Public Health Commissioning Board A Tobacco Control Strategic Plan An update Liz Fisher Health Improvement Service Lead Tobacco Control Manager February 2014

Setting the scene-Professor Eugene Milne PHE Why Smoking Still Matters Fall in heart attacks and asthma admissions Decline in cancer rates Fall in smoking prevalence Decline in 15 year olds Smoking Unlikely to reach Smoking in Pregnancy targets (11% by 2015)

National Tobacco Control Initiatives

Lung Cancer Incidence and Smoking Prevalence

Harm Reduction Approach – Hazel Cheeseman ASH Harm reduction means trying to reduce the harm that people do to themselves, or others, as a result of their behaviour. NICE guidance published June 2013 Approaches for those not yet ready or willing to quit –Cut down smoking –Replace smoking –Temporarily abstain from smoking Many smokers are not yet ready to quit although 2/3 say they want to Deprived communities have most to gain Sick from smoking but unable to quit Poor understanding about Nicotine Containing Products and nicotine

HWb, PH and TC Priorities Reduce Smoking Prevalence to 18.5% or less in each district Reduce the uptake of Smoking in Young People Reduce Smoking in Pregnancy to 7% or less by 2016 Reduce the harm from second- hand smoke Promote Smokefree public sector organisations and healthy workplaces

Setting the scene - workshop focus on health inequalities 170,000 smokers in Hertfordshire (19.4%) One in two adults dying prematurely from smoking related illness = 1500 residents per year For every smoking related death, 20 people are suffering from a smoking-related disease Smoking accounts for 50% of the difference in life expectancy between the richest and poorest; the health inequalities gap is widening!

Reduce smoking in every district by 18.5% or less by Localities have smoking prevalence above ambitions 4 are unlikely to reach the 18.5% ambition: (Stevenage: 27.6%, Welwyn Hatfield: 23.6%, Three Rivers: 22.3% & Broxbourne 21.5%) →Local Action Groups (Key Partners) → Tobacco Control Enforcement → Smoking Cessation → Drugs and Alcohol

Workshop Feedback Increase workplace services and highlight savings to businesses Promote training to a wide range of partners Specifically target high prevalence areas and groups (shopping areas, pharmacies, hospitals incl healthy living volunteers, BME groups, youth groups, health forums and locality groups, groups who work with mental health service users incl mental health champions, non-hospital settings) Good use of data – aware of limitations of tobacco profiles at district level. Ensure stop smoking services are developed with high prevalence groups. Ensure providers respond to service user evaluation

Workshop Feedback Develop district Smokefree policies – e.g. Smokefree playgrounds and services for staff Support implementation of NICE Guidance with NHS colleagues Work with drug and alcohol services Develop effective communication and marketing tools – using social media to communicate with partners and smokers (denormalising smoking with young people) work with range of partners to promote Smokefree lifestyles Capitalise on national campaigns (NSD/ Stoptober/health harms etc. Complete ASH review on Tobacco Control Tackle illegal tobacco and under-age sales Consider harm reduction approach and develop guidelines for e-cigarettes and oral tobacco use

2. Reduce smoking in young people, so that less than 9% of 15 year olds smoke by 2016 Under-age smoking and access to tobacco Preventing the uptake – Dispelling myths – Youth projects Smoking and Young People – Advocacy work e.g. standardised packaging – Smoking cessation (Yeah Butt)

Workshop Feedback School curricula – link to Ofsted Training/skills development for teachers and PHSE leads etc. whole school approach to Hwb Schools receiving Pupil Premium Funding should be prioritised Work on ‘social norms’ – change perceptions about smoking Use social media to communicate with young people –elicit negative reactions (disgust and fear) Use positive Smokefree role models – sports champions Target parents to stop smoking – esp R and M group Develop peer interventions with younger pupils (ASSIST) Develop innovative programmes such as ‘Operation Smokestorm’ EHDC ‘Young and Smokefree’ project

Workshop Feedback Work with range of partners e.g. Health visitors, Youth Connexions, Children's Centres, NHS Trusts Use young people in design of services for young people Promote participation in Health related behaviour survey Work with young people at greatest risk of other harmful behaviours Challenge Video gaming industry – popularisation of smoking E-cigarette policy for young people – discourage use and include in policies.

3. Reduce smoking in pregnancy so that less than 7% of pregnant women smoke throughout their pregnancy by the end of 2016 Risks and Impact: Smoking is the single most modifiable risk factor for adverse outcomes in pregnancy → 14,500 deliveries in Herts in 2014 → 9.8 % smokers (1,450 residents) → 29% in lower socio-economic groups → 45% in mothers under 20 → 9.0% in Maternity Services CCG commissioning mechanisms Smoking in Pregnancy Specialist Reducing Smoking pre-pregnancy

Workshop Feedback Identify barriers why women don’t take up support Provide services in a range of settings inc pharmacy, workplace and Children's Centres and out of hours Use social norms – not normal to smoke in pregnancy Increase use of Children's Centres to support this Link to Smokefree homes and cars Join up partners e.g. midwives, GPs SSSs Children’s Centres

Workshop Feedback Develop Smoking in Pregnancy Support Groups Provide more intensive 1-1 support for pregnant smokers More work post-natal support to sustain quitting. Local information on Smoking in Pregnancy (data) Use social media to communicate with pregnant smokers Use loyalty scheme (incentives) to maintain engagement Work with other partners e.g. Youth Hostels and Housing Ass’ns to promote services Joint sessions with midwives and Stop Smoking Services Develop/use visual aids to support quitting in pregnancy

4. To protect young people from second hand smoke by rolling out a smoke free cars and homes scheme Dangers of second-hand smoke → 2 million children exposed in the UK → 3x risk of lung cancer → Increased risk of respiratory infection Current legislation – and Gov’t action Smokebusters Pledges Partnerships i.e. Fire and Rescue

Workshop Feedback Work with a wide range of partners to promote Smokefree Homes and Cars (statutory, voluntary and private) – train the trainer/sign the pledge esp. Children's Centres and midwives and schools and pre-school groups Provide Brief Intervention training on smoking and the dangers of second- hand smoke to range of partners Use local dignitaries (Tobacco Control Champions) to promote Use social media and have pledge on-line to promote Include Smokefree Homes and Cars in all Tobacco Control advocacy work

5. All public sector workplaces are completely smoke free including grounds by 2016 Cost to Hertfordshire employers* → £50.5 million on smoking related sickness → £58.6 million lost productivity (breaks) Building on smoke free legislation Public Health Responsibility Deal HCC tobacco policy: Exemplar organisation Hertfordshire Workplace Offer *ASH toolkit (2012)

Workshop Feedback Guidance on e-cigarettes required for workplaces Offer Stop Smoking training to workplaces and offer on- site and alternative services Promote National Campaigns Improve access to medication in the workplace County-wide assessment of public sector workplace policies e.g. HCC Tobacco Policy. Develop a business-case template for HR to support Smokefree organisations Utilise Workplace health and wellbeing days Consistent advice on Smokefree legislation and NICE guidance to promote Smokefree NHS organisations Enforcement Officers on Public Sector Grounds

Communications → National campaigns such as Stoptober → Social Marketing Positive examples of good practice → CLeaR: Excellence in tobacco control Alternative forms of tobacco & nicotine use → Niche products → Electronic Cigarettes Tobacco Control Strategic Plan cont.

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