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Why do people in the north of England tend to smoke more? Why do people in the north of England tend to smoke more?
(7 months later)
The north of England has always had relatively high smoking prevalence rates, although high rates of prevalence do not necessarily mean that people in the north are smoking "more". To understand the true picture, we need to ask what circumstances are unique to the north of England and what aspects are simply northern manifestations of national trends.The north of England has always had relatively high smoking prevalence rates, although high rates of prevalence do not necessarily mean that people in the north are smoking "more". To understand the true picture, we need to ask what circumstances are unique to the north of England and what aspects are simply northern manifestations of national trends.
The Andy Capp stereotype, with roll-up hanging out of the mouth, no longer has much purchase (if it ever did) except with those in the south who don't know what it's really like to live in some of the most disadvantaged communities in the country. It's important to remember the interactive map presents overall figures for each region, whereas the detailed picture everywhere is a mosaic with variations within regions much greater than those between them.The Andy Capp stereotype, with roll-up hanging out of the mouth, no longer has much purchase (if it ever did) except with those in the south who don't know what it's really like to live in some of the most disadvantaged communities in the country. It's important to remember the interactive map presents overall figures for each region, whereas the detailed picture everywhere is a mosaic with variations within regions much greater than those between them.
The first reason why any individual will smoke is obvious: nicotine is a substance more addictive that heroin or cocaine and most smokers start as children, well before the legal age for tobacco sales. Our research indicates three key reasons why rates of smoking in the north of England in particular are relatively high: a working through of historical trends; the availability of illegal tobacco products, and the ultimately key factor – relative levels of disadvantage, deprivation and poverty.The first reason why any individual will smoke is obvious: nicotine is a substance more addictive that heroin or cocaine and most smokers start as children, well before the legal age for tobacco sales. Our research indicates three key reasons why rates of smoking in the north of England in particular are relatively high: a working through of historical trends; the availability of illegal tobacco products, and the ultimately key factor – relative levels of disadvantage, deprivation and poverty.
Industrial scale cigarette production in the UK dates from the 1880s and cigarette use among men rose dramatically before and during the first world war, declining again briefly before reaching a second peak during and shortly after the second world war. A disproportionate number of northern men were involved in both these conflicts.Industrial scale cigarette production in the UK dates from the 1880s and cigarette use among men rose dramatically before and during the first world war, declining again briefly before reaching a second peak during and shortly after the second world war. A disproportionate number of northern men were involved in both these conflicts.
Many cigarette manufacturers were located in the region – the company Ogden's of Liverpool produced a brand – 'Tabs' – which has left its legacy in the vernacular for cigarettes and rollups in the northeast of England. There were three large factories in Co Durham alone in the last quarter of the 20th century. People in Spennymoor – the site of a big Rothmans factory (before its closure in 2000 with the loss of 440 jobs) – remember recruiters coming to the local secondary schools with cartons of cigarettes for the children to take home to their families. Those who worked at the Ogden's factory in Liverpool recount being given 200 cigarettes a month free, many of which they sold on to their friends.Many cigarette manufacturers were located in the region – the company Ogden's of Liverpool produced a brand – 'Tabs' – which has left its legacy in the vernacular for cigarettes and rollups in the northeast of England. There were three large factories in Co Durham alone in the last quarter of the 20th century. People in Spennymoor – the site of a big Rothmans factory (before its closure in 2000 with the loss of 440 jobs) – remember recruiters coming to the local secondary schools with cartons of cigarettes for the children to take home to their families. Those who worked at the Ogden's factory in Liverpool recount being given 200 cigarettes a month free, many of which they sold on to their friends.
Price is a major lever in discouraging people from smoking, and the tobacco companies have been clever in introducing ultra low-price brands to keep the hard-up smoking. While most smokers don't smoke illegal tobacco, the availability of smuggled and counterfeit products at half the price of legally sold brands makes it easier for some who might otherwise quit to continue. Such products are (understandably) most commonly accessed and used amongst people from the most disadvantaged backgrounds.Price is a major lever in discouraging people from smoking, and the tobacco companies have been clever in introducing ultra low-price brands to keep the hard-up smoking. While most smokers don't smoke illegal tobacco, the availability of smuggled and counterfeit products at half the price of legally sold brands makes it easier for some who might otherwise quit to continue. Such products are (understandably) most commonly accessed and used amongst people from the most disadvantaged backgrounds.
However, it is the experience of post-industrialisation that has left many communities with few resources, and fewer pleasures, with which to bolster their difficult and frequently stressful lives. Evidence shows that where children are brought up in households with one or more people who smoke, the more likely they are to start smoking themselves. Children from routine and manual classes are also more likely to start smoking earlier than their peers from more privileged backgrounds, and those who start earlier find it harder to stop in later life. There is also evidence that people from disadvantaged backgrounds are more likely to find quitting difficult, irrespective of when they started to smoke.However, it is the experience of post-industrialisation that has left many communities with few resources, and fewer pleasures, with which to bolster their difficult and frequently stressful lives. Evidence shows that where children are brought up in households with one or more people who smoke, the more likely they are to start smoking themselves. Children from routine and manual classes are also more likely to start smoking earlier than their peers from more privileged backgrounds, and those who start earlier find it harder to stop in later life. There is also evidence that people from disadvantaged backgrounds are more likely to find quitting difficult, irrespective of when they started to smoke.
It's not all doom and gloom up north, though. Rates of smoking, at least in the North East, have been declining faster than anywhere else in the country, from a level of 29% in 2005 to a current estimate of 21%. Between 2004 and 2010 it appeared that more North East women were smoking than men, a situation unique within the UK and extremely unusual globally. But it subsequently turned out that an anomalous cohort was going through the survey process and this was skewing the results.It's not all doom and gloom up north, though. Rates of smoking, at least in the North East, have been declining faster than anywhere else in the country, from a level of 29% in 2005 to a current estimate of 21%. Between 2004 and 2010 it appeared that more North East women were smoking than men, a situation unique within the UK and extremely unusual globally. But it subsequently turned out that an anomalous cohort was going through the survey process and this was skewing the results.
Current figures are based on much larger samples and don't give the same readings for women, although they still indicate a higher percentage of northern women smoking than anywhere else in England (a serious matter in public health terms, particularly when this translates into smoking during pregnancy).Current figures are based on much larger samples and don't give the same readings for women, although they still indicate a higher percentage of northern women smoking than anywhere else in England (a serious matter in public health terms, particularly when this translates into smoking during pregnancy).
However 40% of smokers make a quit attempt in any one year and the north of England has some of the best smoking cessation services in the country. Additionally, there is Fresh Smoke Free North East, the UK's first dedicated tobacco control office which, with colleagues in the North West, Yorkshire and Humber, developed the world's first comprehensive programme to counter illegal tobacco in 2009. Successful initiatives such as this help explain the rapid declines we are witnessing.However 40% of smokers make a quit attempt in any one year and the north of England has some of the best smoking cessation services in the country. Additionally, there is Fresh Smoke Free North East, the UK's first dedicated tobacco control office which, with colleagues in the North West, Yorkshire and Humber, developed the world's first comprehensive programme to counter illegal tobacco in 2009. Successful initiatives such as this help explain the rapid declines we are witnessing.
Dr Andrew Russell is a senior lecturer in Health and Human Sciences at Durham University. Dr Susan Lewis is a member of Durham University's school of medicine, pharmacy and health. They are both fellows of the Wolfson Research Institute for Health and WellbeingDr Andrew Russell is a senior lecturer in Health and Human Sciences at Durham University. Dr Susan Lewis is a member of Durham University's school of medicine, pharmacy and health. They are both fellows of the Wolfson Research Institute for Health and Wellbeing
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