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13 March 2019
It’s National No Smoking Day on the 13th March. So what help is there on offer to quit in Wales, and what has the Welsh Government done to move towards a smoke-free future for Wales?
On No Smoking Day, everyone is encouraged to ‘come together to inspire, motivate and support others to take the first step towards quitting smoking’.
Smoking is the UK’s number one cause of avoidable premature death, linked to a range of serious and often fatal conditions (Public Health Wales Observatory).
Who smokes in Wales?
The 2017-18 National Survey for Wales showed that 19% of adults in Wales smoke.
Smoking prevalence in the survey is broken down by Local health Board; Cardiff and Vale report the lowest rates of adult smoking at 16%, while Abertawe Bro Morgannwg and Cwn Taf report the highest at 21%.
Public Health Wales’ annual quality statement 2017/18 notes:
- Over 5,000 deaths in Wales are due to smoking;
- 1 in 6 of all deaths in people aged over 35 are due to smoking;
- More than 26,000 hospital admissions every year are estimated to be due to smoking
According to a Public Health Wales Statistical bulletin (2017/18) on Maternal Health, 21.1% of women across Wales, were smokers at their initial pregnancy assessment. The 2010 Infant Feeding Survey found that more mothers living in Wales (PDF 328KB) smoke throughout pregnancy than in any other nation in the UK.
In response to this finding, Public Health Wales established the Models of Access to Maternal Smoking cessation Support (MAMSS) project, and ran pilot interventions in Health Boards.
The importance of targeting pregnant women who smoke within the antenatal clinic setting was highlighted. The service delivery model developed for MAMSS, including the recruitment of specialist stop smoking practitioners based within the antenatal setting, was found to produce positive results in terms of referrals to services and engagement.
The final project report made a number of recommendations for improvements, including the provision of carbon monoxide (CO) monitors to every midwife in wales, specialist stop smoking support embedded in antenatal care, and improvements to data collection. The report said next steps should include an audit of the implementation of NICE guidance across all maternity and stop smoking service in Wales, and securing funding for specialist support.
What are the Welsh Government doing?
In 2017 the Welsh Government published the Tobacco control delivery plan for Wales 2017-2020, the foreword states:
New Welsh legislation will play a key part in de-normalising smoking and protecting non-smokers from exposure to second-hand smoke. The Public Health (Wales) Act 2017 will address a number of specific public health concerns linked to the harms associated with smoking and; the Well-being of Future Generations Act 2015 will ensure that well-being planning across communities will limit the impact of tobacco on individuals, now and in the future.
The plan outlines outcomes to be achieved by 2020, including;
- Reduce adult smoking in Wales to 16% (from 19%).
- Reduce the percentage of 15-16 year olds who regularly smoke to 5% (from 9%).
- Focus on smokers form the most deprived areas.
- Reduce the number of pregnant women who smoke at 36 weeks gestation, after establishing baseline figures, with year on year decreases in each Health Board.
ASH Wales say that according to current projections, the Welsh Government target of 16% of Welsh Adults smoking by 2020, will be missed by 5 years.
Public Health Wales have reaffirmed their commitment to meeting the 16% target by 2020 despite smoking prevalence in Wales remaining at 19% since 2017.
In 2018 the Welsh Government commissioned an independent review of the provision of smoking cessation services in Wales., to ‘set out the commonalities of thinking of the strategic stakeholders about the best approach to their future provision both locally and nationally’.
Public Health (Wales) Act 2017
The Act re-states restrictions on smoking in enclosed and substantially enclosed, public and work places. Additionally, it places restrictions on smoking in outdoor care settings for children, school grounds, hospital grounds and public playgrounds. According to the Explanatory Memorandum (PDF 2MB), this aims to contribute to the de-normalisation of smoking, by providing fewer opportunities for the activity of smoking to be seen.
The Act gives Welsh Ministers power to extend the restrictions on smoking, to additional premises or vehicles, where it’s considered that this is ‘likely to contribute towards the promotion of the health of the people of Wales’.
The Act goes on to establish a national register for retailers of tobacco products, making it illegal to sell such products without being registered. It also outlines offences relating to the sale of tobacco or nicotine containing products to anyone under 18.
Smoke-free areas are expected to be in place by summer 2019.
For more information on the Public Health (Wales) Act 2017 and its passage, see the Assembly webpages.
Display of tobacco products in shops
The Welsh Government changed the law to remove permanent displays of tobacco, from December 2012 for large shops, and April 2015 for all other shops. The tobacco display ban guidance makes it clear that it is illegal to sell tobacco products to persons under 18, and places restrictions on the display of pricing, and storage, of tobacco products (which must be out of sight).
See our blog post on the removal of tobacco products from public view.
Smoking in cars
From 2015 it has been illegal to smoke in a car in Wales, if a child under 18 is present. The then Health and Social Services Minister Mark Drakeford AM said:
This change in the law is about protecting those children and young people who have no choice but to inhale the second-hand smoke of others. When people decide to light-up while children are in the car with them they risk the lives of those young people.
ASH Wales has published guidance on the law, the reasons behind it and its enforcement.
What help and advice is there to stop in Wales?
Help me quit
Help me quit is the unification of NHS Wales smoking cessation services, and can provide access to all stop smoking services in the Welsh NHS. The webpages detail the choices of support available, as well as a services search by local area. NHS Wales gives information on how you can be referred to Help me Quit either by your GP or via self-referral.
You can call Help me Quit on 0800 085 22 19 for help to give up smoking.
Action for smoking and health (ASH) Wales, is a registered charity, established in 1976, working toward a smoke free Wales (defined as just 5% still smoking).
According to the Welsh Government’s Tobacco control delivery plan for Wales 2017-2020, third sector leadership is provided by ASH Wales. With funding provided for a further three years to enable the organisation to support the tobacco plan.
ASH Wales also runs a campaign called Smokefree baby and me, aimed at supporting pregnant women to quit smoking.
Just B Smoke Free
Developed by Public Health Wales, Just B smoke free is a school based program designed to stop children from starting smoking. Year 8 (12-13 years old) pupils are encouraged to discuss the risks of smoking and the benefits of being smoke free.
65 schools across Wales, in areas with the highest risk of smoking, have been identified to participate in the JustB Smoke Free programme.
The 3 core elements of the program are:
- Whole School approach to tobacco control with links to the Welsh Network of Healthy Schools
- Peer influence model
- Young people to become aware of the tactics the tobacco industry uses to recruit smokers and incorporate elements of successful America ‘Truth’ campaign
What about E-cigarettes?
There is currently no legislation in Wales (or in other parts of the UK) which prevents the use of electronic cigarettes in public places, however organisations are able to set their own policies regarding use of electronic cigarettes on their premises.
In the 4th Assembly the Welsh Government’s Public Health Bill included proposals to restrict the use of electronic cigarettes in enclosed or substantially enclosed public places and workplaces, in line with the restrictions on smoking tobacco. That Bill was not passed, and the public health legislation introduced in this Assembly (now the Public Health (Wales) Act 2017) did not include the proposals to restrict the use of electronic cigarettes. The Act does include some provisions which relate to electronic cigarettes – it prohibits the handing over of tobacco and nicotine products to people under the age of 18, and establishes a register of retailers of tobacco and nicotine products. See our blog post for more information.
Public Health Wales, in 2017, published an updated position statement on E-cigarettes.
Dr Julie Bishop, Director of Health Improvement for Public Health Wales, said:
In simple terms, if you don’t smoke, don’t vape. But if you are a committed smoker who is unwilling or unable to quit, switching completely to e-cigarettes will be beneficial to your health.
Article by Holly Kings, Senedd Research, National Assembly for Wales
The Research Service acknowledges the parliamentary fellowship provided to Holly Kings by the British Biosciences Research Council, which enabled this Research Briefing to be completed.