TOBACCO AND INEQUALITY IN HEALTH Tobacco, a substance that is known to be highly toxic and to provide (in most regards) only relatively modest pleasure, yet which is lawfully sold and used, seems in many ways to be a peculiar product to be permitted for consumption [1]. Harm reduction is one policy option [4]. Nicotine replacement therapy has proven efficacy in over 100 studies (Stead 2012) and has a very benign side-effect profile [19]. Adult smoking usually has its roots in adolescence. If individuals do not take up smoking during this period it is unlikely that they ever will (Mayhew 2000) [22]. There is currently insufficient evidence to recommend one strategy over another to reduce the prevalence or level of children's environmental tobacco smoke exposure [21]. In 2003 the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which now includes 174 countries, covering 85% of the worlds population (WHO FCTC 2003) [26]. Prevention measures should address the specific pattern of smoking inequality observed within a population [32].Tobacco smoking is addictive and causes more death and disability in the UK, and contributes more to social inequality in health, than any other avoidable cause[6]. In terms of reduction in cigarette consumption, nicotine-containing ECs (Electronic Cigarettes) were significantly more effective than placebo ECs and also significantly more effective than nicotine patches in helping people achieve 50% or greater reduction in smoking [23]. It has been projected that with a progressive 50% reduction in uptake and consumption rates of tobacco, as many as 200 million lives could be saved by the year 2050 (WHO 2006) [25]. Studies from Western countries have reported an association between social and economic determinants and smoking to the detriment of those in the disadvantaged groups [27]. Smoking and depression are strongly associated. [24]. Smoking remains the primary cause of preventable illness and premature death in England, and evidence shows that people living with mental health problems are more likely to smoke. Public Health England believe it is vital to reduce smoking rates among people living with mental health problems” [7]

Audrone Barkauskiene