Smoking is a significant public health issue in Scotland and a leading cause of preventable ill health, premature death and disability.

You will find information and resources below on the current tobacco strategy and to help you plan and improve services.

Smoking and health inequalities

There are clear links between tobacco use and inequality, and therefore with health inequalities.

• Smoking rates are still highest in the most deprived areas, with 35% of people living in the most deprived areas of Scotland smoking compared to 10% in the least deprived areas
• 29.3% of pregnant women in the most deprived areas are current smokers at their first antenatal appointment, compared to 4.5% in the least deprived areas.

A child born in a more socially deprived area of Scotland is more likely to

• grow up around smokers
• be born into a family that smokes
• have a mother who smoked during her pregnancy.

Children of smokers are more likely to start smoking themselves.

People living in the most deprived areas are much more likely to smoke as they are

• less likely to feel in control of their life
• less likely to know where to get help to stop smoking
• more likely to experience stress and mental health issues
• likely to have less encouragement and social support to quit
• likely to be less aware of the harm of smoking and second hand smoke
• more likely to smoke heavily and have a stronger nicotine dependence and therefore find it harder to stop.

It is easier to access the things that harm our health in these areas.

Scotland's tobacco control action plan

Raising Scotland's tobacco-free generation: our tobacco control action plan 2018 (external site) was launched by the Scottish Government in June 2018. This five-year action plan sets out interventions and policies to help reduce the harms from tobacco in Scotland. The actions are spread across four themes

• informing and empowering through raising awareness
• encouraging healthier behaviours
• improving services
• providing protection through regulation.

During 2017, NHS Health Scotland and the University of Edinburgh jointly reviewed and reported on the impact of the key policy actions contained within the previous strategy, Creating a tobacco-free generation: A Tobacco Control Strategy for Scotland (external site).

The review found that that actions outlined in the strategy have been implemented across all three areas of tobacco policy. In particular

• tobacco products in supermarkets and shops have been put out of sight and there is an associated reduction in cigarette brand awareness among young people
• there has been a substantial decrease (11% to 6%) in the proportion of children exposed to second-hand smoke in the home
• the ‘Take it Right Outside’ campaign was successful in raising awareness of the harms of smoking
• smoke-free NHS grounds policies have been introduced
• successful quit rates made through NHS smoking cessation services have increased
• there has been a small increase in the number of pregnant women stopping smoking using tailored NHS stop smoking services.

We have also researched the impact of the strategy from the point of view of tobacco control experts. The aim of this research was to seek their views on the impact of the strategy and suggestions for future actions.

There were a number of actions suggested within this study. Two of these were to make tobacco

• more expensive
• less available.

As a result of these suggested actions, we conducted two rapid reviews to identify and evaluate potential policies in tobacco pricing and tobacco availability.

We found a number of options for reducing smoking rates. These include ways to address the particularly high burden of tobacco use by and harm to people in deprived areas. The evidence reviewed was international and based on modelling. Further research needs to be done to determine whether these approaches might work in Scotland.

Impacts on health and health inequalities

We estimated the impacts of two options for reducing smoking rates on health and health inequalities in our ‘Informing Interventions to reduce health Inequalities’ (Triple I) project. We included smoking cessation services and a 10% increase to tobacco taxation.

The project outputs allow users to alter the number of individuals treated by smoking cessation services and the targeting strategy (e.g. to deprived areas) in order to estimate results for local areas as well as for Scotland.

Increasing tobacco taxation had the largest effect on improving health and reducing inequalities, but smoking cessation services were also found to be beneficial if targeted where most needed.

National action on prevention

The action on prevention focuses on children and young people. We will never reduce smoking prevalence if we don’t address the new supply of smokers.

Data from the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) (external site) show that the proportion of 15 year olds who smoke has fallen from almost 30% in the 1980s to 7% in 2015.

The World Health Organization (WHO) has produced policy guidance focusing on reducing inequalities relating to tobacco smoking. The guidance looks at

• the complexity of smoking in terms of inequality
• how tobacco increases inequalities over the life course
• how the use of tobacco contributes to health inequalities
• what tobacco policies need to consider to address inequalities
• the widening socio-economic inequities in tobacco consumption.

You can read the full ‘Tobacco and inequities’ guidance (external) on the WHO website.

Local action on prevention

The Scottish Public Health Observatory (ScotPHO) have created local tobacco control profiles to help with local planning. These provide data on

• tobacco sales
• smoking cessation
• adult smoking prevalence
• smoking related death and disease
• smoking during and post-pregnancy.