Despite widespread publicity about the risks to health posed by smoking, pressure group Ash claims 28 per cent of men and 26 per cent of women indulge the habit, totalling approximately 12 million smokers country-wide. With smoking-related diseases costing the health service £1.5bn a year, it's perhaps surprising that tobacco isn't already a controlled substance.

Yet smoking has long held an iconic and glamorous role in popular culture, while the tobacco industry and pro-smoking organisations exert a powerful influence to preserve its status as a legal, desirable pastime. A picture emerges of a protracted fight for legitimacy, where statistics and advertising are powerful weapons for both pro- and anti-smoking lobbyists and the outcome is, literally, a matter of life and death.

This factfile provides an overview of the key facts, detailing the health risks and economic implications of smoking. It also includes an appraisal of the various methods on offer to help smokers give up. It is an invaluable resource for smokers and for anyone who feels affected by this issue.

Health facts

Source: Action on Smoking and Health (www.ash.org.uk)

General statistics

• Every year, approximately 120,000 smokers in the UK die as a consequence of smoking.
  
   

• Treating diseases caused by smoking costs the NHS in the region of £1.5. billion a year. One analysis of the cost benefits of reaching the government’s targets to reduce smoking has shown that £524 million would be saved through reduced heart attacks and strokes.
  
   

• Half of all regular cigarette smokers will eventually be killed by their habit.
  
   

• Smoking causes at least 80 per cent of all deaths from lung cancer, approximately 80 per cent of all deaths from bronchitis and emphysema and around 17 per cent of all deaths from heart disease.
  
   

  • Those who smoke between 1 and 14 cigarettes a day are eight times more likely to die from lung cancer than non-smokers. Smokers who take more than 25 cigarettes a day have 25 times this risk compared with non-smokers.
    
     
  • Cigarette smoking increases the risk of having a heart attack by two or three times, compared with the risk to non-smokers.
    
     
  • People who smoke and drink alcohol regularly are at greater risk of mouth and throat cancers. One study found that among consumers of both products incidence of these cancers was increased more than 35-fold among those who smoked forty or more cigarettes a day and consumed more than four alcoholic drinks a day.
    
     
  • It is estimated that several hundred cases of lung cancer and several thousand cases of heart disease in non-smokers in the UK annually are caused by passive smoking.
    
     
  • More than 17,000 children under the age of five are admitted to hospital annually because of the effects of passive smoking.

Women's health

• Smoking during pregnancy leads to an increased risk of: spontaneous abortion (miscarriage), bleeding during pregnancy, premature birth, low weight of babies at birth (which is associated with greater risks of ill-health and failure to thrive), Sudden Infant Death Syndrome (cot death).
  
   
• Women who smoke and use a contraceptive pill are 10 times more likely to suffer a heart attack, stroke or other cardiovascular disease than those who take the pill but are non-smokers. Smoking has also been linked with an increased likelihood of menstrual problems (although not with PMT).
  
   
• Smoking leads to an earlier menopause: on average female smokers go through the menopause up to 2 years earlier than non-smokers and are at a greater risk of developing osteoporosis.

Men's health

• Smoking has been associated with sperm abnormalities and with impotence in men.

Features on smoking from the Telegraph archive

• 'I know I will never smoke again' - Christine Doyle examines the controversial drug Zyban
  
   
• Kicking the habit need not be a drag - There are many ways of stopping smoking, but determination on its own may not be enough - support is crucial, says Christine Doyle
  
  
• What's the best way to stop? - Reluctant smokers are spoilt for choice, says Christine Doyle. Budding non-smokers describe their methods
  
   
• Children 'copying parents' smoking - Sarah Womack, Social Affairs Correspondent on a family
  
   
• Cool killer? - Why is smoking seen as stylish and desirable? As James Walton discovers, reason has never been a factor
  
   
• Liar, liar - Telegraph writer Cassandra Jardine admits she is a secret smoker and resolves to try to quit.
  
   
• Stress and smoking - Since 11 September 2001, smoking and drinking have been on the increase in America, writes Rajeev Syal and David Bamber.
  
   
• Gender and smoking Are women more more susceptible than their male counterparts when it comes to smoking? Peter Pallot finds out
  
   
• Paid to smoke - Student Freddie Sayers on how he made £25 an hour promoting cigarette brands in bars.

Giving up

While surveys show that around 70 per cent of smokers would like to stop, quitting isn't easy. Here, we take a look at the various medications and methods thought to help smokers give up.

Zyban (bupropion)

This relatively new drug is the first non-nicotine based medication to aid quitting. Originally designed as an anti-depressant, Zyban's effectiveness is not fully understood, although it is thought to block receptors in the brain linked with the pleasurable sensation of lighting up.

Though Zyban has enjoyed high success rates, some users have suffered adverse reactions. There have been more than 7,000 reports from doctors of side-effects from Zyban treatment, ranging from agitation, shakiness and nausea to sleeplessness, dizziness and blurred vision.

Despite these problems Zyban has proved effective in cases where other methods have failed. Available on prescription only, quitters will need to ask their GP if they are suitable for the treatment.

Nicotine replacement therapy (NRT)

Nicotine replacement products form the most common family of drugs thought to aid quitting. While the types available are diverse, all act on a common principle; by topping up the levels of nicotine in the body by clinical means they help smokers break the link with tobacco, making a final withdrawal easier. Tests have shown quitting aided by NRT is twice as easy as with willpower alone.

An obvious advantage of NRT is that during treatment the smoker avoids the harmful effects of inhaling tobacco smoke, while irritability, anxiety and craving are suppressed by a steady supply of nicotine. Detractors of the treatment point out that chemical addiction is kept alive, not broken, by NRT - albeit in a safer form.

Below is a list of common types of nicotine replacement product. Each has advantages and disadvantages and the key is to shop around to find the one that suits you best.

Chewing gums

The first replacement therapy to hit the markets, gums are straightforward to use. Nicotine impregnated gum is designed to be chewed methodically to release the drug into the system.

Most gums need to be chewed until their peppery taste becomes unpleasantly strong, then 'parked' in the cheeks until it subsides. This action is repeated until the gum is exhausted of flavour and all the nicotine has been released.

The gums are available in different strengths, which the pharmacist will match to your cigarette intake and then decrease as the treatment progresses. They are designed to be taken on an 'as needed' basis up to the manufacturer's daily limit.

Though still a very popular format, users of gum products have complained of the off-putting taste, which lingers on the breath. However, manufacturers have sought to address this problem in recent products and your pharmacist should be able to advise you on the most popular brands.

Microtab

The microtab treatment is another oral medication that some find more convenient than gum. A small white tablet, it is placed underneath the tongue and left to dissolve. Microtabs work by being absorbed into the lining of the mouth.

Trans-dermal patches

Besides gum, trans-dermal patches are the most common nicotine replacement therapy. They work by introducing a steady trickle of nicotine into the bloodstream through the skin.

Patches come in two types, one for days only and one for 24-hour use to suppress cravings in the morning. Small and discreet, the patches must be applied to a hairless patch of skin, though not in the same place two days running.

Whilst effective, some users of the 24-hour patches have complained of nightmares and to avoid this problem pharmacists will often err on the conservative side when helping you select the right dosage and style of treatment. At around £15 a week, patches are not prohibitively expensive but be aware that your GP can prescribe them too, if you prefer.

Nasal sprays

The most potent form of replacement therapy is the nasal spray. This is a small bottle of nicotine solution that is sprayed directly into the nose. Because it acts quickly this treatment is suitable for heavy smokers, especially where other methods of NRT have failed.

Inhalators

Inhalators work well for those who find the physical activity of smoking as addictive as its chemical effect. Loosely shaped like a cigarette and used like one, inhalators release nicotine vapour into the lungs from a replaceable cartridge.

Alternative therapies

Often the target of scepticism, alternative therapies have helped many smokers give up when conventional treatments have failed. Drawing on many medical traditions this class of treatment can augment drugs in the fight against smoking, although some techniques call for other methods to be put aside.

Hypnotherapy

Although nicotine is a physically addictive drug, smoking also has many psychological roots. Hypnotherapy tries to weaken the subconscious mind's dependence on smoking as a habit. There are no clinical tests to prove the effectiveness of hypnotherapy in quitting, but some smokers have found it useful.

Acupuncture

Acupuncture involves needles being inserted into key pressure points on the body. The process is not painful and patients are left to relax for a while after the needles are positioned.

They are then removed except for two tiny ones which remain in the ear. The idea is to touch an ear lobe when a craving comes on.

Clinical trials are yet to prove the effectiveness of acupuncture in quitting, but some smokers have found it valuable.

Cold turkey

Going 'cold turkey' means stopping without any kind of aid. Although physical symptoms can be harshest in the first few days, they fade away within two or three weeks. Most people give up smoking using this method.

Variations on the 'cold turkey' technique include positive-thinking systems designed to foster the right mental attitude. Alan Carr's Easy Way is the most popular of these, although his method eschews the traditional 'willpower' approach, for a subtly persuasive philosophy of his own creation.

Economic overview

Source: Action and Smoking and Health

• The UK government earned £9,510 million in revenue from tobacco duty and VAT in the financial year 2000-01.
  
  
  • A law to ban tobacco advertising and sponsorship was enacted in November 2002. During the period September 2001-August 2002 tobacco companies spent £25 million on advertising, excluding sponsorship and indirect advertising.
    
     
  • The Government currently spends around £17m on anti-smoking education campaigns. A further £20m is spent on measures to help people stop smoking.
    
     
  • The price of 20 premium brand cigarettes is £4.40, of which £3.51 (80 per cent) is tax.
    
     
  • The costs of smoking to industry result from lost productivity caused by smoking breaks and increased absenteeism amongst smokers due to ill-health. One study in Scotland has estimated the cost of smoking related absence to be £40 million per annum.
    
     
  • It is estimated that about 25 per cent -30 per cent of cigarettes consumed in the UK have been smuggled into the country. In order to try to combat the growing problem of tobacco smuggling, the Government has launched a programme of measures costing £209 million.

Cost to the smoker

• Currently, a 20-a-day smoker will spend about £1,600 a year on cigarettes. People on low income spend proportionally more of their income on tobacco than wealthier people. In the financial year 2000-01, households in the lowest income groups spent on average £3.90 per week (3 per cent of income) on tobacco compared with £6.10 per week (1.6 per cent) by households in the highest group.

Useful links

www.ash.org - Action on Smoking and Health. A national charitable anti-smoking and non-smokers' rights organisation based in the US.

www.quitsmokinguk.com - An online community for smokers who want to give up.

Forest - Smokers' rights organisation

www.quit.org.uk - Quit is the independent charity whose aim is to save lives by helping smokers to stop.

www.quitnet.com - US site on quitting.

www.nosmokingday.org.uk - 'No Smoking Day'; a charity that helps smokers stop.

www.mindbodysoul.gov.uk/smoking/smomenu.html - Wired for health.

www.healthnet.org.uk/new/smokes/ - Healthnet.

www.doh.gov.uk/smokexec.htm - Department of Health on smoking.

www.givingupsmoking.co.uk - NHS on giving up smoking.

www.smokingsides.com - Diverse perspectives on smoking.

www.netdoctor.co.uk/health_advice /facts/smokehealth.htm - Netdoctor on smoking.

www.tobacco.org - US information site on cigarettes and tobacco.

www5.who.int/tobacco/index.cfm - United Nations Tobacco Free Initiative.

www.roycastle.org - Lung cancer charity.