Quit with Us. Service Evaluation. August 2016

Transcription

1 Quit with Us Service Evaluation August 2016

2 Contents 1. Executive Summary Introduction Background Data Collection Methods Results Preferred smoking quit methods Actual methods used to make quit attempt Location Recommendations References

3 1. Executive Summary 1.1 This model for Quit with Us is particularly effective for accessing smokers. 97.7% of participants described themselves as smokers. 1.2 During the intervention, 84.9% of participants expressed an intention to quit smoking. 1.3 Following the intervention, 76% of participants made a total or partial quit attempt. 1.4 The most popular quit methods were patches and spray (22.7%). After this, e-cigs were the most popular at 21.7%. 1.5 For those who made a quit attempt, it was felt that the products given (23.1%) and health reasons (23.1%) were the most popular reasons why they were successful. 2

4 2. Introduction 2.1 Currently, in Wales, 19% of the adult population smoke (Welsh Health Survey, 2015). Furthermore, there is a marked association with deprivation and smoking. The numbers of smokers in the most deprived areas are double that of smokers in the most affluent areas; this is a key driver for health inequalities (Welsh Government, 2011). 2.2 The Tobacco Control Action Plan for Wales was launched in 2012 with the aim to reduce smoking prevalence in Wales to 20% by 2016 and 16% by 2020 (Welsh Government, 2012). Research has shown that 70% of smokers want to quit, therefore we need to look at innovative ways of supporting smokers which are not presently available to them. 2.3 In this context Tenovus Cancer Care developed the Quit with Us intervention that provided the opportunity to deliver brief intervention for smoking cessation in workplaces. 3

5 3. Background 3.1 Quit with Us was developed following the success of Here Comes the Sun; a Tenovus Cancer Care sun safety intervention delivered through a partnership with Sheppards pharmacies and Tenovus Cancer Care shops during July and August The first Quit with Us Campaign took place in early 2013, to coincide with National No Smoking Day. This year has been the 4 th year that the Quit with Us campaign has been run. 3.2 The intervention gives smokers the opportunity to quit by providing them with a Welsh Government Fresh Start Quit pack, a sample Nicotine Replacement Pack and other literature signposting them to local support services. 3.3 The findings from the 2015 Quit with Us Campaign identified workplaces were a particularly acceptable setting to deliver the intervention. What also became apparent from the results from 2015, was the importance of being able to deliver Nicotine Replacement Therapy (NRT) packs to all participants as they were a highly influential factor in creating a smoking behaviour change. Therefore, the model was adjusted this year to ensure all workplace venues had a specialist community pharmacist present to distribute NRT. The campaign launched on 9 th March and ran for 11 weeks. 3.4 Individuals were provided with details on avenues of support, particularly local Pharmacy level 3 services. In areas where community pharmacy services were provided we worked closely with them to publicise their smoking cessation services. In addition, sample NRT packs, were put together and given to smokers through associated pharmacies and through other, targeted events organised by Tenovus Cancer Care. The packs were dispensed by the pharmacist on all occasions. 3.5 We wanted to highlight the availability of the pharmacy service as a recent study by the Bevan Foundation found that smokers from lower 4 socio-economic groups faced significant barriers to participating in methods such as Stop Smoking Wales. The report recommended effective alternatives to Stop Smoking Wales services for smokers unable or unwilling to use that service, (The Bevan Foundation, 2013). 4

6 4. Data Collection Methods 4.1 Pharmacies Tenovus Cancer Care partnered with 23 Sheppards pharmacies across South Wales. Pharmacies were required to currently offer a Level 3 smoking cessation service to meet the inclusion criteria. All participating pharmacies were offered a training session arranged by Johnson and Johnson on how to use Nicorette products. Nicorette products were supplied to 23 pharmacies by Tenovus Cancer Care to create 15, 48 hour supply of Nicotine Replacement Therapy (NRT) packs. All Nicorette products were given out with the manufacturer s instructions of how to use. The NRT packs were given to any smokers wanting to make a quit attempt using NRT. They consisted of; 1x Tenovus Cancer Care Quit with Us leaflet A 48 hour supply of Nicorette Invisi 25mg Patch Nicotine (2 patches) To be used in conjunction with; One Nicorette 15mg Inhalator Nicotine (with 4 cartridges) or One Nicorette Quickmist 1mg/spray Mouthspray Nicotine (150 sprays) or One Nicorette Cools 4mg Lozenge Nicotine Icy Mint (20 lozenges) All smokers given an NRT pack were asked to provide their contact details for followup. 4.2 Corporates Four corporates were interested in the campaign; Admiral (four sites), Money, Ford and EE. The Health and Wellbeing team offered smokers C0 readings, Welsh Government quitting material and NRT packs dispensed by a Sheppards pharmacist. All corporates were sent an appointment schedule to allow enough time for a brief intervention conversation including a demonstration of how to use the products. Where possible drop-in appointments were also welcomed. Again, all smokers given an NRT pack were asked to provide their contact details for follow-up. In total, 306 NRT packs were dispensed by pharmacists at their pharmacy or in a corporate. Of these, 178 smokers provided a telephone number and gave consent to be contacted. 5

7 5. Results 5.1 In total, there were 306 brief interventions for smoking cessation. Of these, 295 were current smokers, 1 was a non-smoker and 6 gave no answer. An additional 4, although identifying themselves as smokers, were e-cigarette users when asked to provide more information. Conversations with smokers included distributing an NRT pack and taking part in a follow up telephone interview. Do you consider yourself a smoker? 0.3% 1.9% Yes No No Answer 97.7% 5.2 Of the 306, 43.1% were male, 54.6% were female and 2.3% did not answer. The option of other when asking gender had no response. Gender % 2.3% 54.6% 43.1% Males Females No Answer 6

8 5.2 Of the 306 participants, the most common age group spoken to were aged with 41.5%, followed by 19.6% in the age group. The strategy this year was to target workplaces which employ people in the demographic that has an above average number of smokers e.g. call centres. Those aged are part of this demographic. Therefore, this shows that the strategy was successful here. 1.6% 3.6% 10.8% 13.7% 19.6% Age % 1.3% 7.8% 41.5% 21 and Under No Answer 5.3 When looking at how many cigarettes were smoked per week, 26.6% answered between cigarettes totalling 6 to 10 smoked per day. 23.3% of participants noted cigarettes per week, up to 15 smoked per day. Only very few indicated that they smoked over 211 cigarettes per week. This may be for several factors including a) this is a fair representation amongst the smoking population, b) when smoking that many, smokers are feel less able to quit and c) working in locations such as those where the intervention took place means that it would be difficult to smoke that many as they all have no-smoking policy preventing smoking inside at work. Cigarettes smoked per week on average % 1.0% 0.3% 3.3% 3.0% 21.0% 23.3% 0.7% 1.6% 2.0% 17.4% 26.6% 35 or under Other No Answer 7

9 6. Preferred smoking quit methods 6.1 As a result of the brief intervention conversation, 84.9% of participants intended on quitting smoking. 10.8% were unsure and 3.6% gave no answer leaving only 0.7% saying they do not intend to quit. This is largely unsurprising given that the focus of the campaign was to work on an appointment basis meaning that only individuals with an interest in quitting are likely to take part. Last year, with more of an emphasis coming from cold conversations taking part in the shops the percentage of those showing an interest in quitting was closer to 50%. Again, this shows that the strategy is successful. Intention to quit as a result of the conversation % 3.6% 0.7% 10.8% Yes No Unsure No Answer 84.9% 6.2 Of those who intended to quit, participants were able to express a preference of quit method to use. 47.7% indicated they would use the community pharmacy smoking cessation service. This method was heavily promoted during the conversation due to a pharmacist distributing the NRT packs. Preferred method to quit smoking % 47.7% 7.6% 9.9% 15.4% 6.7% 2.1% 7.8% 3.0% 8

10 6.3 The community pharmacy smoking cessation service response to quit has been removed to highlight the alternative methods to quit smoking. Will power was the most popular preferred method to quit smoking with a 29.4% response. Preferred method to quit smoking % (Excluding community pharmacy smoking cessation service) 29.4% 14.5% 18.9% 12.7% 14.9% 3.9% 5.7% Stop Smoking Wales E-Cigarette Will Power GP Other Unsure No Answer 9

11 7. Actual methods used to make quit attempt 7.1 From the 306 conversations, 178 agreed to a call back. Of these, 71 were successfully contacted. Quit attempt made No % Yes Partially No Total As the chart below shows, of the 71 participants successfully contacted, 57.7% had made a quit attempt following the intervention. An additional 18.3% had made a partial attempt. This largely means they have cut down their cigarette consumption. In total, 76% of participants changed their smoking behaviour following this intervention. Quit attempt made? % Yes Partially No 10

12 7.3 The most popular methods indicated were the use of patches and spray. The use of the e-cig came next with 21.2%. Whilst the level 3 pharmacy only made 6.1%, this could largely be due to the way the information was reported. Many of those who indicated a particular product would have received these through their accessing a level 3 pharmacy. Previous evaluations did not find the products to be quite as successful. Whilst it is only speculative at this stage, it does suggest that having a pharmacist present throughout, giving appropriate advice as to how to use the products, makes them more successful. Methods used for total or partial quit attempt % E-Cig GP Inhalator Lozenge Willpower Patch Spray Level 3 pharmacy 7.4 The spray (25%), patches (23.1%) and the e-cig (21.2%) continue to be the most popular methods used for making a quit attempt amongst those who made a total quit attempt. It appears that the lozenge is less effective here (1.9%). Methods used for total quit attempt % E Cig Inhalator Patches Pharmacy Lozenge Willpower Spray No answer 11

13 7.5 Interestingly, the e-cig is the most popular method used for those claiming to have made a partial quit attempt. This may possibly be because some regard an e-cig in the same category as the cigarette, thus feeling they have not totally quit. It may also show that some are using the e-cig in place of cigarettes on certain occasions, perhaps when cigarettes are prohibited, but do smoke cigarettes as well. Further, qualitative research is required to investigate this relationship. Methods used for partial quit attempt % E-Cig Lozenge Inhalator Willpower Patches Spray No answer 7.6 The majority (68.5%) of those who have made a quit attempt have also tried quitting in the past. Have you attempted quitting in the past? % Yes No No Answer 12

14 7.7 When asked how many times they have made a quit attempt, participants gave a variety of answers and these have been categorised as best as possible. 20.7% of participants report having attempted to quit twice before or a few times. 17.2% have tried only once before but 6.9% reported over 12 previous attempts. Research suggests that it can take as many as 20 attempts to quit smoking. If yes, how many times? % or 3 4 or 5 6 or A few times Loads of times 13

15 participants gave reasons as to why they feel they have been successful on this occasion. 23.1% felt that the NRT packs given were particularly influential in making the behaviour change. 23.1% also gave up for health reasons. This might mean a health scare to themselves or to a significant other. Why do you think you have been able to quit on this occasion% Health Reasons Increased awareness Less stress More motivated No interest Pressure from friends/family Products given Support given Switch to E-cigs 7.9 Finally, those who were unsuccessful were asked for reasons as to why they felt they were unsuccessful. There were far fewer answers identified for this question but answers given included: Logistical factors for attending groups. Lack of motivation Feeling that the timing is not right Stress Enjoyment. All of these are common reasons for giving for being unable to quit. 14

16 8. Location 8.1 The campaign targeted both workplaces and partnered with Sheppards pharmacies to dispense NRT packs to smokers looking to quit. The graph shows the gender of those who were part of the campaign. Gender % Pharmacies Workplaces Males Females Unknown 8.2 As the graph below shows, workplaces are far more effective than pharmacies in targeting the younger age groups, particularly the age group 22-34, the demographic most likely to smoke. However, work places (perhaps obviously) are not suitable for accessing those over the age of 65. Age % Pharmacies Workplaces and Under No Answer 15

17 8.3 Both locations are highly effective for accessing smokers. Do you consider yourself a smoker % Pharmacies Workplaces Yes No No Answer 8.4 Interestingly, there seems to be a difference in the smoking habits between the different locations. In workplaces, the majority of smokers (55.9%) smoked 70 or less per week (10 a day or less). Those visiting pharmacies were likely to smoke more. Cigarettes smoked per week on average % Pharmacies Workplaces or under Other No Answer 16

18 8.5 Again, both locations seem to be highly effective motivating smokers to consider a quit attempt with over 80% in both locations declaring themselves willing to do so. Intention to quit as a result of this conversation % Pharmacies Workplaces Yes No Don't know No answer 8.6 Of those who were followed up, slightly more people (63%) made a quit attempt after visiting a Sheppards pharmacy compared to workplace (54%), although both locations show over 50% making a quit attempt. Quit attempt made? % Pharmacy Workplace Yes Partially No 17

19 9. Recommendations 9.1 This report has provided evidence which shows the intervention to be effective in both pharmacy and workplace settings. Therefore, the intervention should continue in both these locations and also explore variations, such as smaller workplaces or more rural locations to measure these variables. 9.2 Follow up interviews with pharmacists showed that the most successful models were when technicians also dispensed NRT. This should be explored as part of future interventions to both increase reach whilst reducing costs. 9.3 From the position of sustainability, cost must be considered. This report can be used as evidence of effectiveness. Alongside the evidence from the previous year s campaign, NRT packs are a particularly effective resource but are also one of the most successful components necessary for the campaign to run. Therefore, to cover these costs, it seems reasonable to charge workplaces for the intervention in future. 9.4 There was no evidence to suggest that the shops were particularly effective in raising awareness of the campaign. Therefore, reducing resources going to shops would reduce overall cost further with minimal impact to the effectiveness of the campaign. 18

20 10. References Welsh Government. (2015). Welsh Health Survey 5015: Initial Headline Results. Available: Last Accessed 24 th October