Survey reveals support for tougher tobacco control in Wales including smoking bans in town centres

The people of Wales are calling for tougher measures to reduce smoking prevalence, including bans on smoking in all town centres.

Results from the latest ASH Wales Cymru YouGov survey into attitudes towards tobacco control in Wales have been published to mark World No Tobacco Day and reveal overwhelming support for new measures and outdoor smoking bans.

Of those surveyed, 59% said they would support a ban on smoking in all town centres in Wales and 63% agreed smoking should be banned in the outdoor eating areas of cafes and restaurants. Meanwhile 63% of those surveyed said they would support a move to ban smoking in all cars.

According to the survey, nearly half (47%) of Welsh adults feel the government is not doing enough to reduce smoking prevalence in Wales up from 39% in 2018. A total of 68%, said they would support new government action to reduce smoking rates to less than 5% by 2035.

There was strong support too for measures aimed at reducing smoking among young people; 58% said they would support raising the age of sale limit for tobacco from 18 to 21. Meanwhile 83% called for businesses to be required to hold a valid licence to sell tobacco which would be removed if they were found selling to underage smokers more than once.  The survey also found 67% of Welsh adults support banning smoking from entertainment media aimed at young people.

John Griffiths AM, chairman of the Welsh Assembly’s Cross-Party Group on Smoking, said funding is needed to support smoking cessation activity in the community:

“As Chair of the Welsh Assembly’s Cross-Party Group on Smoking, I welcome the latest YouGov survey results which highlight that there is strong support for tackling smoking in Wales. The results show that nearly 70% of people would support new action to reduce smoking prevalence in Wales by 2035.

“Smoking is still the biggest cause of preventable mortality and health inequality in Wales and rates have stagnated at 19% since 2015. Community based actions at grass roots levels must have the financial support they need to effectively help people quit cigarettes for good. I look forward to continuing to work alongside ASH Cymru to further improve smoking cessation services and ensure we soon have a smoke-free Wales.”

Suzanne Cass is CEO of ASH Wales Cymru. She said the survey results prove how far the tide of public opinion has turned against smoking:

“These survey results show just how far we’ve come, from a society in which smoking was regarded as a normal part of daily life, to one where the public are demanding tougher measures to help stamp out this deadly addiction.

“There is now far greater awareness of the devastating health consequences of smoking with the older generation now suffering the consequences of a lifetime of smoking and 5,388 smoking related deaths in Wales alone every year.

“Thanks to a combination of tobacco control measures and campaigns to raise awareness of the impact of smoking on people’s lives, it is gradually become de-normalised, particularly among the all-important younger generation.”

The theme of this year’s World No Tobacco Day, is the impact of tobacco on lung health. Currently smoking prevalence in Wales stands at 19% of the adult population – 476,000 adults.

There are 5,388 smoking attributable deaths annually in Wales and the cost to the Welsh NHS is £302million. Across Wales lung cancer is the most common cause of cancer deaths – there were 1,891 deaths from lung cancer in 2017 and it accounted for over one in every five cancer deaths – more than bowel and breast cancer combined.

Tobacco and lung health – a global view

Dr Vinayak Prasad leads the World Health Organisation’s (WHO) Tobacco Free Initiative and is a world authority on the damage caused to health by smoking.  To mark World No Tobacco Day 2019, which this year focuses on lung health, we spoke to him about the impact of tobacco smoking globally.

 Does the impact of tobacco on lung health vary greatly across different countries?

The tobacco smoking risks are the same or similar across all countries. But the cause of death or disease patterns differ according to the way tobacco is used. For instance, in Southern Asia, there is a far greater use of smokeless tobacco, in other words chewing tobacco. So, in that part of the world diseases caused by chewing tobacco such as oral cancer are becoming predominant. It is also affected by which health conditions are more common in certain regions.

What are the links between smoking and tuberculosis?

Tuberculosis is a big problem in some countries and there a greater risk of mortality among those with TB who smoke. It is a cause of mortality that has been well established for more than a decade.  Smoking also more than doubles the risk of developing tuberculosis.

How big a threat is smokeless tobacco to global health?

Smokeless tobacco is used in over 80 countries and that’s huge. There are a lot of challenges in Sri Lanka for example, where smoking rates are still high but declining and smokeless tobacco use is rising. It is popular because it’s cheaper and it’s easily accessible for young people to consume and to use without being noticed in school.  80% of oral cancer deaths in that part of the world are because of one single product, smokeless tobacco.

Is there sufficient awareness globally about the harms caused by tobacco smoking?

Lung health and lung disorders are the most common disease factors in the world. This can come from multiple factors, whether it’s air pollution or tobacco. Interestingly in more than 30 countries where surveys have been carried out, 90% of people know that tobacco causes cancer, even in countries with a less literate population. However, it’s not the same story for  other conditions such as cardiovascular disease and COPD. Only 60 per cent know about these risks to lung health because of smoking.

How big is the impact of secondhand smoke globally?

The global picture is that more than 60% of secondhand smoke exposure affects women and children, which is a concern because they are not smokers but they are being affected. Children are hugely prone to asthma and to respiratory diseases from their parents smoking.

Most people don’t smoke in the workplace because of legislation but they go home and they tend to smoke.  The law of the land doesn’t prevent them from smoking at home at all. It’s more and more important to raise awareness of the harms of second-hand smoke.  And that cannot be imposed by law, it requires more community engagement and literacy. It’s very important, for instance, to teach children that it’s risky so they can go home and tell their parents that if they want to smoke they can go outside and smoke.

What should governments do to reduce the impact of tobacco on lung health globally?

World Tobacco Day 2019 is focused on tobacco and lung health to raise awareness of the negative impact of tobacco use on people’s health ranging from cancer to chronic respiratory diseases . And for us at this stage it’s important to raise awareness among all stakeholders. Tobacco control is the key factor to reducing NCDs (non-communicable diseases). Governments must prioritise tobacco control as part of their policies.

The WHO has a package of measures which we call MPOWER which are key demand reduction measures such as graphic warning labels on the products, banning tobacco advertisements and raising taxes. The UK has done extremely well in raising tobacco taxes.  Tax is the best instrument. That is the best levy.  It makes it difficult for the poor, the vulnerable, even the rich to consume so much tobacco. And it provides the government has additional revenue with which they could then help tobacco smokers to quit and launch awareness campaigns.

A classroom full of children still start smoking in Wales every day with the poorest teens most likely to take up the habit

New figures released today reveal the gap in smoking rates amongst Wales’ richest and poorest teenagers has widened.

According to the latest Health Behaviour in School-aged Children Report, youngsters from the most deprived families in Wales are now twice as likely to smoke compared to their affluent counterparts.

The survey of over 100,000 students, carried out by researchers at Cardiff University, showed 9% of 15-16-year-olds smoke at least once week, a figure that despite concerted efforts, has remained unchanged since 2013/14. More than 11,000 children still take up smoking every year in Wales

Differences in smoking rates across social classes remain a major concern as smoking is more than twice as common in adults in the most deprived areas of Wales (28%) compared to the least deprived (13%).

Across Wales smoking is a leading cause of death and ill health and a major driver of health inequalities.

Among those from the least affluent families, 6% of secondary school aged children now smoke at least weekly, compared to just 3% of those from the most affluent families.  This compares to 4% of the least affluent and 3% of the most affluent as reported in 2013/14.

Commenting on the latest figures, Suzanne Cass, CEO of ASH Wales, said: “It is shocking to discover that despite efforts to curb smoking among young people in Wales, a classroom’s worth of children continue to take up the habit every single day.

“Meanwhile the differences in the smoking rates between our richest and poorest youngsters are actually getting worse.

“Among the adult population of Wales, it is those people from the deprived areas that are the most likely to smoke. It is essential that we take action to prevent young people from those areas from becoming the next generation of adult smokers in Wales and from perpetuating the health inequalities that continue to blight our most deprived communities.”

Those who start smoking earlier in life are likely to become the heaviest smokers later in life as well as the least likely to quit. Research has shown the earlier children start smoking then carry on into adulthood, the greater their risk is of developing lung cancer or heart disease in later life.

The report also reveals the following differences in smoking prevalence and exposure to smoking between the most and the least affluent youngsters in Wales:

  • 46% of Year 11 students from the most deprived families first tried a cigarette at 13 or younger compared to 34% of the most affluent. In 2013/14, 61% of those from the least affluent families had tried at cigarette at 13 or younger, compared to 38% from the most affluent families.
  • 8% of young people were exposed to smoking during their most recent car journey – a significant decrease compared to 13% in 2013/14. This figure rises however depending on the young person’s background with 5% of those from a more affluent background having been exposed to smoke during their last car journey, compared to 14% from the most deprived families.  In 2013/14 23% of youngsters from a deprived background said someone was smoking the last time they were in a car, compared to 10% of youngsters from a more affluent background.
  • E-cigarette use has not been shown to vary greatly depending on a child’s background. 28% of those from the least affluent families said they had tried an e-cigarette, compared to 24% from the most affluent.  The figure was the same for both groups in 2013/14 at 12%. Only 4% of those from the least affluent backgrounds and 3% from the most affluent said they used e-cigarettes regularly.

Following the release of the figures, ASH Wales is calling for a more targeted approach to reducing youth smoking prevalence, with prevention and cessation work provided in those areas where it is most needed.

Suzanne Cass, CEO of ASH Wales, said: “It is clear from these figures that tobacco control policies designed to restrict young people’s access to cigarettes are not working, with no change in the number of pupils lighting up.

“Tobacco companies want nothing more than to trap these youngsters into a cycle

of addiction that will see them become their customers for life. The only way to break that cycle is to identify those most at risk of smoking and arm them with the tools they need to resist temptation or to quit.”

“We would like to see prevention and cessation support for young people available in both community and educational settings and families provided with the support they need to quit together. In addition, we believe smoking prevention work should form part of the new National Curriculum for Wales 2022.”

Currently 19% of the adult population in Wales smoke. There are around 5,388 smoking related deaths and 26,489 smoking related hospital admissions in Wales every year and the cost of this to NHS Wales is around £302 million a year.

Student Health and Wellbeing In Wales: Report of the 2017/18 Health Behaviour in School-aged Children Survey and School Health Research Network Student Health and Wellbeing Survey, was compiled by Cardiff University’s Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer).

Editor’s Notes

Enquiries: Diana Milne | PR Officer  | diana@ashwales.org.uk |

Or Beth Mahoney | marketing and communications manager | Beth@ashwales.org.uk |

Interviews available. Please contact using the details above.

Mental Health, Smoking and Me?

Charlotte Harding, author of Welsh Mummy Blogs overcame the challenge of giving up smoking, despite suffering from mental health problems. To mark Mental Health Awareness Week, she tells us her story.

Can you tell us about your experiences of mental health issues?

I have suffered ill mental health from a young age. I first started seeing a psychiatrist at 14 years old when I was suffering from anorexia. From there I was diagnosed with an anxiety and panic disorder. I suffer with depression at times and I was diagnosed with a more severe mental health illness years later.

When did you start to smoke?

I started to smoke on and off around 15 years old, I was smoking full time at 16.

Did you smoke to relieve symptoms of your mental health issues?

100% yes! I found smoking stopped me eating. I also found that I smoked more when my anxiety was high. Smoking in a way regulated my breathing and this would help with my panic attacks, or so I thought.

Do you think suffering from mental ill health made it more challenging for you to give up smoking?

I made the stop smoking Wales service aware of my mental illness before I started the smoking cessation. I explained that I am not good sitting in a group environment and would benefit more if I was having 1:1 meetings. They said it wasn’t a problem, I just had to wait for a space to be available.

Giving up was extremely difficult. I found I was craving a cigarette every time my anxiety played up, which was constant when quitting. I found I had really bad mood swings which played on my mental health.

I also found that I was hungry more often whilst giving up, and I gained around 1st due to snacking. This caused a few problems, I found I tried to restrict calories in my food due to the weight gain. This did resolve itself once the cigarette cravings lessened.

I explained I was finding quitting difficult to my GP and she decided to support me after the smoking cessation finished. I was prescribed my Quick Mist Spray for almost a year. In the end, I decided to go ‘cold turkey’ and I quickly found that I was no longer addicted to nicotine, I just had a habit of reaching for my spray when I felt stressed or anxious.

Would you say there is enough support available for those suffering from mental ill health to give up smoking?

I was lucky, I had a really supportive GP who prescribed me nicotine replacement after the 12 weeks stop smoking service. The GP said she would rather put the nicotine replacement on my repeat than me going back to smoking. If I didn’t have a good GP I would probably had started smoking after the 12 week service.

What advice would you give to anyone with mental ill health who would like to give up smoking?

Go for it! You will feel so much better once you have quit. It may be hard at times but it is so worth it. Be honest with your GP and/or stop smoking adviser, they will help. Most GPs would prefer you on nicotine replacement than smoking.

Mind over matter – why quitting smoking could improve your mental health

Did you know that quitting smoking could improve your mental health? To find out more, we’ve taken a look at how smoking affects your state of mind.

Smoking and stress

It’s a common misconception that smoking helps to relieve feelings of stress and anxiety. Many smokers will automatically reach for a cigarette when the going gets tough.  And while it’s true that puffing on a cigarette will bring a feeling of instant relaxation, in the long term, smoking becomes the cause not the cure for stress.
Once gripped by nicotine addiction, smokers quickly find themselves in a never-ending cycle of smoking to relieve nicotine withdrawal symptoms, experiencing the warmth of a nicotine hit, before the withdrawal symptoms kick in once again. These withdrawal symptoms and cigarette cravings then become the cause of anxiety symptoms which can only be relieved by smoking another cigarette, and so the cycle goes on.

Smoking and depression

It is unclear whether smoking leads to depression or vice versa however, according to the Mental Health Foundation, smoking rates in the UK, are around twice as high among adults with depression as among the general population.    It can be more challenging for people suffering from depression to give up smoking.   Nicotine stimulates the release of dopamine in the brain which is the chemical responsible for triggering positive feelings. Those with depression often have low levels of dopamine. As a result, some people use cigarettes to temporarily increase their levels of dopamine. Regular smoking leads the brain to switch off its own mechanism for making dopamine, meaning that in the long-term supplies decrease, encouraging people to smoke even more.

Medication

Smoking can make prescribed medication for some mental illnesses less effective. This means the smoker would have to take higher doses of their medication in order for it to work effectively. Smoking is known to interfere in particular with the way some antipsychotic medication and antidepressants work.

The benefits of quitting for mental health

According to the NHS quitting smoking can be as effective as antidepressants when it comes to  treating anxiety and depression.   Although coping with cigarette cravings can be tough, those with mental health problems who successfully quit the habit are likely to feel calmer, more positive and have a better quality of life.  Quitting means escaping the cycle of nicotine cravings but also the pressure to fund a habit that costs on average £56 a week and £243 a month for a 20-day smoker.

How to quit

All smokers are different and there is not one quit method or smoking cessation services that suits everybody. To help you find the quit smoking support that is best for you contact Help Me Quit, NHS Wales’ free smoking cessation service.  To get in touch text HMQ to 80818, call 0800 085 2219 or click here to visit the Help Me Quit website.

Depression and smoking – one woman’s journey to a smokefree life

To mark Mental Health Awareness Week we have asked ex-smokers who have experienced mental health problems to tell us their smoking story and how they quit. Today we hear from Tracey Jones *  from North Wales  who suffers from depression and has recently quit smoking.

Can you tell us about your own experiences of mental health issues?

I have experienced depression at low and stressful times of life. The longer the stressful situation, the worse it gets. I’d describe it as like having a very sad stone in your stomach, it’s always there. Sleeping takes away the feeling.

When did you start smoking

I started smoking at around 15 or 16-years-old. At first I just wanted to have a go but I was hooked instantly. Yes, smoking helped to relieve my depression but all it does really is hide issues, and build up a habit at the same time.

In your experience do you think there is enough support out there to help people with mental health issues to stop smoking?

I do think that people with depression and anxiety need much more support, and it’s not out there. Most help is fully booked, and the staff, well meant as they are , don’t really understand. And it’s the dealing with people thing that makes it even more difficult.
Quitting is extra hard I guess for people dealing  with depression and addiction on top of that. The lack of nicotine and habit is extra pressure ( not to mention pressure from other people)

How did you give up smoking?

This my fifth serious attempt at quitting. This time I didn’t tell anyone, and used inhalators bought online. I bought sugar free mints, and used an app to monitor the benefits. To be honest, the hardest thing has been food, and feeling sad.

How has your life changed as a result of giving up smoking?

It’s early days still. But I already have a better sense of taste and smell. My home smells better. My chest is clear, and I have no cough. And I have a lot more time on my hands! And my bank is much healthier.

What advice would you give to anyone who suffers from anxiety or depression and is worried about quitting smoking?

Do it your way. Prepare. Read up. Monitor your progress with an app. Nap when you can ( the body kind of goes into shock when you quit), and empty your house of all smoking paraphernalia!

* Surname changed