Action on Smoking and Health

Tag Archives: stopping smoking

Smoking, pregnancy and fertility

Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage, and pre-term birth. Smoking during pregnancy also increases the risk of children developing
several respiratory conditions, attention and hyperactivity difficulties, learning difficulties, problems of the ear, nose and throat, obesity, and diabetes. December 2021.

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Smoking and Multiple Sclerosis

There is growing evidence of smoking as a risk factor for multiple sclerosis (MS). There is also evidence that smoking can increase the rate at which the disease progresses, meaning quitting smoking could be an important step in slowing the development of disability.
April 2020.

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Smoking and Multiple Sclerosis

There is growing evidence of smoking as a risk factor for multiple sclerosis (MS). There is also evidence that smoking can increase the rate at which the disease progresses, meaning quitting smoking could be an important step in slowing the development of disability.
April 2020.

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Stopping Smoking: Guide

The health benefits of stopping smoking start within hours of putting out the last cigarette.  Using a combination of medication and behavioural support can substantially increase the chances of successfully quitting.
March 2020.

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Smoking and Mental Health

Higher smoking rates remain the single largest cause of the estimated 10-20 year reduced life expectancy for people with mental health conditions. August 2019.

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Tobacco and Ethnic Minorities

Smoking rates vary considerably between ethnic groups and within groups they vary by gender. August 2019.

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Smoking and Dementia

Smoking is ranked third among nine modifiable risk factors for dementia and is linked to an estimated 14% of cases of Alzheimer’s disease worldwide. July 2019.

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Nicotine and Addiction

A comprehensive look at why and how nicotine is so addictive. This fact sheet examines the mental and physical aspects of nicotine addiction. August 2018.

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Smoking and Diabetes

There is a growing body of evidence to suggest that smoking is an independent risk factor for diabetes and that among people with diabetes, smoking aggravates the risk of serious disease and premature death. November 2017.

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Stoptober: ASH calls for more mass media campaigns to help smokers to quit

20 September 2016

In advance of the annual Stoptober stop smoking campaign, ASH is calling on the Government to increase the frequency and the amount of money spent on stop smoking campaigns.

Deborah Arnott Chief Executive of ASH said,

“ASH strongly supports Stoptober which provides the support and encouragement that we know most smokers need to help them stop.  However, we are very concerned about the recent announcement by the Health Minister in the Lords that funding for mass campaigns like Stoptober has been cut again this year. The evidence is clear, to be successful mass media campaigns need to run throughout the year; Stoptober alone is not enough.”

During a parliamentary debate, the Health Minister, Lord Prior said that the expenditure allocated for this financial year was £4 million.*  Last year it was £5.3 million and it has declined significantly in the last 6 years; in 2008-09 it was nearly £25 million.

Financial year[1] Media Spend (£m)
2008-09 23.38
2009-10 24.91
2010-11 0.46
2011-12 3.16
2012-13 8.21
2013-14 7.64
2014-15 6.92
2015-16 5.3


ASH is also calling on the Government to publish without delay its new Tobacco Control Plan, replacing the previous one which expired at the end of 2015.  The new plan needs to clearly set out how the Government intends to fund tobacco control including mass media campaigns and Stop Smoking Services.


Contact:   Deborah Arnott 020 7404 0242 (w) or 07976 935 987 (m)

Notes and links:

Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see:

ASH receives core funding from Cancer Research UK and the British Heart Foundation.

* Hansard. HoL Debate.  Lord Prior of Brampton:  “£4 million has been allocated for tobacco-specific marketing activities, £1 million of which is for the Stoptober campaign launching next month.”


Effectiveness of Mass media campaigns


  1. Research has shown that mass media campaigns are highly effective and cost-effective in motivating quit attempts and discouraging uptake of smoking.[i] However, the UK is currently falling far below best practice spending on mass media campaigns.


  1. In 2009 funding for anti-smoking mass media campaigns in England was just under £25 million: by 2015 this figure had been cut to only £5.3 million, with further cuts expected this year. If England were to fund mass media campaigns at levels recommended by the US Centers for Disease Control and Prevention, it should have been spending around £60 million; more than ten times the amount spent in 2015.[ii]


  1. Studies carried out in England in the past few years have found that mass media campaigns have been effective in triggering quit attempts and have been responsible for a significant proportion of the reduction in smoking prevalence,[iii] and that the freeze on mass media campaigns at the time of the 2010 election was associated with a reduction in quitting activity.[iv] A systematic review of economic evaluations of mass media campaigns noted that all of these found mass media campaigns to be cost effective[v], but these campaigns need to have sufficient intensity and be sustained in order to have a meaningful effect.[vi]


  1. A 2016 regional mass media campaign conducted by Fresh North East and Smokefree Yorkshire and Humber illustrates the value of mass media in promoting quit attempts. The campaign which focused on 16 cancers caused by smoking, reached approximately 333,000 people via TV, radio, print and online. Of those who saw the campaign 16% (around 55,300 people) cut down on their smoking. A further 8.4% (around 28,000 people) made a quit attempt as a result of the campaign while 4% switched to electronic cigarettes. This shows the clear impact mass media campaigns have on triggering quit attempts and changes in behaviour.



[i] Langley T. et al. The impact of media campaigns on smoking cessation activity: a structural vector autoregression analysis, Addiction 2012, 107(11):2043-50. 

[ii] Hopkinson NS, Millett C, Glantz S, Arnott D, and McNeill A (2016) UK government should fund stop smoking media campaigns not give tax breaks to films with smoking imagery. Addiction. doi: 10.1111/add.13511

[iii] Sims M, Salway R, Langley T. et al.. Effectiveness of tobacco control television advertising in changing tobacco use in England: a population-based cross-sectional study Addiction. 2014 109 (6): 986-94

[iv] Langley T, Szatkowski L, Lewis S et al. The freeze on mass media campaigns in England: a natural experiment of the impact of tobacco control campaigns on quitting behaviour.  Addiction 2014: 109: 995-1002

[v] Atusingwize E, Lewis S, Langley T. Economic evaluations of tobacco control mass media campaigns: a systematic review  Tobacco Control 2015: 24: 320-327

[vi] Durkin S & Wakefield M.  Commentary on Sims et al. (2014) and Langley et al. (2014) Mass media campaigns require adequate and sustained funding to change population health behaviours.  Addiction 2014: 109: 1003-1004.

Calls for work in North East to cut smoking in pregnancy to be rolled out nationwide

16 September 2016.  News Release on behalf of the Smoking in Pregnancy Challenge Group 

Work in the North East to cut smoking in pregnancy by nearly 1/3 has been hailed as an example for the rest of England to follow by a coalition of national health and baby charities.

Francine Bates, Chief Executive of the Lullaby Trust and Professor Linda Bauld who are Co-Chairs of the Smoking in Pregnancy Challenge Group, along with ASH which co-ordinates the group, praised the rapid fall in North East maternal smoking rates after a four year initiative to help midwives raise smoking as a crucial issue affecting unborn babies’ health.

Every woman in the North East is now routinely given carbon monoxide monitoring when they first see a midwife – and those with high readings referred to a stop smoking service, following the NICE guidance[i]. For those women still smoking at 12 weeks, a midwife leads a detailed discussion highlighting the potential harm to the unborn child – resulting in rates falling from 22.2% of women smoking at the time they gave birth in 2009-10 down to 15.6% in 2016.

Fresh – the North East’s tobacco control office funded by all 12 local authorities – has overseen the rollout of the “babyClear” approach[ii] which works in two ways:

  • Women receive carbon monoxide (CO) monitoring as part of the routine tests during their booking appointment at around 8 weeks into the pregnancy. All high CO readings are routinely referred to Stop Smoking Services within 24 hours where they can get help to quit.
  • Women still smoking at their 12 week dating scan are talked through a more hard hitting and factual discussion on the harms of smoking with their midwife, using software to show the potential harm being done when an unborn baby is exposed to smoke.

The Smoking in Pregnancy Challenge Group, including ASH, the Royal College of Midwives, Tommy’s and the Lullaby Trust, published a report[iii] in 2013 calling for more action to fully embed the NICE (National Institute for Health and Care Excellence) guidance around smoking in pregnancy and renewed the call for action in a review of progress in 2015.[iv] The Group recommends midwives raise smoking as an issue, use carbon monoxide monitoring to check high levels of exposure to tobacco smoke; and refer all smokers to local stop smoking services.

Deborah Arnott, chief executive of health charity ASH, which co-ordinates the Challenge Group, said:

“The North East has made great strides in reducing smoking in pregnancy by a combination of hard work and a well thought out, evidence-based approach. If the government is to meet its commitment to reduce the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030 all of England needs to follow their lead.”

Francine Bates, Chief Executive of The Lullaby Trust and Co-Chair of the Challenge Group said:

“The North East region is to be hugely congratulated for the work they are doing to support women to stop smoking in pregnancy.

“Maternal smoking is now the single biggest modifiable factor for sudden infant deaths. This programme will undoubtedly have saved many babies’ lives and greatly improved health outcomes for families previously exposed to second-hand smoke. I hope that other parts of the country will take note and implement a similar systematic approach.”

Professor Linda Bauld, Co-Chair of the Smoking in Pregnancy Challenge Group and Professor of Health Policy at the University of Stirling said:

“The North East of England has taken a lead in implementing evidence-based recommendations from NICE and the Smoking in Pregnancy Challenge group.

“The progress that has been achieved is impressive and provides a valuable example for other parts of the country. These changes have undoubtedly saved lives – not just for babies and infants but also for mothers, as pregnancy provides a unique opportunity for women to stop smoking and stay stopped over the longer term.

“The region have also evaluated their approach through independent research and I look forward to the publication of those results, which will provide invaluable evidence for us to continue to make the case for action that contributes to continued declines in smoking in pregnancy in the future.”

Ailsa Rutter, Director of Fresh, said:

“Most women who smoke will have started in their teens or younger, and we recognise it is an addiction that is not always easy to quit. Women need the facts but also to know there is excellent free support to quit smoking where they will be supported and helped, not have the finger wagged at them.

“Some women can find the facts quite shocking – but most are very glad they have been told and come to expect this as part of their ante-natal care.”

Peter Kelly, North East Public Health England Centre Director, said: “Supporting women in having a healthy pregnancy is essential for their health and their unborn child.  Stopping smoking is a critical element of a healthy pregnancy and it is very encouraging to see such progress in the North East.”

Following babyClear’s launch in 2012, around 450 midwifery staff and 150 Stop Smoking Service advisers have received skills training to discuss the issues with women in a factual, blame-free way, as well as being provided with equipment to deliver interventions.

When a smoker inhales, the 5000 chemicals in smoke, such as arsenic, benzene and formaldehyde, are absorbed through the lungs and move into the bloodstream. In pregnant women, these chemicals are passed to the unborn baby, depriving them of vital oxygen. Exposure to CO may cause harm to an unborn child, including low birth weight, perinatal death (stillborn and deaths within the first four weeks of birth), and behavioural problems.

A report by the Royal College of Physicians published in 2010 (Passive smoking and children) found maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths (stillbirths and sudden infant deaths within the first four weeks of birth) and 2,200 premature births a year nationwide. In the North East that breaks down to 360 miscarriages, 22 perinatal deaths (stillbirths and sudden infant deaths with the first four weeks of birth) and 160 premature births.

Research with midwives by NHS North East and Newcastle University in 2010 found not all midwives felt confident or equipped to raise smoking during pregnancy, with many wanting more training and resources such as CO monitors. Feedback from wards has also found women come to expect smoking being raised as an issue, and does not affect the positive relationship they have with their midwife.

Figures published in August 2016 revealed the North East has also seen the biggest fall in overall adult smoking rates in England since 2005, from around 29% of people smoking down to 18.7% in 2015.



[i] NICE guideline PH48 – Smoking: acute, maternity and mental health, and NICE guideline PH26 – Smoking: stopping in pregnancy and after childbirth

[ii] babyClear – an intervention developed by the Tobacco Control Collaborating Centre

[iii] Smoking Cessation in Pregnancy – a Call to Action


The Smoking in Pregnancy Challenge Group, which includes the Royal College of Midwives (RCM), Royal College of Paediatrics and Child Health (RCPCH), the third sector and academia, was established in 2012 in response to a request by the Rt Hon Anne Milton MP, the then Public Health Minister.

The challenge to the Group was to produce recommendations for accelerating progress towards the Government ambition of reducing the rate of smoking at the time of delivery to 11% or less by 2015.

In June 2013 the Group produced recommendations on how the Government ambition for reduced rates of smoking in pregnancy could be achieved.   (Smoking Cessation in Pregnancy – A Review of the Challenge)

The Group continues to collaborate to and in 2015 published a review of progress and updated recommendations. More information about the Challenge Group is available on the Groups webpage.

Briefing: Smoking and surgery

This document was created by ASH in partnership with the Royal College of Surgeons of Edinburgh, the Royal College of Anaesthetists and the Faculty of Public Health. It was endorsed by the Royal College of Surgeons, Royal College of Physicians and the Royal College of General Practitioners. It has been designed for health professionals and commissioners, to provide clear advice and examples of good practice in relation to smoking and surgery.

Joint Briefing: Smoking and Surgery

UK Tobacco Control Policy and Expenditure: An overview

Health policy is largely formulated and implemented by the devolved administrations of each of the member countries of the United Kingdom. However, as tobacco falls within the remit of a number of different government departments: e.g. Treasury, Business, HMRC as well as Health, tobacco control policy is partly determined at UK-wide level and partly by the devolved administrations. The four nations of England, Scotland, Wales and Northern Ireland have responsibility for their own smoking cessation and health education campaigns while UK-wide policy and law applies to taxation, smuggling, advertising, and consumer protection issues such as the provision of health warnings on tobacco packaging. Some of these measures are determined by European Union legislation.

UK Tobacco Control Policy and Expenditure: An overview

ASH Research Report: Asthma and smoking

This Research Report examines asthma and smoking: the causes and the consequences.

ASH Research Report: Asthma and smoking