FAQ’s The Sheffield Tobacco Control Strategy Consultation 2017- 2022

Sheffield City Council and partners are currently refreshing the Tobacco Control Strategy for 2017-2022. On the 31st of March 2017 all our current contracts are due to end. This provides an opportunity to review what we have in place, and consider how we can do better to support smokers in the city to stop, and children and young people not to start.

We are consulting with the public and a number of key stakeholders to understand views and opinions about the proposed new strategy.

Why Smoking?

Smoking is still the biggest killer in the UK and is the biggest cause of health inequalities between rich and poor[i]. We have made good progress in tackling tobacco both nationally and locally, however we cannot say the job is done when we still have approximately 79,260[ii] smokers in the city. Tobacco kills 16 people per week in the Sheffield[iii] – those who smoke can expect to have shorter, less healthy lives. 900 women smoke at the time their baby is born[iv]. Addiction to tobacco begins in childhood and takes hold into adulthood.

Our vision

Our vision for Sheffield over the next 5 years is that Sheffield will become a Smokefree city in which to live, work and play; people will live longer and healthier lives,smokefree; children will grow up in a city where smoking is unusual and no children will take up this habit.This level of ambition requires a shift away from a focus solely on individual behaviour change to more investment in prevention and population level policy based approaches.

Our ambitions are to:

  • Reduce smoking prevalence in adults (18 years +) from 18.4% (APS 2015) to 10% or less by 2025 – and to 13% by 2022.
  • Reduce smoking prevalence amongst routine and manual workers from 29% (APS 2015) to 21% or less by 2025 – and to 24% by 2022.
  • Reduce smoking prevalence in pregnant women year on year. Reduce smoking prevalence in pregnancy from 15.1% (2014/15 CCG) to 7.5% or less by 2025 and to 11% by 2022.
  • Reduce smoking prevalence amongst 15 year olds from 8.2% (2014/15 WAY) to 4% or less by 2025 – and to 6% by 2022.
  • Reduce smoking prevalence amongst people with mental health conditions from 40% (2014/15) to 32% or less by 2022 and to 29% by 2025. (Measured through local data sources GP register and SHSC. This equates to a 1.6% reduction year on year in line with Stolen Years (2016) recommendations

What works?

We have reviewed local need and the best evidence of “what works”. The World Health Organisation recommends that a comprehensive programme of tobacco control is adopted in order to effectively reduce the number of smokers. This includes action to:

  • support smokers to quit;
  • prevent young people starting to smoke;
  • use communication campaigns to increase awareness of dangers of smoking;
  • remove cheap and illicit tobacco from our communities;
  • extendSmokefree environments to protect from the harms of secondhand smoke and to change social norms around smoking.

Since 2015 there have been reductions in the level of funding available for local authorities to spend on public health. Therefore, this has meant that difficult decisions have to be made. We are unable to fund everything to the level we would like. This means we need to prioritise interventions that will deliver the largest public health benefit.

Our current tobacco control programme 2014-2017

In Sheffield the budget for tobacco control is £1.1 million. Currently 60% of this budget funds stop smoking services and 40% funds wider tobacco control work(including prevention in schools, smokefree environments, cheap and illicit tobacco reduction and maternal relapse prevention).

What we would like to do

We are proposing to invest more in prevention and population level Smokefree policy based approaches. Our approach combines interventions we know are effective in reducing health and social care costs, as well as costs to wider society.

We are proposing to move £220,000 from stop smoking services in order to invest this money into:

  • prevention work with all secondary schools in the city and begin a primary school programme
  • increase the number of outdoor smokefree sites and events (e.g. hospital, university, Council, NHS and leisure centre grounds)
  • increase the investment in communication and media campaigns targeting those who find it the most difficult to quit smoking and who are the most addicted.

Countries such as New York, California and Australia have implemented extensive tobacco control programmes and as a result have seen impressive reductions in their smoking prevalence compared to England. For example: New York smoking prevalence in adults is 13.9% (2014), California is 11.7% (2013)[v] and Australia is 13.3% (2013[vi]). England smoking prevalence is 18% (2014). However it is important to state that they did also invest significantly.

The Sheffield Tobacco Control Strategy 2017-2022 consultation Questions FAQ.

Consultation question 1. Are you in favour of us doing more work in schools to prevent children from starting to smoke, and funding this work by moving some money out of stop smoking services?

During in the last three yearswe have worked with 10 secondary schools in areas of high smoking prevalencedeliveringasmoking prevention programme. This has involved the delivery of a whole school approach to tobacco control within each school,which includes:

  • A smokefree peer educator programme, peers delivering key smokefree messages (in and outside the classroom) and encouraging their peers not to smoke
  • The development and delivery of Smokefree social norms campaigns
  • Smokefree education and awareness weeks
  • Smokefree policies extended to include outdoor areas
  • Stop smoking support sessions within schools
  • Resistance building skills and coping strategies
  • Increasing knowledge and awareness of the dangers of smoking and benefits of being smokefree through taught lessons in class
  • Parent education and awareness sessions

This programme has been developed around the best evidence from the Assist model and NICE guidance[vii], which states that tackling youth smoking is most effective if it involves a comprehensive approach that addresses individual (family friends, access) social and community and societal influences of smoking uptake.

This programme has been particularly successful with young people who were occasional, experimental or ex-smokers. These are the people at high risk of smoking. Also the programme has previously achieved a sustained reduction in the smoking uptake of adolescents for years post its delivery[viii] .

Tobacco is an addiction that takes hold in childhood. The majority of people begin smoking as teenagers, 67% before age 18 and 84% by age 19, very few start post twenty-one years. It is estimated that 5 children start smoking every day in Sheffield. Therefore this intervention is timely in terms of preventing smoking uptake.

We want to work with all 26 secondary schools in the city to equip children with the skills to resist starting to smoke. We are also keen to develop a smoking prevention programme for primary schools however, this will be a pilot as there is currently no evidence base in this area around what is effective. We will work with two schools initially to develop the pilot before roll out.

Consultation question 2. Are you in favour of us doing more work to increase the number of Smokefree outdoor sites in the city (e.g. outside NHS buildings, hospitals, universities, Councils, leisure centres, at events such as Skyride/Sheffield half marathon/Christmas light switch on) and funding this work by moving some money from Stop Smoking Services?

Sheffield City Council (SCC) and partners have implemented a range of Smokefree policies in order to change social norms around smoking in Sheffield.

  • In July 2016 we implemented a citywide Smokefree playground policy
  • In May 2016 the Sheffield Health and Social Care Trust implemented a full Smokefree policy including all outdoor spaces
  • We have consulted the public on which outdoor areas they are in favour of becoming Smokefree
  • SCC are reviewing our smokefree policy

We know that children learn the smoking habit from observing their parents and others, so we want to reduce the number of public places where people are visibly smoking so that children don’t think it is normal and copy this harmful behaviour.Smokefree policies also contribute to a reduction in the amount that adults smoke, increase the number of people who quit, and support relapse prevention.

We want to increase the number of outdoor smokefree sites across the city including outside NHS buildings, hospitals, universities, council buildings, sport and leisure centres, at events such as Skyride/Sheffield half marathon/Christmas light switch on.

Consultation question three - are you in favour of us funding more work on mass media campaigns; targeting those who find it the most difficult to quit smoking and who are the most addicted (i.e. routine and manual workers, black and ethnic minorities, people with mental health conditions, pregnant women, children and young people, people living in deprived communities) and funding this by moving some money from stop smoking services?

Evidence suggests a very effective way of motivating smokers to quit is by developing mass media campaigns that smokers can relate to, using targeted messages about the reasons to quit. Certain groups smoke more than others, are more heavily addicted, and find it harder to quit. These groups are more at risk of poor health outcomes. We need to ensure that we successfully motivate these groups to quit smoking.

SCC have previously funded mass media/ marketing campaigns however this was done on a South Yorkshire regional footprint. Campaigns delivered include:

  • Stop Cigs For Kids, aimed at reducing the availability of cheap and illicit tobacco, increasing reporting of illegal sales
  • Mind the Bump, encouraging pregnant women to stop smoking
  • Youthlight (peer to peer) encouraging young people not to start
  • My Smokefree Pet and My Smokefree Home encouraging people to make their homes Smokefree

Campaigns were developed following consultation with the following priority groups (who smoke the most): routine and manual workers, pregnant women, and children and young people.

The aim of the campaigns was to increase awareness of the dangers of smoking and encourage these groups to quit smoking. Key messages and images were identified that these groups felt would prompt them to consider quitting. Post campaign delivery survey reports outlined: increased awareness of the dangers of smoking; impact of secondhand smoke on health, and increased willingness to want to quit.

Public Health England runsnational campaigns such as Stoptober and Health Harms annually which prompt significant amount of population quits.

Howeverwe would like to deliver more local campaigns targeting our priority groups.We would like to do more local mass media work as we know that in order to achieve sustained behaviour change we need to deliver campaigns at the right level of intensity and duration to achieve the largest impact.

Consultation question four- are you in favour of us supporting only the most addicted groups who find it very difficult to quit smoking, rather than having a universal service that anyone can access?

Since 2003 we have had a stop smoking service that anyone can access and we have supported around 3000 smokers a year to quit. From 2010 local demand for stop smoking support has reduced. This has happened alongside increasing popularity and use of

e-cigarettes. More people are also choosing to quit on their own. Since 2015 councils across the country have faced significant budget cuts to public health grant funding from central government.

This means there is less money to fully fund a stop smoking service that meets the needs of everyone. We are therefore proposing to spend the most on those who find it hardest to quit. For those smokers who are able to quit alone we will direct them to online advice and support.

The Sheffield Stop Smoking Service offer will be as follows:

  • In line with NICE guidance and NCSCT, those groups of smokers who smoke the most will receive 8 weeks of face to face stop smoking support plus stop smoking medication (priority groups only)
  • Universal offer - open rolling programme – relapse prevention and smoking cessation advice
  • Online support plus purchase own medication

Consultation question fiveAre you in favour of us funding stop smoking medication (e.g patches, gum etc) for the groups of smokers who smoke the most, are the most addicted and find it hardest to quit?

By stop smoking medications we mean, Nicotine Replacement Therapy (patches, gum, inhalator, lozenges, nasal spray, throat spray and microtabs) Champix and Zyban.

Due to the significant budget cuts to public health grant funding made by Central Government we are consulting the public on their opinion on funding stop smoking medication (such as patches) for the groups of smokers who smoke the most , who find it hardest to quit, and who are the most addicted.

This would mean that other smokers would self-purchase their own over-the-counter medicines (such as nictotine replacement products) and other quit aids (such as e-cigarettes), but would not have access to prescription medications (Champix and Zyban).

Consultation question six- Are you in favour of promoting vaping to current smokers as a harm reduction method?

E-cigarettes have become popular amongst smokers. Public Health England recommends that all smokers should stop in the first instance, however those who cannot or will not stop smoking should swop to using an e-cigarette. There is evidence from Public Health England and the Royal College of Physicians to suggest that e-cigarettes are less harmful to a smoker as they contain significantly less toxic chemicals than mainstream cigarettes, and so encouraging smokers to switch to e-cigarettes will reduce the overall harms from tobacco.

E-cigarettes have the potential to reduce smoking prevalence in our more disadvantaged

communities who have not benefited from the overall reduction in smoking prevalence seen in the general population.

It is proposed that Sheffield County Council promotes theuse of e-cigarettes responsibly to help smokers to quit or reduce smoking, whilst acknowledging that e-cigarettes are not entirely without risk, and monitorongoing impact and evidence. This line is entirely consistent with national guidance: Public Health England (PHE) published an independent evidence review inAugust 2015: E-cigarettes: An evidence update and Royal College of Physicians in April 2016: Nicotinewithout smoke: tobacco harm reduction.

References

[i] Smoking still kills. Protecting children and reducing inequalities, ASH (2015)

[ii] Ash ready reckoner

[iii] Sheffield Smoking attributable mortality aged 35+ Local Tobacco Control Profiles 2014/15, PHE

[iv] Smoking status at the time of delivery. Data collections Team, Health and Social Care information Centre July 2014.

[v] Best Practice guidelines for tobacco Control Programmes 2014 CDC

[vi] Tobacco control key facts Australia (2014)

[vii]Smoking Prevention in Schools NICE Guidance, PH23, 2010

[viii]Campbell, R., Starkey, F., Holliday, J., Audrey, S., Bloor, M., Parry-Langdon, N., Hughes, R., Moore, L (2008). An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet.371:1595–1602.

Sarah Hepworth

Health Improvement Manager

Place Public Health