Smoking Prevention and Cessation in Tayside Andrew Radley and Paul Ballard Tayside Public Health Network March 2006

White Paper Breath of Fresh Air 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 AreaAnnual Deaths due to Smoking Current Smoking Prevalence (%) Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Source: Harding O, CPHM, ISD Scotland 2005

Estimated number and percentage of hospital admissions for diseases attributable in part to smoking by cause CANCER Admissions to Tayside 2004/2005 Percent due to smoking Lung1,49685 Oesophagus32669 Bladder39840 Kidney12128 Stomach23828 Pancreas39224 Myeloid leukaemia20015 RESPIRATORY Chronic obstructive lung disease1,50084 CIRCULATORY Ischaemic heart disease33223 Aortic aneurysm12755 DIGESTIVE Ulcer of stomach or duodenum32251 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

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

Outcome Data for Glasgow Project (June 03 – Feb 04) Reference Point One MonthThree Months Twelve Months Cohort at Week One Data analysed on an intention to quit basis Number 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 RiskWeight Relative Risk (Random) 95% Cl (%) (Random) %CI Dunkley /50 50/ [0.85, 1.00] Solomon /77 63/ [0.83, 1.11] Strecher /88 77/ [0.88, 1.08] Thornton / / [0.94, 1.08] Stages of Change- Cochrane Review The Cochrane Collaboration Favours Treatment Favours Control

Rewards - Cochrane Review StudyTreatment Control Relative Risk Weight Relative Risk (Random) 95% Cl (%) (Random) %Cl Donatelle78/112 99/ [0.66, 0.87] Sexton 296/ / [0.71, 0.83] The Cochrane Collaboration Favours Treatment Favours Control

Randomised controlled trial using social support and financial incentives for high risk pregnant smokers Treatment Group Control Group 8-Month Gestation Quit Rate 32%9% 2-Month Post-Partum Quit rate 21%6% Donatelle R. Tobacco Control 2000;9: Χ 2 = 18.4 (p<0.0001)

GP practice based service – one-to-one Support Group Buddy contact Community Service Community Pharmacy Service Details of service Best Guide Ever Practice leaflet Directions Contact Numbers Blurb about Service Enter basic details CHI Demographics Basic elements of PATH data set Make appointment on-line? Send contact details to Service? ELECTRONIC REFERRAL PATHWAY

Smoking Cessation Activity & Estimated Outcomes Number of attempts 5,00011,00012,500 Quitters at 12 months

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 quitters in year one

COMMUNITY APPROACH Resources £240,000 p.a. Recruit Cessation Co-ordinators and Lay support staff Commence March quitters in year one

NEW NHS TAYSIDE SMOKING POLICY Approved by NHS Tayside Board on Commence on 23 November 2006

NHS TAYSIDE SMOKING POLICY KEY 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 POLICY RATIONALE 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