Tobacco Control Alliances An Effective Health Improvement Tool

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Tobacco Control AlliancesAn Effective Health
Improvement Tool
Welcome to the West Park Conference Centre,
Dundee Chair David Robertson, Alliances
Manager ASH Scotland
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Preventing young people from becoming smokers

• Emma Cepok
• Youth Development officer
• ASH Scotland
• Local Tobacco Control Alliances Seminar
• 31st October 2007

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Overview

• Smoking prevalence
• Who are more likely to be smokers
• Factors associated with smoking
• Policy context for preventing people becoming
  smokers
• Recommendations to prevent people smoking
• ASH Scotlands support networks (STCA)

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Smoking prevalence

• Tobacco kills over 13,000 people in Scotland each
  year
• 1.1 million people in Scotland smoke
• Most deprived communities 41
• Least deprived communities 13
• gt 80 of adult smokers started in their teens
• Most are addicted before they are 20
• (Breath of Fresh Air 2004)

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Smoking Prevalence of 15 and 13 year old boys
and girls 1996-2006
SALSUS 2007
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Smoking prevalenceYoung people
13 15 year olds SALSUS 2007, 16 24 Scottish
Household Survey 2005/2006
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Smoking, drinking and drug use

• 13 year olds
• No. never smoked having used drugs 1
• No. regular smokers having used drugs 48
• 15 year olds
• No. never smoked having used drugs 3
• No. regular smokers having used drugs 65
• SALSUS 2002

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Who are more likely to become smokers?

• If parents or siblings smoke
• Living with a single parent or step parent
• Low parental supervision
• Friends who smoke
• Possible school whole effect
• Truancy and exclusion from school
• Juvenile offending
• Socio-economic disadvantage

Towards a Future Without Tobacco - SE Smoking
Prevention Working Group Report November 2006.
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Factors reinforcing young peoples smoking
behaviour

• Nicotine is addictive
• Few Y/P recognise they are addicted
• Many recognise smoking is unhealthy
• Many think it has some benefits
• coping with anxiety/ stress
• weight control
• create a positive self-image/ identify
• perceived attractiveness of smoking
• Towards a Future Without Tobacco - SE Smoking
  Prevention Working Group Report November 2006.

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Where do young people get their cigarettes?

• Buying from shops
• 15 yr old regular smokers 82/ occasional smokers
  39
• 13 yr old regular smokers 47/ occasional smokers
  23
• Buying from friends or relatives
• 15 yr olds regular smokers 19/ occasional
  smokers 11
• 13 yr olds regular smokers 26/ occasional
  smokers 13
• Being given by friends
• 15 yr olds - regular smokers 38/ occasional
  smokers 60
• 13 yr olds regular smokers 44/ occasional
  smokers 57
• SALSUS 2007

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Factors associated with smoking
Figure 1.1 Factors associated with smoking
Towards a Future Without Tobacco. The SE Smoking
Prevention Working Group Report November 2006.
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Tobacco Control Action Plan (2004)

• 3 key aims
• help as many smokers as possible stop smoking if
  they wish to
• protect the public from the effects of
  second-hand smoke
• prevent as many young people as possible from
  start to smoke

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Towards a Future without Tobacco (2006)

• 5 year Smoking Prevention Action Plan
• Spring 2008
• 31 Recommendations on how to do it
• Targets
• Research
• Reducing availability
• Discouraging young people from smoking
• Towards a Future Without Tobacco - SE Smoking
  Prevention Working Group Report November 2006.

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Recommendations

• Reducing availability in Scotland
• age of purchase
• enforcement
• licensing scheme
• point of sale displays
• Towards a Future Without Tobacco - SE Smoking
  Prevention Working Group Report November 2006.

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Recommendations

• Discouraging young people from smoking
• media campaigns
• review of prevention and education programmes in
  schools
• provide consistent, accurate and credible
  information to young people
• parents role
• whole school approach (Health Promoting Schools
  framework)
• support most vulnerable young people
• develop a prevention and education programme for
  the 16 24
• no-smoking policies
• Towards a Future Without Tobacco - SE Smoking
  Prevention Working Group Report November 2006.

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ASH Scotlands support networks (STCA)

• Scottish Tobacco Control Alliances
• Youth and Tobacco Forum
• Aim To provide those with an interest for
  young peoples health and well-being an
  opportunity to network and share practice on
  tobacco related issues and influence policy
  development at a national and local level

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Interests/Membership

• Research, policy development, enforcement, youth
  and community work, health promotion, education,
  stop smoking etc.
• Statutory and non statutory organisations
• Practitioners
• Managers
• Policy makers

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Key topics

• attitudes to smoking by young people
• involving and engaging young people in the shape
  and delivery of tobacco control interventions
• sharing good practice in addressing cannabis use
• sharing good practice in the provision of NRT for
  young people
• youth smoking cessation
• tobacco and cannabis
• smoke-free homes
• raising the age of purchase to 18

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Contact details

• Emma Cepok
• Youth Development Officer
• Tel [phone]
• Email emma.cepok_at_ashscotland.org.uk
• Youth Development Website Front Page
• www.ashscotland.org.uk/ash/4502.6.541.html

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Tobacco Control AlliancesAn Effective Health
Improvement Tool
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LocalTobacco Control Alliances
Janet Wilson Local Alliances Officer
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Overview

• Cross cutting issues of tobacco control
• Challenge of tobacco control work
• Added value provided by a tobacco control
  alliance
• The Local TC Alliances Project

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Cross Cutting Issues

• WHO Framework Convention on Tobacco Control (TC)
• Unique Global Health Treaty
• 168 Countries signed up 149 ratified

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ScotlandsTC Action Plan

• Partnership Working
• Prevention and Education
• Smoking Cessation Support
• Secondhand Smoke
• Protection and Controls

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Challenge

• Complacency
• Perception that tobacco has been sorted

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Challenge
Figure 1.1 Factors associated with smoking
Towards a Future Without Tobacco. The SE
Smoking Prevention Working Group Report November
2006.
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Challenge

• .youth smoking prevention and control efforts
  have had mixed results but there are a number of
  prevention strategies that are promising
  especially if conducted in a co-ordinated way to
  take advantage of potential synergies across
  interventions.
• Investing in youth tobacco control a review of
  smoking prevention control strategies. Tobacco
  Control 2000 Lantz, P.M, et al

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Added Value

• A Tobacco Control Alliance is an overarching,
  co-ordinating entity which
• Brings together diverse organisations and groups
• Offers an opportunity to work across
  organisations and disciplines
• Can maximise media opportunities
• Can influence policy makers and practitioners
  across organisations

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Added Value

• A shared action plan
• Enable an increased understanding of each others
  aims and objectives
• Pooling resources, co-ordinating efforts and
  avoiding duplication
• Provide opportunity to access additional funding

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Alliances Project

• Web based local alliances development tool
• Proposals, recruiting partners, setting the
  agenda, developing an action plan, maintaining
  commitment
• Areas for action
• Policies and guidelines, Research and projects,
  useful contacts

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Alliances Project

• Networking Local Tobacco Alliances across
  Scotland
• Regular information briefings on key and current
  issues
• A media support pack to enable alliances to
  establish good relations with local media

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Alliances Project

• Regional seminars
• Generate dialogue and engagement
• Explore how national tobacco control priorities
  can translate into practical action at a local
  level

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Contact details

• Janet Wilson
• Local Alliances Officer
• Tel [phone]
• Email janet.wilson_at_ashscotland.org.uk
• Local Alliances Website Front page
  ashscotland.org.uk/ash/5144.6.781.html

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Tobacco Control AlliancesAn Effective Health
Improvement Tool
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Tobacco AlliancesThe Dundee Experience

• Paul Ballard
• Deputy Director of Public Health
• Honorary Senior Lecturer
• University of Dundee Medical School

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Smoking in Tayside
Estimated number and percentage of smokers in
the adult population, by CHP and within CHP,
2003/04
Estimated number and percentage of smokers in the
adult population, by CHP and within CHP, 2003/04
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Smoking and Deprivation
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Smoking and Deprivation
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Background to Dundee Tobacco Alliance

• Tayside Inequalities Strategy (2003)
• Community Planning Partnership/JHIP
• Tayside Health Improvement Committee (2002-2006)
• Smoke-free Dundee (2004)
• Best Value review (BVR) (2004)
• Smoke-free Public Places Legislation (2006)
• NHS Tayside Smoking Policy (2006)
• Devolvement of Funding (2007)

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History of Dundee Tobacco Alliance

• Formed in September 2005 for Public Places
  Legislation
• Took over co-ordination of Dundee BVR (2006)
• Co-ordination of Keep Well projects (2006)
• Co-ordination of other funded projects (QOL and
  new 2007/08 Government funding) 2006/07 onwards
• Monitored compliance with Public Places
  legislation 2006 onwards and new 18 age for
  buying cigarettes October 2007 onwards

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Role of Alliance

• Membership
• Researching
• Prioritising
• Investing
• Monitoring/Evaluating
• Reporting

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Application of Best Practice

• Use of evidence and innovation
• Give it up for Baby
• Drama and Dance
• Community Pharmacies
• Passive Smoking
• Healthy Working Lives
• Mental Health

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Give it up for Baby
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Give it up for Baby
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Strengths of the Dundee Tobacco Alliance

• Joint planning and joint accountability
• Joint funding
• Mutual respect and support for roles of member
  organisations
• Power through Unity
• Committed and able members
• Trust

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Tobacco Control AlliancesAn Effective Health
Improvement Tool
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Value of Alliances from a Local Authority
Perspective

• CRAIG SOMERS
• Dundee City Council
• ENVIRONMENTAL HEALTH TRADING STANDARDS

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Dundee Tobacco Control Alliance

• Tayside NHS Report in August 2005 recommended
  that a Dundee Tobacco Control Alliance be created
  
• Committed at inception to linking with and
  supporting environmental health colleagues
• Initial focus of Alliance to plan coordinate
  activity to prepare for the smoking prohibition
  legislation

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Benefits of membership for EHTS

• Support to move Dundee City Council NHS Tayside
  to a position of compliance prior to the
  prohibition becoming law.
• Support to raise awareness locally among the
  public business on how the prohibition would
  effect them.
• Support to raise awareness of the potential
  benefits of the proposed smoking prohibition

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LA can offer an Alliance

• Compliance building to assist those businesses,
  organisations and people who want to comply
• Direct involvement of Council departments
• Enforcement, where necessary to ensure that the
  smoking prohibition is not ignored is seen to
  be upheld

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Compliance building

• Advise on compliance given during routine
  visits/inspections
• Advisory visits made on request
• Appropriate no smoking warning signs provided to
  proprietors of premises operators of vehicles
• Advice given also relates to secondary
  issues/problems created by compliance

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Secondary or indirect issues

• Increase in issues that arise as consequence of
  ban
• Noise
• Litter
• Smoke infiltration
• Fire Safety
• Planning Building Control issues
• Licensing

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Council departments

• Education
• Social Work
• Leisure Communities
• Planning Transportation
• Personnel
• Waste Management

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Enforcement Activity

• On going, as of 26/10/07
• Over 2,000 monitoring visits
• 66 warning notices
• 212 fixed penalty notices
• 6 FPNs appealed (unsuccessfully)
• Non payment, Sheriff Officers instructed to
  recover outstanding FPN amount plus costs

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Mutual benefits

• Good communication between partners
• Consistent message
• Profile of tobacco control both regulatory and
  health promotion maintained in the public
  imagination
• Targeting of resources

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Response to Prohibition

• Implementation of legislation is a success
• Almost 97 compliance
• Public business proprietors supportive
• Staff in hospitality trade supportive
• Publicans, most are supportive
• Press, mixed

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The Way Forward

• Maintain the profile of Smoking Prohibition
  Tobacco Control
• Expand the membership of the Dundee Tobacco
  Control Alliance other alliances throughout
  Scotland
• Lobby for permanent funding for Smoking
  Prohibition Enforcement Officer posts

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The end

• Thank you for listening

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Tobacco Control AlliancesAn Effective Health
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Breaking the cycle of childrens exposure to
tobacco smoke
BMAs Board of Science and Education April 2007

• Dr Andrew Thomson
• BMA Board of Science and Education

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I saw a young boy on a number of occasions
suffering from severe asthma attacks. His mother
said she could not think of anything that brought
on the attack but the young boy said 'I always
get sick after seeing grandad'. Apparently his
grandfather owns a small (usually smoke filled)
restaurant. 2005
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The report

• Draws together evidence / research on SHS
• Focuses on the consequences that parental smoking
  has on children
• Childrens health
• Damage to finances and family wellbeing
• Influence parents smoking has on children
• Summarises interventions to support parents and
  protect children

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Smoking Trends

• Prevalence has declined steadily over the last 2
  decades
• Varies with
• Age
• Socio-economic status
• Gender
• Location

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Smoking trends

• Perpetuation of poverty
• Disproportionate affect on children
• Premature death / disability deepen poverty
• Harms health, educational underachievement.
• Deprivation cycle

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Cycle of Exposure
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Smoking in pregnancy

• Risk factors for smoking during pregnancy
• low income
• low socioeconomic status
• unemployment
• young age
• lower educational attainment
• no partner / partner who smokes
• unplanned pregnancy

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Pregnancy Smoking
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Neonatal Health

• Largest preventable cause of neonatal and infant
  ill health and death in the UK
• Ectopic Pregnancy, miscarriage
• Risk to maternal health
• 40 increase stillborn / perinatal death
• SHS associated with low birth weight
• Smoke more greater risk
• Reduced / shortened breastfeeding
• ADHD x 2
• Increase in cardiovascular disease
• Smokers Mum Smoking baby
• Partnership issues

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Impacts of parentalsmoking on child health and
wellbeing

• Womb to adult life
• Majority are exposed to SHS
• Smoke free legislation will help but exempts
• HOMES
• CARS

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Smoking in the Home
Most significant environment for SHS
5 million UK children affected
Only safe home is a smoke free home
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Smoking in the home

• Ineffective measures
• opening windows
• smoking less
• not smoking in front of children
• smoking in different rooms
• smoking out of the window
• smoking under kitchen extractor fan
• air purifiers.
• Environmental storage
• Smoke free laws increase smoke free homes

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Smoking in the home
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Health inequalities - Effect of legislation
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Views about SHS
8 out of 10
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Smoking in cars

• Smokers less likely to have smoke free cars than
  smoke free homes
• Significant risk to children.
• Smokers are 50 more likely to die in a crash.

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Attitudes to smoking in front of children
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Health impacts
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Parental knowledge of health effects of SHS
exposure
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Children as Smokers

• 6 of 13 year olds and 19 of 15 year olds are
  regular smokers
• Children are between 2-3 times more likely to
  smoke if parents smoke
• 10 of teen smokers given cigarettses by parents
• Parental smoking cessation is the most effective
  way to decrease smoking initiation
• Smoke free homes 74 less likely to start,
  double the chance to quit.

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Children as smokers

• Declining prevalence
• Risk factors associated with youth smoking
• Parental smoking
• Peer influence
• Low socioeconomic status
• Female sex
• Low parental education
• Single parent household
• Poor academic performance
• TV and films
• Mental illness

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UK policies to reduce exposure to SHS

• Increase tobacco taxation
• Legislation to ban advertising, sponsorship and
  smoke free legislation.
• Specialist smoking cessation services
• Media health promotion campaigns.
• Scotland Smoking prevention working group
  report.
• Targets

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A co-ordinated Approach
Parental Smoking
Childrens SHS Exposure
Children Smoking
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Effective interventions

• Comprehensive tobacco control programmes
• Health promotion and advice by health
  professionals.
• Encourage parents to reduce childrens exposure
  to SHS
• Promote smoke free environments
• Smoking cessation

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Take the Smoke Outside
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Smoking Cessation
Single most effective intervention
Key to comprehensive tobacco control strategy
UK is leading the world
4 times as likely to succeed
Pregnancy and Young Smokers
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Policies to reduce supply and demand
Raise purchase age to 18
Marketing controls
FOCUS ON
Tobacco tax policies
Licensing scheme for tobacco sales
10 packs Vending machines
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Recommendations

• Policy for UK Governments
• Smoking cessation services
• adequately funded and resourced
• targeted to higher risk populations
• Taxation on all tobacco products, standardised /
  increased
• Cigarettes should not be displayed at the point
  of sale
• Tobacco vending machines should be banned.
• Ban the sale of packs of 10 cigarettes
• Min. age for sale of tobacco products 18 across
  UK strictly enforced.
• Introduce a positive licensing scheme
• Inform the public about the health effects of
  exposure to SHS smoke.

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Recommendations

• For Healthcare Professionals
• Inform parents who smoke of the health risks that
  it poses to their children.
• Parents who smoke should be encouraged and helped
  to quit smoking
• Persistent smokers should be encouraged to adopt
  smoke-free homes.
• Responsibility to help patients stop smoking

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Recommendations

• Internationally
• European Commission
• Smoke free legislation across all member states
• Policies to reduce bootlegging
• Reduce the indicative level for cigarettes from
  3,200 to 200
• Worldwide governments introduce tobacco control
  in line with WHO.
• Comprehensive bans on smoking in work / public
  places
• Increased taxation
• Advertising bans
• Health warnings
• Increased age for purchase
• Action on smuggling
• Comprehensive cessation services

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Recommendations

• Research
• Evaluation of current cessation services
• Develop and evaluate new cessation approaches
  Develop and evaluate initiatives of increasing
  smoke free homes and cars
• Continue to monitor childrens exposure
• Childrens and young persons views on SHS
• Explore links and associations of SHS with
  specific disease areas

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EDUCATION
TRAINING
BREAKING THE

Tobacco Exposure
LEGISLATION
RESOURCES
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Thank you

• A copy of the report is available at
• www.bma.org.uk
• Any questions?

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Tobacco Control AlliancesAn Effective Health
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• Salford Smoke Free Homes
• By Elizabeth Wigg, Salford City Council

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Background -Health inequalities

• Life expectancy. Men 3 years less, women 2.5
  years less than England Wales
• Big inequalities between East West Salford
• Men Heart disease(28), cancer(22),
  accidents(10), suicide(7)
• 1 in 3 people smoke
• 1 in 5 deaths every year are from smoking in
  Salford
• 12th most deprived area out of 354 in 2004

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Salford
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Smoking prevalence in Salford

• Broughton - 39.31
• Langworthy -38.67
• Ordsall - 37.62
• Irwell Riverside - 36.94
• Little Hulton - 36.87
• Barton - 35.97
• Winton - 35.86
• Weaste and Seedley -35.19
• Walkden North - 34.95
• Pendlebury - 33.81

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Background

• In the UK, it is estimated that 42 of children
  are exposed to second hand smoke every day. This
  figure rises to 60 in areas of social
  deprivation.
• Everyday in the UK, 50 children are taken to
  hospital everyday due to exposure the second hand
  smoke.
• 3500 deaths of adults each year are blamed on
  exposure to second hand smoke.
• Partnership between City Council and PCT

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What is smoke free homes?

• Its a promise system where people make a pledge
  to take steps to protect other people who live in
  their home from the effects of second hand smoke
• The homes is the most common place for second
  hand smoke exposure. An estimated 90
• Started in the U.S and lead in the UK by the West
  Yorkshire Project.

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The promises

• Gold Promise Promise to make the home
  completely smoke free
• Silver Promise Allow smoking only in one well
  ventilated room and never in the presence of
  children
• Bronze Promise Never smoke in the presence of
  children

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Why it works.

• It works because its an appealing guilt-free,
  non confrontational scheme with low potential for
  negative reaction
• Its not about telling people to stop smoking
  its about where people smoke!
• Its for anyone who has children in their home
  e.g parents, grandparents, smokers and
  non-smokers

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The Benefits

• Improved health of children and adults
• The house will smell fresher and cleaner
• Food will taste better
• Less frequent cleaning/redecoration
• Pets will be healthier
• Decreased risk of house fire
• First step towards a possible quit attempt

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Other referrals through SFH

• Can be referred to the stop smoking service
• Can have a free home safety check from the fire
  service
• Are provided with a goody bag of materials to
  make it easier for them

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Pilot Project in 2004

• Based on a successful pilot in Seedley and
  Langworthy by Debbie Ledgerton and Sure Start
• Total applications - 107
• Gold 69
• Silver 33
• Bronze 5

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Outcomes

• 47 smokers followed up
• 29 smokers cut down (61.7)
• 11 had quit (23.4)
• Strong interest in having local, community based
  people who were signed up to the project
  themselves promoting it

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Out of which came

• 7 Local Smoke Free Advisors, employed through
  CHAP to cover the most needed wards in Salford
  started in July
• Giving advice from next door, not on high.
• Visiting community groups, mother and toddler
  groups to do small presentations and raise
  awareness whilst signing people up.
• An innovative model unique to Salford.

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Working with an SE

• Advantages
• Expertise in that area
• Things can happen more quickly
• Can access groups council employee couldnt
• Disadvantages
• Partnership approach needs time and effort
• NRF budget cut this year, cant cut contract price

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Priority Groups

• Parents with children under 5
• People with respiratory conditions
• Older People
• Cohabitees of smokers
• 50 of homes to include a smoker

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Training

• Training is provided for key partners anyone
  who has contact with people in their homes.
• These will include, the fire service, midwives,
  health visitors, housing staff, sure start staff
  and practice nurses
• Tackling the issue from different angles makes
  sure we get coverage of all the varied
  communities of Salford
• Not easy option, difficult to get people to do it

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Babies and older children

• I wouldnt smoke around children at all.
  especially babies and young kids. As they get
  older youre not as you should be, but I think
  you get a bit lapsy over it. Totally everything
  was different when he was a baby whereas its
  Im lapsy now myself.

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Benefits

• my partner hes give up smoking.
• Ive gone from 60 a day to about 8 and some
  days I dont even smoke that.
• my hair stays whiter. it saves me a
  fortune.

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Positive comments

• its been absolutely superb theyre not in
  your face saying, you know Give up smoking.
  Theyre just basically giving you information
  about passive smoking, how it could damage your
  children I have sat back and looked at how many
  Im smoking, what damage Im doing to my children
  and I actually go outside now. and I have cut
  down. I have cut down a lot and Im so proud
  of me.

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Success

• 1900 homes signed up in 4 months
• Smashed target of 1440 homes by the end of March
• 59 of sign ups from target wards
• 48 of homes include a smoker
• Being seen as a model of good practice for the UK

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Evaluation

• Asked on leaflet if we can follow them up
• Households with a smoker to be sent a
  questionnaire
• Results analysed impact on smoking behaviour
  and health of children
• Can be used to gain more funding

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Thank you for listening Any questions?

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Tobacco Control AlliancesAn Effective Health
Improvement Tool