Smoking and the use of tobacco are the main cause of preventable deaths. Healthy Lives, Healthy People: a Tobacco Control Plan for England was published in March 2011 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124917 Among the main objectives, is the commitment to reduce smoking prevalence overall from 21.2% to 18.5% or less by the end of 2015, and to reduce smoking prevalence among young people and pregnant women. Smoking prevalence in England is falling, however, large variations exist at regional and local levels and smoking related health problems remain a major concern to the NHS and the country as a whole. These profiles were therefore produced to pool together as many indicators that detail the harm caused by smoking and the actions being taken to reduce this harm. They will support local government and health services to monitor their local tobacco control strategies, policies, and initiatives and inform commissioning and planning.
The Local Tobacco Control Profiles for England are produced by the Tobacco Profiles Team within Risk Factors Intelligence, Chief Knowledge Officer, Public Health England.
Since April 2013 the profiles have been updated quarterly usually on the first Tuesday of each of the following months: February, May, August, September and November.
The smoking prevalence indicators that were based on the Integrated Household Survey (IHS) have been discontinued and replaced with new indicators based on the Annual Population Survey (APS). The IHS was a composite survey combining questions asked on a number of ONS social surveys to produce a dataset of ‘Core’ variables. The aim of the IHS was the production of high-level estimates for particular themes to a higher precision and lower geographic level than previous ONS social surveys. The APS was the largest of the surveys included and formed the core of the IHS. Over time the other modules were dropped to leave, from 2015, a dataset solely based upon the APS. Therefore ONS announced it would no longer produce IHS branded or IHS specific products. Instead the questions formerly regarded as the IHS core will continue to be asked in, and output data be provided by the APS. Some differences in survey coverage, imputation and weighting methodology may result in some small discontinuity for certain 'core' variables compared to estimates previously provided as part of the IHS. We have provided data from the APS reweighted back to 2012 to give a time series for the new indicators. The IHS indicators will be kept on the LTCP but will not be updated and should not be directly compared with the APS. Within the LTCP there are also prevalence figures from other data source. A guidance document for comparing the different estimates of smoking prevalence is available here.
Due to changes in methodology and geographical boundaries, for some indicators it is not possible to provide historical data.
Data are aggregated in this way when the number of disease cases/deaths within a single year is small. Data can be aggregated by geography, time, age group or other characteristic such as deprivation. This is done to improve statistical robustness and minimize the impact of random variation. For more information see the former APHO (Association of Public Health Observatories) Technical Briefing 6 on using small area data in public health intelligence, available at http://www.apho.org.uk/resource/item.aspx?rid=74894.
The methodology for this indicator has been revised for 2010/11 in line with changes to the Payment by Results (PbR) system. Despite development, it is recognised that there remain limitations to the current methodology; it is likely the values at local level underestimate true acute healthcare costs per capita and are not robust enough to allow valid comparison. For this reason, confidence intervals are not presented and statistical significance has not been calculated. However, the indicator is currently the only data available which attempts to quantify the cost of acute hospital care attributable to smoking. To compare hospital activity across local areas we recommend using the smoking attributable hospital admissions indicator.
In response to feedback we have received previously, we have taken steps to make the indicator a more sensitive measure of the success of local stop smoking services. Smoking prevalence data from the Annual Population Survey available at local authority level has been adjusted to provide a Local Authority level prevalence. This has been used to estimate the size of the smoking population and provides the denominator for calculating the proportion of successful quitters.
All indicators are reviewed for disclosure control (see the definitions tab within the tool for further information). Where numerators are small or analysis is at a small geographical area, there is potential for disclosure. This is a particular problem in areas where there is non-coterminosity of boundaries. If historical numerator data are required, requests may be made to the Tobacco Profiles Team, please email firstname.lastname@example.org
The indicators use the most recent data that were available at the time of production. Data collectors release their data at different times and the time lag between when the data are collected and when the data are updated within the indicators varies considerably depending upon how much checking, cleaning, and processing is required before the data can be shared.
The indicators were selected by consultation with potential users in local authorities, organisations involved in tobacco control and national experts. We aimed to include indicators of all local tobacco control activities, but could only include ones for which local data were available. The indicators have been further developed since the initial release in 2010 and it is anticipated that development will be ongoing. Comments and feedback are welcome, please email email@example.com
A description of all indicators included in the profiles is contained within the tool in the definitions tab.
Data are presented for Upper Tier Local Authorities, England, former Government Office Regions and where available Lower Tier Local Authorities. Where possible, data presented in the profiles reflect the most recent geographical boundaries available to us.
The methodology for the indicator changed in 2013 to match that of the public health outcomes framework (PHOF); from maternities where smoking status is known, to all maternities. This new denominator implicitly assumes that all patients whose smoking status is unknown are non-smokers. Where the denominator (mother’s whose smoking status was known) fails the validation checks (<5%), the corresponding value is suppressed. For an area that fails the validation check, the value is likely to underestimate the extent of smoking in pregnancy and therefore the indicator cannot be used to measure progress. For more information check the definitions tab within the tool and visit the NHS Digital website.
In July 2015, Public Health England reorganised its Centres (the parts of the organisation that provide local advice and support to the public health system), moving from 15 Centres to 9. The new Centre areas are largely co-terminous with the former Government Office Regions; the only difference is Milton Keynes local authority being located in the East of England PHE centre (whereas it is located in the former South East Government Office Region).