How do we engage better with smokers in our most deprived areas? Rebecca Campbell Health Improvement Lead (Tobacco)
Why did we do this research? What did we do? What did we find? So what?
Policy Context Creating a Tobacco Free Generation: A Tobacco Control Strategy for Scotland 2013 Smokefree Scotland by 2034 Major focus on inequalities and priority groups
A Smokefree Scotland by 2034 45% 40% 35% Smoking prevalence: 1999-2014 and Projected smoking prevalence towards 2034 target SIMD 1 Most deprived 34% 30% 25% 20% 15% 10% SCOTLAND 31% 20% 5% 0% 1999 2004 2009 2014 2019 2024 2029 2034
HEAT 2014-15 NHS Scotland Deliver universal smoking cessation services to achieve at least 12,000 successful quits, at 12 weeks post quit, in the 40% most deprived within-board SIMD areas (2823 for GGC) Numbers through services have dropped 11/12 to 14/15 by 50%.
Universal pharmacy service Local community services: groups, drop in, 1 to 1 Acute inpatient service Pregnancy service Mental Health service Prison service Approx 20,000 people per year
Aim: survey sample smokers & recent ex-smoker in SIMD 1& 2 areas across GGC to establish current attitudes & behaviours for stopping smoking, awareness & views of NHS SS services. Method: Quantitative method. Door to door interviews SIMD 1 & 2 areas Glasgow City, Renfrewshire, Inverclyde & West Dun. Sample: 319 current smokers, 100 recent ex-smokers
Figure 1a: Smokers who might and have quit v. those who would never quit (%) All population (n=850) Might and have quit, 49% Never stop, 51% Smokers who might stop and Ex-smokers (n=419) Smokers who will never stop (n=431) Male, 41% Female, 36% Female, 59% Male, 64% Source: S2 - Which of the following statements best describes your attitude to stopping smoking? Base: All smokers (n=750) plus ex-smokers (n=100) SCOTT PORTER
Current Smokers
Figure 2: Number of cigarettes smoked on average day (%) 1 to 5 3% 4% light smokers 6 to 9 1% 10 to 15 16 to 19 1% 39% 40% medium smokers 20 to 25 44% 26 to 29 0% 30 to 35 8% 56% heavy smokers 36-40 4% 41+ 1% Source: Q2 - How many cigarettes per day do you smoke on average? Base: All smokers (n=319) SCOTT PORTER
Figure 3: Motivation level to stop smoking (%) I don t want to stop smoking now, but I have tried in the past 21% I think I should stop smoking but don't really want to 9% 30% Pre-contemplators I want to stop smoking but haven't thought about when 15% I really want to stop smoking but I don't know when I will 31% I want to stop smoking and hope to soon 20% 66% Contemplators I really want to stop smoking and intend to in the next 3 months 3% I really want to stop smoking and intend to in the next month 1% 3% Ready for Action Source: S2 - Which of the following statements best describes your attitude to stopping smoking? Base: All smokers (n=319) SCOTT PORTER
40% trying to cut down, even within the pre-contemplative group (28%) 53 % have tried to stop in the past (59% female, 46% male)
Figure 4: Methods using to cut down - unprompted, multicode (%) Buying fewer cigarettes 46% Nothing / using sheer willpower 43% Limiting where / when I will have a cigarette Electronic cigarettes 16% 26% Females n=15 Males n=6 18-29 n=5 30-50 n=10 51+ n=6 NRT (patch, gum, inhaler) 5% ABC1 n=4 D n=8 E n=9 One-to-one support 1% Source: Q4 - What are you doing, or using to cut down? Base: All smokers who are trying to cut down (n=128)
Figure 6: Quit methods tried previously Total mentions (%) Nothing /sheer willpower / cold turkey 78% NRT / product on prescription 29% NRT / product without prescription / bought OTC 28% Electronic cigarettes 18% Champix (varenicline) 6% Zyban (bupropion) Acupuncture Other 4% 2% 9% Allen Carr Easyway book 1% Hypnotherapy 1% Phoned smoking helpline 1% 1-2-1 counselling/advice/support sessions 1% Stop Smoking Group 1% Pharmacy for support 1% Other - various Source: Q6a -c: Which methods have you tried TOTAL MENTIONS Base: All smokers who have tried to stop smoking before (n=170) SCOTT PORTER
Figure 9: Quit method would try in the future unprompted, multicode (%) Do it on my own / sheer willpower / cold turkey 42% Buy electronic cigarettes 32% Have a chat with my GP / Practice Nurse 11% Ask for NRT / products on prescription 6% Buy NRT / products without prescription / OTC Have a chat with my local Pharmacist Have a chat with my friends / family Ask for Champix on prescription Don't know 2% 2% 4% 5% 8% Source: Q8a - If you were to try to stop smoking in the future, how would you go about it? Base: all smokers (n=319) 2 mentions each for:: Attend Pharmacy for support Attend a stop smoking group Acupuncture Hypnotherapy 1 mention each for: Allen Carr Easyway book Ask for Zyban on prescription Phone a smoking helpline Inhaler Save up fag cash & go on holiday SCOTT PORTER
Recent ex-smokers
Figure 11: Motivation to quit smoking unprompted, multicode (%) A decision that smoking was too expensive 52% Health problems I had at the time Advice from a GP / health professional A concern about future health problems Being faced with smoking restrictions I knew someone else who was stopping Government TV / radio / press advert I was pregnant 23% 20% 12% 6% 4% 3% 3% Something said by family / friends / children Just wanted to stop Other Don't know 2% 2% 6% 2% Attending local stop smoking event/activity 1% TV advert for NRT/product 1% Health warning on cigarette packet 1% A significant birthday 1% Willpower 1 % The taste of it 1% My mother died of cancer 1% Lent 1% Source: Q10 - What made you want to quit smoking? Base: all ex-smokers (n=100) SCOTT PORTER
Figure 12: Methods used to help quit smoking unprompted, multicode (%) Nothing / sheer willpower / cold turkey 54% Electronic cigarettes NRT / product on prescription 18% 16% Champix NRT / product without prescription / bought OTC Hypnotherapy Attended Pharmacy for support Attended a Stop Smoking Group Pregnancy Saved cigarette money 8% 2% 2% 1% 1% 1% 1% Source: Q11a - What, if anything did you use or do to help you quit (this time)? Base: All ex-smokers (n=100) SCOTT PORTER
All respondents
Figure 15: Awareness levels of NHS Stop smoking services (%) NRT (e.g. patches, gum) on prescription Local Stop Smoking groups Local Stop Smoking drop-in clinics Pharmacy services / support Telephone helpline (e.g. Smokeline) Self-help literature / leaflets / publications One-to-one counselling / advice / support Website (e.g. www.canstopsmoking.com) E-cigarettes Tablets (Champix / Zyban) Vouchers / money incentive Willpower Refused Other Don't know 2% 1% 1% 0% 0% 0% 1% 11% 9% 8% 8% 17% 12% 33% Doctor n=1 Cost n=1 The price n=1 76% Source: Q1 - What are you aware of that s available through the NHS to help smokers quit? Base: All respondents (n= 419) SCOTT PORTER
Table 12: What NHS should provide to help smokers quit SCOTT PORTER
Table 13: What would make NHS services more appealing to smokers in the local community SCOTT PORTER
So what?
Multiple advantages of using e-cigarettes Health benefits no tar or harmful chemicals feel healthier Can alter strength of nicotine to suit own preferences/need states zero nicotine options available No nasty side effects (unlike NRT) inexpensive affordable Financial benefits It s just like smoking keeps hands occupied get similar hit in throat when inhaling still exhaling cloud of vapour satisfies cravings/habit Can use guilt free in places where don t normally smoke (in home, pub, car, work, football matches) can avoid smoking bans Available in wide range of (surprisingly nice) flavours not limited to just tobacco and menthol fruit, desserts, alcohol/drinks too! Produces harmless vapour no lingering odours (on breath, clothes, room, car) if vaping a flavour, faint (but pleasant) smell of chosen flavour (apple, etc) causing no harm to those around you Does not produce ash no dirty ashtrays to empty no smells Becoming socially acceptable (opposite of cigarettes) Prompts a positive change in people s attitude towards you A very effective weight loss tool
Conclusions Many contemplators to engage with many trying to make changes Need to increase visibility in SIMD 1&2 areas Promote what we offer & what we do what is our added value? Cannot ignore e-cigarettes. Although can t prescribe, e-cig friendly services. But what about pharmacy? What about NHS policies?
Questions? Thanks to: Alison Miller & Rachel Bishop from Scott Porter Research who undertook this research project. Ruth Kendall, Senior Public Health Researcher in NHS GGC for advice & support.