Wednesday 13th March 2024
National No Smoking Day, which has occurred annually since its integration with Ash Wednesday in 19841, has served as an annual reminder for individuals striving to quit smoking. In the United Kingdom, No Smoking Day holds significance with campaigns aimed at raising awareness about the health risks associated with smoking and encouraging smokers to quit. The goals of No Smoking Day include promoting smokefree environments, supporting smoking cessation services, and advocating for stricter tobacco control measures to protect public health. This article aims to explore the current challenges faced by those seeking to quit smoking in the UK and educate future generations about the evolving laws surrounding tobacco control policies and the sale and purchase of tobacco products.
In 2019, the UK government released a green paper, announcing that the 2020s will be the decade of proactive, predictive, and personalised prevention2, setting an objective for England to be
‘Smokefree’ by 2030 by reducing adult smoking to 5% or less3, and increasing the legal age to smoke for those born after 2008. Additionally, as of January 2024, the government has announced that by the end of 2025, disposable vapes will be banned to protect children’s health, due to how easily accessible they are. The government also plans to introduce plain packaging and restrict flavours as most vapes come in sweet flavours.
With these new massive law-enforced restrictions that will soon be introduced in England, there are still challenges that we face with smoking cessation including cultural, educational, social, and future challenges.
Current and Future Challenges
Cultural Challenges:
In England, smoking rates among ethnic minorities are lower rates than Caucasian groups, but the rates within ethnic groups are often gendered with men generally higher than women4. In 2019 smoking habits had a large difference in sex in Asian (13.9% in men and 2.9% in women), Chinese (12.6% in men and 4.0% in women), and black (12.9% in men and 6.9% in women) groups5. Other forms of tobacco are more common in some ethnic groups, shisha (waterpipe) use in 2012-2013 was estimated to be frequently used by about 1% of the British population, with higher rates in Asian (7%), mixed (5%), and Black (4%) groups6. The smoking cessation process can pose difficulty when people have recently immigrated to the UK from countries that had higher smoking rates where there are different legal and cultural frameworks taken to tobacco use4.
Educational Challenges:
To help with smoking cessation in the UK, healthcare professionals should be able to advise smokers on how to quit smoking; a short survey conducted by Hunter et al. (2019) aimed to identify the extent of smoking cessation teaching and examination in 21 UK pharmacy schools. The survey concluded that there was a lack of training on the management of pregnant smokers and mental health patients who smoke. It was documented that 11 (52%) schools taught about the management of pregnant smokers and 3 (14%) schools taught about the management of mental health patients who smoke. Smoking during pregnancy is the most preventable cause of adverse pregnancy health outcomes, with half of the pharmacy schools teaching about this. There was also little attention given to mental health patients who smoke, pharmacists need to provide support to vulnerable populations7.
The limited education provided to pharmacists regarding the management of pregnant smokers and mental health patients who smoke may result in a lack of accessibility to smoking cessation support for future patients. The lack of understanding regarding the harms of smoking could lead to significant repercussions.
Social Challenges:
Smoking used to be considered as a social activity, however a 12-year follow-up study by Phillip et al. (2022) found that smokers were more likely to be lonely and socially isolated compared to non-smokers. With a sample size of over 8000, with a mean age of 67 years old, this observational study found that smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with friends and family, less frequent engagement with the community and cultural activities, and being more likely to live alone8.
The idea of smoking being a social activity may be a misconception, with insufficient social support can be a challenge when trying to quit smoking, as individuals not surrounded by friends and family may not find the motivation to stay smoke-free.
Future Challenges:
As the next generation will not legally be able to buy tobacco products, this could create a gap in education and awareness. Without ongoing efforts to educate young people about the dangers of smoking and the benefits of being smoke-free, they may not fully understand the harm it can cause. While the accessibility to tobacco products is already restricted in shops, minors could still be exposed to environments where smoking is normalised, such as having a parent who legally smokes. Without continued education, the future generation might not understand why they legally cannot smoke. With tobacco prices already high and set to rise more to deter smokers, those who still wish to smoke tobacco or sell tobacco products without paying taxes can turn to the illegal importation of tobacco which is sold at cheaper rates on the black market. As of 2020-2021, it is estimated that 16% of cigarettes purchased in the UK were from the black market9. The number of children using vapes has tripled in the last three years with 69% of current vapers aged 11 to 17 years old10. With the upcoming ban on tobacco products and the upcoming ban on disposable vapes, there is still access to non-disposable and refillable vape kits being sold, as well as the existing black market of disposable vapes in corner shops that are illegally imported11.
Those born after 2008 may encounter different challenges related to smoking compared to the previous generations so there needs to be continual regulations, education, and support to advance to smokefree UK.
Carbon Monoxide (CO) testing:
Bedfont® Scientific Ltd. manufactures the Smokerlyzer® range, non-invasive breath testing devices measuring carbon monoxide (CO) to help people stop smoking, one breath at a time. The Smokerlyzer® range consists of the Micro+™, piCObaby™, piCO™, and the homecare CO device the iCOquit®. All devices provide instant results with a traffic light system making CO levels identifiable to patients, whilst acting as a motivational tool to help them quit smoking. In addition to behavioural support and nicotine replacement therapy (NRT), CO devices have been integrated into stop-smoking programmes for years, used as a bio-verification tool that can identify CO on the breath (produced by incomplete combustion burning of tobacco products) and therefore confirm abstinence from traditional tobacco smoking, in addition to being used as a motivational tool for smokers.
To find out more about how you can support families with smoking cessation, visit https://www.bedfont.com/smokerlyzer
References:
1. National No Smoking Day [Internet]. UK Parliament. 2023. [Cited Friday 23rd February 2024]. Available from: https://commonslibrary.parliament.uk/research-briefings/cdp-2023-0056/#:~:text=National%20no%20smoking%20day%20has,supported%20by%20Alzheimer’s%20Research%20UK
2. Advancing our health: prevention in the 2020s- consultation document [Internet]. GOV.UK. 2019. [Cited Wednesday 31st January 2024]. Available from: https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the- 2020s/advancing-our-health-prevention-in-the-2020s-consultation-document
3. The Smokefree 2030 ambition for England [Internet]. House of Commons Library. 2023. [Cited Wednesday 31st January 2024]. Available from: https://researchbriefings.files.parliament.uk/documents/CBP-9655/CBP-9655.pdf
4. Tobacco and Ethnic Minorities [Internet]. ASH. 2019. [Cited Friday 2nd February 2024]. Available from: https://ash.org.uk/uploads/ASH-Factsheet_Ethnic-Minorities-Final-Final.pdf?
5. Adult smoking habits in the UK: 2019 [Internet]. Office for National Statistics. 2020. [Cited Friday 2nd February 2024]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies…
6. Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, Irani J. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review.
BMC public health. 2011 Dec;11(1):1-2. PMID: 21504559 PMCID: PMC3100253 DOI:10.1186/1471-2458-11-244.
7. Hunter A, Bobak A, Anderson C. A survey of smoking cessation training within UK pharmacy education. Currents in Pharmacy Teaching and Learning. 2019 Jul 1;11(7):696-701. PMID:
31227092 DOI: 10.1016/j.cptl.2019.03.007.
8. Philip KE, Bu F, Polkey MI, Brown J, Steptoe A, Hopkinson NS, and Fancourt D. Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older
adults in England. The Lancet Regional Health–Europe. 2022 Mar 1;14. DOI:10.1016/j.lanepe.2021.100302.
9. Outputs for April 2021 to March 2022 [Internet]. GOV.UK. [Cited Tuesday 13th February 2024]. Available from: https://www.gov.uk/government/publications/annual-outputs-for-tacking-tobacco-smuggling/outputs-for-april-2021-to-march-2022#:~:text=The%20government%20has%20had%20a,cigarettes%20and%20hand%2Drolling%20tobacco.
10. Department of health and social care media centre [Internet]. GOV.UK. 2024. [Cited Friday 2nd February 2024]. Available from: https://healthmedia.blog.gov.uk/2024/01/30/creating-a-smokefree-generation-and-tackling-youth-vaping-what-you-need-to-know/
11. The UK disposable vape ban: Impacts and alternatives [Internet] Vape Superstore. 2024. [Cited Friday 2nd February 2024]. Available from: https://www.vapesuperstore.co.uk/blogs/news/are-disposable-vapes-being-banned-in-the-uk