tobacco free cardiff and vale strategy and action …...4.3 smoking prevention 4.4 smoking cessation...

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Tobacco Free Cardiff and Vale

Strategy and Action Plan

2012-2015

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This strategy and action plan is available from: Address: Cardiff and Vale Public Health Team Cardiff and Vale University Health Board Locality Office 2 Stanwell Road Penarth Vale of Glamorgan CF64 3EA Telephone: 02920 350600 E-mail: [email protected] Publication Date: August 2012

mailto:[email protected]

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FOREWORD Cardiff Council, Vale of Glamorgan Council, Cardiff and Vale University Health Board and Cardiff and Vale Public Health Team (Public Health Wales), together with their other statutory and voluntary partners, recognise the important link between smoking and the health of our population. Addressing the issue of smoking in Cardiff and the Vale of Glamorgan is a priority. Tobacco remains a major cause of illness and death among the population of Wales and is a key indicator of health inequalities. It is well known that smoking is a key risk factor in the development of cancer, lung disease and coronary heart disease.

Over recent years, national attention has focussed on legislation with many effective interventions being implemented, including the legislation to ban smoking in all enclosed public places to protect workers and the public from the harmful effects of second-hand smoke; raising the minimum age for purchasing tobacco from 16 to 18 years; and the ban on vending machine sales of tobacco products. More recently, the Tobacco Control Action Plan for Wales (2012) has outlined the vision of reducing smoking prevalence to 16% by 2020. The Tobacco Free Cardiff and Vale Partnership has developed this strategy and action plan in order to contribute to the Tobacco Control Action Plan for Wales (2012). To achieve this national aim, the local action plan will focus on prevention, cessation and smoke-free environments to contribute towards reducing smoking prevalence. There remain areas for development which have been identified in this action plan in order to ensure the vision of the Partnership, that people in Cardiff and the Vale of Glamorgan are fit and healthy, is achieved. Councillor Heather Joyce Council Leader, Cardiff Council

Councillor Neil Moore Leader, Vale of Glamorgan Council

Dr Sharon Hopkins Director of Public Health, Cardiff and Vale University Health Board

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CONTENTS

1.0 Introduction 5

1.1 Why this work is important

1.2 Strategic context 1.3 Local context

2.0 Structure and purpose of this document 8

2.1 Population accountability

2.2 Performance accountability

3.0 What we intend to achieve 10

3.1 The vision

3.2 Indicators

4.0 Local story behind the baseline 16

4.1 Cardiff and Vale of Glamorgan

4.2 Socio-economic status 4.3 Smoking prevention 4.4 Smoking cessation 4.5 Legislation and Environmental Tobacco Control

5.0 Turning the curve – evidence of what works 23

5.1 Prevention

5.2 Cessation 5.3 Smoke-free Environments

6.0 Population accountability – Report card

26

7.0 Performance accountability – Action plan

28

8.0 References

36

9.0 Abbreviations

38

10.0 Appendix 39

Vale of Glamorgan report card, 2010-11

Cardiff report card 2008-11

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1.0 Introduction 1.1 Why this work is important Smoking is a key public health issue as it is the single biggest avoidable cause of disease and early death in Wales. It kills around 5,650 people in Wales each year (Public Health Wales Observatory, 2010). The World Health Organisation (WHO) has identified tobacco smoking as the primary cause of premature illness and death in developed countries (WHO, 2008). It is an important risk factor for Coronary Heart Disease (CHD), stroke, respiratory diseases, many cancers, and is often a cause in fire related deaths. Exposure to environmental tobacco smoke is a major risk factor for conditions such as sudden infant death syndrome and respiratory childhood diseases (National Public Health Service, 2004). Smoking in pregnancy is linked to spontaneous abortion, preterm birth, low birth weight and stillbirth (Royal College of Physicians, 2000). 1.2 Strategic context Our Healthy Future (Welsh Assembly Government, 2009) is the strategic framework for public health in Wales until 2020. It has incorporated a thematic structure and has ten priority areas for action. One of these key priority actions is to reduce smoking prevalence in the population of Wales. This framework is complimented by the NHS Prevention and Promotion National Programme which identifies cost-effective Public Health Smoking Cessation interventions to support NHS Wales. A Tobacco Control Action Plan for Wales has been devised (Welsh Government, 2012) with a vision of a smoke-free society for Wales, in which the harm from tobacco is eradicated. The aim of the action plan is to drive down adult smoking prevalence levels in Wales to 20% by 2016 and to 16% by 2020. The plan includes actions to: discourage young people from starting to smoke, support smokers who want to give up and promote smoke-free environments. 1.3 Local context In order to achieve the national aims, the Tobacco Free Cardiff and Vale Partnership represents the key strategic group leading tobacco control in Cardiff and the Vale of Glamorgan. This strategy is reflected in the “What Matters Strategy 2010-2020” for Cardiff (Integrated Partnership Strategy) which incorporates the components of: Proud Capital Community Strategy, Health Social Care and Well Being Strategy, Children and Young People‟s Plan and the Community Safety Action Plan. The strategy also reflects the components of the Vale of Glamorgan Community Strategy (2011-2021: Children and Young People‟s Plan, Health Social Care and Well Being Strategy, Community Safety Plan and Older People‟s Strategy). The partnership is accountable to the Local Service Board for Cardiff and the Vale of Glamorgan. Under each local authority, the reporting structures are as follows:

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Reporting structures:

Tobacco Free Cardiff and Vale Strategy and Action Plan

Cardiff What Matters

2010:2020

The 10 Year Strategy

Operational Plan 2011-

2014

Vale of Glamorgan

Community Strategy

and Delivery Plan 2011-2021

Tobacco work

accountable to:

Public Health and Wellbeing Board

Tobacco work

accountable to:

Healthy Living Programme Board

Vale of Glamorgan Implementation Group

Vale of Glamorgan Local Service Board

Cardiff Partnership

Board (merged with

Cardiff Local Service Board)

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As part of this local co-ordinated approach to tobacco control, key stakeholders, agencies and partners are able to lead priorities with regard to smoking and influence other groups, partnerships and related action plans. Membership of the group is listed below and includes the key stakeholders that will deliver the action plan as detailed from page 28. Partnerships

Public Health and Wellbeing Board, Vale of Glamorgan Council

Healthy Living Board, Cardiff County Council

Communities First Partnership Boards

Cardiff and Vale Healthy Schools Networks Statutory Partners

Vale of Glamorgan Council o Leisure Services o Environmental Health o Trading Standards o Corporate Health and Safety o Lifelong Learning and Skills o Public Protection o Youth Service o Flying Start

Cardiff Council o Trading Standards o Adult Services o Regulatory and Supporting Services

Cardiff and Vale University Health Board

School Health Nursing Service

Health Visiting Service

Community Dental Health Service Public Health Wales

Cardiff and Vale Public Health Team

Stop Smoking Wales Voluntary Sector Partners

Vale Centre for Voluntary Services

ASH Wales

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2.0 Structure and purpose of this document This strategy has been developed using a „Results Based Accountability‟ (RBA) methodology. RBA is used across the world and increasingly in the United Kingdom public and voluntary sectors, it has been incorporated into Cardiff and the Vale of Glamorgan Council‟s performance management systems and is a locally accepted methodology for agreeing actions. There is a rapidly growing recognition of the potential to help improve results and accountability. RBA is an approach, using „common language‟ developed by Mark Freidman in 2005, for using outcome based thinking to improve the performance of services and the wellbeing of populations. Central to the RBA framework is the recognition of two different sorts of accountability. This is explained briefly below: 2.1 Population Accountability This is the collaborative accountability for conditions of wellbeing for populations or sub-populations regardless of whether they access particular services. Population accountability rests with formal or informal partnerships. Whether at Population or Performance Accountability levels, RBA emphasises that any improvement to the wellbeing of populations or service users must start with the ends which are desired and not with the means which we have at our disposal. The RBA method starts with outcomes or results and works back to means. The population outcome for the Tobacco Free Cardiff and Vale Strategic Action Plan is that all residents in Cardiff and Vale of Glamorgan are fit and healthy. Population accountability works on „an ends to means‟ in 7 questions:

The 7 Population Accountability Questions

OUTCOME What is the quality of life we want for the children, adults and families who live in our community? INDICATORS What would these conditions look like if we could see them?

BASELINES How can we measure these conditions?

STORY BEHIND THE CURVE How are we doing on the most important of these measures?

PARTNERS Who are the partners that have a role to play in doing better?

WHAT WORKS TO DO BETTER What works to do better, including no cost/low cost ideas?

ACTION PLAN What do we propose to do?

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2.2 Performance Accountability This relates to the specific accountability of projects, programmes or services for their service users and target groups being better off as a result of the intervention or action. The four key questions to be answered in performance accountability include:

How much service did we deliver? How well did we deliver it? How much change / effect did we produce? What quality of change / effect did we produce?

Within RBA, these four themes are usually translated into „Report‟ or „Measure‟ Cards with each relevant agency for the agreed actions within the plan taking responsibility for the action. For the purposes of the Tobacco Free Cardiff and Vale Strategic Action Plan, the „Report Card‟ template is on page 26. RBA argues that unless we understand the two different types of accountability and how they fit with each other it will continue to be difficult to do either well.

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3.0 What we intend to achieve The Tobacco Free Cardiff and Vale Strategic Action Plan is focused upon the whole population of Cardiff and the Vale of Glamorgan, which has a population of around 445,000. The strategy has been divided into three parts focusing on prevention, cessation and environmental action. 3.1 The Vision This plan will play a key contribution to one of the overall outcomes of the “What Matters Strategy 2010-2020” for Cardiff and the “Community Strategy 2011-2021” for the Vale of Glamorgan and provides our overall vision:

People in Cardiff and the Vale of Glamorgan are fit and healthy The overall objectives of the Community Strategies which contribute to achieving this vision and form our strategic aim are:

To improve and promote the health and well-being of the population (Vale of Glamorgan)

To promote healthy lifestyles and prevent ill-health (Cardiff)

3.2 Indicators In Cardiff and the Vale of Glamorgan the conditions we would like to see for our population include:

Young people in Cardiff and the Vale of Glamorgan do not start smoking (PREVENTION)

Smokers in Cardiff and the Vale of Glamorgan give up smoking (CESSATION)

Residents and visitors to Cardiff and the Vale of Glamorgan live, work and play in smoke-free environments (ENVIRONMENTAL ACTION)

In order to measure these conditions and any change in these areas a set of indicators needs to be determined. An indicator is a piece of measurable information which helps quantify achievement of an outcome. Four indicators have been chosen to measure the conditions we would like to achieve. Data on smoking for young people are presented at a national level and are only collected through the Health Behaviour in School aged Children (HBSC) Survey, which is completed every four years. Data from the HBSC Survey is available at Local Health Board level from 2010, which provides some insight into local smoking prevalence for 11-16 year olds.

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Data regarding smoking in homes has been collected as a pilot study with Cardiff and Vale of Glamorgan Flying Start teams, to further understand smoking prevalence in the homes and children‟s exposure to second-hand smoke. Data Development Agenda In some instances, further work is required to gather data and information on smoking across Cardiff and the Vale of Glamorgan, in which case a „Data Development Agenda‟ will be developed to explore this. The four indicators for the Tobacco Free Cardiff and Vale Strategic Action Plan are as follows: Indicator 1: Percentage of adults smoking in Cardiff and Vale of Glamorgan

0

5

10

15

20

25

30

2003/0

5

2005/0

7

2008/0

9

2010/1

1

2012/1

3

2014/1

5

Indicator 1: Cardiff & Vale

No action

With action

Figure 1: Percentage of adults smoking in Cardiff and the Vale of Glamorgan, 2003-2012, with projected action to 2014/15 Smoking prevalence data for adults is available from the Welsh Health Survey (WHS), which is carried out annually and provides smoking prevalence at a national, local health board and local authority level.

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0

1

2

3

4

5

62006/0

7

2008/0

9

2010/1

1

2012/1

3

2014/1

5

2016/1

7

2018/1

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Indicator 2: % adults accessing smoking cessation services

Cardiff

The Vale of Glamorgan

No action

With action

Indicator 2: Percentage of adult smokers in Cardiff and the Vale of Glamorgan who accessed Stop Smoking Wales or UHB hospital in-house smoking cessation services and who have quit smoking at 4 and 52 weeks

Figure 2: Percentage of adult smokers in Cardiff and Vale of Glamorgan accessing Stop Smoking Wales, 2006/07-2010/11 with projected action to 2018/19

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0

10

20

30

40

50

60

70

2006/0

7

2007/0

8

2008/0

9

2009/1

0

2010/1

1

Indicator 3b

Wales


Cardiff

Figure 3: Percentage of treated adult smokers who access Stop Smoking Wales and successfully quit at 4 weeks, 2006/07-2010/11 (self-reported data) National and local data is collected by Stop Smoking Wales on adults who want to stop smoking and access the service to quit. Data is collected quarterly and provided on a national, local health board and local authority level. The UHB hospital in-house smoking cessation service at the University Hospital for Wales and Llandough Hospital collect data (validated by carbon monoxide CO monitoring) on adults who want to stop smoking and access the service to quit in a secondary care setting. This data is also available quarterly. Data Development Agenda 1: Whilst data is supplied from SSW and the UHB hospital in-house smoking cessation service, it is acknowledged that other smoking cessation is being carried out in different partner agencies, for example GP practices. The data development agenda includes the scoping of what is required in order to record smoking cessation activity elsewhere within different partner organisations. Also, it is important to ensure data collection is validated (by CO monitoring), where possible.

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Indicator 3: Percentage of smoke-free homes within Flying Start areas in Cardiff and the Vale of Glamorgan

0

20

40

60

80

100

2003/0

4

2005/0

6

2008

2010

2012

2014

2016

Indicator 1

No change

With action

Figure 4: Percentage of non-smoking adults in smoke-free homes in Wales, 2003/04 to 2010, with projected action to 2016 The Welsh Health Survey includes a question relating to non-smoking adults exposed to passive smoke in the home. This provides information to estimate the percentage of smoke-free homes in Wales, as presented in Figure 4. In Cardiff and the Vale of Glamorgan, questions on smoking have been added to the PARIS data collection system, which is used by health visitors to collect information pre and post birth (at the birthing visit, 9 month and 18 month check). These questions provide a baseline relating to the number of smoke-free homes in the Flying Start areas of Cardiff and the Vale of Glamorgan. The information is useful to find out current smoking habits around children and whether any changes have been made to smoking habits in the home following the „brief intervention‟ carried out by the health professional to the client. Data is currently being collated in readiness to publish to understand the local issue of smoking in the home. The questions asked have been updated (December 2011) and include:

Does the mother smoke?

Smoke-free homes and Stop Smoking Wales resources given?

Does the mother want to stop smoking?

Referral made to Stop Smoking Wales?

Does anyone smoke inside the home?

Smoke-free homes resources given?

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Is the intention to make the home smoke-free?

Data Development Agenda 2: The data development agenda includes further work to analyse the data from the PARIS (NHS) system in order to understand the percentage of smoke-free homes in Cardiff and the Vale of Glamorgan. Indicator 4: Percentage of 11-16 year olds in Cardiff and the Vale of Glamorgan who report smoking weekly

Figure 5: Percentage of 11-16 year olds reporting smoking weekly or more by Local Health Board (Health Behaviour in School aged Children)

Figures 1-4 were produced by the Public Health Wales Observatory (PHWO). Projected figures are in-house estimates.

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4.0 Local story behind the baseline 4.1 Cardiff and the Vale of Glamorgan The Tobacco Free Cardiff and Vale Strategic Action Plan focuses on the University Health Board area of the City and County of Cardiff and the County of Vale of Glamorgan, as illustrated in Figures 6 and 7. 445,000 people live in the University Health Board (72.1% in Cardiff and 27.9% in the Vale). The populations within each locality differ, as described below. Cardiff Figure 6: Map of Cardiff, by deprivation fifths

As the capital city of Wales, Cardiff is the regional hub and metropolitan centre for many activities, including sport, culture and tourism, attracting large numbers of visitors on both a regular and special event basis, and also commuters. Cardiff has a diverse community, with a minority ethnic population of 8.4% (Public Health Wales Observatory, 2009): this is above the Welsh average of 6.7%. In addition, there has been an increase in the number of migrant workers and full-time students. The

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resultant cultural diversity makes Cardiff a city of opportunity and an exciting place to live, work and play. The City also experiences serious inequalities, with areas of high deprivation. There are a number of Community First areas in Cardiff, including:

Adamsdown

Butetown

Ely and Caerau

Fairwater

Grangetown

Llanrumney

Plasnewydd

Riverside

Rumney

Splott (including Tremorfa)

Trowbridge (including St Mellons) Vale of Glamorgan Figure 7: Map of the Vale of Glamorgan, by deprivation fifths

Vale of Glamorgan, in general, ranks high in relation to the health status of its population. It is generally a good place to live and is home to some of the most affluent parts of Wales. Most indicators of health, social care and wellbeing show that the Vale of Glamorgan does much better than the Welsh average. These figures mask problems in some areas and these are of concern. For example, parts of Barry have some of the highest levels of deprivation in Wales and people

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living in the county‟s rural areas can have difficulty in accessing services. There are two Communities First areas in the Vale of Glamorgan:

Gibbonsdown and Court

Castleland 4.2 Socio-economic Status The Welsh Health Survey 2010 (Welsh Government, 2011) reported that 24% of the adult population smokes in Wales: this includes 23% in Cardiff and 21% in the Vale of Glamorgan. Determinants of health It is known that there are a range of factors that combine to affect the health of individuals and communities including circumstances and environment (Figure 8). Most of these fall within the remit and influence of local government. They underline a need for partnership working for health improvement. Figure 8: The Health Map

The Health Map Source: Barton and Grant (2006)

The deprivation index takes account of many of these factors, such as income, employment, education, access to services, housing, physical environment and community safety. As highlighted, the Vale of Glamorgan has some of the most deprived areas in Wales, for example parts of Barry and Penarth (Figure 7).

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It is known that more disadvantaged and deprived communities have poorer health outcomes than more advantaged communities, sometimes discussed as health inequality. Health inequity is a term used to describe avoidable difference between the least and most advantaged populations. Smoking is linked to social and economic deprivation. There are substantial national and local inequality gaps between the most and least deprived areas in life expectancy. The slope Index of Inequality (SII) measures the absolute gap in years of life expectancy between the most and least deprived, showing for example, that the gap in life expectancy in males between the most and least deprived fifth is about 11 years as demonstrated in Figure 9. In areas of high deprivation we would expect to see higher rates of smoking and therefore smoking related mortality (Figures 10 and 11).

62.5

62.1

66.3

65.7

81.8

80.7

60.1

59.6

64.2

63.4

77.3

76.1 11.6

11.8

22.5

22.7

16.7

16.7

8.5

9.9

20.2

21.3

12.3

12.9

2001-05 2005-09

Life expectancy

Healthy life

expectancy

Disability-free life

expectancy

Life expectancy

Healthy life

expectancy


expectancy

Males

Females

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS (WG)

Life expectancy with 95%

confidence intervalInequality gap

(SII in years)

Comparison of life expectancy, healthy life expectancy and disability-free life

expectancy at birth, Cardiff and Vale UHB 2001-05 and 2005-09

62.5

62.1

65.9

65.4

81.7

80.6

59.8

59.2

63.7

63.0

76.9

75.9 12.9

12.8

22.5

22.7

17.2

17.1

8.8

10.0

21.0

22.0

12.312.9

2001-05 2005-09

Life

expectancy

Healthylife

expectancy


expectancy

Life

expectancy

Healthylife

expectancy


expectancy

Males

Females

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS (WG)

95% confidence interval

Inequalitygap (SII in years)

Comparison of life expectancy, healthy life expectancy and disability-free

life expectancy at birth, Cardiff 2001-05 and 2005-09

62.5

66.1

81.0

61.5

64.7

77.3

62.0

65.5

79.9

60.8

63.9

75.9

0 10 20 30 40 50 60 70 80 90

Disability-free life expectancy

Healthy life expectancy

Life expectancy

Disability-free life expectancy

Healthy life expectancy

Life expectancy

2001-05 2005-09

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)

Comparison of life expectancy, healthy life expectancy and disability-free life expectancy

at birth, Wrexham 2001-05 and 2005-09

Females

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS(WG)

Males

Figure 9: Comparison of life expectancy, healthy life expectancy and disability-free life expectancy at birth, Cardiff and Vale of Glamorgan, 2001-05 and 2005-09

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2.6 2.8 2.6 2.7 2.6 2.7 2.70

100

200

300

400

500

600

700

800

2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Most deprived within Cardiff & Vale (95%CI) Wales EASR

Least deprived within Cardiff & Vale Cardiff & Vale overall

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG)

Smoking-attributable mortality, males, aged 35 and over, European age-standardised rate

(EASR) per 100,000, Cardiff and Vale UHB and Wales, 2001-09

Rate Ratio - most deprived divided by least deprived

Figure 10: Smoking-attributable mortality in males aged 35+ in Cardiff and Vale of Glamorgan. European age-standardised rates (EASR) per 100,000 population

3.1 3.2 3.0 3.0 3.0 3.1 3.40

50

100

150

200

250

300

350

2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Most deprived within Cardiff & Vale (95%CI) Wales EASR

Least deprived within Cardiff & Vale Cardiff & Vale overall

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG)

Smoking-attributable mortality, females, aged 35 and over, European age-standardised

rate (EASR) per 100,000, Cardiff and Vale UHB and Wales, 2001-09

Rate Ratio - most deprived divided by least deprived

Figure 11: Smoking-attributable mortality in females aged 35+ in Cardiff and Vale of Glamorgan. European age-standardised rates (EASR) per 100,000 population

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4.3 Smoking Prevention There are several programmes of work and activities that specifically aim to prevent children and young people taking up smoking. These include: the SmokeBugs! programme (aimed at 8-11 year olds, Year 4, 5 and 6 primary school aged children), Smoke-free Class Competition (aimed at 11 – 12 year olds, Year 7 secondary school aged children) and ASSIST (A Stop Smoking in Schools Trial, aimed at 12 – 13 year olds, Year 8 pupils). As part of ASSIST, young people are trained to be peer supporters and intervene with their peers to discourage smoking. Additionally, as part of the Wales Network of Healthy Schools Scheme (WNHSS), all schools work towards a whole school approach in providing a health promoting environment. All Local Education Authority (LEA) schools within Cardiff and the Vale of Glamorgan are members of the Network and currently many schools include tobacco control activities as part of their Healthy School approach. 4.4 Smoking Cessation Stop Smoking Wales (SSW) was officially re-launched in 2007 providing evidence based, behavioural support and treatment for adult smokers who wish to quit. The service focuses on four priority areas that include pre-operative services; maternity services; mental health and children and young people. Smokers are four times more likely to give up smoking using SSW than if they try to quit alone. In Wales 15,781 contacts in 2011/12 were made to SSW and 7,061 individuals participated in the treatment programme. 57.3% self reported that they had quit smoking at 4-weeks (Stop Smoking Wales, 2012). Data from Lifestyle and health: Wales and its health boards (Public Health Wales Observatory, 2010) show that Cardiff and the Vale of Glamorgan have the lowest percentage of smokers contacting SSW in Wales (1% compared to the Welsh average of 2.6%), with some areas achieving 4.9%. In 2010/11, only 1,696 smokers contacted smoking cessation services resulting in less than 400 quitting smoking. In order for Cardiff and the Vale of Glamorgan to reach targets set by the Welsh Government by 2016, over 3,000 smokers must be quitting smoking per year. One of the key actions within this strategy will be to increase contact and referral rates to smoking cessation services and to promote „Brief Intervention Training‟ for health professionals. No Smoking Day is a key annual public health campaign and provides a focus for Welsh smokers who wish to stop. The aim of the campaign is to raise awareness of the issues around smoking and tobacco and encourage people to access cessation services to help them quit. 4.5 Legislation and Environmental Tobacco Control Key tobacco control interventions and policies have been put into place during recent years to protect the public from the harmful effects of smoking and second-hand smoke and to reduce the prevalence of smoking. In April 2007, legislation was

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introduced to ban smoking in all enclosed public places in Wales, with high levels of compliance across the country. In the same year the minimum age for purchasing tobacco was raised from 16 to 18 years and new provisions to monitor the selling of tobacco to young people were introduced. Since these legislations have been implemented, further action to extend the protection of the public, in particular children and young people, from second-hand smoke have been developed, including smoke-free homes and smoke-free hospital initiatives. Legislation to ban the sale of tobacco from vending machines has been introduced (February 2012). Vending machines were self-service and allowed easy access for those under the legal age of sale of 18 years. The legislation prohibits sales, restricts access and discourages the use of tobacco products by young people. In 2008, picture warnings on cigarette packaging were introduced and descriptions of the contents of tobacco products have been changed. Consultation is underway (April – August 2012) regarding standardised packaging of tobacco products known as „plain packaging‟ in order to address the issue of affordability, attractiveness and access to tobacco products, especially by young people. There is intention to ban the open display of cigarettes in shops and supermarkets in an attempt to reduce smoking prevalence, particularly amongst young people. This has been introduced in England (April 2012) and is set to follow in Wales.

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5.0 Turning the curve – evidence of what works Smoking is recognised as the single greatest cause of preventable death and ill-health in Wales. This strategic action plan aims to encourage PREVENTION (aimed specifically at children and young people), CESSATION (aimed at encouraging those who smoke to quit) and increase SMOKE-FREE ENVIRONMENTS. NICE (National Institute for Health and Clinical Excellence) is an organisation responsible for providing national guidance on promoting good health and preventing and treating ill-health, outlining the evidence base of best practice and providing examples of what works. Guidance documents relating to public health have been produced. Those which relate to smoking are detailed below. Table 1: NICE Public Health Guidance relating to smoking and tobacco

NICE Guidance Number Date of Publication NICE Title

NICE Public Health Guidance No.1

March 2006 Brief interventions and referral for smoking cessation in primary care and other settings


May 2007 Workplace interventions to promote smoking cessation

NICE Public health Guidance No.10

February 2008 Smoking Cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities


July 2008 Mass media and point of sales measure to prevent the uptake of smoking by children and young people


February 2010 School based interventions to prevent the uptake of smoking among children


June 2010 How to stop smoking in pregnancy and following childbirth

NICE Guidance can be accessed at: http://www.nice.org.uk/guidance/index.jsp?action=bypublichealth&PUBLICHEALTH=Smoking+and+tobacco&page=1#/search/?reload

http://www.nice.org.uk/guidance/index.jsp?action=bypublichealth&PUBLICHEALTH=Smoking+and+tobacco&page=1#/search/?reload


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5.1 Prevention One of the key aims of Smoking Kills (Department of Health, 1998) was to prevent children and young people from starting to smoke. Recent NICE guidelines (2010) listed above have highlighted school based interventions to prevent the uptake of smoking among children and recommend the following:

Smoking policies should support both prevention and stop smoking activities and should apply to everyone using the premises (including grounds)

Information on smoking should be integrated into the curriculum. For example, classroom discussions could be relevant when teaching biology, chemistry, citizenship and maths

Anti-smoking activities should be delivered as part of Personal and Social Education (PSE) and other activities related to Healthy Schools or Healthy Further Education status

Anti-smoking activities should aim to develop decision-making skills. 5.2 Cessation Stop Smoking Wales (SSW) is funded by the Welsh Government and is an integral part of Public Health Wales where it forms a central element of the organisation‟s Tobacco Free programme. SSW contributes to national and local tobacco control initiatives and has a key role in reducing the impact of tobacco on the health of people in Wales. SSW fulfils the requirements set by Designed for Life, which states that every smoker who wants to quit smoking should have access to an NHS smoking cessation service within one month of referral (Welsh Assembly Government, 2005). SSW recognises that the effectiveness of smoking cessation programmes is increased when behavioural support is combined with pharmacological therapy. As part of the SSW intervention, clients of the service will:

Be offered a 6-week intensive behavioural support programme either in groups or one-to-one if assessed as more appropriate

Receive encouragement, support and help to set a quit date and throughout the quitting process

Receive standardised information on the range of pharmacological aids available, which will include brief information on the use of products and on contraindications

Receive support to understand which products would be most appropriate for them in relation to previous cessation attempts and information on their smoking behaviour

Receive supporting information to give to prescribers confirming their motivation to quit, information on their level of addiction and other relevant information on previous cessation attempts

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Be followed-up at 4-weeks and 12-months. A hospital in-house Smoking Cessation Service is in place for the Cardiff and Vale University Health Board, set up in 1985 at Llandough Hospital and later expanded to include the University Hospital of Wales in 2000. The programme incorporates elements from various behavioural therapies to allow flexibility and tailored support to each individual. The first month consists of an intensive phase of weekly advice and support sessions, then there are monthly sessions at the 2nd and 4th months. Sessions at 6 and 12 months are then held for those not smoking at month 3. Success in quitting is defined as sustained, carbon monoxide (CO) validated abstinence in months 1, 3, 6 and 12. As part of the Cardiff and Vale University Health Board‟s „Practising Public Health Organisation‟ approach, tobacco control is one of four main priority areas (the others being food, fitness and alcohol) that are being taken forward as part of a strategic co-ordinated approach. Within this, a Smoke-Free Project has been established with six main programmes of work known as „Products‟. The work of the Tobacco Free Cardiff and Vale Partnership group is captured within „Product One‟ and other areas of work, to include the establishment of pre-operative smoking cessation and maternity smoking cessation services, are also outcomes listed in the action plan. 5.3 Smoke-free Environments Smoke-free legislation was implemented in April 2007, providing protection from exposure to second-hand smoke in virtually all enclosed work and public places, including public transport. Exposure to second-hand smoke is a serious health hazard and the health of children is particularly at risk. Medical and scientific evidence shows that exposure to second-hand smoke increases the risk of serious medical conditions such as lung cancer, heart disease and asthma attacks. The Scientific Committee on Tobacco and Health (SCOTH) concluded in 2004 that children‟s exposure to second-hand smoke increases the risk of pneumonia and bronchitis, asthma attacks, middle ear disease, decreased lung function and sudden infant death syndrome. Evidence shows that babies born to mothers who come into contact with second-hand smoke have lower birth weights.

Recently, the Royal College of Physicians‟ report (2010) reported that passive smoke exposure is around three times higher if the father smokes, over six times higher if the mother smokes, and nearly nine times higher if both parents smoke. Smoking by other carers is also a significant source of passive smoke exposure. Children growing up with parents or siblings who smoke are also 90% more likely to become smokers themselves.

Therefore, the home and private cars are now the main locations for the exposure of both children and adults to second-hand smoke. In addition, the Cardiff and Vale University Health Board, as a Practising Public Health Organisation, has implemented a No Smoking and Smoke Free Environment policy in hospital grounds. The policy prohibits smoking on site (except for anxious smokers where smoking is permitted at designated smoking shelters).

26

6.0 Population accountability - Report Card

Tobacco Free Cardiff and Vale of Glamorgan, 2012-15

What are our main actions?

1. Decrease in the number of adults reporting smoking daily.

2. Increase in the number of adults who have accessed smoking cessation services and quit at 4 and 52 weeks.

3. Continued implementation of a No Smoking and Smoke-Free Environment Policy in hospital grounds.

4. Decrease in the number of 11-16 year olds reporting smoking weekly in Cardiff and the Vale of Glamorgan.

5. Increase in the number of school based smoking prevention initiatives such as ASSIST and SmokeBugs!

6. Increase in the number of homes reported smoke-free.

What are the curves that we need to turn?

Indicator 1: Percentage of adults smoking in Cardiff and the Vale of Glamorgan (Welsh Health Survey) Indicator 2: Percentage of adult smoking population accessing at least one treatment session and successfully quitting smoking at 4-weeks (Stop Smoking Wales SSW) Indicator 3: Percentage of smoke-free homes in Cardiff and Vale of Glamorgan Flying Start areas Indicator 4: Percentage of 11-16 year olds reporting smoking weekly in Cardiff and the Vale of Glamorgan (Health Behaviour in School aged Children)

0

5

10

15

20

25

30

2003/0

5

2005/0

7

2008/0

9

2010/1

1

2012/1

3

2014/1

5

Indicator 1: Cardiff & Vale

No action

With action

0

10

20

30

40

50

60

70

2006/0

7

2007/0

8

2008/0

9

2009/1

0

2010/1

1

Indicator 2b: % treated smokers

Wales

Cardiff


0

20

40

60

80

1002003/0

4

2005/0

6

2008

2010

2012

2014

2016

Indicator 3: % smoke free homes

No change

With action

0

5

10

15

20

25

30

2001/0

2

2009/1

0

2011/1

2

2013/1

4

2015/1

6

2017/1

8

Indicator 4: Wales

% girls No action

% boys With change Figure 1: % adults smoking in Cardiff and the Vale of Glamorgan, Welsh Health Survey Figure 2: % treated smokers who quit smoking at 4-weeks using SSW (SSW) Figure 3: % non-smokers in smoke-free homes (Welsh Health Survey) Figure 4: % 15-year olds reporting smoking weekly in Wales (HBSC) Figures drawn by the Public Health Wales Observatory. Projected figures are in-house estimates.

What other data do we need? (Data Development Agenda)

Analysis of data from the PARIS NHS system to understand the percentage of smoke-free homes in Cardiff and the Vale of Glamorgan.

Record smoking cessation activity among other partner agencies (for example, GP practices), including validated quit rates of quitters.

Outcome: People in Cardiff and the Vale of Glamorgan are fit and healthy

Workstream: Healthy Lifestyles

27

Story behind the curves Prevention: There are several initiatives aimed at reducing the numbers of children and young people taking up smoking. These include:- SmokeBugs!, Smokefree Class Competition and the ASSIST programme. All schools in Cardiff and the Vale of Glamorgan are part of the Welsh Network of Healthy Schools, and many schools include tobacco control activities as part of their Healthy School approach. Socio-economic status: Tobacco use and health inequalities are closely linked. Individuals living in more deprived areas of Cardiff and the Vale of Glamorgan are more likely to smoke than those in prosperous areas (Department of Health, 2008). Smoking deepens deprivation, social inequalities and child poverty. Within Cardiff and the Vale of Glamorgan, there are areas of high deprivation, including the second most deprived Lower Super Output Area (LSOA) in Wales (Cardiff Butetown 2). The Welsh Index of Multiple Deprivation (WIMD) uses LSOAs at a sub-ward level to measure levels of deprivation. There are 12 Communities First areas in Cardiff and two in the Vale of Glamorgan. Although there are limited data on smoking rates at this local level, areas of high deprivation often have higher rates of smoking. Referrals to smoking cessation services: Stop Smoking Wales service was re-launched in 2007 and provides specialist support for people who want to quit smoking. There are and continue to be low referrals to the service from GPs. Smoking cessation support is also available to patients through primary care and hospital based smoking cessation services. Cessation initiatives: Stop Smoking Wales currently undertake several initiatives to strengthen the referral pathways to smoking cessation services: - Brief Intervention for Smoking Cessation training for community and health professionals to encourage effective brief interventions and referrals - Strengthening the referral pathway for patients waiting for elective surgery to smoking cessation services (smoking slows recovery time after surgery) - Strengthening the referral pathway for pregnant women to access smoking cessation services. The No Smoking Day campaign is high profile, and evidence has shown that many people successfully use this day as a target for quitting. Legislation: Recent legislation implemented around smoking and tobacco has included a ban on smoking in public places in 2007, raising the age of purchase of tobacco to 18 years, pictorial health warnings on cigarette packets and a ban on cigarette vending machines. The price of cigarettes has also risen substantially over recent years. The Welsh Government launched the Tobacco Control Action Plan for Wales (February 2012) and indicated that a consultation document about plain packaging would be published in spring 2012. Welsh Government has launched the „FreshStart Wales‟ campaign, discouraging smoking in cars carrying children.

28

7.0 Performance accountability – Action plan

Action Tasks Lead partners Key Milestones Date RAG Status

Resource Required

Does the action relate to a distinct customer/ client group? (RBA performance)

If yes please follow the link

Indicator 1: Decrease in the number of adults reporting smoking daily or occasionally

NHS to recognise its exemplar role as a Practising Public Health Organisation

Cardiff and Vale UHB

Smoking cessation offered to NHS staff

March 2013

Smoking cessation services

NHS staff

Deliver the No Smoking Day campaign to encourage smokers to quit

All partners Delivery of No Smoking Day activities

March 2013

Campaign materials

Adult smokers

Support the tobacco priorities within the Neighbourhood/Area working groups

All partners Priorities identified and developed

March 2013

Staff time All population

Continued implementation and monitoring of a No Smoking and Smoke Free Environment Policy on all hospital grounds


Policy implemented and monitored

March 2013

Staff time Smokers including staff, patients and visitors to hospital grounds

Continued enforcement of the smoking ban in public places

Trading Standards Cardiff Council, Environmental Health Department Vale of

Legislation is enforced March 2013

Staff time Adult smokers

29


Resource Required



Glamorgan Council

Indicator 2: Increase in the number of adults who have accessed smoking cessation services and quit smoking at 4 and 52 weeks

Increase the number of contacts to Smoking Cessation Services, including offering brief intervention training to health professionals

SSW/In-house Smoking Cessation Service, all partners

Increase in the number of adults contacting smoking cessation services

March 2013

Staff time, training sessions

Adult smokers

Strengthen the referral pathway between pre-operative services and the in-house smoking cessation service

In-house Smoking Cessation Service, Cardiff and Vale Public Health Team, Pre-operative clinics

Increase in the number of pre-operative patients accessing smoking cessation services

March 2013

Staff time, training sessions, leaflets

Pre-operative patients who smoke

Strengthen the referral pathway between maternity services and Stop Smoking Wales

SSW, Cardiff and Vale Public Health Team, Midwifery Team

Increase in the number of pregnant women who smoke accessing smoking cessation services

March 2013

Staff time, training sessions, leaflets, CO monitors

Pregnant women who smoke

30


Resource Required



Scope out current smoking cessation service methodologies (Primary Care, SSW, In-house Smoking Cessation Service) to work towards systematised data collection and reporting

Cardiff and Vale Public Health Team, SCS

Clear understanding of the services available to smokers who want support to quit smoking

March 2013

Staff time

Support the development of a smoking cessation pathway from GP practices to smoking cessation support services

SSW/Cardiff and Vale UHB/Cardiff Neighbourhood Management Teams

Agreement of pathway, increase in the number of referrals to smoking cessation services

March 2013


Indicator 3: Increase in the number of homes reported „smoke free‟

Deliver the tobacco elements of the Flying Start programme


Tobacco elements delivered as part of the programme

March 2013

Staff time

Identify actions to take forward the smoke-free homes initiative

ASH Wales, Public Health Wales, Health Visiting

Increase the number of smoke-free homes

March 2013

Staff time

Explore links between the Healthy Pre-Schools Scheme and the smoke-free homes project to promote smoke-free living

Healthy Schools Team, ASH Wales

Pre-Schools include tobacco elements

March 2013

Staff time Children

31


Resource Required



Support the Welsh Government „Fresh Start campaign‟ for smoke-free cars

Welsh Government

Welsh Government formal consultation launched

September 2012

Children, adults who smoke

Indicator 4: Decrease in the number of 11-16 year olds reporting smoking weekly

Implement the tobacco elements of the Healthy Schools Scheme

Cardiff Healthy Schools Team, Vale Healthy Schools Team, Schools

Programmes implemented

March 2013

Staff time Children and young people

Deliver the ASSIST programme to identified secondary schools across Cardiff and the Vale of Glamorgan

ASSIST Programme implemented March 2013

Staff time Young people aged 12-13 years

Secondary schools invited to participate in the Smoke Free Class Competition

Welsh Government

Programme implemented March 2013

Young people aged 11-12 years

Statutory enforcement of under-age tobacco sales restrictions

Trading Standards Cardiff Council, Trading Standards Department Vale of Glamorgan

Enforcement on-going March 2013

Staff time Young people under 18 years

32

Priority actions for 2012/13:

Action Tasks Lead Key Milestones Date Red/ Amber/ Green Status

Resource Required



Indicator 1: Decrease in the number of adults reporting smoking daily or occasionally

Tackle the issue of illicit tobacco and tackle the sale of counterfeit tobacco products

Trading Standards, HMRC

Monitor illicit tobacco and counterfeit tobacco products through the inspection programme

March 2013

Staff time

Awareness of the effects of niche tobacco products among relevant communities

Public Health Wales, ASH Wales

Understanding of the problem of niche tobacco products in Cardiff and the Vale of Glamorgan

March 2013

Staff time

Gain an understanding of the voluntary sector‟s role in smoking prevention work/promoting public health messages

Voluntary sector

Outline of voluntary sector work relating to smoking

March 2013

Staff time

Ensure tobacco related actions as part of the Corporate Health Standard award are in place for relevant workplaces

Cardiff Council, Public Health Wales, SSW

Tobacco actions as part of the Corporate Health Standard are in place

March 2013


33


Resource Required



Indicator 2: Increase in the number of adults who have accessed smoking cessation services and quit smoking at 4 and 52 weeks

Encourage attendance of staff (particularly voluntary sector) at Brief Intervention Training

All partners Number of brief intervention training sessions and number of staff trained

March 2013

Training sessions, staff time

Smoking cessation to be offered as part of the routine treatment of patients with smoking related diseases (Primary and Secondary Care)

NHS (Primary and Secondary Care), Stop Smoking Wales, In-house Smoking Cessation Service

Referral pathway to smoking cessation services in place

March 2013


Review data from all sources available to support smokers to quit

Public Health Wales

Database developed March 2013

Database, staff time

Adult smokers

Improve validation rates of smokers quit status on completion of smoking cessation support

SSW, In-house smoking cessation service, Primary Care

Progress reports include validated quit rates

March 2013

CO monitors, data collection methods, staff time

Adult smokers

Consider qualitative research to understand reasons that smokers are not successfully quitting smoking

Midwifery Team, In-house Smoking Cessation Service

Qualitative research collected

March 2013

Research methods, staff time

Adult smokers

34


Resource Required



Strengthen the referral pathway of pregnant women who smoke to SSW, including introducing the use of CO monitoring as part of routine data collection for maternal and child health records

Midwifery Team

Increase in referrals Data collection methods in place

March 2013

Staff time, CO monitors

Pregnant women who smoke

Indicator 3: Increase in the number of homes reported „smoke free‟

Improve data collection on smoke-free homes using the PARIS NHS system, as part of routine maternal and child health records

Flying Start Data collection established

March 2013

Staff time Pregnant women who smoke

Promote the smoke-free playgrounds initiative, including a pilot in one Communities First area of Cardiff and one in the Vale of Glamorgan

Vale of Glamorgan Council, Cardiff Council, Cardiff and Vale Public Health Team, Communities First, primary schools

Pilot smoke-free playground established in Cardiff and the Vale of Glamorgan

March 2013

Signage, staff time

All ages

35


Resource Required



Indicator 4: Decrease in the number of 11-16 year olds reporting smoking weekly

Deliver a Smoking Prevention Programme to primary schools, including the SmokeBugs! programme

Public Health Wales

Programme implemented Number of schools participating

March 2013

Co-ordination of SmokeBugs required

Children aged 8-11 years

36

8.0 References Department of Health. (1998). Smoking Kills, A White Paper on Tobacco. London: Department of Health. National Public Health Service. (2004). Deprivation and health. Cardiff: NPHS. National Public Health Service. (2009). Stop Smoking Wales Annual Report 2008-2009. Cardiff: NPHS. National Institute for Health and Clinical Excellence (NICE). (2012). http://www.nice.org.uk/guidance/index.jsp?action=bypublichealth&PUBLICHEALTH=Smoking+and+tobacco&page=1#/search/?reload National Institute for Health and Clinical Excellence. (2006). Brief interventions and referral for smoking cessation in primary care and other settings. London: NICE. National Institute for Health and Clinical Excellence. (2007). Workplace health promotion: how to help employees to stop smoking. Public health intervention guidance 5. London: NICE. National Institute for Health and Clinical Excellence. (2008a). Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. PH010. London: NICE. National Institute for Health and Clinical Excellence. (2008b). Mass media and point of sales measures to prevent the uptake of smoking by children and young people. London: NICE. National Institute for Health and Clinical Excellence. (2010a). How to stop smoking in pregnancy and following childbirth. Public Health guidance 26. London: NICE. National Institute for Health and Clinical Excellence. (2010b). School based interventions to prevent the uptake of smoking among young children and young people. Public health guidance 23. London: NICE. NHS Information Centre (2011). Infant Feeding Survey: early results. Available online at: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/IFS_2010_early_results/Infant_Feeding_Survey_2010_headline_report2.pdf Public Health Wales Observatory. (2009). Cardiff and Vale University Local Health Board: Demography profile. Cardiff: Public Health Wales Observatory. Available at: http://www.wales.nhs.uk/sitesplus/888/page/46721#Population Accessed: 22 May 2012 Public Health Wales Observatory (2010). Lifestyle and Health: Wales and its Health Boards. Cardiff: Public Health Observatory.



http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/IFS_2010_early_results/Infant_Feeding_Survey_2010_headline_report2.pdf

http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/IFS_2010_early_results/Infant_Feeding_Survey_2010_headline_report2.pdf

http://www.wales.nhs.uk/sitesplus/888/page/46721#Population

37

Royal College of Physicians. (2000). Nicotine addiction in Britain: A Report of the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians. Royal College of Physicians. (2010). Passive Smoking in Children. London: Royal College of Physicians. Stop Smoking Wales. (2012). Stop Smoking Wales Annual Report 2011-2012. Cardiff: Public Health Wales. Welsh Assembly Government. (2005). Designed for Life. Cardiff: Welsh Assembly Government. Welsh Assembly Government. (2009). Our Healthy Futures Technical Working Paper. Cardiff: Welsh Assembly Government. Available at: http://wales.gov.uk/docs/phhs/publications/100527technicalen.pdf Accessed: 22 May 2012 Welsh Assembly Government. (2010) Welsh Health Survey 2009. Cardiff: Welsh Assembly Government. Welsh Government. (2011). Welsh Health Survey 2010. Cardiff: Welsh Government. Welsh Government. (2012). Tobacco Control Action Plan for Wales. Cardiff: Welsh Government. World Health Organisation. (2008). World Health Organisation Report on the Global Tobacco Epidemic MPOWER Package. Geneva: WHO. World Health Organisation. (2012). Social determinants of health and well-being among young people. Health Behaviour in School aged Children (HBSC) Study. International report from the 2009/2010 publication. Denmark: WHO. Available at: http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf Accessed: 22 May 2012

http://wales.gov.uk/docs/phhs/publications/100527technicalen.pdf

http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf

http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf

38

9.0 Abbreviations CHD Coronary Heart Disease CO Carbon Monoxide HBSC Health Behaviour in School-aged Children LEA Local Education Authority LSOA Lower Super Output Area NICE National Institute for Health and Clinical Excellence NPHS National Public Health Service PSHE Personal, Social and Health Education RBA Results Based Accountability RCP Royal College of Physicians SCOTH Scientific Committee on Tobacco and Health SIDS Sudden Infant Death Syndrome SSW Stop Smoking Wales UHB University Health Board UK United Kingdom WAG Welsh Assembly Government WHO World Health Organisation WHS Welsh Health Survey WNHSS Welsh Network of Healthy Schools Scheme

39

10.0 Appendix – Vale of Glamorgan report card 2010-11 ACTION REPORT CARD

Parts of the Vale of Glamorgan have some of the highest deprivation in Wales which can be mapped to the Middle Super Output Areas (MSOAs) indicating the highest mortality relating to cardiovascular and respiratory disease

Some rural areas experience problems accessing services

Referral rates to Stop Smoking Wales are one of the lowest in Wales

Despite a 2007 ban on smoking in public places rates of smoking in the adult population remain static.

In Wales both males and females aged 15 were amongst the highest in the UK although significantly more 13 year old girls in Wales reported daily smoking.

Flying Start works with families in the most deprived families in our communities

Linking deprivation to increased smoking rates, targeting Flying Start homes, is an important action for Smoke Free Vale.

STORY BEHIND THE

BASELINE:

PERFORMANCE ACCOUNTABILITY: KEY CONTRIBUTING PROJECTS AND

ACTIONS

Healthy Schools (Public Health Wales) – whole school approach to being smoke-free

ASSIST (Public Health Wales)

SmokeBugs (School Health Nursing Service/WAG)

Smokefree Class (WAG/LEA)

Enforcement of underage sales (Trading Standards, Vale of Glamorgan Council)

Flying Start (Cardiff & Vale UHB) - health visitors collecting information regarding „Smoke free Homes‟

SSW Annual Report provides data on contacts and treated smokers.

UHB hospital in-house Smoking Cessation services as part of „Smoke Free UHB‟ are providing data as part of performance reporting

It is accepted that other health professionals also undertake smoking cessation such as GP practices.

A scoping exercise to understand how there may be alignment on data collection needs to be undertaken.

40

10.0 Appendix – Cardiff report card 2008-11 POPULATION ACCOUNTABILITY/

OUTCOME

People in the Vale of Glamorgan are fit and healthy

INDICATORS Indicator 1 CESSATION Percentage of adults in the Vale of Glamorgan who report being a current smoker

Indicator 3 PREVENTION Percentage of 15 year olds in the Vale of Glamorgan reporting

smoking weekly

Indicator 4 ENVIRONMENTS

Percentage of smoke free homes within Flying Start areas of the

Vale of Glamorgan

STORY BEHIND THE BASELINE:

CURRENT POSITION

Adults who reported being a current smoker (2003-2008)

21

22

23

24

25

26

27

28

2003-04 2004-06 2005-07 2007-08 2009-2010

Year

Ag

e S

ta

nd

ard

is

ed

(%

)

Vale of Glamorgan

Wales

Data Development Agenda 3 Data related to the baseline and on-going reporting required

Indicator 2 CESSATION Percentage of adult smokers in the Vale of Glamorgan who accessed SSW and UHB hospital in-house smoking cessation services and who have quit smoking at

4 and 52 weeks

Data Development Agenda 1 Collection of smoking cessation data from all key stakeholders

Number of contacts to SSW one of the lowest

in Wales

DATA DEVELOPMENT

AGENDA:

Data Development Agenda 2 Local Authority area data for children and young people

41

10.0 Appendix – Cardiff report card 2008-11

Tobacco Free Cardiff

42

Cardiff Health Alliance recognises the importance of addressing the issue of tobacco use in Cardiff, particularly in relation to the following three elements:

Prevention of young people starting smoking (prevention): The earlier children start smoking, the greater their risk of developing serious or life-threatening illnesses if they continue smoking into adulthood. People who start smoking before the age of 16 are twice as likely to continue to smoke into adulthood and are more likely to be heavier smokers (NICE, 2010).

Helping people to give up smoking (cessation): Tobacco is a major cause of illness and death amongst the population of Wales, and is a key indicator. The 2009 Welsh Health Survey states that 24% of Cardiff‟s population smokes. There is a large cost to services in terms of treating smoking-related illness. Reducing smoking prevalence is a key action in the WAG strategic framework for public health in Wales, Our Healthy Future (2009). Plans are currently underway to develop a Tobacco Control Strategy for Wales.

Tobacco use kills around 114,000 people in the UK every year. It is an important risk factor for coronary heart disease, stroke, respiratory diseases, many cancers, and is often a cause in fire related deaths. Smoking in pregnancy is linked to spontaneous abortion, preterm birth, low birth weight and stillbirth (RCPL, 2002).

Enabling people in Cardiff to live in smoke-free environments (environmental action): Exposure to second-hand smoke has been attributed to a number of serious illnesses in adults and children (WHO, 2007). Children exposed to second-hand smoke are at risk of developing conditions such as respiratory childhood diseases, and are also at risk of sudden infant death syndrome (NPHS, 2004). With the implementation of the smoke-free legislation in 2007, the main environmental exposure to tobacco smoke now takes place in the home and in private cars. Tobacco use has environmental implications as it can create litter and contribute to a poor quality environment.

Headline Indicators and how are we doing?

1. % smoke free homes (in Cardiff Flying Start areas) (Speculative data used)

2. % adults smoking in Cardiff (Welsh Health Survey)

3. % of adult smoking population who successfully quit at 4-weeks after accessing smoking cessation services

(Stop Smoking Wales)

43

Story behind the baselines

Legislation: Recent legislation implemented around smoking and tobacco (including a ban on smoking in public places in 2007, raising the age of purchase of tobacco to 18 years and pictorial health warnings on cigarette packets). The price of cigarettes has also risen substantially over recent years.

Socio-economic status: Tobacco use and health inequalities are closely linked. Individuals living in more deprived areas of Cardiff are more likely to smoke than those in prosperous areas (DoH, 2008). Smoking deepens deprivation, social inequalities and child poverty. Within Cardiff there are areas of high deprivation, including the second most deprived Lower Super Output area (LSOA) in Wales (Butetown 2). The Welsh Index of Multiple Deprivation uses LSOAs at a sub-ward level to measure levels of deprivation. There are 12 Communities First areas in Cardiff. Although there is limited data on smoking rates at this local level, areas of high deprivation often have higher rates of smoking.

Referrals to smoking cessation services: Stop Smoking Wales service was relaunched in 2007 and provides specialist support for people who want to quit smoking. In 2008/09 the service saw an increase of 18.7% in the numbers of people accessing the service. There are however low referrals to the service from GPs in Cardiff. Smoking cessation support is available to patients through primary care and hospital based cessation services.

Cessation initiatives: Stop Smoking Wales currently undertakes several initiatives to strengthen the referral pathways to smoking cessation services: - Brief Intervention for Smoking Cessation training for community and health professionals to encourage effective brief interventions and referrals - Strengthening the referral pathway for patients waiting for elective surgery to smoking cessation services (smoking slows recovery time after surgery) - Strengthening the referral pathway for pregnant women to access smoking cessation services

The No Smoking Day campaign is high profile, and evidence has shown that many people successfully use this day as a target for quitting.

Prevention: There are several initiatives in Cardiff aimed at reducing the numbers of children and young people taking up smoking. These include:-

4. % 15-year olds smoking in Cardiff (National data from Health Behaviour in School aged Children Survey used: % 15-year olds that smoke weekly in Wales)

Data Development:

Graph 1: Cardiff Flying Start areas used as a study area, which is likely to represent Cardiff as a whole. Data to be collected by health visitors in Cardiff‟s Flying Start areas and logged on PARIS (NHS software) system. Will be available on PARIS by 2011.

Graph 4: Local data to be collected through the Cardiff Super Survey (secondary school survey), available from 2011.

Key: The route we will take if we do nothing

The curve we want to turn

The bars under each graph represent how the indictor impacts on the seven Cardiff outcomes for the city as seen below:

Healthy Environment Safe

Thriving & Prosperous

Full Potential

Live, Work & Play

Fair, Just, & Inclusive

44

SmokeBugs! Smokefree Class Competition ASSIST

All schools in Cardiff are part of the Welsh Network of Healthy Schools, and some schools include tobacco control activities as part of their Healthy School approach. These activities have been shown to deter young people from smoking.

Partners with a role to play

Public Health Wales

Third Sector, including ASH Wales

Stop Smoking Wales (SSW)

Cardiff Council o Adult Services - Health

Partnership Team o Trading Standards o Environmental Health o Youth Service o Healthy Schools Network

Cardiff & Vale University Health Board

o School Health Nursing Service o Health Visiting Service o Pharmacists o Midwifery Service o Secondary Care Settings

Cardiff Health Alliance

Children and Young People‟s Partnership

Safer Capital Partnership

Communities First

What are we going to do?

Environmental action

Continued implementation of smoking ban in public places

Enforcement of Health Act 2009 tobacco control regulations if WAG introduces regulations on point of sale displays and vending machines

Provision of information to families in Flying Start areas by health visitors and collection of data to encourage smoke-free homes

Cessation

Helping people to quit smoking through specialist support from cessation services (SSW, primary care and hospital based)

Brief Intervention for Smoking Cessation training for community and health professionals

No Smoking Day campaign supports people who want to quit smoking

Cardiff & Vale University Health Board as a „Public Health Practising Organisation‟ – strategic leadership, policy development and support of hospital in-house cessation services

Increase number of contacts to SSW, particularly from primary care practitioners

Increase number of self-reported smokers quitting at 4 weeks and 52 week follow-up

Roll-out training of practitioners in using brief interventions for smoking cessation

Develop services to target priority areas of maternity services, pre-operative services, children and young people, mental health and prisons

Ensure all smoking cessation services are working within the smoking cessation standards (launched in October 2010)

Prevention

Whole school approaches to tackling smoking. Incorporate information on smoking into the curriculum.

Deliver anti-smoking activities as part of school Personal and Social Education (PSE) curriculum

Enforcement of underage tobacco sales restrictions

45

Inclusion of smoking in Healthy Schools action plans for schools

Delivery of school-based prevention initiatives: ASSIST, SmokeBugs!, Smoke Free Class Competition

Evidence cited: Scientific Committee on Tobacco and Health (2004). Children’s exposure to second hand smoke increases the risk of pneumonia and bronchitis, asthma attacks, middle ear disease, decreased lung function and sudden infant death syndrome. NICE Public Health Guidance Nos 01 (2006), 5 (2007), 10 (2008), 23 (2010). School based interventions to prevent the uptake of smoking among children.

tobacco free cardiff and vale strategy and action …...4.3 smoking prevention 4.4 smoking cessation...

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