to monitor and discuss the health and social effects of smoking; to review potential changes in existing legislation to reduce levels of smoking; to assess the latest medical techniques to assist in smoking cessation; and to act as a resource for the group’s members on all issues relating to smoking and public health.

Nicotine vaping in England: 2022 evidence update main findings
This evidence review is the eighth in a series of independent reports on vaping originally commissioned by Public Health England and now by the Office for Health Improvement and Disparities in the Department of Health and Social Care. This report was led by academics at King’s College London with a group of international collaborators and is the most comprehensive to date. Its main focus is a systematic review of the evidence on the health risks of nicotine vaping.

OHID Local Tobacco Control Data Profile
For additional data and information relating to smoking and tobacco use in England

References

[1] Cabinet Office and Department of Health & Social Care. Advancing our health: prevention in the 2020s https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document#executive-summary
[2] Office for National Statistics. What affects an area’s healthy life expectancy? https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/articles/whataffectsanareashealthylifeexpectancy/2017-06-28
[3] Office for National Statistics. Adult smoking habits in the UK
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2021#:~:text=The decrease in the proportion,aged 16 to 24 years."
[4] OHID Local Tobacco Control Profiles
https://fingertips.phe.org.uk/
[5] Ash Health Inequalities and Smoking
https://ash.org.uk/uploads/ASH-Briefing_Health-Inequalities_2022-03-24-183145_yuaf.pdf?v=1648146705



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