1. Smoking
Overview
This is the most important preventable risk factor for death from cancer and cardiovascular
disease.i,ii (It is also important to remember that, in addition to the unequivocal evidence that
smoking damages the smoker’s health, there is also substantial evidence that exposure to
second-hand tobacco smoke (e.g. smoke from other people’s cigarettes) harms non-
smokers.iii,iv,v,vi,vii )
Figure 1 shows the estimated prevalence in different London boroughs. Even though Barnet’s
smoking prevalence overall is estimated to be only 17.9% and is one of the lowest in London,
this still means that there are some 60,000 smokers in the borough.
Figure 1: The estimated prevalence of smoking in different parts of London
35
Estimated smoking prevalence (%)
30
25
20
15
10
5
0
Ha row
db m
ea ley
Ea n
sm ch E n g
Ha h a eac ld
en B et
ne Cam ey
Te ham
Ch ton
lli ng
Ne ham
ac n
w th
mn
w Me k
un n
an lin w
ke e
er
ut am
tm rth
W F ts
om g
W dsw st
H ng
al Ha on
ge Fu ng
Ba am
ng a
oy g
ar
lin
do
ic idg
Te de
La sto
Ho gdo
Br in
Ki lse
Is lo
T fi e
Re ha
rn
Cr in
Le be
am le
e
st
l
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t T ex
hi
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rin nd hi
tto So nh
a hw
g
an or
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s
ar
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ity
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Source: Health Surveys for England 2003-2005viii
The risk we face
Tobacco use is the most important preventable risk factor for death from cancer and
cardiovascular disease.ix,x About 2,600 people die in Barnet each year. Of these, about 440 die
from smoking-related diseases.xi This is more than from any other cause and these deaths are
all preventable.
Smoking tobacco causes diseases that affect nearly every part of the body. Smoking is
especially damaging to the lining of blood vessels and leads to a reduced blood supply to
various parts of the body. It is therefore a leading and avoidable cause of heart attack, kidney
failure, intermittent claudication and impotence. For the same reason, people who are smokers
when they have operations are more likely to suffer from wound breakdown and to have
delayed bone healing. Among many other conditions caused by smoking are chronic
obstructive pulmonary disease (COPD), coronary heart disease, osteoporosis, insulin
resistance in diabetes, infertility, age-related macular degeneration (the most common cause of
blindness in older people), premature menopause, Crohn’s disease, gastro-oesophageal reflux
and peptic ulcers, bone resorbtion and tooth loss, multiple sclerosis, thyroid disease, hearing
loss, and liver disease. Women who smoke when pregnant damage the placenta and this leads

2. to a reduced blood supply to their baby. Smoking is also a cause of premature hair loss and
premature skin ageing (so children are right: smoking does make you look older).
In addition to the unequivocal evidence that smoking damages the smoker’s health, there is
now substantial evidence that passive exposure to tobacco smoke harms non-
smokers.xii,xiii,xiv,xv,xvi Second-hand smoke causes lung cancer, coronary heart disease, stroke,
asthma attacks, reduced growth of babies in the womb and premature birth, and in children it
causes cot death, middle ear diseases, respiratory infections, the development of asthma in
those previously unaffected and asthma attacks in those already affected.xvii
The relationship between diversity and deprivation and smoking-related disease
There are differences in smoking habits between the sexes and between people in different
ethnic groups. This is shown in Figure 1. Principally, this is important when planning smoking
cessation services. It is important that promotion and provision of such services are culturally
appropriate and that smokers see them as relevant to them and not just to others.
Figure 1: Current cigarette smoking by ethnic group and sex in England in 1999
General population
White Irish
Indian
Pakistani
Bangladeshi
Black Caribbean
Men
Chinese Women
0 10 20 30 40 50
Proportion of smokers in different ethnic groups (%)
Source: Office for National Statisticsxviii
Smoking is more prevalent amongst people who live in deprived areas. Figure 2 shows the
differences in smoking habits between people from different social classes; people in routine
and manual occupations (and those who are unemployed) are more likely to live in deprived
areas than those in managerial and professional occupations.

3. Figure 2: Cigarette smoking by sex and socio-economic classification, adults aged 16
and over, 2006, Great Britain
35
Men
30
Women
25
20
15
10
5
0
Managerial & Professional Intermediate Routine & Manual
xix
Source: British Heart Foundation
As smoking is the cause of so many deaths, and it is more common amongst people living in
more deprived areas, an important cause of the differences in death rates between affluent and
deprived areas is likely to be smoking. Seeking to increase the proportion and the absolute
number of smoking quitters in deprived areas will thus contribute to reducing health
inequalities.
Finally, deaths from COPD – principally a disease caused by smoking – in Barnet are now
higher amongst women than men, and deaths from lung cancer in women will soon become
more common than deaths from breast cancer. This is simply because an increasing number of
women took up smoking in the 1940s and 1950s: they are now reaping the longer-term
consequences of this.
Local targets
Figure 3 shows how the number of people quitting smoking through NHS services has
increased over the last few years. In 2005/06, Barnet PCT exceeded its target for smoking
quitters for the first time and did so again last year. Currently, the PCT is ahead of our quarterly
target and should exceed the target for 2008/09.
The PCT also has a ‘stretch target’ to enable a higher proportion of smokers in the seven most
deprived electoral wards in Barnet to quit smoking. This target was achieved last year and,
again, the PCT is ahead of its quarterly target and should exceed the annual one.
Figure 3: The number of people quitting smoking through NHS services in Barnet
3500
Number of smoking quitters
3000
2500
2000
1500
1000
500
0
2002/03 2003/04 2004/05 2005/06 2007/08
Source: Barnet PCT Stop Smoking Service data returns to Department of Health

4. Key things that need to be done
The key activities required are:
maintaining current performance on smoking cessation;

identifying greater numbers of quitters in more deprived areas and enabling them to quit (see

also section );
introducing techniques, such as measuring ‘lung age’ to increase quit rates; and

raising awareness amongst health and social care personnel and the public of the risks of

being a smoker when a surgical procedure is required to encourage and facilitate more
smokers to quit.

5. i
Bartecchi CE, MacKenzie TD, Schrier R. The human costs of tobacco use (I).New NEJM 1994;330:907-12
ii
Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on
male British doctors.Br Med J 1994;309:901-911
iii
Eriksen MP, Gottlieb NH. A review of the health impact of smoking control at the workplace. Am J Hlth
Prom 1998;13:83-104
iv
Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco
smoke. Br Med J 1997;315:980-988
v
Zaridze DG, Peto R, (eds). IARC Scientific Publications No. 74. International Agency for Research on
Cancer. Lyon, 1986
vi
Morris PD. Lifetime excess risk of death from lung cancer for a U. S. Female never-smoker exposed to
environmental tobacco smoke. Environmental Research 1995;68:3-9
vii
Siegel MS. Involuntary smoking in the restaurant workplace. JAMA 1993;270(4):490-493
viii
http://www.ic.nhs.uk/webfiles/Popgeog/Model%20Based%20Estimates%20of%20Smoking%20%28adults
%29%20for%20PCOs%20in%20England%2C%202003-2005.xls (accessed 14 October 2008)
ix
Bartecchi CE, MacKenzie TD, Schrier R. The human costs of tobacco use (I).New NEJM 1994;330:907-12
x
Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on
male British doctors.Br Med J 1994;309:901-911
xi
Callum C, White P. Tobacco in London: the preventable burden. London Health Observatory. London. 2004
xii
Eriksen MP, Gottlieb NH. A review of the health impact of smoking control at the workplace. Am J Hlth
Prom 1998;13:83-104
xiii
Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco
smoke. Br Med J 1997;315:980-988
xiv
Zaridze DG, Peto R, (eds). IARC Scientific Publications No. 74. International Agency for Research on
Cancer. Lyon, 1986
xv
Morris PD. Lifetime excess risk of death from lung cancer for a U. S. Female never-smoker exposed to
environmental tobacco smoke. Environmental Research 1995;68:3-9
xvi
Siegel MS. Involuntary smoking in the restaurant workplace. JAMA 1993;270(4):490-493
xvii
British Medical Association. Tobacco – passive smoking British Medical Association. London, 2003
xviii
http://www.statistics.gov.uk/cci/nugget.asp?id=466 (accessed 14 October 2008)
xix
http://www.heartstats.org/temp/Figsp4.8spweb08.xls (accessed 14 October 2008)