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Smoking remains the number one preventable cause of mortality, disability and ill health in the UK, according to NHS data. It causes around 80,000 deaths a year, one in four of all cancer deaths, and killing up to two-thirds of its long-term users.
While the physical health effects of smoking are well-publicised, there are other ways that it can impact people’s lives.
Mental health impacts
“Smoking exacerbates poor mental health, contributing to conditions such as depression, and [damages] people’s wealth, health and employability, all of which can further harm mental health,” says Elaine Londesborough-van Rooyen, public health registrar at Action on Smoking and Health (ASH).
“People with serious mental illness have more than three times the smoking rate than the general population, and smoking accounts for two thirds of the reduction in life expectancy of people with serious mental illness compared to the rest of the population, so stopping smoking can improve people’s mental health and wellbeing.”
However, Elaine says: “Vapes appear to have particular value for people with mental [health] conditions who smoke, partly due to their low cost and ease of use relative to stop smoking medications,” she says.
“ASH data shows that people with mental health conditions are more likely to make a quit attempt using a vape compared to people without mental health conditions.”
Financial impacts
As well as the health impacts, professor Nick Hopkinson, medical director at Asthma + Lung UK, says smoking also has a huge economic impact through “lost productivity, diversion of spending away from more economically beneficial areas, direct health and social care costs, as well as the costs of fires it causes – costing the economy in England £43.7 billion a year, far more than the £6.8 billion per year raised by tobacco taxation”.
On an individual level, Nick says “the average person who smokes could save over £50 a week by quitting smoking” and then there are the personal care costs that can end up going along with being a smoker.
Data from ASH shows around 230,000 people in the UK are unfit to work due to smoking-related illnesses like cancer, heart disease, COPD and diabetes. This also often means that smokers need care to help with basic tasks like dressing and using the toilet on average 10 years earlier than non-smokers.
ASH says for every person killed by smoking, at least another 30 are estimated to be living with serious smoking-related disease and disability.
“Around 230,000 people in the UK are unfit to work due to smoking-related illnesses”
Less obvious effects
Alongside these impacts, there are other effects of smoking that might be less obvious.
For example, exposing children to second hand smoke (SHS) puts their health at risk and also makes it more likely that they will take up smoking themselves.
Exposure to SHS is linked to sudden infant death syndrome, asthma attacks and heart attacks in adults who already have heart problems, and ASH warns that long-term exposure to SHS increases the risk of lung cancer in non-smokers by 20-30 per cent and coronary heart disease by 25-35 per cent.
“Smoking can also worsen obstructive sleep apnoea (OSA), and people who smoke are five times more likely to be hospitalised with flu and twice as likely to get pneumonia,” says Nick, who adds that smoking is also bad for the environment.
“Smoking and the tobacco industry are linked with deforestation, corruption, child labour and other human rights abuses and another big issue is the ‘filter fraud’,” he says.
“Cigarette filters provide no health benefit to people who smoke at all, instead giving a false sense of protection. They are made of plastic, and are a huge environmental problem, with trillions discarded into the environment every year, leaching toxic material into the environment and breaking down to form microplastic particles and fibres that persist in the environment.
Cigarette butts are the most prevalent items of litter in the UK and cost local authorities around £40 million per year to clean up.”
Exposing children to second hand smoke (SHS) puts their health at risk and also makes it more likely that they will take up smoking themselves.
“People who smoke are five times more likely to be hospitalised with flu”
Pharmacy quit support
“People are three times more likely to quit smoking for good with a stop smoking service compared to going it alone,” according to Elaine.
Alongside the health benefits of quitting smoking, Elaine says people can expect a wide range of other benefits including “better fitness, better sense of taste and smell, improved complexion and freedom from worrying about when you can next have a cigarette during work or long journeys”.
With around 1.6 million people visiting community pharmacies each day, Nick says this puts pharmacy teams in a great position to offer people help with quitting – with training available from the National Centre for Smoking Cessation and Training (NCSCT).
“To begin with, pharmacy teams can offer people help to get started to break their tobacco dependence”, he says, “and they can also advise on treatments and aids such as nicotine replacement therapy, smoking cessation medicines, and e-cigarettes to help with cravings, and put them in touch with local NHS Stop Smoking Services”.
Local Stop Smoking Services are free, friendly and can boost the chances of quitting for good using a range of proven methods alongside professional support during the first few months, and access to affordable stop smoking treatments including nicotine replacement therapy patches or gum, and medicines such as varenicline and bupropion.
Any nicotine-based product, including nicotine gum pouches, can have detrimental effects on oral health.
Sustainable switches
Nicotine pouches are small pouches of nicotine – that do not contain tobacco – which are placed in the mouth between the lip and the gum, and release nicotine into the bloodstream. They are usually sold in a small container of approximately 20 pouches and come in a variety of flavours.
Sometimes nicotine pouches are incorrectly referred to as ‘snus’. Snus is a Swedish tobacco product consisting of a pouch filled with tobacco, also placed in the mouth, which has a long history of use in Scandinavia but has been banned across the EU and UK since 1992.
Action on Smoking and Health (ASH) says currently around 1.1 per cent of adults in Britain use nicotine pouches, and use among 18 to 34-year-olds increased from 1.2 per cent in 2023 to 2.6 per cent in 2025.
Worryingly, nearly four per cent (3.8 per cent) of 11-17 year olds say they’ve tried nicotine pouches, which amounts to approximately 210,000 children.
As nicotine pouches are fairly new products, ASH says there is little research on how they affect oral health, but Nyree Whitley, chief clinical officer at mydentis, says: “It’s important to know that any nicotine-based product can have detrimental effects on your oral health, and this includes snus and nicotine pouches.
The four key signs to watch out for are recurring or persistent ulcers, white patches in your mouth, bleeding gums, or changes on your teeth such as staining."
"These could all be signs of conditions such as mouth cancer or gum disease and you should contact your dentist as soon as possible for a check-up to provide you with tailored guidance and, where needed, treatment options.”
If gum disease has already become apparent as a result of consuming any nicotine-based product, Nyree warns it may be more difficult to reverse these side-effects, but pharmacy teams can always advise people who are concerned about their oral health due to smoking to contact their dentist.
“People who smoke are at much higher risk of developing mouth cancer and gum disease, so early detection is immensely important in treating these conditions,” she says, “and with cases of mouth cancer increasing in the UK, I’d strongly advise anyone who does smoke to ensure they continue with their routine dental check-ups, as their dentist will be well placed to spot any early signs that could appear”.
Self care advice
Ongoing self care advice is also important, says Reshma Malde, pharmacist at John Bell & Croyden, as it “empowers customers to take ownership of the decision to quit and the process involved”.
Reshma says this advice can be given during casual conversations at the counter such as:
- Motivating them to start – support customers in setting a quit date, identifying smoking/vaping triggers, and exploring how to remove cigarettes/e-liquids around them to control temptation
- Talking through coping strategies – suggest healthy distractions like short walks, hydration, sugar-free gum or breathing exercises, as quitting smoking can be difficult due to managing withdrawal symptoms
- Suggesting techniques to manage stress points – many people smoke/vape to manage stress, so talk through quick relaxation techniques and suggest mindfulness apps, or journaling
- Creating social support – encourage customers to tell friends and family about their quit attempt and how they can support them to stay accountable
- Explaining the difference between slips and relapse – stress that a single slip doesn’t mean failure and encourage the customer to return to the quit plan immediately to avoid relapse.
OTC support
Nicotine Replacement Therapy (NRT) products come in patches, gum, lozenges, inhalers and sprays and work by giving the body lower amounts of nicotine without the harmful chemicals in cigarettes, allowing people to slowly reduce the amount of nicotine in their system.
Different products work for different people, so Kenny Chan, Numark lead information services pharmacist, says:
“Some people may find it more effective to use a combination of NRT products – for example, nicotine patches can provide a steady supply of nicotine, while gum or lozenges can be used to manage sudden cravings.
“Quitting smoking is a process and it’s normal to have setbacks, so encourage customers to be persistent and not to get discouraged if they slip up,” he adds.
“Having empathy and acknowledging the difficulty of quitting smoking will validate your customer’s feelings and this can help build trust and rapport. Let them know that they are not alone and emphasise that it’s never too late to quit and that every step towards quitting is a positive one.”
Vapes as smoking cessation tools
Vapes are the most popular stop smoking aid in Britain, according to data from Action on Smoking and Health (ASH), with an estimated 2.4 million adults in Britain quitting smoking with a vape in the last five years.
“Vaping is the most powerful quit smoking tool we have ever had,” says Damien Bové, chief regulatory and scientific officer at analysis, testing and compliance, regulatory and research company ADACT Medical.
“It’s not just nicotine, it’s the sensomotory stimulation from inhaling vapour that triggers a powerful anti-craving effect. Patients that have not been successful with NRT should consider vaping.
It’s 95 per cent safer than smoking, according to Public Health England (PHE), and a very successful tool which has led to a global drop off in smoking numbers that are seen in markets where vapes are allowed. In fact, there are countless anecdotal stories of people quitting after a lifetime of smoking with the help of vapes.”
Indeed, a major evidence review published by the Office for Health Improvement and Disparities in 2022 concluded that vaping poses a small fraction of the risks of smoking in the short and medium term, but it is not risk-free, particularly for people who have never smoked.
“Although much safer than smoking, vaping is not harmless, and people should aim to quit vaping too in the long run, though not at the expense of going back to smoking,” says professor Nick Hopkinson, medical director at Asthma + Lung UK.
“This is especially true in people with lung conditions as vaping is likely to aggravate them as well.”
Professor Hopkinson believes vapes need to be considered as a smoking cessation tool and “kept out of the hands of children and people who have not smoked”.
He added that “people who use vapes as a tool to quit smoking may need further support with their nicotine addiction, so they can eventually also end their use of vapes completely”.
Professor Hopkinson suggests many of the same techniques used to quit tobacco smoking can be used to quit vaping “such as dual nicotine replacement therapy (NRT) or the newer nicotine analogues (varenicline, cytisine).
At Asthma + Lung UK, we want to see all stop smoking services transformed into nicotine cessation services, to support people to quit vaping when the time is right.
These services should be paid for by a ‘polluter pays levy’ on the tobacco industry, which continues to make massive profits from the harm they have caused without penalty”.
Disposable vapes are now band in the UK whilst the average person who smokes is thought to potentially save over £50 a week by quitting smoking.
In Conditions