Smoking

Last updated: 2017-11-10 13:51:13
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1. Summary

 

Issue number

1 = highest priority

Strategic issue?

What needs to be done?

1

Smoking attributable hospital admissions and mortality are significantly worse than the national average.

Ensure that secondary care providers implement NICE PH 48 Smoking: acute, maternity and mental health services. This will provide immediate, systematic and comprehensive nicotine dependency support to all inpatients who have been identified as smokers via routine enquiry.

2

The number of people accessing the stop smoking service is reducing each year.

Implement a community champion approach to promote smoking cessation, encourage smokers to quit using the local stop smoking services and support individuals to maintain quitting.

3

Smoking during pregnancy is significantly worse than the national average.

Evaluate the impact of the Maternity Transformation Programme delivered through Hartlepool and Stockton-on-Tees CCG. The programme will utilise CO monitors and visual aids in a wider setting (e.g. children’s centres) to demonstrate how smoking during pregnancy can affect an unborn child. 

 

Last updated: 10/11/17

2. Introduction

Smoking is the single largest cause of preventable mortality in England and tobacco use is one of the Government’s most significant public health challenges.

Approximately 8.5 million people in England (1 in 5) smoke.

Smoking causes over 80,000 premature deaths each year.

There are approximately 1.7 million admissions for conditions that could be caused by smoking. This is an average of 4,500 admissions per day.

Smoking is estimated to cost the NHS £2.7 billion a year. The wider costs to society through sickness, absenteeism, the cost to the economy, social care, environmental pollution and smoking-related fires are estimated to be around £13.7 billion. 

More than 1 in 10 babies are born to women who smoke.

About one-third of all cancer deaths can be attributed to smoking.   These include cancer of the lung, mouth, lip, throat, bladder, kidney, stomach and liver.

Other JSNA topics this topic closely linked to:

Respiratory diseases

Alcohol misuse

Circulatory diseases

Illicit drug use

Cancer

 

Poverty

 

 

 

Last updated: 10/11/17

3. Data and Intelligence

In 2016, an estimated 12.4% of adults in Stockton-on-Tees were smokers. This is statistically significantly lower than the England (15.5%) average.

In 2015/16, there was a statistically significantly higher rate of hospital admissions attributed to smoking in Stockton-on-Tees (2,536 rate per 100,000) than England (1,726 per 100,000).

In 2015/16, there was a statistically significantly higher mortality rate attributed to smoking in Stockton-on-Tees (321.9 rate per 100,000) than England (283.5 per 100,000).

In 2015/16, 18.1% mothers in Stockton-on-Tees were smoking during pregnancy. This is statistically significantly higher than the England (10.6%) average.

In 2015/16, the rate of smokers setting a quit date Stockton-on-Tees has reduced by 34% since 2013/14.

In 2015/16, the rate of smokers successfully quitting for four weeks Stockton-on-Tees has reduced by 38% since 2013/14.

Last updated: 10/11/17

4. Which population groups are at risk and why?

 

Age

 

Gender

Socioeconomic status

Unemployed people (35 per cent) (not working but seeking work) were almost twice as likely to smoke as those either in employment (19 per cent) or economically inactive (16 per cent) (for example, students or retired people).

Qualifications

 

Mental health

There is a strong association between smoking and mental health problems.  The highest levels of smoking occur among inpatients in mental health units, where up to 70% of people smoke, often heavily. 

Ethnicity

Bangladeshi and Irish men were more (Indian men less) likely to report smoking cigarettes than men in the general population. 

Self-reported smoking prevalence is higher among women in the general population than most minority ethnic groups, except Irish and Black Caribbean women.

 

Prisoners

Rates of smoking in prisons are extremely high compared with the general population.

Sexual Orientation

Smoking prevalence is higher amongst people identified as Lesbian Gay Bisexual and Transgender (LGBT) compared with Heterosexual/Straight.

Looked after children

Looked after children are far more likely to smoke than children of the same age who are not in the care system.

 

Last updated: 10/11/17

5. Consultation and engagement

The following are a selection of results from the “Don’t be the 1” survey carried out by Fresh North East in 2014:

Issue number

1 = highest priority

Strategic Issue

1

Most smokers do not mind a health professional asking about their smoking status and expect to be asked the question.

Over 85% of the public support the smoke free area.

2

Smokers would like to stop smoking but it is hard for them to combat the addition of nicotine without support or help.

Over 40% of the smokers thought that they could stop smoking without any support.

3

No consultations have taken place

 

Last updated: 10/11/17

6. Strategic issues

 

Issue number

1 = highest priority

Strategic Issue

1

Smoking attributable hospital admissions and mortality are significantly worse than the national average.

2

The number of people accessing the stop smoking service is reducing each year.

3

Smoking during pregnancy is significantly worse than the national average.

 

Last updated: 10/11/17

7. Evidence base

 

Issue number

1 = highest priority

 

1

Source

BMJ (2016)

Title incl. web link

Effectiveness of a hospital–initiated smoking cessation programme: 2-year health and healthcare outcomes. http://tobaccocontrol.bmj.com/content/early/2016/05/17/tobaccocontrol-2015-052728.full

Summary

To implement a hospital-initiated smoking cessation intervention would reduce mortality and downstream healthcare usage e.g. significantly lower rates of all-cause readmissions, smoking-related readmissions and emergency admission.

Source

NICE (2013)

Title incl. web link

Smoking: acute, maternity and mental health services (PH48) https://www.nice.org.uk/guidance/ph48

Summary

This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes “smokefree” policies & services and recommends effective ways to help people stop smoking or to abstain from smoking while using/working in secondary care settings.

2

Source

Leeds Metropolitan University (2010)

Title incl. web link

Community health Champions: Evidence review

http://www.altogetherbetter.org.uk/SharedFiles/Download.aspx?pageid=4&mid=112&fileid=90

Summary

This evidence review looks at the evidence base for community health champions and similar roles. Community members (either as volunteers or paid community health workers) undertake health promotion activities within the neighbourhoods and communities where they live and/or work. “Altogether Better” is based on an empowerment model. At the heart of this model is the concept that community health champions can be equipped with the knowledge, confidence and skills to make a difference in their communities. The evidence indicates that using Health Champions has improved access and increased uptake to services.

3

Source

NICE (2010)

Title incl. web link

Quitting smoking in pregnancy and following childbirth (PH26) https://www.nice.org.uk/guidance/ph26

Summary

This guideline covers support for women to stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help quitting, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups where the smoking rates are highest.

Source

BMJ Journals (2017)

Title incl. web link

Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation http://tobaccocontrol.bmj.com/content/early/2017/02/10/tobaccocontrol-2016-053476

Summary

Evaluation of the BabyClear intervention – the implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

 

Last updated: 10/11/17

8. What is being done and why?

Specialist stop smoking service

The Stockton and Hartlepool Specialist Stop Smoking Service (SSS) provided by North Tees and Hartlepool NHS Foundation Trust, provides stop smoking drop-in clinics. These clinics are in a variety of community locations (in the areas of most need) and are at varied times throughout the day. 

Pharmacy provision

Pharmacies in Stockton-on-Tees operating under the “Community Pharmacy Stop Smoking Enhanced Service” scheme provide support, advice and nicotine replacement treatment.

The “Community Pharmacy Stop Smoking Enhanced Service” was commissioned to improve access for routine & manual workers, pregnant women and young people. This was achieved by the extending opening hours and increasing the convenience (and choice) of stop smoking services.

Community provision

The community provision is piloted to target vulnerable group e.g. sex workers who are hard to reach and do not access the stop smoking service or pharmacies.

BabyClear

The ‘BabyClear’ project was fully implemented in February 2014, including a new ‘risk perception’ intervention. Those who declined stop smoking support at the first booking appointment were specifically targeted.

Last updated: 10/11/17

9. What needs are unmet?

 

Issue number

1 = highest priority

Unmet need

1

It is estimated that one in six people admitted to hospital is a current smoker. Inpatient smokers do not routinely receive systematic and comprehensive nicotine dependency support within the secondary care setting as part of their treatment plan.

2

The traditional leaflet drop has been unable to increase the number of smokers accessing the stop smoking services.   The MOSAIC segmentation tool informs us that the smokers in most need in Stockton-on-Tees are more receptive to “face to face” interventions to engage and motivate smokers to access the local Stop Smoking Services.

3

The impact of the Maternity Transformation Programme on smoking in pregnancy is not known.

 

Last updated: 10/11/17

10. What needs to be done and why?

 

Issue number

1 = highest priority

What needs to be done?

Why?

1

Secondary care providers to implement NICE PH 48 Smoking: acute, maternity and mental health services, especially to provide immediate, systematic and comprehensive nicotine dependency support to all inpatients who have been identified as smokers via routine enquiry.

A clinical research showed that the intervention is significantly lower rated of all-cause readmissions, smoking-related readmissions, and all-cause emergency visit.

2

Using community champion approach to promote smoking cessation messages and encourage smokers to quit using local stop smoking services. The champions would also support individuals to maintain quitting.

Community champion approach has provided effective in engaging health and wellbeing matter within the community.  Evidence shows that the Health Champion has improved access and increased uptake to services.

3

Continue to support the BabyClear approach within the maternity setting to be delivered via mid-wife and utilise the maternity health care assistants to provide stop smoking support to pregnant smokers.

Evaluate the impact of Maternity Transformation Programme to be delivered through Hartlepool and Stockton-on-Tees CCG. The programme will utilise CO monitor and visual aids to demonstrate how smoking during pregnancy will affect unborn child at a wider setting e.g. children centre.  

BabyClear approached is based on NICE Guidance - Quitting smoking in pregnancy and following childbirth (PH26). The initiative was associated with significant increase in rates of quitting during pregnancy.

The Maternity Transformation programme is added value to BabyClear project and the evaluation will support what can be done to support this agenda.  

 

 

Last updated: 10/11/17

11. What additional needs assessment is required?

A greater understanding of e-cigarette usage of Stockton-on-Tees residents is required.

Last updated: 10/11/17

12. References

Public Health England (2016), Local Tobacco Control Profiles. Available at: http://www.tobaccoprofiles.info/profile/tobacco-control/data#page/6/gid/1938132885/pat/6/par/E12000001/ati/102/are/E06000004/iid/1207/age/202/sex/4

North Tees and Hartlepool NHS Foundation Trust (2017) Stop Smoking Service. Available at: http://www.nth.nhs.uk/services/stop-smoking-service/

Health and Social Care Information Centre (2016), Statistics on smoking. Available at:

http://content.digital.nhs.uk/catalogue/PUB20781/stat-smok-eng-2016-rep.pdf

Fresh North East (2014) don’t be the 1. Available at: http://www.freshne.com/what-we-do/our-campaigns/dont-be-the-1/results

Last updated: 10/11/17

13. Key contact

Name: Ruby Poppleton

Job title: Health Improvement Specialist

Organisation: Stockton-on-Tees Borough Council

Phone number: 01642 526697

Contributor/s:

Kerry Anderson

James O’Donnell

Last updated: 10/11/17

Ruby.Poppleton@stockton.gov.uk