Smoking Facts

1
Smoking Facts

• Smoking is largest preventable cause of death
  disability in the UK
• Smoking causes gt120,000 deaths each year (gt2000
  per week, 300 per day, 13 per hour every hour)
• Treatment of smoking related illness costs the
  NHS 1.7 billion/year
• 28 of adults smoke
• Half will die from smoking related illness
• Fewer than half of all smokers consider their
  smoking problematic

2
Stopping smoking reduces health risks

• Overall mortality risk approaches that of
  never-smoker after 10-15 years
• Decline in lung function approaches that of
  never-smoker after 3-4 years
• Risk of lung cancer reduced by between a third
  and a half after 10 years
• Risk of CHD reduced by at least half after 1 year

3
Smokers attempts at cessation

• Two-thirds of smokers say they want to quit
• Approximately one-third attempt to stop smoking
  each year
• Only 2-3 succeed without treatment or support
• Only about 25 of quit attempts involve NRT
• patch used most commonly, followed by gum
• Only about 5 of women and 2 of men use
  professional help to quit.

4
Government Action

• White Paper Smoking Kills (Dec 1998)
• reduce smoking among children and young people
• to help adults, especially the most
  disadvantaged, to give up smoking
• to offer particular help to pregnant women who
  smoke.

5
National Service Framework for Coronary Heart
Disease (March 2000)

• 10 standards to reduce prevalence and risk of CHD
  provide better services to treat CHD
• Smoking cessation directly contributes to 2 of
  the 10 standards
• Standard 2 The NHS and partner agencies should
  contribute to a reduction in the prevalence of
  smoking in the local population
• Standard 3 GPs and primary care teams should
  identify people with established CVD and offer
  them comprehensive advice and appropriate
  treatment to reduce their risks.

6
Hertfordshire Smoking Cessation Services

• 3) Opportunistic/Brief Interventions
• 2) Intermediate interventions
• 1) Specialist smoking cessation clinics/services
• Levels 1 and 2 to be monitored according to DoH
  guidance

7
Level of health professional intervention

• Not routine in spite of supporting evidence
• Advice on smoking given to
• only 29 of smokers by GP (HEA, 1995)
• only 39 of pregnant smokers (HEA, 1996)

8
Level 3 Brief Interventions

• Opportunistic interventions by all healthcare
  professionals as part of normal duties
• Aims to
• encourage smoker to think about stopping
• and refer patient for further advice/support.

9
Brief intervention in Hertfordshire

• Information packs and an instructional video was
  mailed to all GPs early in 2001
• Aim was to provide up to date information
  regarding smoking cessation advice and
  appropriate referral to smoking cessation
  services.

10
Level 2 Intermediate Services

• One-to-one intervention by appropriately trained
  health professional
• Primary care based
• Intervention provided weekly for at least four
  weeks past clients quit date
• Monitored according to DoH Guidelines.

11
Intermediate Service in Hertfordshire

• Currently, 60 GP practices and 21 pharmacies
  across Hertfordshire have signed up to provide an
  Intermediate Smoking Cessation Service.
• Providers are reimbursed for service provision
  and for returning monitoring information to the
  Central Team
• Monitoring of this service is managed centrally
  by the Hertfordshire Smoking Cessation
  Co-ordinator
• Providers must complete appropriate training
  course prior to signing up to provide
  Intermediate Service.

12
Hertfordshire Training Programme

• Two levels of training offered to all health care
  professionals
• Intermediate and Advanced
• Both levels of training are one day courses
• Over 400 health care professionals trained
  throughout Hertfordshire.

13
Intermediate Service cont.

• The Central Team provides additional 11 smoking
  cessation sessions according to client demand in
  each PCT
• This service is openly available to all PCT
  residents
• Currently this service is provided in Watford
  Three Rivers, Dacorum, SE Herts, RBBS, North
  Herts Stevenage PCTs
• Plans are underway to extend this service
  provision to other PCT areas.

14
Level 1 Specialist Smoking Cessation Clinics

• Aim to provide more intensive support and is
  particularly designed for
• more heavily dependent smokers
• motivated to stop smoking
• previous unsuccessful attempts to quit.
• Intensive, group oriented treatment
• Run by trained smoking cessation specialists from
  the Central Team
• Includes use of Bupropion (Zyban) or NRT
• Co-ordinated, monitored and funded centrally.

15
Group treatment of smoking

• Counselling increases chances of quitting
• NRT/Zyban behavioural support
  increased cessation rates
• Up to 35
• Group treatment cost effective way to
• Provide motivation support
• Assess needs monitor progress
• Provide education
• Prevent relapse
• Conduct research

16
Specialist Service in Hertfordshire

• Called Pack It In
• Operational in all PCT areas of Hertfordshire
• Runs groups on a rolling programme
• Smokers may self-refer via freephone number
• Advertised regularly on radio, in local press and
  via mailout to health professionals.
• Current success rate 70 (at 4 weeks post quit
  date)
• 69 still stopped after 1 year
• Relapse prevention sessions run on a regular
  basis.

17
Pack It In programme

• Week 1
• Motivation to stop smoking
• Information about treatments
• Week 2
• Planning to quit
• CO monitoring
• Week 3
• Quit day
• Weeks 4-6
• Managing withdrawal symptoms other issues
• Week 7
• Relapse prevention evaluation

18
Targets and success of Services

• Target for 2001/2002 654 four week quitters
• A total of 1165 four week quitters was achieved
• Overall success rate of about 70
• Targets for 2002/2003 have doubled and are PCT
  specific
• Current projections based on quarter 1 2
  results are positive
• Targets to increase by 170 each year for the
  next 3 years.

19
Smoking Cessation in Pregnancy

• January 2001, Government announced additional 3
  million towards reducing smoking in pregnant
  women
• November 2001, each HA received 32,000

20
Smoking cessation in pregnancy in
Hertfordshire

• March 2002, Specialist Facilitator in smoking
  cessation in pregnancy appointed
• Jane Hudson
• Role is to co-ordinate and develop appropriate
  smoking cessation services for pregnant women,
  new mums and their partners in Hertfordshire
• Service development currently progressing well.

21
Smoking cessation in young people in Hertfordshire

• Both Intermediate and Specialist Services are
  open to people of all ages
• The Central Team runs appropriate smoking
  cessation training for professionals working with
  young people
• The aim is that services are provided within an
  environment that is familiar and accessible for
  young people.

22
What can you do?

• Offer appropriate advice to those who want to
  quit
• Support appropriate use of NRT and bupropion
• Refer smokers to Stop Smoking Services
• 0800 389 3 998