Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking

In England, around 20% of the population are smokers and 13% drink excessively. These behaviours are leading risk factors for several non-communicable diseases, including cancer, diabetes and chronic respiratory and cardiovascular conditions. It is estimated that around 8000 deaths/year are alcohol-related and 80 000 deaths of adults aged 35 and over are attributed to smoking annually. The prevalence and adverse effects of high-risk drinking and tobacco use are not equally distributed across the country, with large regional variations.

A North–South divide exists for smoking, with higher rates of tobacco use, smoking-related deaths and smoking-related harm in northern regions. 

In contrast, excessive alcohol consumption tends to be lowest in central and eastern regions, while an East versus West divide is seen in the prevalence of alcohol dependency and alcohol sales. These regional variations in consumption do not always map onto experienced harm, a phenomenon known as the Alcohol Harm Paradox. In 2014, alcohol-related death rates were significantly higher among regions in the north of England compared with those in the south.

Objectives: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Figure 2Figure 2: Association between Government Office Region and high-risk drinking: (A) unadjusted;
(B) adjusted for gender, age, ethnicity and socioeconomic status (reference region: South West). Note: this shows the relative risk difference for each region relative to the South West (dotted reference region). Increasing red tones reflect increasingly higher significant risk and increasing blue tones reflect increasingly lower significant risk. Regions shaded white have a similar risk to the South West. Online supplementary figure S9 labels the Government Office Regions in England.
Expand Image – More diagrams in the main report

Conclusions: In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

Strengths and limitations of this study

  • Used a representative survey about smoking and drinking conducted on a large sample of the adult population in England.

  • Based on the most up-to-date information in England on regional differences in smoking and high-risk drinking accounting for disparities in gender, socioeconomic status (SES), ethnicity and age.

  • Respondents may have underestimated or failed to report their drinking and smoking.

  • Patterns of smoking and alcohol use were only available at the Government Office Region level, whereas important variation may occur at a more micro-geographical level.

bmj

Copyright information:
Published by the BMJ Publishing Group Limited.

 

Read the full report here!

Advertisements

Cigarette smoking increases coffee consumption: findings from a Mendelian randomisation analysis

Marcus Munafò and his colleagues at the University of Bristol, have looked into the smoking and drinking habits of about 250,000 people. They found that smoking makes you drink more caffeinated drinks, possibly by changing your metabolism so that you break down caffeine quicker, pushing you to drink more to get the same hit.

It’s impossible to do a randomised controlled trial (the most rigorous kind of scientific trial) when it comes to smoking, because it would be unethical to ask a randomly selected group of people to smoke. The next best thing is to study huge biobanks of health data. These biobanks contain information about people’s genes, diets and lifestyles.
coffee-cigarettes-smoking-400x400.jpgTo explore the relationship between smoking and caffeine, Munafo and his colleagues analysed data from biobanks in the UK, Norway and Denmark. They were particularly interested in people who had inherited a variant of a gene that has already been shown to increase cigarette smoking.

Chain drinking

The team found that people who had this gene variant also consumed more coffee – but only if they smoked. British people with the same variant also drank more tea, although their Danish and Norwegian counterparts didn’t. This is probably due to cultural differences, says Munafò. “People in Norway and Denmark don’t chain drink tea in the same way that people in the UK do,” he says.

The genetic variant seems to influence how much nicotine a person consumes. You can have zero, one or two copies – and each additional copy is linked to an increase in smoking of about one cigarette per day. Each copy also appears to increase coffee consumption by 0.15 cups per day.

“You could extrapolate from that and say that if you smoked 10 cigarettes per day more than the next person, you would be drinking the equivalent of about one and a half extra cups of coffee per day,” says Munafò. He is wary of doing so, though, because the amount of nicotine a person gets from a cigarette will depend on the type of cigarette and the way it is smoked.

The gene variant codes for a nicotine receptor, which is not known to directly interact with caffeine. This suggests that cigarette smoking increases caffeine consumption and not the other way around.

“The team have used a rather clever technique to establish causality, which normally you wouldn’t stand a cat in hell’s chance of doing with an epidemiological study,”

Robert West – University College London.

What’s the link?

There’s a chance that cigarette smoking and caffeine consumption are linked through habit – that smokers tend to pair the two. But Munafò thinks that the nicotine in cigarettes might also influence the way a person metabolises caffeine. “It’s possible that smokers metabolise caffeine more quickly,” he says. If that is the case, smokers might need to consume more caffeine to get the same effects that a non-smoker would experience.

It’s also possible that the apparent link between smoking and coffee drinking could be down to some unknown function of the genetic variant, says West. “It evolved for a purpose, and it wasn’t to smoke,” he says.

A relationship between smoking and coffee might make it harder for smokers to quit, says Munafò. If a smoker stops smoking, but continues to drink plenty of coffee, they might start to experience unpleasant side effects, such as jitteriness. This might be misinterpreted as a symptom of smoking withdrawal, says Munafò. His team plans to investigate this.

newscience
By Jessica Hamzelou

Journal reference: bioRxiv, DOI: 10.1101/107037

Report launch: New issues and age-old challenges: a review of young people’s relationship with tobacco | 27/02/17

launch.PNG

Join Prof Amanda Amos and Prof Marcus Munafo to discuss the current landscape, challenges and opportunities including a focus on young people, tobacco and mental health.

Please book your free please here>

The face of youth smoking in the UK is evolving.  Young people are growing up in a society radically disrupted by new technologies and societal norms, which are reshaping their perceptions of personal health, image, and values.

New issues and age-old challenges: a review of young people’s relationship with tobacco, brings together the available evidence on youth smoking and articulates a clear demand for action across the system.

Martin Dockrell from Public Health England will chair the panel session.

Full agenda is available here>

Experts say WHO needs better understanding of the evidence on e-cigs to inform its international tobacco control treaty.

A new WHO report fails to properly evaluate the evidence on e-cigarettes and could even undermine international efforts to reduce smoking, says a group of UK based academics.

UK academics are calling for better understanding of the potential benefits of e-cigarettes to reducing the smoking pandemic ahead of an international gathering of countries that have signed the World Health Organisation’s Framework Convention for Tobacco Control.

The 7th session of the Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), a global public health treaty, will be held in Delhi, India from 7th-12th November 2016. At this meeting, Parties to the treaty (countries and other jurisdictions) will discuss whether similar policy measures recommended to reduce tobacco use should be applied to e-cigarettes.

In advance of the COP the World Health Organisation published a report about Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENDDS), also known as e-cigarettes. This aimed to summarise the evidence about these devices.

Academics from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence, have today published a robust critique of the WHO report setting out a series of concerns about the content of the document which, in their view, screen-shot-2016-10-26-at-12-37-14does not fairly represent existing evidence on e-cigarettes. Their critique examines each element of the WHO report and identifies flaws in the way the evidence is presented and problems with how the report could be interpreted, potentially encouraging countries to adopt excessive restrictions on e-cigarettes which could undermine efforts to reduce smoking.

The UKCTAS critique points to evidence set out in the recent Royal College of Physician’s’ report ‘Nicotine without Smoke’ and subsequent research which recognise that e-cigarettes are far less harmful than smoking and that smokers who find it difficult to stop should be encouraged to use them.

The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking; fails to accurately quantify any risks of e-cigarettes compared with smoking; misrepresents existing evidence about any harms to bystanders; discounts the fact that e-cigarettes are helping smokers to quit; does not recognise the place of some promotion of e-cigarettes to encourage smokers to switch to these less harmful products; fails to understand that the flavours in e-cigarettes are useful for people trying to stop smoking; mischaracterises the current e-cigarette market screen-shot-2016-10-26-at-12-39-18and appears to support very restrictive policies on e-cigarettes without including any good policy analysis. In addition, the WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.

Finally, the researchers point out that the WHO briefing is based on four unpublished papers which are still undergoing peer review, which does not allow for open, transparent scrutiny of the evidence. This does not, therefore, provide a good basis for policy making and risks undermining rather than promoting the aims of the FCTC, which is a treaty that was designed to help countries reduce smoking rates and save lives.

To read the full report click here.

Continue reading