The Welsh Government recently launched a consultation on its draft tobacco control strategy and delivery plan. The ambition is for Wales to be smoke-free by 2030.
This article looks at what this means in the context of current smoking trends. It provides an update on smoking legislation in Wales, and revisits the evidence about the role of e-cigarettes in smoking harm reduction.
What does a ‘smoke-free Wales’ mean?
The Welsh Government’s draft strategy describes a ‘smoke-free Wales’ as achieving a smoking prevalence rate in adults of 5% or less over the next eight years. A prevalence of 5% is understood to be the threshold at which the tobacco smoking epidemic would become unsustainable.
To achieve this, the strategy is focused around three key themes:
- reducing inequalities;
- future generations, i.e. creating an environment where smoke-free is the norm for children and young people, and for them to remain smoke-free into adulthood; and
- a whole-system approach, using all available levers to create a smoke-free Wales.
Similar commitments to a smoke-free future have been made elsewhere in the UK. England has also said that 2030 will be its target for reducing smoking prevalence to 5%. Scotland aims to achieve this level by 2034.
In February 2020, Cancer Research UK reported that, based on current trends, neither Wales nor the other UK countries would achieve a 5% smoking prevalence rate by the target dates. For Wales, it estimated that:
If current smoking prevalence trends observed in Annual Population Survey continue, average adult smoking prevalence in Wales will reach 5% in 2037. […] the pace of change needs to be around 40% faster than projected.
Current smoking trends
According to National Survey for Wales figures for January to March 2021, 14% of adults in Wales smoke. National Survey changes during the pandemic mean that these figures aren’t directly comparable with previous years, but there is a general decreasing trend.
An inequality gap remains. 21% of adults in the most deprived areas of Wales smoke, compared to 8% in the least deprived. This contrast can also be seen in health outcomes – Public Health Wales reported that smoking-related mortality was around three times higher in the most deprived areas than in the least deprived.
Among children and young people, the 2019/20 School Health Research Network Student Health and Wellbeing Survey found that:
- 4% of young people reported smoking tobacco at least weekly;
- there was a clear age effect, with 1% of students in year 7 reporting that they currently smoke, rising to 9% by year 11; and
- young people from less affluent families were twice as likely as those from more affluent families to report current smoking.
Concerns have been reported about the impact of the COVID-19 pandemic and lockdown restrictions on smoking. For example, a study in England found that the number of young adults (18 to 34 year olds) who smoke increased by 25% during the first lockdown. However, further research is needed to assess the pandemic’s full impact on smoking (and vaping) behaviour.
Smoke-free legislation in Wales
The Smoke-free Premises etc. (Wales) Regulations 2007 were introduced to protect people from the harmful effects of second-hand smoke by banning smoking in ‘enclosed’ or ‘substantially enclosed’ public places, including workplaces and vehicles. The Regulations were amended in 2015 to require cars carrying children to be smoke-free.
The 2007 Regulations were replaced by the Smoke-free Premises and Vehicles (Wales) Regulations 2020, made under the Public Health (Wales) Act 2017. The Act re-stated the existing restrictions on smoking. It also extended the smoking ban to outdoor childcare settings, school grounds, public playgrounds, and hospital grounds. This came into force on 1 March 2021.
Additionally, the Act gives the Welsh Ministers powers to extend restrictions on smoking to further settings, where it’s considered that this is “likely to contribute towards the promotion of the health of the people of Wales”. ASH Wales Cymru is calling for the legislation to be extended to outdoor seating areas of pubs, cafes and restaurants. At present, this is at the discretion of individual local authorities and business owners.
The delivery plan for 2022-2024 which accompanies the Welsh Government’s draft strategy includes a commitment to explore the establishment of additional smoke-free spaces in Wales.
What role is there for e-cigarettes?
There is growing evidence that e-cigarettes are an effective tool in smoking cessation and reduction. Public Health England’s most recent annual evidence review (February 2021) recommended that all stop smoking services should have a consistent approach to vaping products such as e-cigarettes:
[…] combining vaping products (the most popular source of support used by people making a quit attempt in the general population), with stop smoking service support (the most effective type of support), should be an option available to all people who want to quit smoking.
It also said that the lack of a medicinally-licensed vaping product should be urgently reviewed.
In October 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) issued guidance to encourage the licensing of e-cigarettes and other inhaled nicotine-containing products (NCPs) as medicines. Dr June Raine, Chief Executive of the MHRA, said:
The evidence is clear that e-cigarettes are less harmful to health than smoking tobacco and that nicotine-containing e-cigarettes can help people quit smoking for good. The updated guidance on licensing requirements we have published today is a strong first step towards availability of safe and effective licensed e-cigarette products.
While there’s consensus that vaping is a much less harmful activity than smoking, the potential risk of e-cigarettes re-normalising smoking and acting as a gateway to tobacco use has been subject to debate. The Welsh Government’s draft delivery plan highlights the lack of long-term evidence on the use of e-cigarettes. It commits to exploring the role of e-cigarettes (and other nicotine products) in smoking cessation during 2022-24.
The Smokefree Action Coalition (SFAC) is a group of over 300 organisations across the UK committed to ending smoking. The Coalition’s Roadmap to a Smokefree 2030 states that “sustained declines in smoking prevalence can only be achieved if government action is systematic, co-ordinated and properly resourced”.
The SFAC calls on the UK Government to legislate to require tobacco manufacturers to finance a ‘Smokefree 2030 Fund’ (the ‘polluter pays’ principle), to provide sustainable funding for tobacco control action in the UK. It suggests that the devolved nations could potentially opt in to the Smokefree 2030 Fund.
The Welsh Government’s draft delivery plan acknowledges that working in partnership with the other UK nations will be “crucially important” to achieving a smoke-free Wales.
Eight years is not a long time, and as highlighted by the SFAC and Cancer Research UK, achieving smoke-free status by 2030 is no small challenge. But there has been good progress towards a smoke-free society. ASH (Action on Smoking and Health) says “the goal is achievable and popular”. It also says that it will give people five extra healthy years of life, while narrowing the health inequality gap between the richest and the poorest.
Article by Philippa Watkins, Senedd Research, Welsh Parliament