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