Tobacco use: introduction

Smoking-related morbidity and mortality

Smoking is the most important preventable cause of ill-health and premature death in Scotland. In 2009, there were almost 13,000 smoking-related deaths in Scotland - about 1 in 5 of all deaths (Peto et al (2012)). Smoking is also a major contributor to health inequalities, with some of the highest rates of smoking and smoking-related diseases found in the most disadvantaged communities. In the period 2000-2004, almost a third (32%) of deaths in the most deprived quintile of Scotland were attributed to smoking, compared with 15% in the least deprived quintile (Taulbut et al, 2008).

Smoking is a major cause of illness and death from diseases of the heart and blood vessels, the lungs, stomach, kidney and other organs. Smoking's causal effect on lung cancer is probably the most widely recognised, although smoking causes more deaths from other diseases than from lung cancer (Doll et al (2004), Peto et al (2000)). Other major causes of death related to smoking include chronic obstructive pulmonary disease (bronchitis and emphysema), coronary heart disease and stroke. It has been estimated that half of all regular cigarette smokers will die prematurely as a result of smoking (Doll et al (1994)).

Many smoking-related diseases can cause years of disability and reduced quality of life, as well as eventually resulting in premature death. Smoking is also associated with a range of usually non-fatal medical conditions, which can have a significant adverse effect on a person's health and quality of life. These include angina, back pain, impotence, loss of vision and peptic ulcer. ASH UK have produced a factsheet (1,040Kb) on illnesses associated with smoking. Details of the benefits of stopping smoking are synthesised in NHS Health Scotland's Guide to smoking cessation in Scotland (2010). It has been estimated that the NHS in Scotland spends over £271 million each year treating smoking-related diseases (Ash Scotland (2010)).

The risk of developing various smoking-related diseases increases with how long and how much someone has smoked. However, these risks are known to fall substantially if smoking is stopped, even for long-term smokers. As such, there are positive health gains from stopping smoking at any age and, in some cases, even after the development of a smoking-related disease. The General Lifestyle Survey (formerly the General Household Survey) has consistently estimated that around two-thirds of smokers in Britain would like to give up smoking. In practice, far fewer make a quit attempt through smoking cessation services. In Scotland, an estimated 7.4% made a quit attempt in 2010. Nicotine is a highly addictive drug and many smokers find it very difficult to successfully quit smoking. 

Maternal smoking

It is widely accepted that smoking during pregnancy is harmful to both mother and baby. Women who smoke during pregnancy are more likely to have premature and low birthweight babies. Smoking during pregnancy is also associated with increased risk of miscarriage, stillbirth and sudden infant death syndrome. In addition, children whose parents smoke are more likely to suffer from middle ear disease, asthma and other respiratory diseases. They are also more likely to become smokers themselves compared to children of non-smoking parents.

Smoking among young people

There is particular concern about smoking among children and young people. The vast majority of smokers take up the habit as teenagers and many children and young people who smoke will continue to smoke all their lives. Studies have suggested that children who smoke are more likely to report poor academic performance, be more pessimistic about the future, dislike school and have an unhealthy diet. Smoking has also been associated with the use of alcohol and illegal drugs.

Second-hand smoke

In recent years there has been a growing awareness of the health risks associated with inhaling second-hand tobacco smoke, also known as environmental tobacco smoke or second-hand smoking (these terms tend to be used interchangeably).

The Scientific Committee on Tobacco and Health (SCOTH) provides advice to the UK Chief Medical Officers on the health effects of smoking. In November 2004, SCOTH published an update to its 1998 report that reviewed scientific evidence on the health effects of exposure to second-hand smoke. This update confirmed that second-hand smoke represents a substantial public health hazard. It estimated that there is a 24% increased risk of lung cancer and 25% increased risk of heart disease in non-smokers when exposed to second-hand smoke. It also concluded that children exposed to second-hand smoke have an increased risk of serious respiratory illness and asthma attacks, sudden infant death syndrome and middle ear disease (SCOTH (2004)(165Kb)).

In a study commissioned by the (then) Scottish Executive and NHS Health Scotland, Professor David Hole of Glasgow University estimated that environmental tobacco smoke exposure was associated with at least 865 deaths per year in Scotland among lifelong non-smokers. This estimate was restricted to four major disease categories: lung cancer, coronary heart disease, stroke and respiratory disease. By including other diseases known to be related to smoking, the estimate could be as high as 1,000 deaths per year. By including ex-smokers as well as lifelong non-smokers, the estimate could increase to 1,500-2,000 deaths per year (Hole (2005)(734Kb)).

Tobacco smoking in Scotland

The report Tobacco smoking in Scotland: an epidemiology briefing (published by ScotPHO in March 2008) is a useful summary resource on smoking in Scotland. This report discusses how tobacco impacts on the population health of Scotland, why people take up smoking and continue to smoke, and what measures and interventions may help to reduce smoking in Scotland. It also presents summary data on smoking in Scotland.