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There is little question that, after almost 25 years, No Smoking Day
still has an important job to do. According to Healthcare Commission
statistics, about 10 million adults in the UK smoke and, in England alone,
86,500 people die each year due to a smoking-related condition. In addition,
smoking is the principal cause of health inequalities in the UK and a
Healthcare Commission report published in January showed that people
in deprived areas are more likely to take up smoking, to start smoking
at a younger age and to smoke more heavily.
However, 70 per cent of smokers say they want to quit and, the Healthcare
Commission also found, primary care trusts in deprived areas had some
of the best smoking cessation services — of PCTs rated as “excellent” almost
half were in areas defined as the most deprived by the index of multiple
deprivation.
A key part of the Government’s work to reduce smoking and smoking-related
deaths is its introduction of bans on smoking in public places. Smoking
in enclosed public places and workplaces will be illegal in Wales from
2 April and in England from 1 July.
John Griffiths, deputy health minister at the Welsh Assembly Government,
said of the Welsh legislation: “The smoking ban in enclosed spaces
is the single most important public health measure that the assembly
has addressed. We estimate that at least 400 non-smokers die each year
in Wales as a result of exposure to second-hand smoke — a compelling
reason for introducing the legislation as soon as possible.
When she announced the English ban in October 2005, health minister Patricia
Hewitt described it as “a huge step forward for public health and
will help reduce deaths from cancer, heart disease and other smoking
related diseases”.
No Smoking Day 2007
No Smoking Day 2007 takes place next Wednesday, 14 March. The
theme for this year’s campaign is “Making a fresh start”.
The campaign image, contrasting stubbed-out cigarettes with a daisy,
is designed to reflect the difference between a smoke-filled and
a smoke-free life, the No Smoking Day organisers say. “‘Make
a fresh start’ is about waking up on No Smoking Day and started
a life that isn’t filled with bad breath, wasted money and
stale smoke. The theme is about starting a fresh-smelling life,
with more money to spend, better health and better looking skin
and hair.”
Ben Youdan, chief executive of the No Smoking Day charity, adds: “Stopping
smoking is the ultimate lifestyle overhaul. You’ll feel fitter,
healthier and have more energy and money,” More information
about local events for No Smoking Day is available on 0800 1690169
or via www.nosmokingday.org.uk
Ahead of No Smoking Day, the Department of Health has launched
a new campaign on the dangers of second-hand smoke. Up to 85 per
cent of second-hand smoke is invisible and odourless and just as
harmful as visible smoke, the DoH says. A TV advertisement will
run from 5 March to 8 April and be supported by press, online and
outdoor advertising.
Launching the campaign public health minister Caroline Flint said: “Smoking
is harmful not just to smokers but to the people around them. What
this new campaign brings home very clearly is the full impact of
second-hand smoke. Eighty-five per cent of smoke may be invisible
and odourless but it is still damaging people’s health. Wafting
and blowing away smoke may seem like the right thing to do but
in reality, it makes little difference to the amount of second-hand
smoke inhaled by people around you.” |
Lessons from Scotland
Scotland has already taken this step — the ban on smoking in public
places came into effect there on 26 March last year. According to Scottish
Executive health minister Andy Kerr, the ban is the most important piece
of public health legislation in a generation.
“The people of Scot-land have fully embraced the smoking ban and
it has been a resounding success,” he said.
“We are already beginning to reap the health benefits.” he
added. “A
study of bar workers carried out just two months after the ban showed
that their health had already begun to dramatically improve, with improved
lung function and reduced nicotine levels in their bloodstream. And scientists
in Aberdeen have also found that air pollution levels in Scotland’s
pubs have dropped by 86 per cent since the ban was introduced.”
Experience from Scotland also suggests that there will be a huge increase
in demand for smoking cessation services in the run-up to the legislation
coming into force in Wales and England. The Scottish Health Executive
found that in the run up to 26 March 2006, calls and texts to the Smokeline
advice line almost tripled, with over 3,000 people contacting the service
each week in February and March.
In addition to seeking advice, smokers wanting to quit also accessed
stop smoking services in greater numbers in the run-up to the introduction
of the new service. Linda Bauld, reader in social policy at the University
of Bath, compared the number of smokers across five smoking cessation
services in Scotland setting a quit date in the first and second quarters
of 2006 with the same periods in 2005.
She found that, from January to March 2006, the number of smokers setting
quit dates with NHS smoking cessation services increased by 51 per cent
compared with the same period the year before. One service saw five times
as many clients setting quit dates in the first quarter of 2006 than
had done the previous year.
Dr Bauld argues that, because the same periods are being compared across
the two years, it is unlikely that the usual seasonal shifts in client
numbers (such as boosts resulting from New Year’s resolutions and
No Smoking Day) account for the rise in
demand.
In the wake of the ban, from April to June 2006, client numbers dropped
off, however. Only 11 per cent more people set quit dates than did so
at the same time in 2005 and one service saw demand drop below the levels
seen in 2005. Overall, 57 per cent less people set quit dates than did
in the first quarter of 2006, compared with only a 41 per cent drop the
year before, Dr Bauld found.
“The fact that significant increased demand was not sustained in Scotland
after the ban was introduced was slightly disappointing,” she says. “It
may be that many smokers have learned to ‘live’ with the
ban and continue smoking.”
Nonetheless, the figures clearly indicate the need for providers of smoking
cessation services to ready themselves in the months before the introduction
of no-smoking legislation. “It seems likely that services in England
and Wales need to prepare three to four months ahead of a ban, rather
than ‘gearing up’ for implementation,” Dr Bauld says.
“This means staffing and other resources need to be secured as soon
as possible to prepare for the potential rush,” she adds. “Primary
care advisers will need to have adequate protected time to treat clients.
In some cases, services may want to consider running more groups, rather
than one-to-one support. Even if the rush is temporary, this is an opportunity
to help many more smokers to quit. It is important that the health gains
can be achieved are not missed because of lack of planning, staff, time
or money.”
Raising awareness of the smoking ban in Wales
The Welsh Assembly Government has been raising awareness
of the no-smoking legislation steadily over the past six months
and, in February, businesses
across Wales were issued with guidance outlining the Regulations
covering the ban.
WAG has also introduced the “Try it” campaign — businesses
have been urged to implement a no-smoking policy for a day, or just
an hour, ahead of the ban’s introduction on 2 April. A number
of restaurants took up the challenge to go smoke-free on 13 December
last year and have since become permanently smoke-free in advance
of the ban. Cardiff International Airport became a smoke-free environment
at the end of January, and hotels, cafés and golf clubs have
also introduced bans before the legislation comes into force. WAG
says that Brian Gibbons, minister for health and social services,
is visiting “as many smoke-free venues as possible” in
the run-up to the ban to help promote awareness of the legislation.
In addition, 60 days ahead of the no-smoking legislation coming
into force, WAG unveiled a digital countdown clock on the roof
of the
tourist information office in the centre of Cardiff and an advertising
van equipped with a countdown clock which is touring towns and
villages in Wales. The clocks will countdown the days, hours, minutes
and
seconds until the ban comes into effect. |
Pharmacists’ role
The usual increased interest in smoking cessation services seen after
New Year will continue as the year progresses, fuelled by the publicity
surrounding No Smoking Day and the smoking bans, Iain Miller, co-ordinator
of the Durham and Chester-le-Street stop smoking service for County
Durham Primary Care Trust, believes.
“Between the January and March quarter of the year we usually see almost
double the number of people we see during other quarters and this year is no
different,” he says. “We have the usual surge of people who have
made a resolution to stop smoking in the New Year,” he adds.
“The forthcoming legislation and the growth in smoke-free polices in public
places has encouraged a lot of smokers to do what the majority want to do anyway,
stop smoking. … With the approach of No Smoking Day and all the publicity
that attracts, I don’t think the level of activity will slow down. That’s
why we need as many outlets where people can access support and pharmacies
have been shown to be as effective as traditional service delivery through
GP practices,” he said.
In fact, it may be that pharmacies are particularly well placed to offer additional
support to smokers looking to quit. Mr Miller has found that although it involved
far fewer people, the pharmacy part of the Durham and Chester-le-Street stop
smoking service showed a higher success rate than that seen across the rest
of the primary care part of the service. From April to December last year,
for instance, the overall success rate for the smoking cessation service in
primary care was 48 per cent (592 people successfully gave up of the 1,234
who set a quit date). However, 45 people set quit dates through the pharmacy
smoking cessation service and 25 of those quit, representing a 56 per cent
success rate.
Pharmacists have also begun to engage smokers outside the traditional confines
of pharmacy. For instance, Graham Phillips, a community pharmacist in Hertfordshire,
has tried to engage young people with the health risks of smoking. The key
to this is, he believes, engaging them with the immediate impact on their health.
“I recently went into a school to talk to a group of 14 to 15-year-olds
about smoking,” he says. “The teacher left so that they could talk openly
to me about their smoking. Most of them were smokers, even though they knew
all about the risks and could quote the risks better than I could. But the
risks to their health and the threat of dying in their 50s just did not connect
with them.
“I also took my Smokerlyser with me, however, and when they saw their carbon
monoxide levels and what that meant, they realised the damage that smoking
was already doing to their health. That really made an impact on them. A few
of them were competitive sportsmen and they realised that they were giving
themselves a serious competitive handicap; it was as if they were playing with
one hand behind their backs. So the impact there was really about engaging
young people with the impact their smoking was already having on their lives.”
Other measures to reduce smoking
Alongside the introduction of public smoking bans,
other areas of progress in reducing the prevalence of smoking have
been raising
of the age at which cigarettes can be bought — in October,
the age at which young people in England can buy cigarettes will
increase from 16 to 18 — and the introduction of cigarette
warning labels.
A Canadian study published last month in the American Journal
of Preventive Medicine (2007;32:210) showed that more prominent
labels,
such as those introduced in the EU in 2003, are associated with higher
levels of awareness and perceived effectiveness among smokers. Although
text-based warnings had a considerable effect, the authors suggest
that pictorial warnings, such as those implemented in Canada and
seven other countries to date, are likely to be the most effective
means of communicating the full range and severity of health risks
to smokers.The DoH is considering introducing such images in the
UK and, last summer, launched a consultation featuring some
of the pictures that might be used (PJ, 3 June 2006, p649). |
Cut backs
However, the success of pharmacy smoking cessation services has not
meant that they have been immune from cost-cutting across the NHS.
Last year, St Albans and Harpenden Primary Care Trust, which faced
a £3.7m
deficit, refused
to fund a pharmacy-based smoking cessation clinic (PJ,
18 March 2006, p315). And this week The Journal reports (p269)
that Brent Teaching PCT is withdrawing support for its pharmacy-based
smoking cessation
services. Financial constraints mean the service has to cut costs and
withdrawing community-based services is seen as the most effective way
of doing so.
However, other sources of funding for pharmacy-based smoking cessation
services have been successfully mined. For instance, Mr Miller was able
to secure central government funding to extend pharmacy provision of
the Durham and Chester-le-Street stop smoking service for County Durham
PCT.
“Two community pharmacies in the area have recently started a Saturday
morning stop smoking clinic,” he says. “In the past they
were limited on what support they could offer at the weekend. They would
be dealing with fewer prescriptions and therefore have fewer staff in
on a Saturday. With the help of an allocation of funding from central
government to encourage joined-up working County Durham PCT has been
able to set up a payment scheme, which enables the pharmacies to pay
extra staff to come in to cover while the clinic is running.” |
The
Pharmaceutical Journal