Tobacco Needs Assessment

Identified Needs

Reviewing the available data and evidence has shown that there are several cohorts of the population which have significantly higher smoking prevalence than the general population. Although the smoking prevalence in these groups has decreased over the last few years, it is still high. 

• Routine and Manual Workers: The Swap to Stop pilot aimed at routine and manual workers, which provided smokers with vapes and stop smoking support was effective with some businesses, but not others, where engagement was low. The timing of the clinics, and engagement with the service after the initial appointment, were factors which contributed to lower quit rates. Lessons learned from the pilot will form the basis for future engagement with routine and manual workers.
• Mental Health: The mental health stream of the Treating Tobacco Dependency Programme is not yet fully implemented. Once established, this should support people leaving hospitals and community care to quit smoking.
• Drug and Alcohol Service: The Swap to Stop programme highlighted that less than 3% of smokers who entered the service were referred to the Stop Smoking Service. Working with Via, our drug and alcohol treatment service, as part of the programme, increased the number of referrals and this should continue.
• Smoking in Pregnancy: The development of the in-house maternity service has resulted in a decrease in the number of pregnant women smoking at the time of delivery. Although the rate is now below 6%, there is still work to be done to reduce this further and support household members who smoke.
• Place Priorities Cardiovascular Disease (CVD) and Cancer: Smoking is the leading cause of premature, preventable death globally, as a result of both direct tobacco use and non-smokers being exposed to second-hand smoke. CVD prevention is a priority of the new Cheshire West and Chester Health and Wellbeing Strategy 2026-2031 (in development). The Combined Intelligence for Population Health Action (CIPHA) platform has been developed to integrate health and social care datasets across Cheshire and Merseyside to inform key decisions in Public Health and can be used to target interventions.
• Access to support: The local Stop Smoking Service supports approximately 5% of the smoking population to quit. Consideration needs to be given as to how Place partners can provide support to smokers who do not wish to, or are unable to, access the service.

 

Gaps

This needs assessment has identified several gaps in knowledge on both smoking and vaping prevalence including:

• UK prison and criminal justice system: There is limited data both nationally and locally on the prevalence of both smoking and vaping across the criminal justice system. Including those with custodial sentences, within the community, probation and post-supervision, and the Youth Justice Service.
• Rough sleepers and those in temporary accommodation: Nationally smoking prevalence within the homeless sector is thought to be between 75% and 85%, however there is limited data available locally.
• Social housing: Evidence suggests that nationally people who live in social housing are more likely to be smokers. It is not known whether local social housing providers collate data on smoking prevalence; this requires further investigation.
• Children and Young People: There is only one data source locally which collects information on children and young peoples’ smoking and vaping habits, the Trading Standards North West Youth Survey.
• Global ethnic majority groups: Only 1.8% of the people who set a quit date in 2024/25 with the Stop Smoking Service were from global ethnic majority groups. Work needs to be undertaken to explore this further.
• Cancer and Mortality: National data around cancer prevalence and smoking related mortality has not been updated since 2019. It is unclear whether the data has stopped being recorded or whether analysis of the data has been paused.
• People serving in the Armed Forces: The Ministry of Defence collates data on the smoking prevalence among serving personnel through the Defence Medical Information Capability Programme. However, this data is not routinely accessible.

 

Challenges

1. Cost

The Government has committed to provided additional funding local Stop Smoking Services until 2029/30, but the funding is allocated annually, making long-term planning difficult. Although funding has increased, it remains inadequate to support all smokers, especially those with complex needs. A universal service is needed, with targeted support for high-risk groups such as routine and manual workers, individuals living with mental health conditions, or substance use issues. Additionally, there is rising demand for help to quit vaping and nicotine products to be nicotine-free. The current service focuses on tobacco cessation, but consideration should be given to evolving it into a broader nicotine addiction service, which would significantly affect costs.

2. Tackling maintenance

Smokers who are very dependent on smoking / nicotine may see smoking as a low priority. A fifth (20%) of people surveyed as part of the All Together Smokefree (ATSF) research were ingrained smokers. Many may live in families with higher rates of smoking, which normalises smoking behaviour. Effective interventions need to tackle households and build in resilience, providing coping and harm-reduction strategies to maintain a long-term quit. Offering linked support around other stressors as part of a holistic offer, should be considered.

3. Vaping / e-cigarettes

Vaping remains an emotive subject, with the public perception of harm associated with e-cigarettes as a more harmful product than smoking, growing each year. The long-term impacts of vaping on health cannot be ascertained at this time, due to the lack of longitudinal studies. Current national guidance states that nicotine e-cigarettes are an effective quit tool. Clear, consistent messaging around the short-term use of vapes as an effective quit tool for smoking cessation should be provided. Ensuring that children and young people are not exposed to vaping, so that it becomes normalised behaviour. As per the UK Chief Medical Officers’ advice, “if you don’t smoke, don’t vape”.