CREATING A TOBACCO-FREE GENERATION A Tobacco Control Strategy for Scotland. Dr Catherine Calderwood Chief Medical Officer For Scotland

Transcription

1 CREATING A TOBACCO-FREE GENERATION A Tobacco Control Strategy for Scotland Dr Catherine Calderwood Chief Medical Officer For Scotland

2 Tobacco remains the biggest single preventable cause of death in Scotland. We will continue to tackle this issue and aim to reduce the 13,300 adult deaths and thousands of illnesses caused by tobacco every year by ensuring a new comprehensive robust tobacco control strategy for Scotland is put in place to replace the current strategy which has come to an end. This strategy will focus on prevention and cessation and include ambitious targets for reducing smoking across Scotland. SCOTTISH NATIONAL PARTY MANIFESTO 2011

3 56,000 hospital admissions each year Quarter of all deaths in Scotland each year 300m- 500m NHS Costs each year 15,000 young people each year 1.1 billion cost to Scotland each year

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5 A Tobacco-free Scotland by % Smoking prevalence: and Projected smoking prevalence towards 2034 target 40% 35% SIMD 1 Most deprived 34% 30% 25% 20% 15% SCOTLAND 31% 20% 10% 5% 0%

6 Adult smoking prevalence Scottish Household Survey

7 Adult smoking prevalence by age & gender Scottish Household Survey

8 Trends by Age and Gender

9 Adult smoking prevalence by economic status Scottish Household Survey

10 Adult smoking prevalence by SIMD Scottish Household Survey

11 PROTECTION PREVENTION CESSATION HEALTH INEQUALITIES

12 Prevention

13 Protection

14 Future Challenges

15 Health (Tobacco, Nicotine etc) and Care (Scotland) Bill Ban sales of e-cigs to under 18s; Ban e-cig vending machines Ban proxy purchase Include e-cigs on Retailers Register Restrict domestic advertising of e-cigs Challenge 25 for tobacco and e-cigs

16 E-cigarette use in Scotland Source: Scottish Health Survey % of adults currently used e-cigs with 10% previously having used them.

17 E-cigarette use by smoking 120 status Currently using Ever previously used Never used Ever used 20 0 % % % % Never smoked cigarettes regularly Ex-regular smoker Currently smokes cigarettes Total Source: Scottish Health Survey 2014, adults aged 16+. Amongst never smokers, only 1 person had ever used an e-cigarette and there was no current use.

18 Percent of smokers and recent exsmokers Prevalence of e-cigarette use: smokers & recent ex-smokers Use of e-cigarettes in smokers and recent exsmokers is continuing to grow slowly Any Daily Source: Smoking Toolkit, England only. N=18668 adults who smoke or who stopped in the past year; increase p<

19 E-cigarette use among children is confined to those who have smoked Source: Bauld L, MacKintosh A, Ford A, McNeill A. Nicotine & Tobacco Research, 2015

20 Defining safety Are electronic cigarettes safer than tobacco cigarettes? Safer = less harmful In discussions of safety the appropriate comparator is tobacco both harm to users and bystanders

21 Percent of smokers trying to stop Aids used in most recent quit attempt E-cigarette use for quitting is still increasing E-cigs NRT OTC NRT Rx Champix Beh'l supp Source: Smoking Toolkit Study, England only N=10756 adults who smoke and tried to stop or who stopped in the past year; method is coded as any (not exclusive) use

22 Cochrane Review: just two trials of now obsolete devices Categoria 7.2mg nicotine EC vs. 4.8mg nicotine EC vs. no nicotine EC 300 smokers (unwilling to quit) 1 year abstinence rates: 13%, 9% and 4% (Caponnetto et al. 2013) Elusion 16mg nicotine EC vs. nicotine patch vs. no nicotine EC 657 participants 6 month abstinence rates: 7.3%, 5.8% and 4.1% (Bullen et al. 2013)

23 Other recent/ongoing trials Adriaens et al, smokers not wanting to quit, moderately strong dependence; 3 treatment arms: 2 different tank models (both 18mg/ml nicotine); no e-cigarettes. 8 week supply. 3 lab sessions 8 weeks: 34% quit in the 2 treatment arms versus 0% (p<0.02) 2 ongoing trials in UK (Hajek/McRobbie): one comparing the tank e-cigarette with standard treatment (NRT/combination NRT) one adding cigalike e-cigarette to standard treatment compared with standard treatment

24 UK observational studies (use during quit attempts) 1. Cross-sectional study, smokers in England who used e- cigarettes to quit were significantly more likely to quit than smokers using no help or OTC NRT (Brown et al, Addiction, 2014) 2. Cohort study, International Tobacco Control Policy Evaluation Study, smokers in England and US who used e-cigarettes to quit were more likely to quit than smokers using no help or NRT but no more or less likely than using varenicline/bupropion (Hitchman et al, 2015 SRNT conference presentation)

25 ITC longitudinal and US+UK data Preliminary findings (N=462) (Hitchman, SRNT 2015) Help at last quit attempt N % quit OR LCI UCI p- value E-cigarette ref No meds/e-cigarette NRT Varenicline/bupropion Adjusting for: demographics, survey mode, quit intention, HSI, time since QA, total # of Qas, interwave interval Other significant predictors of being quit: HSI, p=0.06 and time since last quit attempt No significant country interaction, p=0.86*unweighted frequencies and percentages

26 Dual use : use alongside smoking Ex-smokers Dual users Ex-smokers Dual users ASH Smokefree GB data ; Base: All e-cigarette users

27 E-Cig Conclusions E-cigarette use is prevalent in Scotland & the UK but confined to current or ex smokers E-cigarettes are far safer than tobacco but not risk free There is growing evidence of effectiveness for smoking cessation Worrying trends in harm perceptions in Scotland we urgently need to make sure smokers have accurate information & if using e-cigarettes, should be supported to switch completely & stop smoking New studies on e-cigarettes are being published on an almost weekly basis, and we need to keep tracking the evidence

28 Cessation within the strategy Recognised as key strand Commitment to: Conduct review of smoking cessation services Increase focus on smoking in pregnancy NHS target focus on longer term quits in most deprived areas Review of training

29 Smoking cessation Established evidence base and models of service delivery (national guidelines) Services in all Board areas multiple settings Increasing demand and improving success Standardised data collection and reporting 3 year HEAT target Achievement of HEAT target across all NHS Boards

30 Change in target Smoking cessation 1 year target: successful quits at three months Since 2012, numbers accessing NHS services has dropped by 39% Increasing popularity of e-cigarettes In 2014, 32% of smokers/ex smokers attempting to quit had used an e-cigarette (Scottish Health Survey) Introduction of pharmacy contract Harm reduction approaches - CDTQ Clients with more complex needs Challenging financial situation

31 Smoking cessation Declining demand for NHS services

32 Smoking cessation in pregnancy In 2014, 2876 quit attempts in pregnancy(3073 in 2012) 888 successful quits at one month (1026 in 2012) 468 successful quits at three months (498 in 2012) Drop in % quit rate to 30.9% from 33.4% MCQIC 97% women CO monitored at booking, 90% with raised CO referred to services Not translated into increased quits Package of care for those continuing to smoke Incentives trial

33 Smoking Cessation Review findings Reducing variation in outcomes and improving consistency between services Branding, varenicline, feedback, improving referral Increasing reach and success, particularly with priority groups Community development and 3 rd sector approaches, increasing options for smokers, young people, specific settings, pregnancy Improving processes within services and training for staff Follow up, CO monitoring and training

34 Moving forward (cont.) New LDP standard Improving support in maternity settings Joined up working MCQIC, Early Years Collaborative, NHS smoking cessation services, FNP Focus on specific populations and settings acute, mental health, prisons NHS E cigarette friendly services Partnership working NHS, Smokeline, Community Pharmacy Training

35 A Partnership Approach Given the wide range of factors that impact on smoking prevalence - and on health and wellbeing more widely - it is clear that effective local tobacco control strategies require a partnership response.

36 Getting in touch