People who smoke

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Smoking remains the greatest contributor to premature death and disease across Northumberland.

  • It is estimated that up to half the difference in life expectancy between the most and least affluent groups is associated with smoking.
  • In Northumberland, smoking prevalence is around the national average.
  • Death rates from smoking are statistically significantly higher than the rest of England.
  • It is estimated that 87% of deaths from lung cancer, 73% of deaths from upper respiratory cancer, and 86% of deaths from chronic obstructive lung disease are attributable to smoking.
  • In 2008/09 in Northumberland, 20.2% of pregnant women were smokers at the time of delivery.
  • Despite considerable effort and activity, smoking among young people has remained relatively stable since 1998. However, there are is no local data to monitor prevalence.
  • Stop smoking support from the NHS is available to all smokers free of charge in all communities across England.  NHS Stop Smoking Services are extremely cost-effective compared with other healthcare interventions and smokers who use NHS support are up to four times more likely to quit successfully than those trying to go it alone using ‘cold turkey’. 
  • Seven smokers in every ten say they want to quit, but only around half of these respond positively when asked about wanting to take immediate action on their smoking behaviour.  Each year, around 5% of smokers report that they use the NHS Stop Smoking Service.
  • Narrowing the gap in health inequalities.  For information on the contribution that smoking makes to the gap in life expectancy, see health inequalities section.
  • Reducing smoking rates in deprived communities is one of the greatest challenges in health improvement, but is vital to closing the health inequalities gap.  There has been an increase in investment in publicity and social marketing activities in 2008/09, particularly focused on routine and manual workers.
  • The Health Inequalities National Support Team recommends that those in greatest need should be targeted, recognising the multiplicity of risk (e.g., those with CVD, those who are obese, and those who are pregnant) and the potential for the biggest returns in health gain.

What we know - Statistical information

More details about these headline statistics is available in the NHS North of Tyne Strategic Health Needs Assessment 2009/10.

National

  • The General Household Survey is used to assess smoking prevalence in adults (aged 16 years and over); this shows that smoking prevalence for England has declined steadily over the last decade from 27% in 2000 to 21% in 2008.  More information available from: www.statistics.gov.uk/ghs/
  • For 2005-2007, it is estimated that within England, 210 in every 100,000 deaths were linked to smoking - we call this smoking attributable mortality.  Further information is available from the national Health Profiles website.
  • In 2008/09, NHS Stop Smoking Services supported 337,054 people across England to quit smoking (i.e., to be self-reported 4 week smoking quitters).  This is equivalent to a quit rate of 813 persons for every 100,000 people aged 16 and over.  Further information is available from the NHS Information Centre.

Regional

  • At regional level, data from the General Household Survey is used to assess smoking prevalence in adults (aged 16 years and over); this shows that whilst the smoking prevalence for the North East had been relatively static at 27-29% between 2000 and 2005, there have been dramatic decreases to 21% in 2008.  More information available from: www.statistics.gov.uk/ghs/
  • Since 2007, the North East has no longer had the highest regional smoking prevalence and the region has made significant progress in narrowing the prevalence gap with England.
  • For 2005-2007, it is estimated that for the North East region rates of smoking attributable mortality are 268 per 100,000; this is significantly higher than the England average.  Further information is available from the national Health Profiles website.
  • In 2008/09, NHS Stop Smoking Services supported 22,325 people across the North East to quit smoking (i.e., to be self-reported 4 week smoking quitters).  This is equivalent to a quit rate of 1,063 persons for every 100,000 people aged 16 and over.  Further information is available from the NHS Information Centre.

Local

 

  • In the absence of robust local data, synthetic estimates based on the Health Survey for England are used to compare smoking prevalence in adults (aged 16 years and over) in local authorities.  These show that for 2003-2005 estimated smoking prevalence for Northumberland was 23.5% - however looking at the former districts of Northumberland estimated prevalence ranged from 16.2% in Castle Morpeth to 28.7% in Wansbeck.  Further information is available from: http://neighbourhood.statistics.gov.uk/dissemination/
  • Local alternatives to using the synthetic estimates include use of GP practice register data.  For Northumberland, this suggests that smoking prevalence amongst persons aged 16 and over is around 18%.
  • For 2005-2007, it is estimated that for Northumberland rates of smoking attributable mortality are 228 per 100,000; this is significantly higher than the England average.  Further information is available from the national Health Profiles website.
  • Northumberland also has a relatively high rate of smoking attributable mortality when compared to similar PCTs (using the Prospering Smaller Towns Group of the ONS Area Classification).
  • In 2008/09, NHS Stop Smoking Services supported 2,203 people across the Northumberland to quit smoking (i.e., to be self-reported 4 week smoking quitters).  This is equivalent to a quit rate of 859 persons for every 100,000 people aged 16 and over.  Further information is available from the NHS Information Centre.
  • Northumberland also has a relatively high smoking quit rate when compared to similar PCTs (using the Prospering Smaller Towns Group of the ONS Area Classification) and a higher than expected quit rate, when taking into account the estimated prevalence of smoking in the population.
  • The Health Inequalities Intervention Tool for Spearheads presents key data and modelling aimed at helping Spearhead Local Authorities improve life expectancy quickly.  Based on mortality data for 2006-2008, this tool shows that cardiovascular diseases (mainly coronary heart disease), cancers and respiratory diseases (particularly chronic obstructive airways disease) account for 69.4% of the gap for males and 54.5% of the gap for females in the former district of Blyth Valley and 60.0% of the gap for males and 63.3% of the gap for females in the former district of Wansbeck.
  • Reducing the prevalence of smoking will impact on all three causes highlighted above and therefore remains the number one priority for reducing inequalities in life expectancy.  See the NHS North of Tyne Health Inequalities Action Plan for more information.

Related Performance Indicators are:

 

The measure of the rate per 100,000 persons aged 16 years and over of self reported 4 week smoking quitters is included in key plans across the local strategic partnership:

 

What people have told us – consultation and feedback

Engagement activity

Over the past two years, NHS North of Tyne focussed on developing robust mechanisms to make sure that local people across Northumberland have the opportunity to influence decisions about health developments and importantly, that their comments are fed into the commissioning system and taken into consideration whenever possible.  Engagement activity includes regular meetings with some groups in the rural communities and also better links being developed with black and minority ethnic communities and with the deaf community.

During 2009/10, the engagement team has supported close involvement by the NHS Stop Smoking Service team and NHS Health Trainers with the Health and Race Equality Forum (HAREF) to discuss Supari addiction, which is linked with oral cancer; further action is planned.

Social marketing

During 2009/10, NHS North of Tyne has made concerted efforts to increase knowledge and competence in social marketing and to formalise its use in strategic programming and the development of public health campaigns.

 

Scoping work has been undertaken to help us to tailor stop smoking messages for routine and manual groups to attract them in to NHS Stop Smoking Services and better support them in their quit attempts.  Key messages and insights arising from this work as follows:

 

  • Family, and especially children, are important to this group of people.
  • They are motivated to stop smoking by positive localised publicity, personal requests from their children or their hope for a future family.
  • They are aware of the negative effects of passive smoking and alter their behaviour accordingly.
  • Routine and manual workers would rather be given choices on how to stop smoking - when they are ready to do so.
  • They need a friendly, supportive and non-judgemental stop smoking service incorporated into their work days.
  • They want to take advantage of a time when they tend not to smoke, to incorporate their new habit of not smoking and doing other healthy, relaxing activities in their everyday lives.

 

In summary, stop smoking services must be flexible and local to routine and manual workers so they can access the services at time that is convenient to them.

Policy and Research

National

A smokefree future

The new tobacco control strategy for England, published in February 2010, establishes a vision of eradicating tobacco harms and creating a smokefree future, so that we can support people to live healthier and longer lives.  To deliver a smokefree future, the strategy sets out three overarching objectives to make significant progress towards a smokefree society:

  • To stop the inflow of young people recruited as smokers.
  • To motivate and assist every smoker to quit.
  • To protect families and communities from tobacco related harm.

Health Act 2009

The Health Act 2009, which received Royal Assent in 12th November 2009, includes legislation to remove tobacco displays in shops and to restrict the sale of cigarettes from vending machines, which were discussed in the consultation on the future of tobacco control.

Health Act 2006

Virtually all enclosed public places and workplaces in England must be smokefree, including all pubs, clubs, membership clubs, cafes and restaurants as of 1 July 2007, in accordance with the Health Act 2006.

NHS Stop Smoking Services: service and monitoring guidance 2010/11

Provides best practice guidance relevant to the provision of all NHS stop smoking interventions and sets out fundamental quality principles for the delivery of services which can be used to inform the development of local commissioning arrangements. It also includes full details of the data reporting requirements for NHS Stop Smoking Services

The Children and Young Persons (Sale of Tobacco etc.) Order 2007

This legislation, which came into effect in October 2007, changed the age of sale from 16 years to 18 years for tobacco products and strengthened sanctions against retailers for under-age sale of tobacco.

Choosing Health: Making healthy choices easier

This White Paper, published in 2004, sets out the key principles for supporting the public to make healthier and more informed choices in regards to their health.

Smoking Kills: A White Paper on Tobacco

The document, published in 1998, set out for the first time in the UK, a comprehensive tobacco control strategy and announced the introduction of a new NHS Stop Smoking Service.  The focus of the service would be to help all smokers quit smoking, whilst specifically targeting young people, pregnant women and socio-economically disadvantaged smokers.

Other tobacco and smoking related policy documents are available from the Department of Health website.

Regional

Better Health, Fairer Health

The North East's first ever health and wellbeing strategy was launched in February 2008.  This ambitious plan aims to transform the region into the healthiest in England within a generation.   Tobacco is one of the key themes of this strategy.

Fresh: Smoke Free North East

A dedicated tobacco control office, was set up in May 2005 following negotiations between key partners including the Association of North East Councils, the Regional Assembly, the Public Health Group North East, Primary Care Trusts and both Strategic Health Authorities.  It was agreed that a Regional Tobacco Strategy was needed, delivered by a coalition of organisations and partners under the umbrella term of Fresh.

Local

 

NHS North of Tyne Strategic Plan 2010-2014

The ambitious five year plan aims to improve well-being and health for almost 800,000 people living across Newcastle, North Tyneside and Northumberland.  The Plan has been developed within the context of health needs assessment which shows that many of the major health conditions for the population are linked to lifestyle choices.  There is a clear link to the indicators that we have selected as World Class Commissioning (WCC) outcomes - including the measure of smoking quitters.

Annual operational plan

The North of Tyne annual operational plan sets out the developments we are planning over the next year to improve health and well-being and health services across Newcastle, North Tyneside and Northumberland.  The plan has been drafted in line with national and local priorities and reflects discussions we have had over the past year with key partners including members of the public.

Action Plan to Tackle Health Inequalities

This report documents current performance against the national health inequalities target, focussing particularly on the life expectancy target.  It includes consideration of performance across NHS North of Tyne in the implementation of key highlighted evidence based interventions which have the potential to narrow the life expectancy gap and the formulation of an action plan intended to accelerate performance towards the target.

Releasing the Strength of our Communities

The current Sustainable Community Strategy for Northumberland was adopted by the partnership in September 2007 and covers the period to 2021.  It outlines an aspirational long-term vision for the communities of Northumberland and defines a series of shared priority outcomes that form the basis for delivering a fundamental step change to the quality of life in Northumberland.  “Lead healthier lifestyles” is one of the key themes of the strategy.  The Strategy will be updated during 2010/11.

Local Area Agreement

Northumberland’s Local Area Agreement 2008-2011, and refreshed targets as at March 2010 include a target to maintain the rate of self reported 4 week smoking quitters.

Healthy lives, stronger communities

A strategy to improve health and well-being in Northumberland, published in 2007, includes tackling smoking as a priority.

Our priorities for the future

We have identified reducing the prevalence of smoking as the number one priority for reducing inequalities in life expectancy.  Action to tackle smoking prevalence is drawn from the wider Tobacco Control agenda; increasing smoking quit rates through the NHS Stop Smoking Service is only one element of this work.

Due to difficulties in maintaining year on year increases in smoking quit rates against a backdrop of falling prevalence, the two NHS Stop Smoking Services covering North of Tyne were recommended for internal improvement review.  The review aimed to expand the reach, appropriateness and effectiveness of NHS support for all smokers by implementing a package of interventions, phased in according to available resource. Key recommendations include the following:

  • The purchase of a new database and customer recall system to facilitate systematic patient recall, reduce numbers of people lost to follow up and improve monitoring and data quality;
  • Social marketing initiatives to encourage routine and manual workers, in particular, to access local services;
  • A locally enhanced service agreement with Level 2 (‘Intermediate’) providers with tiered incentive payments and an expansion of pharmacy providers across North of Tyne;
  • Take advantage of the levers afforded by the Commissioning for Quality Innovation (CQUIN) payment framework to engage frontline health staff in tobacco control activities.

In response to the detailed social marking work with routine and manual smokers, we are implementing the following into our programme for tackling smoking:

  • Deliver a campaign using ‘real’ ex-smokers who have stopped smoking, advertised locally in workplaces, supermarkets and local pubs to meet people ‘on their turf’.
  • Take stop smoking services into their places of work using a mobile unit/bus to vary the locations and make it easier to engage in the service with friends and meet the service in a non judgemental situation.
  • Change service provision, including extended opening times.
  • Continue support and aftercare once users have completed the programme.

In addition to helping smokers quit, we must strive to reduce the inflow of young people recruited as smokers.  We are currently evaluating the young people’s theatre in education package facilitated in 2009/10 in seven Newcastle high schools and will develop a youth prevention programme focusing on access to cigarettes via illicit routes, to build on this approach.

The Northumberland Tobacco Alliance will be reviewing its work programme in the light of the recently published Tobacco Control Strategy for England.