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Smoking ban in England has a dramatic impact on prevalence

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New research suggests that the smoke-free legislation introduced in England a year ago has encouraged more people to give up smoking. Nerys Hairon reports

The smoking ban in England, which came into effect in July 2007, has helped more smokers to quit than ever before and will help prevent an estimated 40,000 deaths in the next 10 years, according to research (Cancer Research UK, 2008; West, 2008).

The Smoking Toolkit Study, presented at the UK National Smoking Cessation Conference in Birmingham last week, interviewed more than 32,000 people in England before and after the smoke-free law took effect and found smoking prevalence fell significantly after its introduction. In addition, the research found that NHS Stop Smoking Services are ‘highly effective’ in helping smokers to quit (West, 2008).

The study is the first in the world to examine in detail the impact on smoking rates solely from smoke-free legislation without the influence of any other tobacco control measures. The findings suggest the smoking ban is encouraging people to quit. This is mirrored in Scotland, which introduced its ban in March 2006, while Plaid Cymru has just released figures showing a decrease in cardiac emergency admissions in Wales since the country’s ban began in April 2007.

Meanwhile, a survey of high school children in Scotland has shown that pupils who experience positive and inclusive social environments in schools are less likely to take up smoking (Medical Research Council, 2008; Henderson et al, 2008).

The new research (West, 2008; Henderson et al, 2008) has implications for practice and school nurses. Practice nurses are vital in encouraging patients to quit smoking and signposting them to services that can help. It is also important for school nurses to be aware of those factors that may make schoolchildren more likely to start smoking.

Smoking ban

The Smoking Toolkit Study, funded by CRUK, McNeil, Pfizer and GlaxoSmithKline, interviewed 32,454 adult participants over the nine months before and nine months after the smoke-free law came into effect in England. It found that the law has had a dramatic effect on smoking prevalence, with an impressive 5.5% decline in the nine months after its introduction, compared with a 1.6% fall in the previous nine months. This is the largest fall ever recorded and the effect has been similar across the social spectrum (West, 2008). Based on these findings, the researchers estimate that at least 400,000 people quit smoking as a result of the ban on smoking in public places (CRUK, 2008).

Smoking cessation aids
The study also asked participants about the use of smoking cessation aids in the past year. It found that around 50% of quit attempts involve the use of a cessation aid, and this is mostly nicotine-replacement therapy (NRT) bought over the counter. Use of smoking cessation drug varenicline is rising but still low (West, 2008). The research found that 5–10% of quitters (3% of smokers) use NHS Stop Smoking Services and the rate has not changed significantly.

The research also explored trends in certain groups. Smokers aged over 35 are more likely to use medications and behavioural support. In addition, those from lower socioeconomic groups and women are more likely to use NRT on prescription, although there is no difference in the use of behavioural support.

Interestingly, the study found that those attending NHS Stop Smoking Services were three times more likely to be successful than those not attending (West, 2008).

Smoking reduction was also examined. Over half (57%) of smokers report trying to cut down, and one-quarter (25%) of those reported using NRT. Patches and gum are the most popular forms. The study found no difference in the use of NRT for reduction by gender or social class but smokers aged over 35 were more likely to use it.

In summary, the study found that use of aids is similar across the social spectrum in quit attempts. However, smokers from lower socioeconomic groups are more likely to use prescription NRT. The average short-to medium-term cessation rate is 6%, and this is much higher in more affluent groups.

The study also examined peak times for quit attempts and cessation. When participants were asked about attempts to stop smoking in the past month, the study found the major peaks were at the start of the year, with minor peaks in March–April and when the smoking ban took effect. This was also the case for quitting.

These findings indicate the most popular aids to help people quit smoking, as well as the impact on likelihood of success of NHS Stop Smoking Services. Practice nurses can signpost patients to these services for help and support (see www.gosmokefree.nhs.uk for more information).

Wales and Scotland

Figures from Plaid Cymru (2008) show a reduction in hospital treatment for MIs since the ban was introduced in Wales. There was a 13% reduction in cardiac emergency admissions in the period October–December 2007 compared with the same period in 2006. In these three months in 2007, there were 4,669 cardiac-related emergency admissions, compared with 5,339 in the same period in 2006 and 5,452 in 2005.

Scotland has also reported positive results since the introduction of its ban. The Scottish Government (2008) reports that 40,000 people tried to quit smoking in the previous year across the country (see www.scotland.gov.uk for more information).

Innovative schemes to encourage smokers in deprived communities to quit are also being introduced. NHS Tayside in Dundee has announced an incentive scheme for smokers, set to start in the autumn of this year, which will offer participants money for fresh food and groceries (excluding alcohol and cigarettes), in exchange for staying smoke free.

Preventing smoking

In addition to helping people quit smoking, an important aspect of public health promotion is preventing young people from taking up smoking. Henderson et al (2008) investigated whether school characteristics can account for differences in smoking rates between schools.

The survey, led by the MRC and based on 5,092 secondary school pupils in 24 Scottish schools, found that school-level characteristics have an impact on both male and female pupils’ rates of smoking up to 15/16 years of age. The size of the ‘school effect’ was greater for boys at this age. The research found that the social environment in schools – particularly the quality of teacher-pupil relationships, pupils’ attitudes to school and the school’s focus on caring and inclusiveness – can influence both boys’ and girls’ smoking.

The MRC says that this research is particularly important because the decreases in adult smoking witnessed in recent years have not so far been matched in adolescent smokers. The survey found that, on average, 25% of males and 39% of females aged 15–16 reported that they either regularly or occasionally smoked.

The MRC (2008) says that teachers who succeed in creating a positive environment in school may be responsible for their pupils staying smoke free. The authors conclude that the findings provide support for the school-wide or ‘health promoting school’ approach to smoking prevention.

Conclusion

The new research on smoking prevalence in England demonstrates the dramatic impact of the smoke-free legislation introduced a year ago. The study also highlights the most effective and most popular methods of smoking cessation aids. Nurses can use this knowledge in further public health promotion, to encourage even more patients to quit smoking.

Key messages for practice

  • This is the first study in the world to examine in detail the impact on smoking rates solely from smoke-free legislation without the influence of any other tobacco control measures.

  • The smoking ban in England has had a dramatic effect, leading to the largest fall ever recorded.

  • NHS Stop Smoking Services are highly effective in helping smokers to quit successfully.

  • Around half of quit attempts involve the use of some form of aid but use of NHS Stop Smoking Services is low and not increasing.

Source: West (2008)

References

Cancer Research UK (2008) Smoking ban triggered the biggest fall in smoking ever seen in England. Press release, 30 June 2008. www.cancerresearchuk.org

Henderson, M. et al (2008) What explains between-school differences in rates of smoking? BMC Public Health; 8: 1, 218.

Medical Research Council (2008) Supportive schools can help reduce student smoking. Press release, 20 June 2008. www.mrc.ac.uk/index.htm

Plaid Cymru (2008) Heart attacks drop in Wales after smoking ban. Press release, 1 July 2008. www.plaidcymru.org

The Scottish Government (2008) Second anniversary of Scotland’s smoking ban. Press release, 25 March, 2008. www.scotland.gov.uk

West, R. (2008) Key Performance Indicators on Smoking Cessation in England: Findings from the Smoking Toolkit Study. Last updated 6 June 2008. www.aspsilverbackwebsites.co.uk

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