Smoking and mental health

This edition of Health Matters focuses on smoking among people living with a broad range of mental health conditions | Public Health England

This resource focuses on smoking among people living with a broad range of mental health conditions, ranging from low mood and common conditions such as depression and anxiety, to more severe conditions such as schizophrenia and bipolar disorder.

Full detail: Smoking and mental health

ASH: Smoking and poverty

ASH | October  2019 | Smoking and poverty

Analysis of UK Government data carried out for ASH (Action on smoking and health) shows that the high cost of tobacco is driving over a million people
into poverty. The research also indicates that poverty rates across all smoking households increase from around one fifth (22.3%) to one third (31.3%) when the cost of tobacco is taken into account. 


ASH’s analysis shows that:

  •  447,000 households in the UK are currently living in poverty due to the cost of tobacco.
  • Around 1,011,000 people – including 263,000 children – live in poverty as a direct result of income lost to tobacco.
  • 143,000 pensioners are pushed into poverty by the cost of tobacco, which increases the proportion of pensioners living in poverty from 14.9% to 26.5%.
  • A third (31.3%) of households which include at least one person who smokes live in poverty, which would reduce to one in five (22.3%) if income lost to tobacco was returned.

Read the report Smoking and poverty


See also:

OnMedica Smoking link to poverty highlighted

The costs of smoking to the English National Health System

Ash| September 2019 | The costs of smoking to the English National Health System

Ash the smoking support charity have commissioned research to measure the impact of smoking on the need for social care. This updated  previous analyses of the cost of smoking on social care; and a multi-wave analysis of the English Longitudinal Study of Ageing (ELSA) and the Health Survey for England was undertaken.
Image source:

The analysis finds that 670,000 people have care needs as a result of smoking:
• 25,000 adults receive social care from their local authority because they
smoke or smoked;
• 5,000 adults receive social care they pay for themselves because they smoke
or smoked;
• 345,000 adults receive informal social care because they smoke or
smoked; and a further
• 300,000 adults have unmet care needs because they smoke or smoked

The costs of the additional care needed due to smoking are high to both local authorities
and smokers themselves:
• The cost of smoking-related social care to local authorities is £720 million
a year
• The cost of smoking-related social care to individuals who pay for their
own care is £160 million a year (Source: Ash)

The costs of smoking to the English National Health System

In the news:

OnMedica Care needs come earlier for smokers


Stoptober campaign

Public Health England | September 2019 | Stoptober helping you split up with smoking this October 

Resources for this year’s Stoptober campaign include an app, email support, tips to quick and case studies from individuals who have quit smoking.
Image source:

See the full range of resources from Public Health England 

Of interest:

Statistics on NHS Stop Smoking Services in England April 2018 to March 2019

Smoking, Drinking and Drug Use among Young People in England

NHS Digital | August 2019 | Smoking, Drinking and Drug Use among Young People in England

smoking yp

The Office for National Statistics  and NHS Digital have released the findings of the biennial survey of secondary school pupils in England in years 7 to 11 (mostly aged 11 to 15), focusing on smoking, drinking and drug use. The survey covers a range of topics including prevalence, habits, attitudes, and for the first time in 2018, wellbeing.

A summary report showing key findings, excel tables with more detailed outcomes, technical appendices and a data quality statement (Source: NHS Digital).

Full details are available from NHS Digital



Cochrane: Incentives for smoking cessation

University of East Anglia | August 2019 | Incentives for smoking cessation

A study conducted by researchers from the University of East Anglia, the University of Oxford and University of Stirling has now been published on the Cochrane Library. This new review summarizes the results of 33  radomized controlled trials (RCTs) which included more than 21000 people in 8 countries. They looked at the long-term effect of  incentives such as vouchers, cash payments on smoking; all of the studies included had data on the participants for at least 6 months’ following the intervention.  Studies included in the review were from a range of settings such as workplaces, the community, clinics or institution- based.


The research team also looked at studies of pregnant women who smoke separately, finding ten trials, nine based in the USA and one in the UK, covering 2571 pregnant women who smoke. 


Even after excluding low quality data from the review, the authors’ conclude that their certainty in the findings is high as those who were receiving rewards had a higher likelihood (approximately 50 per cent) of not starting smoking than those in the control groups.

The study’s lead author Dr Caitlin Notley, from UEA’s Norwich Medical School, said:

“We found that six months or more after the beginning of the trials, people receiving rewards were approximately 50 per cent more likely to have stopped smoking than those in the control groups.  In people not receiving incentives, approximately 7% had successfully quit for six months or longer, compared to approximately 10.5% of those receiving incentives. This is an important increase when we consider the enormous harms of smoking, and benefits of quitting, and suggests that incentives can be a useful part of a comprehensive approach to help people quit smoking. Another really important thing is that success rates continued beyond when the incentives had ended.

University of East Anglia Rewards incentivise people to stop smoking  [press release]

Cochrane Plain Language Summary


Smoking is the leading cause of disease and death worldwide. Most smokers want to quit, but stopping smoking can be very challenging. Quitting smoking can greatly improve people’s health. Rewards, such as money or vouchers, can be used to encourage smokers to quit, and to reward them if they stay stopped. Such schemes can be run in workplaces, in clinics, and sometimes as community programmes.

Study types

We conducted our most recent search for studies in July 2018.

General trials: We found 33 trials, covering more than 21,600 people, that tested different rewards schemes to help smokers to quit. Two studies included smokers from mental health clinics, two from primary care clinics, two from head‐and‐neck cancer treatment clinics, two from colleges or universities, and one in Thai villages. Twenty‐four of the trials were run in the USA. All the trials followed up participants for at least six months. Those who had quit were checked by testing their breath or bodily fluids. Rewards were cash payments, vouchers, or the return of money deposited by those taking part.

Pregnancy trials: We looked at studies in pregnant women separately. We found ten trials, nine based in the USA and one in the UK, covering 2571 pregnant women who smoked. Rewards were vouchers that were sometimes increased in value, depending on how long the woman had managed to stay quit.

Key results
General trials: Six months or more after the beginning of the trial, people receiving rewards were more likely to have stopped smoking than those in the control groups. Success rates continued beyond when the incentives had ended. Studies varied in the total amounts of rewards that were paid. There was no noticeable difference between trials paying smaller amounts (less than USD 100 (US dollars)) compared to those paying larger amounts (more than USD 700).

Pregnancy trials: Combining data from nine trials showed that women in the rewards groups were more likely to stop smoking than those in the control groups, both at the end of the pregnancy and after the birth of the baby.

Quality of the studies
Some of the studies did not provide enough data for us to fully assess their quality. Taking out the lowest‐quality trials from the analysis did not change the results. Our certainty in our main findings is high. Our certainty in our findings in pregnant women is moderate, as some studies were of lower quality.

The full review is available from the Cochrane Library 

Full reference:

Notley  C, Gentry  S, Livingstone‐Banks  J, Bauld  L, Perera  R, Hartmann‐Boyce  J. | 2019| Incentives for smoking cessation| Cochrane Database of Systematic Reviews | Issue 7. Art. No.: CD004307| DOI: 10.1002/14651858.CD004307.pub6.



Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes.


To determine the long‐term effect of incentives and contingency management programmes for smoking cessation.

Search methods

For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register,, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018.

Selection criteria

We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed‐population setting (e.g. community, work‐, clinic‐ or institution‐based), and also studies in pregnant smokers.

Data collection and analysis

We used standard Cochrane methods. The primary outcome measure in the mixed‐population studies was abstinence from smoking at longest follow‐up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow‐up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel‐Haenzel random‐effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster‐randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations.

Main results

Thirty‐three mixed‐population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49. Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up, suggesting the impact of incentives continues for at least some time after incentives cease.

Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits.

We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38, in favour of incentives.

Authors’ conclusions

Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives. There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations.




Stub it out

Association of Optometrists | July 2019| Stub it out

The Association of Optometrists have launched a new campaign to raise awareness of the association between smoking and sight threatening conditions. A recent poll highlights that round 20 per cent of people (a fifth)  who smoke do not recognise that smoking can cause blindness or sight impairment. 



The campaign signposts smokers to free help that is available to encourage them to stop smoking.  They also underline that optometrists can provide a full eye health check as part of a routine appointment and can help detect diseases early, whether you are a smoker or not (Source: Association of Optometrists).

In the news:

BBC News Smoking ‘damages eyes as well as lungs’ 

Of interest:  Office for National Statistics Adult smoking habits in the UK Adult smoking habits in the UK: 2017