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Key points from our tobacco deep dive session

In September 2023, the Reducing Inequalities Alliance network came together to discuss tobacco control.

This was to support the Bradford District Tobacco alliance in developing their new strategy, which is being led by Public Health. Below you will find areas of focus from the session.

Smoking prevalence

Smoking is the principal driver of health inequalities. Smoking has a far greater impact on life expectancy than a person’s social position in society. It is the leading cause of preventable disease, disability and premature death in England and the leading cause for the gap in life expectancy between rich and poor.

Smokers loose on average 10 years of life, or around 1 year for every 4 years of smoking after the age of 30. Reducing smoking across the population will reduce inequality and the burden of preventable mortality and morbidity on the whole system.

Smoking causes poverty

  • Smoking helps to sustain deprivation, just as deprivation sustains smoking which directly causes ill health and poverty, which leads to further ill health
  • Disadvantaged smokers are least likely to try to quit and less likely to succeed.
  • Long-term smokers are 7.5% less likely to be employed than non-smokers
  • Around a third of households with a smoker fall below the poverty line.
  • Current smokers are 2.5 times more likely to require social care support

Bradford District and Craven

  • Each year in Bradford when income and smoking costs are taken into account 14,323 households are driven into poverty (4,389 pensioners, 11,347 children)
  • 1,133 people in Bradford are estimated to be out of work due to smoking
  • In Bradford over 835 women a year are smokers when they give birth and almost 29,000 live in households with adults who smoke.
  • Current smokers need social care on average 10 years earlier than non-smokers, accounting for 8% of local authority spending on adult social care.
  • Overall, it is estimated that smoking costs Bradford £128.80 million each year including costs of healthcare, social care, productivity, and fire costs.

Children and young people are at high risk, with a big percentage of smoking uptake before the age of 18, which is why there is a focus on smoking cessation services.

Whilst there are no safe levels, there is a relationship between the amount of cigarettes smoked and health conditions related to smoking. Any reduction is beneficial however reduction is not in the general approach. This is a challenging area.

Smoking and ethnicity

Smoking is most prevalent among White British ethnicity with GPs and pharmacies seeing 73% of smokers from this group. This is followed by Asian British (Indian/Pakistani or other) ethnicity at 17%.

In diverse ethnicities most smokers are in younger groups. In white British smokers, are in younger age groups and in their 50s and early 60s.

Smoking and CORE20+5 priorities

  • MATERNITY – One in ten women smoked at time of delivery in 2019/20 (25% in Keighley, 22% in Tong), particularly younger poorer women. Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes.
  • SMI – People with Serious Mental Illness have higher smoking rates and smoke more, what contributes to the excess mortality and morbidity in these populations.
  • COPD – Stopping smoking leads to immediate improvements in respiratory health. Current smokers are 36% more likely to be admitted to hospital. Smoking accounts for up to 90% of COPD cases.
  • CANCER – Smoking is the biggest cause of cancer, with 1 in 4 deaths from all cancers estimated to be from smoking in the UK. Stopping smoking can improve treatment outcomes.
  • HYPERTENSION – People who smoke are twice as likely to suffer acute coronary events, and when they do, twice as likely to die from them. Around 10-15 years after quitting former smokers showed a similar CVD risk to never smokers.


Please note: This map under-reflects numbers smoking in Bentham, where most people are registered with a practice in Lancashire and South Cumbria ICB.


What are vapes?

Vapes, electronic cigarettes and e-cigarettes are all terms used to describe a battery-powered device which allows its user to inhale nicotine through a vapour rather than smoke. They are activated by inhaling and work by heating a nicotine containing liquid and producing emissions usually described as a ‘vapour’. Vapes consist of a battery, a cartridge (disposable, replaceable or refillable) with liquids (called ‘e-liquids’) and a heating mechanism. They contain nicotine, propylene glycol, glycerine and flavourings.


Vapes shops are not licensed, however they need to follow regulations and adhere to the advertisement laws:

      1. The tank should be limited to 2ml
      2. The sale of the refill container should be restricted to 10ml
      3. The strength of nicotine should be restricted to 20mg/ml

Vapes are easily accessible online and in shops, however, it is illegal to sell to under 18 and shop owners could face fines and prosecutions.

Nicotine vapes are not yet licensed as medicines but are proven effective and have become the most popular quitting aid for adults. Young people should not vape as long term consequences and they are NOT harmless – vapes should be used as an aid to quitting smoking and not substitute to smoking.  You can learn more abut this on the Living Well website: Support to Quit – Living Well (

There is a lack of evidence relating to vaping and the conversion from vaping to smoking.

Illicit tobacco

Illicit tobacco is linked to organised crime and community safety, with huge amounts of money being made. There is evidence of links between illicit tobacco and modern day slavery, human trafficking, sexual exploitation, money laundering and the trade of drugs and firearms.

Those dealing in illegal tobacco are willing to sell cigarettes, and other age-restricted nicotine products, to under 18s at pocket money prices. This means honest, hardworking local shops and businesses are harmed by the illicit tobacco trade.

Cheap tobacco undermines public health initiatives to reduce smoking prevalence, removing the financial incentive for smokers to quit.

Anonymous reporting of illicit trade is available via trading standards and via Citizens Advice. To anonymously report illegal or underage tobacco sales you can contact the Citizens Advice Consumer Helpline on 0808 223 1133.

For more information, or to book an education session for your community setting or workplace, contact the Illicit Tobacco Education Officer on 0113 53 53 101

What we are doing in response

Tobacco control strategy

In Bradford District and Craven, our vision is achieve a smoke free generation by 2030, in line with the national ambition for England, while narrowing the gap in health inequalities related to tobacco. In response to this teams across the district are developing a system-owned Tobacco Control Strategy.

The strategy will focus on reducing the harms and inequalities associated with tobacco, prioritising areas where evidence is stronger (smoked tobacco).

It will consider actions to reduce the harm caused by other forms of tobacco consumption eg, chewing and other forms of nicotine use eg, vaping, while not losing the focus on reducing the harm caused by smoking.

Strategic priorities:

  1. Making tobacco control everyone’s business through development of a system-owned strategy and plan
  2. Prevent the uptake of smoking among children and young people through targeted communication and tackling availability of illicit tobacco in the most disadvantaged communities
  3. Support smokers to quit prioritising groups at high risk of tobacco-related harm (see NICE guidance) eg pregnant women, people with SMI – includes mass/targeted communications
  4. Reduce variations in smoking rates ensuring smoking cessation support is being promoted and is available to the most disadvantaged
  5. Promote and effectively enforce smoke free environments and regulation of tobacco and nicotine products

We will share the strategy when it is ready.

Our Core20PLUS5 hyper local approach

We are also working from within communities to ensure the tobacco strategy has a focus on the correct target populations and that access for these specific groups to smoking cessation is considered throughout.  In addition we want to consider how we support the Core20PLUS5 population to receive additional smoking cessation services proportionate to the need identified in the local data.

Examples of some projects we have in place to tackle smoking rates are community champions, physical activity groups, respiratory health focussed support, community health checks and wider social prescribing models.

Of the people who access Core20PLUS5 programme interventions:

  • More people will understand the harms of smoking
  • More people will know how to access smoking cessation services and,
  • More people will be supported to access services and stop smoking.

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