• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Overview

Smoking is the biggest identifiable cause of ill health and premature death in the UK. A quarter of the adult population smokes, and the prevalence is declining very slowly. If current trends continue we will not meet the targets for reducing smoking prevalence in the UK. Smoking will kill half of people who smoke throughout their life and half of those will die before reaching retirement age.

Stopping smoking can reverse much of the harm to health and reduce the risk of death, depending on what age people stop smoking. Beyond age 40, smokers will lose three to four months of life for every year they continue to smoke. The main causes of premature mortality due to smoking are cardiovascular disease (mainly myocardial infarction and stroke), some cancers, and respiratory disease (particularly chronic obstructive pulmonary disease).

Smoking is a main cause of socioeconomic inequalities in health. A major goal of public health policy is to reduce inequalities, improve overall rates of health, and reduce illness and death in the population. An estimated 21% of the socioeconomic inequality in mortality in men and 11% in women could be eliminated if everyone stopped smoking. ^{1 2}

Most smokers want to stop and intend to do so. The rate of attempts to stop is high –78 attempts per 100 smokers per year – although some people make several attempts in a year. Nearly half of all smokers expect not to be smoking in a year’s time, but only 2–3% actually stop; most attempts fail.

Lopez described four phases of the tobacco epidemic. ³ The UK is in the fourth phase, where smoking becomes increasingly concentrated in the most disadvantaged sectors of society. Forty years ago there was little association between smoking and disadvantage. The link is becoming increasingly strong and this will continue unless we take specific public health actions.

Smoking cessation is prompted by individual factors and societal influences. For example, tax raises have a major influence on behaviour and there is some evidence that banning smoking in indoor public places can also have modest effects on smoking cessation. ⁴ In the UK, Scotland and Wales have banned smoking in indoor public places, while Northern Ireland will do so on April 30 2007 and England will on the 1 July 2007.