1. Health Inequalities and Smoking
Dr. Helen McAvoy, Senior Policy Officer
Institute of Public health in Ireland

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European Week Against Cancer 2013
Aviva Stadium , Dublin
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Tobacco and Health Inequalities
Dr Helen McAvoy
Institute of Public Health in Ireland
www.publichealth.ie
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www.publichealth.ie
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All-island body
o Inequalities in health
o North-South cooperation
Three work strands:
o strengthening public health intelligence
o building public health capacity
o policy and programme development and evaluation

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Outline
Cancer & inequalities in life expectancy
Inequalities in tobacco-related harm
Inequalities in smoking behaviours
 Social & commercial determinants
 Time to develop a more comprehensive
approach to addressing inequalities in
tobacco-related harm?
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Source:
NI Health and Social Care Inequalities
Monitoring System – 2013
An overview of changes in NI life
expectancy 2001-03 to 2008-10
Comparison of life expectancy
‘deprivation gap’ in Northern
Ireland
- most deprived vs. least
deprived

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Source:
NI Health and Social Care
Inequalities Monitoring
System – 2013
An overview of changes in
NI life expectancy 2001-03
to 2008-10
Contribution of the life
expectancy gap of 7.6
years between NI most
& least deprived areas
2008-10 by cause of
death (males).

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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie
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Age-standardised incidence of cancer by deprivation category of patient
residence 2007-2009 – Republic of Ireland

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Source: National Cancer Registry Ireland, 2011 – Lung Cancer Incidence,
Mortality, Treatment & Survival in the Republic of Ireland 1994-2008.
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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie

10. 10Source: Cancer in Ireland 2011. National Cancer Registry of Ireland - www.ncri.ie 10
5 year survival for cancers diagnosed during 1994-1997, 1998-2002, 2003-2007

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Source: Cancer in Ireland 2011.
National Cancer Registry of Ireland.
www.ncri.ie
5 year relative survival for
cancers diagnosed in men
and women 2003-2007

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Behind the lung cancer statistics
 Delays in presentation? (men especially)
 Knowledge & differentiation of symptoms
 Shame, guilt and stigma
 Inequalities in multi-morbidity
 Choices about where to die ( Sharp et al, IMJ, 2010)
 Fewer empowered survivors to carry the
flag for early detection, research, political
attention and investment

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Cancer inequalities are multifaceted
 Risk – incidence, type, age of diagnosis
 Finding out – achieving a timely diagnosis
 Health system, social and economic
assets for optimal treatment, survival and
recovery

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Inequalities in tobacco-related
harm
 Health harms
 Social and economic harms
 Socio-economic disadvantage associated
with life-course accumulation of cancer
risk

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Smoking in pregnancy by deprivation in Northern Ireland 2005 – 2011
Source: NI Health & Social Care Inequalities Monitoring System 2012

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Risk profile of the low
income smoker
- Exposure to tobacco in
utero and SHS in
childhood
-Grew up in family and
community with high
smoking rate
-Early initiation
-Heavier smoking
-Equally likely to attempt
quitting (?)
-Less likely to succeed at
quitting - definitely

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SHS exposure in childhood
Young Persons Behaviour and Attitudes
Survey 2010 Northern Ireland – 49.8% of
11-16 yr olds report adults smoke inside
their home
ISAAC study – Ireland sample 2007 – 45%
CHETS study Northern Ireland – SHS
exposure is socially patterned
Indoor Air Pollution and Health – STRIVE
report 2013 - Mean 24-hour level in smoking
homes of 143μg/m3 4 times higher than US
EPA ‘ unhealthy’ level for sensitive groups

18. Percentage of boys who report they
are current smokers
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Source: The Irish Health Behaviour in School-Age Children Study 2010
www.nuigalway.ie/hbsc

19. Percentage of girls who report they
are current smokers
Source: The Irish Health Behaviour in School-Age Children Study 2010
www.nuigalway.ie/hbsc
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20. Adult smokers by social class (2007)
Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report 20

21. Percentage of cigarette smokers who reported
trying to quit in the previous 12 months
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Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report

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Tobacco industry role
 Recruiting ‘FUBYA’ a priority
 PPACTE report – adapting price strategies
 Roll your own tobacco
 Illicit tobacco

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Source:
Irish Independent
newspaper
2008

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Tobacco control through an equity
lens
 How would we judge success/failure?
 Health intelligence requirements
 Regulation of tobacco industry and supply
chain
 Education, health promotion
 Smoking cessation services, monitoring
and review

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Dr Helen McAvoy
Institute of Public Health in Ireland
helen.mcavoy@publichealth.ie
@HelenMcAvoy2
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