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Alcohol, smoking and drugs


Alcohol consumption has doubled in the UK since 1950s and is a contributing factor in hospital admissions and deaths from a wide range of conditions.  The misuse of alcoholic beverages is also linked to a proportion of violent crimes, particularly related to the night time economy, and it is also implicated in the escalation of domestic abuse.

The latest set of Local Alcohol Profiles for England (LAPE) estimate that 25.9% of Herefordshire adults drink over 14 units of alcohol a week and 21% of all adults binge drink (2011-14 estimates)1. In the same period, 14.4% of Herefordshire adults reported they abstain from drinking alcohol.

In 2016/17, there were 618 hospital admissions for alcohol-specific conditions (those caused exclusively by the consumption of alcohol) in Herefordshire, which equates to a rate of 319 per 100,000 population; significantly lower than the rate for both the West Midlands region (543 per 100,000) and England (563 per 100,000).  The local admission rate for adults has remained relatively consistent between 2008/09 and 2016/17.

The admission rate for those aged under 18 has shown a decrease since 2006/07 and although the rate has remained above both the national and regional rates, the gap has reduced over this period. In the period 2014/15 to 2016/17 the rate was 40.7 per 100,000 compared to 34.2 per 100,000 across England and 28.5 in the West Midlands region.

Figure 1:  Hospital admissions for alcohol-specific conditions, under 18s.

Chart showing the trend in alcohol-specific hospital admissions for under 18s in Herefordshire compated to England between 2006 to 2007 and 2014 to 2015 (three year aggregated data)

Source:  PHE, Local Alcohol Profiles for England.

Individuals from the most deprived areas of the county are over three times as likely to be admitted to hospital due directly to alcohol consumption as those living in the least deprived areas.

In 2014/16 the age-standardised rate of alcohol specific mortality in Herefordshire was 7.8 per 100,000, significantly lower than the in the West Midlands region (12.9) and lower than in England as a whole (10.4), though not significantly so.  The rate has remained relatively stable since 2006/8.

In Herefordshire, in 2016 the proportion of alcohol users leaving alcohol treatment successfully who did not re-present to treatment within 6 months was significantly lower than in the West Midlands region, England and all but one of Herefordshire’s comparator group.


Smoking is the most important cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix.

"Smoking is the UK's single greatest cause of preventable disease and early death. Death rates are tripled for smokers aged 45-64, and doubled for those aged 65-84.  Half of all regular smokers will die from smoking related disease.  Differences in smoking prevalence between social classes accounts for much of the inequality in health outcome between social classes."

Chief Medical Officer's Annual Report 2003

Smoking Behaviour

  • Smoking prevalence in Herefordshire has shown a decline in recent years and in 2016 the local figure was 14% compared to 20% in 2010; in 2015/16 there were an estimated 27,000 smokers aged 15 and above across Herefordshire.
  • Among the Herefordshire population males are a third more likely to smoke than females.
  • Relatively low levels of smoking prevalence occur in rural and semirural areas with higher levels recorded in Hereford and market towns.
  • Prevalence of smoking in adults in routine and manual occupations in Herefordshire is significantly higher than that recorded for the adult population as a whole.
  • In line with the national pattern the prevalence of smoking in pregnancy in Herefordshire has fallen almost by a half since 2006/07 and since 2014/15 has been below the “national ambition” of 11%.
  • In 2014/15 almost 6% of 15 year olds in Herefordshire reported that they smoked cigarettes which was lower than the figures of 8.2% and 7.0% across England as a whole and the West Midlands respectively.

Smoking Ill Health and Mortality

  • In 2015/16 there were 2,015 smoking attributable hospital admissions in Herefordshire which represents an admission rate of 1,567 per 100,000 population, a figure significantly lower than the national rate.
  • The admission rate for males was approximately 50% higher than that for females.
  • Between 2010/11 and 2011/12 the average cost per capita of each smoking attributable hospital admission in Herefordshire was £32.75 compared to £37.47 for England and £34.89 for the West Midlands.
  • The local smoking attributable mortality rate has shown a general decrease, falling from 265 per 100,000 population to 235 per 100,000 between 2007 and 2015 and has been consistently lower than the national and regional rates.
  • In 2013-15 lung cancer was the underlying cause of 29% of smoking related deaths in Herefordshire, while chronic obstructive pulmonary disease (31%), heart disease (12%) and stroke (3.6%) were also important.
  • As of September 2016 the estimated total annual cost of smoking-related sickness in Herefordshire is £9.2 million.

Smoking Cessation

  • Since 2011/12 the number of smokers setting a quit date in Herefordshire has fallen steadily which mirrors the national and regional patterns.
  • In 2015/16 the proportion of smokers in Herefordshire setting a quit date successfully quitting was 51%, the same figure recorded nationally and regionally.
  • In 2016/17, the rate of successful smoking quitters at four weeks in Herefordshire was 571 per 100,000, much lower than in England (2,248) and the West Midlands region (2.159) and was the lowest among Herefordshire’s comparator group. Between 2013/14 and 2016/17 the rate at which individuals successfully quit smoking declined by 1,208 points from 1,725 per 100,000.

Children and young people smoking

The only information about young people smoking is from the Every Child Matters (ECM) survey, which was carried out in participating primary and secondary schools in Herefordshire in the spring of 2009.  Different questionnaires were used, reflecting what it was appropriate to ask different age groups.  Years 1 to 3 cover early years in primary school, approximately 5 to 8 year olds.  Years 4 to 6 are the top three years in primary school, approximately 8 to 11 year olds.  Years 7 to 10 are the first four years of secondary school, approximately 11 to 15 year olds.

50% of pupils in years 1 to 3 reported that someone smoked in their family.

Children in primary school were asked whether they thought they would smoke when they were older.  The available answer options varied in the questionnaire for pupils in years 1 to 3 and those in years 4 to 6.  While in years 1 to 3 a simple "no", "maybe", "yes" was used, for years 4 to 6 it was "NO!", "no", "maybe", "yes", "YES!".  In order to show results across the whole of the primary age group, the results for years 4 to 6 are shown grouped into three categories.  It is not expected that the greater number of categories for years 4 to 6 will have made a noticeable difference in the proportions selecting "yes" or "no" overall.

Overall, 6% of pupils in years 1 to 3 and 3% in years 4 to 6 thought they would smoke when they were older.  13% in years 1 to 2 and 11% in years 4 to 6 said “maybe”.  Year 1 boys were the most likely to think they would smoke when they were older, with 13% saying “yes”.  The percentage saying yes is then roughly constant for boys at 5% or 6% until year 6, where 1% of boys thought they would smoke.  Among girls, there was not such a clear cut pattern with age.

For pupils in years 1 to 3, it is possible to look at whether they think they will smoke when they are older according to whether there are any smokers in their family.  Although the overwhelming answer among both groups of pupils is “no”, pupils who live in a family with a smoker are more likely to say “yes” (9%) and “maybe” (17%) than those with no smokers in their family (4% “yes”, 8% “maybe”).

Pupils in years 4 to 10 were asked which of a series of statements about smoking habits described them best.  There were some slight variations in wording between the primary and secondary questionnaires, but these are minor enough that the questions are still comparable.

96% of pupils in years 4 to 6 had never smoked at all; in years 7 to 10 this was 72%. The figure for years 7 to 10 has seen no change since 2006 (72%). Up to year 6, the figure stayed more or less constant, followed by a decrease with age from years 7 to 10.  In year 10, 54% of boys and girls said they had never smoked at all.

4% of pupils in years 4 to 6 had tried smoking once or twice. In years 7 to 10 it was 15% (similar to the 17% seen in 2006). There was also a rise with age among secondary pupils, from 5% of boys and 8% of girls in year 7, to 22% for both boys and girls in year 10. Less than half a percent of pupils in years 4 to 6 said they smoked regularly.  In secondary pupils, it is 5% (similar to 6% in 2006). 11% of males and 10% of girls in year 10 smoked regularly – around half of these would like to give up.

When considering the number of cigarettes smoked in the week prior to the survey, the numbers are fairly low.  1% of pupils in years 4 to 6 had smoked any cigarettes, compared to 7% in years 7 to 10 (8% in 2006). In years 7 to 10, 3% had smoked 11 or more cigarettes (4% in 2006).  Older pupils were more likely to have smoked, and to have smoked greater numbers of cigarettes.

Smoking while pregnant

Smoking in pregnancy has well known detrimental effects for the growth and development of the baby and the health of the mother. Pregnancy-related health problems associated with smoking include complications during labour and an increased risk of miscarriage, premature birth, stillbirth, low birth-weight and sudden unexpected death in infancy. Encouraging pregnant women to stop smoking during pregnancy may also help them kick the habit for good, and thus provide health benefits for the mother and reduce exposure to second-hand smoke by the infant. The Government's Tobacco Control Plan contained a national ambition to reduce the rate of smoking throughout pregnancy to 11% or less by the end of 2015.

In 2016/17 the proportion of mothers in Herefordshire who were smokers when giving birth was 13.8%, above the national ambition of 11% and significantly higher than the proportion nationally (10.7%) and in the West Midlands region (11.8%).  However, it should be noted that there are currently data quality issues surrounding this indicator, which are being addressed by Herefordshire Clinical Commissioning Group (CCG).


Prolonged or regular drug misuse can cause short and long-term physical and mental health problems.  Drug overdoses can result in permanent health damage or death. Some drugs are highly addictive and addicts are more likely to become perpetrators or victims of crime and experience a wide range of social problems, such as homelessness, relationship breakdown and unemployment.  Those who use needles can put themselves at a higher risk of exposure to blood-borne viruses such as HIV/AIDS and hepatitis.

In 2015/16, it is estimated that around 1 in 12 (8.4%) adults aged 16 to 59 in England and Wales had taken an illicit drug in the last year. This equates to around 2.7 million people2.

In 2014, there were 2,248 deaths in England and Wales related to drug misuse; a 15% increase on 2013 and 44% higher than 2004.  Deaths related to drug misuse were at their highest level since comparable records began in 19933.

In Herefordshire, the estimated prevalence of opiate and/or crack cocaine users was 8.2 per 1,000 population in 2014/15, lower than that nationally (8.6) and regionally (9.6), but not significantly so.

In 2016, 29.3% of non-opiate drug users in Herefordshire who received drug treatment left treatment successfully and did not re-present to treatment within 6 months; lower than nationally (37.1%) and regionally (35.4%), but not significantly so.

In the same year, 2.4% of opiate users in Herefordshire who received drug treatment left treatment successfully and did not re-present to treatment within 6 months; significantly lower than nationally (6.7%) and regionally (5.7%).

1Estimate of the percentage of adults who consume at least twice the daily recommended amount of alcohol in a single drinking session (that is, 8 or more units for men and 6 or more for women).

2Statistics on Drugs Misuse: England, 2016, NHS Digital, 28 July 2016. 

[3]  Statistics on Drugs Misuse: England, 2016, NHS Digital, 28 July 2016.