Understanding the impact of the recession on smoking

1
Understanding the impact of the recession on
smoking
Robert West

• University College London
• June 2009

2
Outline

• Why might the recession influence smoking
  cessation?
• Is the recession influencing smoking and if so
  how?

3
Why might the recession influence smoking?
Unemployment
Increased smoking
More idle time
Anxiety
Reduced salaries
Reduced motivation to stop
Depression
Insecurity about job/business
Greater difficulty stopping
Lose sense of purpose
Less disposable income
Increased motivation to stop
Unemployment in close relatives
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What would one expect?

• Balance of forces
• Rise in real cost of smoking leading to reduced
  smoking
• Vs
• Financial stress deterring quit attempts and
  making it harder to stop
• Actual income reduction in early phase of the
  recession is limited to minority of smokers while
  increased stress would be more widespread
• Prediction
• smokers would delay quitting and focus on
  immediate priorities
• smokers who try to stop would find it harder
• smoking prevalence would rise or fail more slowly

5
Smoking prevalence trends
Total population

• Smoking prevalence declined rapidly for the first
  9 months following the ban on smoking in indoor
  public areas in July 2007
• There was a rebound at the start of the recession
  (2nd quarter of 2008) and prevalence has remained
  static since then

Pre-ban
Post-ban
Recession
By social grade
Refs 1) www.smokinginengland.info 2)
Financialadvice.co.uk. When did the UK recession
officially start?. URLhttp//www.financialadvice.
co.uk/news/12/ukeconomy/9795/When-did-the-UK-reces
sion-officially-start-to-kick-in.html. Accessed
2009-05-31. (Archived by WebCite at
http//www.webcitation.org/5hBmp6M4c)
6
Attempts to stop in past month

• Monthly rate of attempts varies from 5 to 14 of
  smokers
• The major peaks are at New Year with minor peaks
  in March-April and at the time of smoke-free

Refs www.smokinginengland.info
7
Attempts to stop 2007 vs 2008

• Fewer attempts to stop in 2008 compared with 2007
• At least partly due to extra peak due to
  smoke-free
• No obvious decline since start of recession

Refs www.smokinginengland.info
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Tentative conclusion

• Recession may be making it harder to stop rather
  than reducing number of quit attempts

9
Key findings from McNeil survey

• Stress is a major perceived barrier to quitting
• Cost of smoking is less of a barrier because
  smokers cut back on other spending instead
• Almost half of smokers do not believe that NRT is
  helpful
• Almost one-third of smokers do not know NRT is
  available on prescription

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Addressing the problem

• Greater efforts to educate smokers
• NRT greatly increases chances of quitting
• It is available on prescription
• Makes it cheaper
• Provides opportunity for professional support
  from GP or stop smoking service
• Higher dose forms and safe and effective
• Combining patch plus an acute form is better than
  using either alone

Ref Stead, L.F., et al., Nicotine replacement
therapy for smoking cessation. Cochrane Database
Syst Rev, 2008(1) p. CD000146.
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Discussion points

• What can health professionals do?
• Emphasise potential value of prescriptions
• Put efficient system in place for obtaining NRT
• Make smokers are aware of benefits of newer ways
  of using NRT
• Specifically address issue of stress arising from
  economic situation