Smoking and mental health - NCSCT

Smoking and mental health
6.2.6 Illicit tobacco
Illicit tobacco undermines tobacco control policy by reducing the price of
cigarettes, thus increasing demand and contributing to tobacco-related health
inequalities; the most disadvantaged people who smoke, among whom the
prevalence of mental disorders is particularly high, are twice as likely to buy illicit
tobacco as the most affluent. 44 It has been argued, particularly by the tobacco
industry, that smuggling is driven by high taxes, although this is not invariably
the case. 45
In the late 1990s, an estimated 20–30% of the market for tobacco in the UK
comprised illegally imported cigarettes. 46,47 Since 2000, HM Revenue and
Customs has taken measures to reduce illicit supply in the UK, and the market
share of illicit cigarettes is now estimated at around 10%; however, the market
share of illicit hand-rolling tobacco remains extremely high, at about 46%. 48
6.2.7 Minimum legal age for cigarette purchase
Laws restricting access to tobacco, if well enforced, can reduce use in young
people. 49 In 2007 (2008 in Northern Ireland) the minimum legal age of purchase
for tobacco products in the UK was raised from 16 to 18 years, and appears to
have had an impact on smoking uptake in England, where smoking prevalence
decreased more in 16–17 year olds between 2006 and 2009 after the increase in
age of sale, than in older age groups. 50 Proxy purchasing remains a problem,
however.
6.2.8 Smoking cessation services
At an individual level, UK tobacco control policy is targeted at offering people
the best help to quit smoking. Around two-thirds of those who smoke in the UK
report that they want to stop smoking, and over half have made a significant
attempt to do so in the past 5 years. 51 However, as only 3–5% of unaided quit
attempts are successful, providing people who smoke with the support needed to
increase the likelihood of a successful quit attempt is a fundamental aspect of
tobacco control. 52 As outlined in section 5.3, in the UK the NHS provides access
to free, local stop smoking services (SSS) for all smokers who want to quit. SSS
are offered predominantly in primary care, pharmacies and community settings,
and are effective, with around 14% of users achieving validated long-term (12-
month) abstinence. 53 The services are also highly cost-effective and may help to
reduce socioeconomic inequalities in smoking prevalence. 2,54 The NHS also runs
a stop smoking helpline, which offers advice and support, free of charge, to
smokers who want to quit. The main limitation of NHS SSS is, however, their
limited reach, because only 5% of quit attempts are made with the support of the
114 © Royal College of Physicians 2013