Scotland youth smoking rising or falling?

Do you believe this (Youth smoking rate continues to rise, from 2008) or this: Teenage smoking falls to lowest level since 1982, from five days before Christmas)?

Knowing the authorities in Scotland, either version will be used as a good reason for repeating its annual reminder to smokers that now is as good a time as any to give up.

The Scotsman's version includes a choice quotation from Ms Sheila Duffy:

Chief executive of ASH Scotland Sheila Duffy said: 'Many smokers decide to quit and find it easier than they thought it would be.'

This depends on your definition of 'many'. NHS services acknowledge that only 8 per cent of quitters are recorded as successful at 12 months.

A Daily Record story from last month is downbeat about youth smoking rates and smoking rates in deprived areas, and takes the opportunity to attack cuts in tobacco control expenditure in Scotland to £11.4 million. This is a lot of money to spend 'controlling' a legal substance, especially when the results of expenditure result only in an uptake of pharmaceutical smoking cessation products, and complete cessation of smoking in so few cases.

The different stories about whether smoking is going up or down emphasise only that no one really knows what the smoking rates are. Even if it were clear that smoking rates were coming down, it would be no guarantee that people's choices would lead either to greater longevity or improved quality of life.

Scotland's ten-year decline in heart disease and stroke deaths

Less than a week after we learned that the drop in smoking rates especially among Scotland's deprived communities has been disappointing, we discover that Scotland's heart and stroke deaths have dropped sharply over the last ten years, with most of the gains in deprived communities.

The source is Scotland's official source of figures: you can view the relevant chart by going to document MC1 (the top one) and clicking the tab at the bottom left hand side of the document (I don't know how to import an excel page into blogspot post).

The figures here are about the success of treatment rates – they concern an improvement in mortality after conditions have been treated, rather than prevention.  The impact that Professor Jill Pell's study declared was on hospitalisations, not deaths.

Taken together, what do we learn? The figures show no trace of the 17 per cent drop in heart attacks that were alleged to have followed the Scottish smoking ban: there is no sudden dip following 2006. There is also no real drop in smoking rates, making the claims originally made by Professor Jill Pell even more problematic (there can be no significant drop in smoke exposure if there is no significant drop in smoking rates). Finally there is a decline in heart attacks and stroke deaths in deprived areas, which have not seen a significant drop in smoking rates – although this is attributed to more successful treatment rather than a lower incidence.

Licensees are quitting, not smokers, says SLTA

Today Paul Waterson has bid for another look at the smoking ban.  He begins:

Five years ago our pubs were generally full of life, had a great atmosphere and were just about holding their own against vicious price competition from the supermarkets.

A promising start. We knew that the supermarket prices had always been a problem, but it was a problem that broke the surface only when the smoking ban had sent away a good number of traditional pub customers.

Mr Waterson's piece goes on to explain how the smoking ban as enacted in Scotland has failed to catch on in Europe, pointing out that the better the weather, the laxer the enforcement tends to be. In terms of trade, bars are closing at four times the rate that they closed before the smoking ban came in. The losses have amounted, he says, to one-eighth of Scotland's pubs.

Comparing this to the smoking cessation rate in Scotland is an interesting move. Although the ban was not introduced (ostensibly) to prevent people from smoking, it's clear that the alleged damage from secondary smoke won't decline in the long term unless the smoking rate declines as well. And Mr Waterson has good reason to draw attention to the poor long-term success rate of smoking cessation interventions by the NHS. The latest official report (summary here) gives this paragraph:

Quit outcomes based on client follow-up at 12 months after the quit date use data for the 2009 calendar year (12 month outcomes for the full 2010 calendar year are not yet available). Based on data for 2009, the quit rate at 12 months was 7% with 68% of cases 'lost to follow-up'/smoking status unknown by this stage. 

A 7 per cent quit rate at 12 months (that's 7 per cent of the 7.4 per cent of smokers that even tried to give up)  seems rather bleak from where I am sitting. Sheila Duffy does her best to sound optimistic but this is all she can manage:

While giving up smoking can be difficult for some, it is encouraging to see that at least 39% of those who attended stop smoking services in 2010 remained quit a month later. [emphasis added] 

Surely anyone wanting to give up would like a fair idea of their chances after the first few weeks of intensive support. Failure to give any information after four weeks doesn't look promising. A rough ballpark figure suggests that from one year to the next, 93 per cent of the smoking population carries on smoking, plus 92 per cent of the remaining 7 per cent who have tried to quit, plus any youngsters who have taken up the habit and minus any smokers who have died. It gives Paul Waterson good grounds for saying that the impact of the smoking ban has been far greater on licensees and their establishments than it has on the smoking rate.

Mr Waterson speaks of moderate amendments, the old days having gone forever, and so on. Whatever. As long as government dominates the discussion of what should be allowed the trade will need to grow teeth before it will make any impact – if my reading of the current Scottish Government's agenda is accurate. Begging the government to increase drinks prices to ridiculous heights will not help the drinks industry and will not help the licensed trade either. To quote at second hand from here:

The hospitality industry lobbies for more restrictions on supermarket-bought alcohol to boost sales in bars; small brewers push for more punitive tax rates on big brewers... the only winners are the healthists who get support bit by bit for more regulations on everything. It's like a bunch of folks on the scaffolds complaining that the other guy's noose isn't quite tight enough. Y'all might instead direct your attention to the hangman sometime and try helping each other cut those ropes.

Things could get more ridiculous yet, as some health expert (not in Scotland thankfully) has said the drinking age should be raised to 24. Raising any legal purchasing age so far beyond the age of majority would not, I suspect, go down well with young people in this country. But some people will enjoy flying this kind of kite.

The licensed trade and its associates and rivals need to consider their strategy very carefully. But it's good to see that the smoking ban is at last getting some of the attention it deserves.