NPRI case studies: Tobacco use
- A comprehensive evaluation of the impact of English tobacco control policy on smoking cessation activities
- Smoke Free North East: a model of good practice for England?
- Promoting smoking cessation in ethnic minority groups
A comprehensive evaluation of the impact of English tobacco control policy on smoking cessation activities
(Professor Sarah Lewis, University of Nottingham: July 2008 – December 2010)
Increasing smoking cessation is probably the single most important means of reducing the burden of lung cancer, heart disease and stroke in the UK in the next 20 years. Since 2002 a range of tobacco policies have been introduced in the UK in an attempt to increase rates of quitting and abstinence.
A 2-year NPRI-funded research project at the University of Nottingham is evaluating the impact of recent tobacco control policies in England, including larger and harder-hitting health warnings on cigarette packs, the introduction of varenicline as a new smoking cessation treatment, and the broadening of indications for nicotine replacement therapy (where broadening includes making NRT available for adolescents, people with CVD, pregnant smokers, people using NRT to cut down and extending their period of use to nine months).
The study has collated data from a range of sources, including surveys and primary care records, to create the Nottingham Tobacco Control Database. The NTCD is a unique resource, which encompasses monthly estimates of smoking prevalence and indicators of quitting behaviour such as rates of prescribing of smoking cessation medications and self-reported quit attempts, broken down by age group, gender, region and markers of socio-economic status.
A key aspect of the NPRI project is the assessment of the external validity of key variables within the new database. Results suggest that the primary care records data from (the pre-existing) The Health Improvement Network (THIN) can provide accurate estimates of smoking prevalence and smoking cessation medication prescribing, and could therefore be used in monitoring the impact of national policy.
The next stage of the NPRI study will be to use measures in the NTCD to evaluate the impact of tobacco control initiatives both on the overall population and on specific target groups such as the socially disadvantaged.
Further information is available from Professor Sarah Lewis
Professor Sarah Lewis
Email: Sarah.Lewis@nottingham.ac.uk
Smoke Free North East: a model of good practice for England?
(Dr Andrew Russell, University of Durham: April 2006 – March 2009)
It is estimated that smoking costs businesses and organisations in the UK over £70 million a year in sickness leave and absenteeism. The North East had the highest smoking rates in the country - killing around 5,500 people every year - and it was there that the a consortium of committed regional partners set up, in 2005, the UK’s first regional tobacco control office (Fresh Smoke Free North East, or “Fresh”).
NPRI-funded research capitalised on the establishment of Fresh to independently evaluate its operations and effectiveness. The project used multidisciplinary, anthropology-centred, action research techniques to highlight key issues in establishing a new umbrella organisation in public health. Working with Fresh and its partners, the research team identified the operational challenges that arose in partnerships responsible for delivery of regional plans. A Local Alliance Toolkit, developed with Fresh, was taken up by the Department of Health’s National Support team for Tobacco and adapted for use by tobacco control alliances across England.
The NPRI-funded research team provided advice in developing the Department of Health’s guidance on tobacco control and gave evidence to the All Party Parliamentary group on Smoking concerning illicit tobacco use by young people. Their involvement also helped Fresh win the Chief Medical Officer’s inaugural gold award for public health in 2009, and is testimony to the value of collaboration between the research community and public sector organisations in delivering improvements in public health.
Further information is available from Dr Andrew Russell
Dr Andrew Russell
Email: a.j.russell@durham.ac.uk
Promoting smoking cessation in ethnic minority groups
(Professor Aziz Sheikh, University of Edinburgh: September 2006 – June 2009)
Lifestyle surveys in recent years have shown marked differences in smoking prevalence between ethnic groups in the UK. Tobacco use is particularly high amongst Bangladeshi and Pakistani males. Stopping smoking is especially important in these populations because Pakistani and Bangladeshi people are at significantly increased risk of heart disease and stroke compared to the white population, and stopping smoking would reduce the risk of these illnesses several-fold. Smokers who receive behavioural support and medication quadruple their chances of stopping smoking, but evidence suggests that Bangladeshi and Pakistani populations do not use National Health Service (NHS) smoking cessation clinics as frequently as would be expected given their high prevalence of smoking.
This NPRI-funded pilot study aimed to redesign NHS Stop Smoking Service (SSS) delivery to be more acceptable to Bangladeshi and Pakistani adult men. The study evaluated the effectiveness of four trained Pakistani and Bangladeshi smoking cessation outreach workers operating in an outreach capacity to improve access to and success of NHS smoking cessation services compared with standard care. During the 12-month intervention, outreach workers approached Bangladeshi and Pakistani people on the streets of Birmingham and targeted local businesses in busy shopping areas including money transfer businesses and supermarkets. Promotional events were held in religious and community centres, gyms, sports centres, language centres, adult education training centres and libraries as a means of motivating people to use the services. Drop-in clinics were set up in more hard-to-reach places such as taxi bases, bus depots and car garages.
During the period in which outreach workers were operating, there was a 30 per cent increase in the rate of initial use of the NHS SSS and also in quit rates in the areas outreach workers were working, in comparison to the previous year. The intervention did not, however, increase attendance at weekly SSS behavioural support sessions nor improve adherence to pharmacotherapy, hence the proportion of people who succeeded in quitting was unchanged. Nevertheless, the 30 per cent increase in abstinence was encouraging although chance is a possible explanation for this effect given the relatively small sample size.
The total cost of running the intervention was £124,000, including the additional behavioural support and medication used to treat smokers. The best estimate is that this led to an additional 86 people stopping with NHS SSS. Based on modelled relapse rates, this gave an estimated cost per quality adjusted life year (QALY) of approximately £8,500, which is considerably less than the benchmark set by National Institute of Health and Clinical Excellence (NICE), where interventions costing less than £30,000 per QALY are frequently recommended.
This developmental work represents an important advance in service provision models through which to reduce health inequalities. The increases in service use and quit rates observed suggest that outreach worker models of care are likely to be worthwhile. However, this was a preliminary trial and a definitive trial would be needed prior to recommending this model be adopted in the NHS in areas with significant ethnic minority populations.
Further information is available from Professor Aziz Sheikh
Professor Aziz Sheikh
Email: Aziz.Sheikh@ed.ac.uk