Bolton Community Profile: Smoking and Health
Introduction
Compared with the England average, the health of Bolton’s residents varies significantly. According to Public Health England (2016), Bolton is among the 20% most deprived areas in England, with an estimated 13,000 (22%) children living in deprived households. Life expectancy for adults is lower than the England average, with a disparity of 11.3 years for men and 10.9 years for women between the most and least deprived areas in Bolton (Public Health England, 2016).
By age six, 668 (19.6%) children in Bolton are obese (Public Health England, 2016). The prevalence of alcohol-related hospital stays for children is 43.1 per year (Public Health England, 2016). Levels of breastfeeding initiation and smoking at childbirth are worse than the country’s average. For adults, the rate of alcohol-specific stays is 763 per year, higher than the England average of 641, representing 1,836 stays per year (Public Health England, 2016). The incidence of self-harm-specific hospital stays is 265.5, worse than the country’s average of 191.4, representing 755 stays annually (Bolton Unitary Authority, 2016). The smoking-associated mortality rate is 336.7, higher than England’s average of 274.8, representing 468 deaths per year (Bolton Unitary Authority, 2016).
Although Bolton district’s health priorities include heart disease, stroke, maternal, and child health (Bolton Unitary Authority, 2016), smoking is associated with many chronic illnesses and contributes to the reduced life expectancy of adults in the district (NHS Bolton & Bolton Council, 2012). This paper investigates the prevalence of smoking in Bolton, its risk factors, and the community and nursing interventions to facilitate smoking cessation.
Smoking Profile
Current smokers in Bolton comprise about 20.5% of the adult population, with 4.7% being heavy smokers who smoke 20 or more cigarettes daily (NHS Bolton and Bolton Council, 2012). The ratio of smokers in Bolton has declined consistently from 30% in 2001 to 20.5% in 2010, although it remains higher than the England average of 18% (Health & Social Care Information Centre [HSCIC], 2016).
The prevalence of smoking in Bolton varies by socioeconomic status, being highest in the most impoverished communities and lowest in the wealthiest. Smoking rates are highest in the poorest areas and quantile 2, although recently, quantile 2 has surpassed the poorest areas by a small margin (NHS Bolton & Bolton Council, 2012). The smoking rate in Bolton's routine and manual groups is 38.4%, compared to England’s 30% (NHS Bolton & Bolton Council, 2012).
Smoking prevalence also varies with gender and age; men are more likely to smoke than women, and middle-aged groups have higher smoking rates than older age groups (NHS Bolton & Bolton Council, 2012). Ethnic disparities exist as well, with smoking being more prevalent among white communities, although South Asian men have smoking rates comparable to the white population. South Asian women, however, have very low smoking rates, contributing to lower rates in South Asian communities overall (NHS Bolton & Bolton Council, 2012). Among Black and Minority Ethnic (BME) groups, the "White Other" and "Asian Pakistan" categories have the highest smoking rates in Bolton. Additionally, gay, lesbian, and bisexual groups show a higher prevalence of smoking at 38.9% compared to the general population (NHS Bolton & Bolton Council, 2012).
According to the Trading Standards North West report, 36% of 14-17-year-olds attempted to smoke e-cigarettes in 2015, compared to 20% in 2013 (Auton, Turner, & Lavery, 2015). Among 15-16-year-olds, 58.2% had attempted smoking, with 22.5% being smokers as of 2009 in the North West area (Atkinson et al., 2009). In Bolton, 23% of 14-17-year-olds were self-proclaimed smokers, an increase from 2007 (Atkinson et al., 2009). Despite the risks during pregnancy, 18.3% of women in Bolton smoke during pregnancy, higher than the 13.2% average in England and 17% in the North West region (NHS Bolton & Bolton Council, 2012).
Health Risks of Smoking
Smoking is a risk factor for numerous diseases, including cancer, cardiovascular diseases, and respiratory conditions (National Health Service [NHS], 2015). The high prevalence of smoking in Bolton has been directly linked to significant inequalities in life expectancy. Higher smoking prevalence among men exacerbates the life expectancy gap between genders (NHS Bolton & Bolton Council, 2012).
Smoking is linked to many chronic diseases, particularly cancer and cardiovascular diseases, which are major causes of mortality in Bolton. Smoking-related deaths in Bolton are 277.0 per 100,000 persons, higher than England’s average of 216.0 and the North West region’s 264.9 (NHS Bolton & Bolton Council, 2012). Specific causes of death include 44.9 from heart disease, 16.6 from smoking-specific strokes, 47.7 from lung cancer, and 35.2 from chronic obstructive pulmonary disease (COPD).
Bolton has an incidence of 1,468.9 smoking-related hospital admissions per 100,000, higher than England’s average of 1,417.2 but lower than the North West average of 1,594.5 (NHS Bolton & Bolton Council, 2012). The rate of lung cancer registration in Bolton is 62.1 per 100,000, worse than England’s average of 48.3 but lower than the North West's 59.0 (NHS Bolton & Bolton Council, 2012). The rate of oral cancer is 10.1 per 100,000, higher than England’s rate of 8.9 and the same as the North West’s 10.4 (NHS Bolton & Bolton Council, 2012). Thus, smoking is a major public health issue that requires urgent intervention.
Smoking Cessation Initiatives
Various initiatives have been started to help Bolton residents quit smoking. The Bolton NHS Stop Smoking Service has successfully helped an estimated 14,000 residents quit smoking since its inception in 2003 (NHS Bolton & Bolton Council, 2012). The service offers one-to-one therapy sessions, community quit groups, and seven-week intensive quit groups based at maternity units, GP practices, and local pharmacies. The smoking cessation service also provides a drop-in service at 12 health centers in Bolton, including individual appointments and 25 hours’ worth of drop-in services each week (NHS Bolton & Bolton Council, 2012).
A repeated health equity audit of the domestic Stop Smoking Service in 2012 showed an increase in the ratio of individuals from poorer areas of Bolton successfully quitting smoking, almost equalling that of residents from wealthier areas (NHS Bolton & Bolton Council, 2012). A Stop Smoking Specialist at the Royal Bolton Hospital trains staff to counsel and support patients who smoke and to design new practices to encourage smoking cessation (NHS Bolton & Bolton Council, 2012). Additionally, the Bolton Smoke Free Homes project encourages residents to commit to keeping their homes smoke-free to protect adults and children from second-hand smoke (NHS Bolton & Bolton Council, 2012).
Role of Nurses
The National Institute of Health and Clinical Excellence (NICE) recommends that nurses consult their patients about quitting smoking (Hamilton, 2009). Understanding the motivations and obstacles to smoking cessation is essential for nurses to effectively contribute to smoking cessation efforts in Bolton. Nurses play a crucial role in raising the issue of quitting smoking with patients and providing a balanced perspective on the challenges they might face, guiding them to the best smoking cessation options (Hamilton, 2009).
Health professionals who smoke at hospital premises can undermine public health smoking cessation messages (Mackereth, Finchett, & Holt, 2016). Nurses can inspire smoke-free zones in hospitals, offer brief interventions, and motivate patients, carers, and fellow nurses to stop smoking (Mackereth et al., 2016). Community nurses, in particular, have opportunities to promote smoking cessation in older people affected by smoking-related health conditions (Phillips, 2016).
Conclusion
Bolton district’s health profile indicates that the region exceeds the national average in several public health variables, including smoking-specific hospital admissions and mortality rates. Smoking cessation services are available to help residents quit smoking. Nurses can contribute significantly by discussing quitting with patients and providing relevant support.
References
Atkinson, A., Bellis, M., Hughes, K., Hughes, S., & Smallthwaite, L. (2009). Smoking behaviour in North West schoolchildren: A study of fifteen and sixteen year olds.
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Hamilton, S. (2009). Understanding the nurse's role in smoking cessation. British Journal of Nursing, 18(11).
Health & Social Care Information Centre (HSCIC). (2016). Statistics on smoking: England 2016.
Mackereth, P., Finchett, C., & Holt, M. (2016). Smoke-free hospital site conversations: How nurses can initiate change. British Journal of Nursing, 25(21).
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Phillips, A. (2016). Supporting smoking cessation in older patients: A continuing challenge for community nurses. British Journal of Community Nursing, 21(9).
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