SMOKING CESSATION ANNUAL REPORT
2009-10
August 2010
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Contents
Introduction ............................................................................... 3
HEAT Target (H6) .......................................................................... 3
Funding from Scottish Executive ......................................................... 4
The Local Service .......................................................................... 5
Quit Rates 2009/2010 ..................................................................... 6
Smoking in Pregnancy ................................................................... 12
Smoking and Young People ............................................................. 12
Nicotine Replacement and other drug treatments .................................... 13
NRT and Drugs prescribed by GP Practices ............................................ 14
Summary & Recommendations ........................................................ 15
Appendix 1 Smoking Population Data ................................................ 17
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Introduction
The following report is an update on the statistics of the Smoking Cessation activities in
Shetland for the period 1st April 2009 – 31st March 2010.
The most recent estimates of smoking prevalence among adults in Scotland are that 25.2%
of adults (26% of men and 25% of women) aged 16 years and over were cigarette smokers
in 2008. This suggests that there are over 1 million adult smokers in Scotland.i
Shetland’s smoking population rate is well below the national average. In 2005 local figures
(GPASS) showed that Shetland’s smoking population was at 20%, in 2007 the Household
Survey estimated that Shetland’s smoking population is down to 14.2%. This decline could
have been influenced by a number of factors including dedicated smoking cessation
services, a ban on smoking in public places, a reduction in the legal age limit for tobacco
sales and both local and national campaigns to continue to raise awareness of the dangers
of smoking and passive smoking.
Smoking, however, still remains the main reason why inequalities in health are widening
between the general population and disadvantaged groups. Only one in 4 of the adult UK
population smokes. But smoking rates are as high as 8 out of 10 amongst certain groups
including the poorest, Asian men, prisoners, mental health service users, homeless people,
drug and alcohol addicted and the gay community. These groups are often described as
‘Hard to Reach’ but the tobacco industry seems to be able to get to them! However it is
more difficult for smoking cessation services to access and target smokers from hard to
reach or socially disadvantaged groups. It is important that we try to overcome this barrier
to ensure that everyone has the same opportunities to access the services that we provide.
HEAT Target (H6)
The NHS HEAT (Health, Efficiency, Access, Treatment) target for Shetland is to support 8%
of adults who smoke to successfully quit over the period 2008 – 2011. According to the
2007 Household Survey, Shetland’s estimated total number of smokers is 2559. If we are to
reach the HEAT target we will need to help 204 people successfully quit between now and
2011. With a quit rate of 50% at 4 weeks this would mean we would need to see over 400
people through the smoking cessation service in order to reach the target.
However, we recognise that as our smoking population is one of the lowest in Scotland; this
means we are now working with some of the hardest to reach groups and it is likely that
quit rates and up take of services will reflect this.
Progress towards meeting the Smoking Cessation HEAT target is monitored through the
national smoking cessation data-base.
Smoking cessation support is provided through health centres and community pharmacies
as well as through the smoking cessation specialist service. All these services assess current
smoking behaviour and work with the client to put actions in place to help them quit. This
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may involve the use of medication such as nicotine replacement therapy. A smoking
cessation assessment questionnaire is completed for each client and the information from
this is fed into the national data-base.
Over the past year monitoring of collected data highlighted that not all quit attempts that
were happening in Primary Care and Community Pharmacies were being collected and
recorded. In order to improve data collection the questionnaire was revised; it is now
easier to follow and takes less time to complete. The revised form has been gradually
introduced to relevant professionals Shetland-wide.
To improve data collection further we have been working with a specialist software
company Blue Bay to create an electronic version of the smoking cessation assessment
questionnaire. We have spoken to one of the local health centres in Shetland about
piloting it. If successful it will be rolled out across all health centres in Shetland.
Meanwhile in community pharmacies work has begun involving the NHS Shetland IT
department to allow pharmacies to enter data directly onto the smoking cessation national
data-base.
Shetland still has the lowest smoking prevalence of any of the Scottish NHS Boards.
Smoking Prevalence is projected to decline in all Boards but Shetland is predicted to have
one of the steepest declines.
We shouldn’t be complacent; young people still continue to take up the dangerous habit
every year. To combat this we have been working closely with the Shetland Islands Council
Trading Standards and Education Departments and an audit of tobacco education in schools
has been completed. This has revealed the need for a tobacco education pack in schools.
Work is now underway to develop a pack linking with the Curriculum for Excellence Health
and Wellbeing outcomes. The pack will cover nursery up to secondary 3.
In addition work will continue on prevention through the annual promotion of “National No
Smoking day” in March, the local smoke free homes campaign featuring the Puff family, as
well as joint work on anti-littering.
Funding from Scottish Executive
Shetland NHS Board was allocated £59,000.00 for 2009/10. This funding was spent on
providing a dedicated smoking cessation service and other Health Improvement activities
relating to Smoking & Tobacco Control e.g. No Smoking Day campaign.
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Smoking Cessation Budget expenditure 2009/10
The Local Service
The Smoking Cessation Service within Shetland is overseen by the Health Improvement
Department and employs one full time Smoking Cessation Advisor who offers specialist
support to smokers on a one to one and group basis. This post holder also supports a
network of intermediate level advisors in Primary Care. Other members of the Health
Improvement team also provide smoking cessation services. In addition, a Senior Health
Improvement Advisor spends approximately one day per week managing the service and
taking the lead on Tobacco Control. There is also management support from the Health
Improvement Manager and Consultant in Public Health.
1 This NRT expenditure is for the Specialist Smoking Cessation service only. The free NRT scheme
for Primary Care is separate and comes under the heading of ‘Drugs used in Substance Dependence’.
Health Improvement Practitioners (Smoking Cessation Advisors) £31,900
Senior Health Improvement Advisor (Tobacco Control) & other management
support £10,000
Puff Family Campaign £2,000
Smoke Free Football Team £1,000
Advertising and publicity £1,000
Resources and equipment £3,500
Catering & Room hire £500
Travel £1,500
1NRT spend by Smoking Cessation service £5,500
Training £300
Overheads and miscellaneous £1,800
Total Expenditure £59,000
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Quit Rates 2009/2010
The following tables represent the data collected by the Smoking Cessation Service on
behalf of NHS Shetland, for all clinics.
Table of quit rates
Year Number of people
through service
Number of
people set a quit
date
4 Week
Quit Rate
3 Month
Quit Rate
12 Month
Quit Rate
2003/04 108 101 76% 51% 24%
2004/05 101 88% 50% 2%
2005/06 216 41% 34% 18%
2006/07 122 48% 25% 13%
2007/08 188 100 51% 16% 9%
2008/09 114 119 48% 15% 6%
2009/10 231 223 46% 12% Not yet
known
Our local 2009/10 4 week quit rate is 9% higher than the national average. We continue to
have a high percentage of people contacted for 4 week follow up; in this period we
captured 80% of those folk setting a quit date, (down from 82% in 2008/9), but very good in
comparison to previous follow up rates and a national average of 63%. We validated a
higher percentage of these quits with Carbon Monoxide (CO) monitoring than the national
average.
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Breakdown of patients who set a quit date in Shetland 2009/10 Table 1: Grouped by age
Numbers Percentages
Unknown: 1 0%
Under 16: 2 1%
16 - 17: 2 1%
18 - 24: 21 9%
25 - 34: 47 21%
35 - 44: 61 27%
45 - 59: 51 23%
60+: 38 17%
Total: 223 100%
Chart
Table 2: Grouped by gender
Numbers Percentages
Female: 103 46%
Male: 120 54%
Unknown: 0 0%
Total: 223 100%
Chart
Nationally more females tend to access smoking cessation services, whereas in Shetland,
we have more males than females.
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Table 3: Grouped by ethnic origin
Numbers Percentages
White: Scottish: 144 65%
White: English: 4 2%
White: Welsh: 1 0%
White: Northern Irish: 1 0%
White: British: 43 19%
White: Irish: 2 1%
White: Gypsy/traveller: 1 0%
White: Polish: 2 1%
White: Other (please
specify): 4 2%
Mixed or multiple: any: 0 0%
Asian: Pakistani: 0 0%
Asian: Indian: 0 0%
Asian: Bangladeshi: 0 0%
Asian: Chinese: 0 0%
Asian: Other (please
specify): 0 0%
African: 0 0%
Caribbean: 0 0%
Black: 0 0%
African/Caribbean/Black:
Other (please specify): 0 0%
Other ethnic group:
Arab: 0 0%
Other ethnic group:
Other (please specify): 2 1%
Not disclosed: 3 1%
Unknown: 16 7%
Other (please specify): 0 0%
Total: 223 100%
Chart
Although 3 people did not disclose their ethnic origin and 16 have answered ‘unknown’ to
this question, it appears that no people of Asian or any other ethnic group other than white
have accessed the smoking cessation service. We therefore need to do some work on
identifying whether people of other ethnic origins within Shetland smoke, and if they do
smoke, how we can best support them in stopping.
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Table 4: Grouped by employment status
Numbers Percentages
In paid employment: 131 59%
Full-time student: 5 2%
Homemaker/full-
time parent or
carer:
13 6%
Unemployed: 20 9%
Retired: 33 15%
Permanently sick or
disabled: 3 1%
Other (please
specify): 4 2%
Unknown: 14 6%
Total: 223 100%
Chart
Table 5: Grouped by whether pregnant
Numbers* Percentages
Not pregnant: 91 88%
Pregnant: 4 4%
Unknown: 8 8%
Total: 103 100%
Chart
*The above list only includes female clients
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Table 6: Grouped by whether free prescriptions were received
Numbers Percentages
Yes: 101 45%
No: 75 34%
Unknown: 47 21%
Total: 223 100%
Chart
Table 7: Grouped by practitioner/advisor type
Numbers Percentages
Unknown: 75 34%
Dentist / dental
nurse: 0 0%
District nurse: 0 0%
GP: 2 1%
Health visitor: 0 0%
Midwife: 0 0%
Occupational health
nurse: 0 0%
Practice nurse: 36 16%
School nurse: 0 0%
Specialist nurse: 0 0%
Other: 0 0%
Pharmacist: 47 21%
Smoking cessation
specialist: 63 28%
Total: 223 100%
Chart
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Table 8: Grouped by referral source
Numbers Percentages
Unknown: 0 0%
Consultant: 0 0%
Dentist: 0 0%
GP: 12 11%
HealthPoint: 0 0%
Health visitor: 1 1%
Incentive scheme: 0 0%
Practice nurse: 27 25%
Specialist nurse: 5 5%
Other: 3 3%
Pharmacist: 45 41%
Phoneline: 0 0%
Self-referral: 14 13%
Stop smoking
roadshow: 0 0%
Midwife: 2 2%
Total: 109 100%
Chart
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Smoking in Pregnancy
Smoking at Booking (Mothers who have delivered):
2004/2005 2005/2006 2006/2007 2007/2008
*
2008/2009 2009/10
Number of
women
smoking at
booking
28
12.3%
31
13.9%
35
13.6%
16
10.9%
32
13.4%
40
14.4%
Number of
women not
smoking at
booking (Inc
former
smokers)
158 165 191 96 152 215
Not Known 42 27 30 4 54 22
Totals 228 223 256 146 238 277
*Please note 2007/2008 data incomplete.
These figures are collected by maternity staff at booking which usually happens in the first
three months of pregnancy. The percentage of women smoking at booking over the past
five years has remained fairly constant and suggests we need to do more work with women
of childbearing age to help them quit prior to getting pregnant.
Smoking and Young People
Offering effective Smoking Cessation interventions for young people still remains a
challenge. Nationally the focus has shifted to that of prevention. In light of this, the Health
Improvement Team have worked closely with Trading Standards on developing a post that
will target young people in the vulnerable transition period with positive smoking
prevention messages and develop a local test purchasing scheme to combat sales to young
people under the legal age. This post will hopefully be in place in the next financial year.
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Nicotine Replacement and other drug treatments
Free Nicotine Replacement Therapy (NRT) Scheme
The Scottish Government provides funding for smoking cessation. There is an expectation
that only up to 20% of the smoking cessation allocation should be spent on NRT. This
equates to £11,800.00 this period. Shetland NHS Board is expected to pick up any
additional cost.
During 2008/2009 the Smoking Cessation Specialist Service spent £5515.00 on NRT; this is a
slight increase from last year figure of £3992.00, but has not reached previous periods of
over £15,000.00. We increased provision again in this period, this was due to identifying a
drop in three-month quit rates being a possible outcome of dramatically reducing the
amount of NRT we were providing. However so far there has been no significant increase in
the 3 and 12 month quit rate. These rates are in line with national figures.
During this period the intermediate smoking cessation services (i.e. through GP practices)
spent £1406.65 on the Free NRT scheme.
Monitoring will continue to identify any trends and therefore any required actions over the
next year.
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NRT and Drugs prescribed by GP Practices
During 2009/2010 a total amount of £16177.10 was spent on prescribed NRT compared to
£10696.25 during 2008/9. £17308.20 was spent on Varenicline Tartate and £621.66 on
prescribed Amfebutamone by the GP Practices (a combined total of £17,929.86, compared
to £25876.87 on prescribed Amfebutamone and Varenicline Tartate during 2008/9). NRT
expenditure was up from last year by £5500.00 whereas prescribing of Varenicline Tartate
(Champix) and Amfebutamone (zyban) has decreased by nearly £8,000.00.
During this same period the Health Improvement Team received the following data returns
from the GP practices:
Surgery No. of
data
returns
received
Quantity of NRT
Dispensed
(items e.g.
patch)
Quantity of NRT
used under the
free scheme
(items e.g.
patch)
Quantity of
Varenicline
Tartate
(Champix)
Dispensed
(tablets)
Quantity of
Amfebutamone
(Zyban)
Dispensed
(tablets)
Yell 10 2156 0 0 300
Unst 10 230 24 228 0
Scalloway 2 1610 0 3562 60
Hillswick 4 2857 40 427 0
Brae 14 2584 0 2113 0
Lerwick 7 5733 0 5332 300
Levenwick 13 1992 60 546 0
Bixter 11 955 36 452 0
Walls 1 804 0 0 60
Whalsay 0 0 46 1 60
There was a significant increase in the smoking cessation activity undertaken by community
pharmacies this year, as they saw 53 clients during the year. Of these, 15 had quit smoking
at 4 weeks.
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Summary & Recommendations
The Smoking Cessation Service (in particular the specialist service) is making progress, but
needs to step up a gear if we are to meet the 2010/11 HEAT target of having supported 8%
of the Board’s smoking population in having quit smoking (at one month post quit). The
quality of the data we capture around smoking cessation activities has improved for the
specialist service but unfortunately only slightly for the intermediate (mostly GP Practice)
services. What we can say is that prescribing is happening, but the behavioural support,
follow up and data collection appears to be absent.
The following actions are required in order to reach the target set:
See over 400 people through the smoking cessation service between now (April
2009) and March 2011.
Address the drop in quit rate between the 4 week and 3 month post quit follow
up.
Target women of childbearing age to give up prior to getting pregnant.
Challenge the increase in expenditure of prescribing Champix in relation to quit
rates and data returns.
Investigate the cost and need to spend smoking cessation allocation on staffing
for primary care services in order to offer evidence based practice and provide
the board with the minimum data.
Develop a computer-based system for collecting data using the Bluebay
programs.
All frontline staff in primary and secondary care should have a minimum level of
skill in delivering brief smoking cessation advice (as part of the range of brief
advice on risk factors)
All frontline staff are clear about their role and responsibilities in delivering
smoking cessation and clear about when and how they should be referring to
the Specialist Smoking Cessation Service
Barriers to the uptake of smoking cessation services among potentially
disadvantaged groups should be identified and an action plan put in place to
increase levels of uptake.
We must ensure that the Smoking Cessation Service we deliver is in line with
best practice recommendations and the Smoking Cessation Service Protocol.
We must ensure that we receive accurate, useful and timely information from
pharmacy and primary care on the amounts and costs of NRT distributed and
the minimum dataset.
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We must continue to do everything possible to encourage smokers who want to quit to
give it a go! With any of the groups where smoking is at high levels, it is harder to get even
small numbers to quit. But there are many smokers wanting to quit in all these groups.
Research shows that people in these disadvantaged groups are trying to quit but have less
success in staying stopped and may take many attempts until they do. The challenge for
local smoking cessation services is to find ways of encouraging more smokers who want to
quit to try to stop and finding ways to support them to stay stopped.
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Appendix 1 Smoking Population Data
i Scottish Public Health Observatory : Tobacco Use – Key points accessed 26.08.10
http://www.scotpho.org.uk/home/Behaviour/Tobaccouse/tobacco_keypoints.asp
Taulbut, M (2010) Smoking prevalence trends in Scotland: Simple Projections to 2010 Martin, Public Health Observatory