Smoking Prevention and Cessation in

TaysideAndrew Radley and Paul BallardTayside Public Health Network

March 2006

• White Paper• Breath of Fresh Air• 2010 - Smoking

Regulation of Smoking in Public Places

Minimum Data Set

BVR Review

• Lay people• Smoking in Pregnancy• Community Pharmacists• E-referral• Smoking Cessation Coordinators

SMOKING CESSATION LANDSCAPE

NHS Tayside Smoking Policy

WEDNESDAY 15 FEBRUARY 2006 THE INDEPENDENT

Smoking Ready Reckoner

Health Board Area Annual Deaths due to Smoking

Current Smoking Prevalence (%)

Argyll & Clyde 989 32.0Ayrshire & Arran 859 30.6Forth Valley 591 32.5Grampian 994 29.1Greater Glasgow 2030 35.1Lanarkshire 1135 33.7Lothian 1506 28.6Tayside 897 33.8

Source: Harding O, CPHM, ISD Scotland 2005

Estimated number and percentage of hospital admissions for diseases attributable in part to smoking by cause

CANCERAdmissions to

Tayside 2004/2005Percent due to smoking

Lung 1,496 85

Oesophagus 326 69

Bladder 398 40

Kidney 121 28

Stomach 238 28

Pancreas 392 24

Myeloid leukaemia 200 15

RESPIRATORY

Chronic obstructive lung disease 1,500 84

CIRCULATORY

Ischaemic heart disease 332 23

Aortic aneurysm 127 55

DIGESTIVE

Ulcer of stomach or duodenum 322 51

TOTAL 5,807

Effect of smoke-free workplaces on smoking behaviour: a systematic review

Fichtenberg CM,Glantz SA

BMJ 2003; 325:188

“Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8%

(95% CI 2.8% to 4.7%)”

If this effect was observed in Tayside, then 10,812 people would give up in the first 24 months of the ban

Numbers of contacts for Tayside's Smokeline

0

10

20

30

40

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60

70

80

April 2005 May 2005 June 2005 July 2005 August 2005 September2005

October2005

November2005

December2005

January2006

National Targets

22% of adults over 16 years by 2010

11% of young people by 2010

20% pregnant women by 2010

33.2% in the most deprived communities

Proportion of smokers by Depcat: Dundee City

R2 = 0.9626

0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6 7

Deprivation category (1=most affluent)

% p

op

ula

tio

n w

ho

sm

oke

Areas with the Greatest Number of Smokers

DD3 9 2,487

DD2.2 2,444

DD1.3/4 1,396

DD4.9 3,684

DD4.8 3,971

DD4 6 2,325

DD4 0 2,448

DD3.7 3,156

DD3.6 2,645

DD3.0 2,041

DD2.4 3,848DD8.1 2,003

PH1.3 2,109DD2.3 2,623DD10.9 1,901

PH2.8 1,218DD1 5 1,224DD11.5 1,687

PH1.5 1,879DD1 2 763DD11.1 1,964

PH1.2 3,847DD1 1 473DD10.8 1,902Key Postcode Areas

PerthDundeeAngus

0

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400

600

800

1000

1200

1400

1600

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No.

of p

atie

nts

Figure 3. DepCat status of patients directly recruited through pharmacies (n=4,570)

Outcome Data for Glasgow Project (June 03 – Feb 04)

Reference Point

One Month

Three Months

Twelve Months

Cohort at Week One

35 15.2 5.9

Data analysed on an intention to quit basisNumber at week one = 5,578

Smoking in pregnancy

The Scottish average rate for mothers who smoke during pregnancy is currently 23.8%

The overall Tayside rate for mothers who smoke during pregnancy is currently 27.8%. Over 900 pregnant women choose to smoke each year.

The rate in many of the deprived postcodes in Dundee is over 40%. Over 600 pregnant women

who smoke are from Dundee

Study Treatment Control Relative Risk Weight Relative Risk (Random) 95% Cl (%) (Random) %CI

Dunkley 1997 46/50 50/50 2.6 0.92[0.85, 1.00]

Solomon 2000 63/77 63/74 1.3 0.96 [0.83, 1.11]

Strecher 2000 78/88 77/85 2.1 0.98 [0.88, 1.08]

Thornton 1997 186/209 185/209 3.0 1.01 [0.94, 1.08]

Stages of Change- Cochrane Review

The Cochrane Collaboration

Favours Treatment Favours Control0.5 0.7 1.5 2

Rewards - Cochrane Review

Study Treatment Control Relative Risk Weight Relative Risk (Random) 95% Cl (%) (Random) %Cl

Donatelle 78/112 99/108 1.4 0.76 [0.66, 0.87]

Sexton 296/463 393/472 2.6 0.77 [0.71, 0.83]

The Cochrane Collaboration

Favours Treatment Favours Control0.5 0.7 1.5 2

Randomised controlled trial using social support and financial incentives for high risk pregnant smokers

TreatmentGroup

Control Group

8-Month GestationQuit Rate

32% 9%

2-Month Post-PartumQuit rate

21% 6%

Donatelle R. Tobacco Control 2000;9: 67-69

Χ2 = 18.4 (p<0.0001)

GP practice based service – one-to-oneSupport GroupBuddy contactCommunity ServiceCommunity Pharmacy Service

Details of serviceBest Guide EverPractice leafletDirectionsContact NumbersBlurb about Service

Enter basic detailsCHIDemographicsBasic elements of PATH data set

Make appointment on-line?Send contact details to Service?

ELECTRONIC REFERRAL PATHWAY

Smoking Cessation Activity & Estimated Outcomes

2005 2006 2007

Number of attempts

5,000 11,000 12,500

Quitters at 12 months

350 700 830

SMOKING IN PREGNANCY

• Resources of £140,000 p.a. allocated• Stakeholder Working Group• Key role for midwives and health

visitors• Community Focus/DHLI• Referral Pathways• PGD NRT from Community Pharmacies• Incentive Scheme

COMMUNITY PHARMACIES

• Resources of £100,000 p.a.• 28 Pharmacies already signed up• Trained Staff• Inequalities Focus• PGD NRT• Commenced 9 January 2006• 180 quitters in year one

COMMUNITY APPROACH

• Resources £240,000 p.a.• Recruit Cessation Co-ordinators and

Lay support staff• Commence March 2006• 270 quitters in year one

NEW NHS TAYSIDE SMOKING POLICY

• Approved by NHS Tayside Board on 23.2.06

• Commence on 23 November 2006

NHS TAYSIDE SMOKING POLICYKEY COMPONENTS

• Ban on smoking in NHS grounds for everyone except in-patients

• Review of Shelters• Domiciliary Visits• Staff Safety• Smoking Cessation Services

NEW NHS TAYSIDE SMOKING POLICYRATIONALE

• Development of de-normalising of smoking and no-smoking culture

• An incentive for prevention and cessation• In line with Scottish Executive National

Guidance• Embrace the direction of travel