How many cigarettes are there in a bottle of wine? A comparison of gender-linked population cancer risks between alcohol and tobacco

ydes, T.J., Burton, R., Inskip, H., Bellis, M.A., & Sheron, N. | 2019 |A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine? | BMC Public Health | 19| 316 |

A study published in the BMC Public Health  calculated ‘cigarette-equivalent of population cancer harm’ for alcohol intake as the cancer risk associated with cigarettes is much better understood, than the cancer risk associated with alcohol consumption. 

The researchers found that consumption of one bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. For men this increased absolute cancer risk was equal to smoking five cigarettes a week.

phe smoke
Image source: @phe_uk



In contrast to our knowledge about the number of cancers attributed to smoking, the number of cancers attributed to alcohol is poorly understood by the public. We estimate the increase in absolute risk of cancer (number of cases per 1000) attributed to moderate levels of alcohol, and compare these to the absolute risk of cancer attributed to low levels of smoking, creating a ‘cigarette-equivalent of population cancer harm’.



Alcohol and tobacco attributable fractions were subtracted from lifetime general population risks of developing alcohol- and smoking-related cancers, to estimate the lifetime cancer risk in alcohol-abstaining non-smokers. This was multiplied by the relative risk of drinking ten units of alcohol or smoking ten cigarettes per week, and increasing levels of consumption.



One bottle of wine per week is associated with an increased absolute lifetime cancer risk for non-smokers of 1.0% (men) and 1.4% (women). The overall absolute increase in cancer risk for one bottle of wine per week equals that of five (men) or ten cigarettes per week (women). Gender differences result from levels of moderate drinking leading to a 0.8% absolute risk of breast cancer in female non-smokers.



One bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. These findings can help communicate that moderate levels of drinking are an important public health risk for women. The risks for men, equivalent to five cigarettes per week, are also of note (Source:  BMC).


The full paper is available at Public Health BMC

Related: PHE Health Matters: tobacco and alcohol CQUIN

In the news: BBC News How many cigarettes in a bottle of wine?

BBC News Is it time to raise the smoking age to 21

Identifying and offering brief advice to tobacco and alcohol users

The latest edition of Health Matters focuses on preventing ill health caused by tobacco and alcohol use | Public Health England

This professional resource focuses on preventing ill health caused by tobacco and alcohol use and makes the case for why NHS providers should implement the Screening and brief advice for tobacco and alcohol use in inpatient settings CQUIN, published in March 2019.

tobaco and alcohol
Image source:

Smoking is the single largest cause of preventable ill health and premature death, and there are over 6 million people in England who smoke. It costs the NHS in England approximately £2.6 billion a year for treating diseases caused by smoking, but every £1 spent on smoking cessation saves £10 in future health care costs and health gains.

An estimated 1 in 4 patients in acute hospital beds in England are smokers and the prevalence of smoking in secure mental health units is even higher at 64% of patients. Therefore, a large number of smokers can be reached through health services and in particular hospitals.

Alcohol misuse contributes wholly or partially to 200 health conditions, including cancers, cardiovascular conditions, depression and liver disease. The toxic effect of alcohol misuse over time and acute alcohol intoxication lead to hospital admission.

In England, 10.4 million people consume alcohol at levels above the UK CMOs’ low-risk guideline, increasing their risk of alcohol-related ill health. Alcohol identification and brief advice (IBA) can identify and influence patients who are drinking above low risk.

The national CQUIN scheme offers the chance to identify and support:

  • inpatients who smoke
  • inpatients who are drinking above low risk

It is intended to complement and reinforce existing activity to deliver interventions to smokers and those who use alcohol at increasing risk and higher risk levels.

Full resource at Public Health England

NICE updates guideline on alcohol education in schools

NICE |  February 2019 | NICE updates guideline on alcohol education in schools

NICE is updating its guideline on Alcohol interventions in secondary and further education.

New draft recommendations will support the Department for Education’s (DfE) plan to make alcohol education a compulsory component of personal, social and health education (PSHE) in all state-funded schools in England from September 2020.


The guideline, developed with Public Health England, advises a positive approach to alcohol education; inviting classroom discussion and wider school policies to embed a ‘whole-school approach’ to PSHE.

Full details from NICE 

New year, new you – why Dry January is taking off

University of Leeds | January 2019 |  New year, new you – why Dry January is taking off

New research from the University of Leeds sought to investigate the popularity of Dry January, it is the first study to use qualitative research to explore the alcohol abstinence challenge. 

The research team examined 30-plus promotional emails issued by charity Alcohol Concern (now part of Alcohol Challenge UK)  during Dry January in 2017.

They analysed participants’ experiences of taking part by assessing 62 posts and 2,500 comments made between 1 January 2017 and 4 February 2017 in an open Facebook group.


Following analysis of the comments, the researchers determined that fundraising for charity was not a motivating factor to participate, as the participants were more likely to discuss personal benefits.

These included sleep quality, appearance, energy levels, weight loss, levels of self-esteem, and surprise at discovering their own strength and willpower (Source: University of Leeds).

The study has been published in the journal Drugs: Education, Prevention and Policy,

Full reference:

Yeomans, H. |2018| New Year, New You: a qualitative study of Dry January, self-formation and positive regulation| Drugs: Education, Prevention and Policy| DOI: 10.1080/09687637.2018.1534944


In the last 5 years, giving up alcohol for January has become a common social practice in UK. Inspired by Alcohol Concern’s Dry January initiative and other related campaigns, an estimated 5 million UK adults attempted to abstain from alcohol in January 2017. Moreover, evaluative research has suggested that a 1-month spell of abstinence is an effective way of reducing average, longer-term drinking. However, the popularity and apparent effectiveness of Dry January are not well-understood. This article presents the first qualitative analysis of the meaning and significance of this important new cultural phenomenon. Based on analysis of media and social media content, it examines both how Dry January is managed by Alcohol Concern and how it is experienced by participants. The burgeoning popularity of Dry January is found to result from how this process of temporary abstinence is underpinned by positive regulatory techniques and the salience of embodiment. Consequently, rather than being a simple regime of bodily abstinence and self-control, Dry January should instead be understood as an embodied experience of ethical self-formation. The article also reflects on the implications of this finding for alcohol regulation more widely.

The full article is available to read and download online from Drugs: Education, Prevention and Policy 

Alcohol-specific deaths in the UK: registered in 2017

Office of National Statistics | December 2018 | Alcohol-specific deaths in the UK: registered in 2017 

Data from the Office of National Statistics (ONS) has found that mortality rates related to alcohol have risen.  The data analysed  includes only those health conditions where each death is a direct consequence of alcohol misuse (that is, wholly-attributable deaths. Most of these are chronic (longer-term) conditions associated with continued misuse of alcohol. 


Key findings:

  • In 2017, there were 7,697 alcohol-specific deaths in the UK, an age-standardised rate of 12.2 deaths per 100,000 population.
  • For the UK, alcohol-specific death rates have increased in recent years to similar rates observed in 2008 where they were at the highest recorded.
  • Since the beginning of the time series in 2001, rates of alcohol-specific deaths among males have been more than double those observed among females (16.8 and 8.0 deaths per 100,000 in 2017 respectively).
  • In 2017, alcohol-specific death rates were highest among 55- to 59-year-old females and 60- to 64-year-old males. (Source: ONS)

See also: Public Health Funding to help improve the lives of those affected by alcohol

In the news:

Daily Mail Record number of British women are dying because of alcohol as figures show drink-related deaths are up 15% since 2001

The Independent UK alcohol deaths approaching levels last seen in 2008 recession, ONS data shows

 Guardian Alcohol-related deaths among UK women at highest rate in 10 years

The Telegraph Baby boomers’ drinking blamed for pushing alcohol-related deaths among women to highest ever level

Safeguarding children affected by parental alcohol and drug use

Public Health England|December 2018 |Safeguarding children affected by parental alcohol and drug use

Public Health England have released a guide for local authorities and substance misuse services to help them work together to safeguard and promote the welfare of children (PHE).


Local authorities and substance misuse services can use this guidance to:

  • understand more about parental alcohol and drug use and how it affects children
  • understand the implications of Working together to safeguard children for substance misuse services
  • improve joint working between local authority adult and children’s social care services and substance misuse services
  • develop joint protocols between alcohol and drug treatment services and adult and children’s social care services (Source: PHE)

Full details are available from Public Health England

Latest alcohol and drug treatment statistics

Public Health England has published the latest alcohol and drug treatment statistics, which are for April 2017 to March 2018


The report contains a wide range of data, which includes trends over recent years. This Public Health Matters article focuses on the following issues that this year’s statistics have shown:

  • Alcohol treatment numbers are still falling
  • Crack cocaine treatment numbers are still rising
  • Better data on drugs and mental health problems
  • Better data on parental substance misuse
  • Housing and homelessness

All the data points towards treatment services needing to reach out to the most vulnerable people in their population and to make sure they are able to respond to changing patterns of need.

More information on the treatment statistics can be found in the report summary  and in the full report, including all the data tables and charts.

Full article: What we’ve learned from the latest alcohol and drug treatment statistics

Full report: Substance misuse treatment for adults: statistics 2017 to 2018

Public Health England has conducted a rapid inquiry to better understand what was behind the fall in numbers of people in treatment for alcohol dependence in England. The report,PHE inquiry into the fall in numbers of people in alcohol treatment: findings’ sets out findings from the inquiry as well as recommendations and next steps.