Smoking Cessation Ruby Poppleton Health Improvement Specialist

Background: smoking Smoking is the single biggest preventable cause of premature death in Stockton 18% of deaths in adults over 35 are a result of smoking People from lower socio-economic group who smoke, start smoking at an earlier age Smoking costs Stockton approx. £56 million each year The average smoker could save £2,873 a year by stopping smoking – based on £7.87 / 20 cigarettes a day Cigarettes are as addictive as drugs such as heroin or cocaine 18% of deaths in adults over 35 are a result of smoking (approx. 290 deaths per yr in Stockton) – 2010 data Smoking accounts for over half of the difference in risk of premature death between social classes. Death rates from tobacco are two to three times higher among disadvantaged social groups than among the better off. Long-term smokers bear the heaviest burden of death and disease related to their smoking. Long term smokers are disproportionately drawn from lower socio-economic groups. People in poorer social groups who smoke, start smoking at an earlier age: of those in managerial and professional households about one third start smoking before age 16 compared with almost half of those in routine and manual households. Estimated that smoking costs approximately £56 million per year in Stockton, including NHS and non NHS costs (sick days, lost productivity, domestic fires & smoking litter)

Smoking: Effects on health Smoking is associated with a range of diseases - Cardiovascular Disease (CVD), Chronic Obstructive Pulmonary Disorder (COPD) and Cancer Smoking during pregnancy – increases risk of miscarriage, premature births and a range of other health outcomes Second-hand smoke - increases infant mortality rates by 40%, around 13,000 children need GP or Hospital treatment from glue ear, wheeze and asthma every year in the North East due to breathing in second-hand smoke in their home Quality of life ↓– a 25 year old smoker can expect to lose 10 years of healthy and disability-free years of life compared to a person who don’t smoke Smoking causes: 17% of deaths from heart disease. 80% of deaths from COPD (bronchitis and emphysema), 90% of deaths from lung cancer, Smoking in pregnancy –There is also a high chance that the child will become a smoker themselves when grown up. •Smoking is harmful not only to smokers but also to the people around them. Breathing in smoke results annually in around 13,000 GP or hospital appointments among North East children aged from newborns to 16. (regional breakdown by population of figures from Royal College of Physicians Passive Smoking and Children report) QALYs (quality-adjusted life years) are a way researchers can look at the total impact of a risk factor on quality of life. QALYs combine reductions in life expectancy with loss of health causing disability and pain. The calculations can be complex, but the way to think about QALYs is the number of healthy, disability-free years of life. Here are some risk factors and their QALY number. Smoking and Quality of Life - A 25 year old who smokes can expect to lose 10 to 11 QALYs compared to a person who never smoked.

Smoking Prevalence in Stockton-On-Tees 21.6% of adults smoke (approx. 32,000 people) Massive inequalities in smoking prevalence across Stockton wards - strong correlation between smoking & deprivation High smoking prevalence wards - Stockton Town Centre, Roseworth, Norton South, Newtown, Mandale & Victoria, Hardwick and Parkfield Young people: Stockton Social Norms Project: identified that approx. 15% of college students in sample smoked, with 38% taking up smoking at 14 years of age 21.6% of adults (18+) smoke, this equates to approximately 32,000 people. Based on the 2012 integrated household survey which surveys approx. 1,400 residents. Although we have seen a recent reduction in prevalence there are still massive inequalities in smoking prevalence across the wards in Stockton. Some of the more deprived wards have a smoking prevalence which is 2 times the Stockton average (next slide show the ward level info). On average, for those accessed to stop smoking service, only 40% of those quitted @ 4-weeks and 60% of those either lost to follow up or fail Young people - Stockton Social Norms Project provides a proxy and identified that approx. 15% of college students in sample of 922 smoked, with 38% taking up smoking at 14 years of age.

Smoking Prevalence by Wards

Smoking prevalence continued… Smoking in Pregnancy: 19.4% of pregnant mothers in Hartlepool & Stockton CCG area were reported as smokers at time of delivery (Q3 13/14) Smoking in Mental health: High prevalence of smoking in those with mental health problems (70% in inpatient units) Smoking in Occupation: Higher smoking prevalence amongst the Routine & Manual group than professional & managerial group

Challenges Majority of smokers would like to stop smoking but find it difficult due to the addiction average smokers usually require 4 to 5 attempts to stop smoking some smokers require intensive support and motivation. Smokers from the deprived wards or from the routine and manual group are less likely to succeed. On average, for those accessed to stop smoking service, only 40% of those quitted @ 4-weeks and 60% of those either lost to follow up or fail

What could the VSC organisations do? Provide brief advice and motivation to smokers to stop through the local stop smoking services Organise peer support group - follow-up & given motivation Raise awareness of the services and how the service could help individual Engage and support smokers to access the services ‘Denormalise’ smoking – to help create an environment that smoking will be viewed as more socially unacceptable for our children in the future

What is available to support people to quit? For Smokers Local Stop Smoking Services (SSS) with behavioural support & treatment – Pharmacy & drop-in across the Borough – people who stop smoking with the SSS is 4 times more likely to succeed For VCS sector Free training – Brief Intervention / second-hand smoke / shadowing opportunity Free resources to borrow from the Public Health resource library – www.sphil.nhs.uk

Potential measures of success Number of smokers given brief intervention Number of smokers referred to the Stop Smoking Services Number of smokers accessed the stop smoking services Number of smokers who accessed the services and successfully quitted at 4weeks, 12 weeks and 6 months

Number of staff attended the brief intervention training Other requirement:- Number of staff attended the brief intervention training Demographic information e.g. age, occupation, ward details, previous unsuccessful attempts stop smoking System in place to record service user’s smoking status /whether BI is given / whether individual has accepted the referral