NEWS
WITH THE ELEVENTH NATIONAL SCOTTISH SMOKING CESSATION CONFERENCE TAKING PLACE IN NOVEMBER, A NEW REVIEW OF THE SCOTTISH GOVERNMENT’S TOBACCO CONTROL STRATEGY HAS SHOWN THAT IT HAS HAD A POSITIVE IMPACT. SP TAKES A CLOSER LOOK…
SCOTTISH GOVERNMENT’S TOBACCO STRATEGY MAKING IMPACT
E
veryone is aware of how much smoking is a key contributor to health inequalities. Smoking
defi nitely affects every social group, but the highest smoking rates are found within areas of high socio-economic deprivation, and in particular groups, such as those experiencing mental health problems and prisoners, and steps are already being taken to address these issues.
While adult smoking prevalence in Scotland is falling and smoking prevalence among children and young people has rapidly declined since 1996, smoking rates are still highest in the most deprived areas, with 35 per cent of people living in the most deprived areas of Scotland smoking compared to ten per cent in the least deprived areas.
In July of this year, meanwhile, the Scottish Prison Service (SPS) announced that it intended to make Scotland’s prisons smoke free by the end of next year. Inmates are currently permitted to smoke within cells and in some outside areas within prisons, but this will come to an end in November 2018.
It was in 2013 that the government launched ‘Creating a tobacco-free generation: A Tobacco Control Strategy for Scotland’, a strategy, which included the ambitious aim of making Scotland tobacco- free by 2034 and proposed 46 actions to help meet this aim.
At the time the strategy was published, Scotland had come a long way in shifting cultural attitudes to smoking, and adult
6 - SCOTTISH PHARMACIST
smoking prevalence was falling. Yet smoking was still the single most preventable cause of ill health and premature death in Scotland, with around 10,000 deaths and 128,000 hospital admissions every year.
Now, a review by of the Scottish Government’s tobacco control strategy by NHS Health Scotland and the University of Edinburgh has shown that the strategy has had a positive impact over the last fi ve years.
The purpose of this review was to map the actions in the strategy and synthesise the evidence on the impact of key policy actions.
A mapping of the 46 actions in the 2013 tobacco control strategy was undertaken to ascertain if they had been implemented. A rapid search of the evidence around each of the key policy areas was undertaken and the evidence critically appraised.
Findings were classifi ed into the following categories: smoking prevention, protection from second- hand smoke, and smoking cessation.
SMOKING PREVENTION The reviewers looked in detail at ASSIST: a peer-led, school-based smoking prevention programme, focusing on creating non-smoking social norms among young people by training twelve to fourteen-year-old students to work as peer supporters.
A process evaluation of ASSIST in Scotland found that the programme was both acceptable and feasible. However, no evidence has yet been gathered relating to the effectiveness of the programme in reducing
smoking. Furthermore, the low prevalence rates of smoking among this age group may make ASSIST less valuable as a prevention tool. The Scottish Government introduced legislation banning tobacco Point of Sale (PoS) displays in all shops in April 2015 (known as the display ban) because of their potential impact on youth smoking. There is evidence that compliance with the ban was high and the ban was associated with a reduction in young people’s exposure to tobacco advertising in shops. However, the review authors pointed out, evaluation is still ongoing and conclusions about the infl uence of the display ban on young people’s smoking and cigarette purchasing behaviour cannot yet be drawn.
PROTECTION Evidence from the Scottish Health Survey found a signifi cant decrease in the proportion of children who were exposed to second-hand smoke in the home (eleven per cent to six per cent) between 2014 and 2015. The ‘Take It Right Outside’ campaign was launched in March 2014 to raise awareness of the harmful effects of second-hand smoke in the home to empower both smokers and non-smokers to make their homes smoke free.
The campaign was associated with an increased awareness of the harms of second-hand smoke, but the impact upon behaviour itself is less clear. Policies to introduce smoke free NHS grounds were implemented across all NHS sites, but compliance, the authors conclude, remains a challenge.
SMOKING CESSATION The key actions categorised under
‘smoking cessation’ included continued support of NHS smoking cessation services, and specifi cally smoking cessation services for pregnant women.
Quit attempts made through NHS smoking cessation services have reduced. However, quit rates have increased at both four and twelve weeks.
All NHS Boards now offer a service for pregnant women, which includes the offer of carbon monoxide (CO) monitoring at booking and automatic referral for women who smoke, or have a raised CO level. Currently, 95 per cent of pregnant women who smoke are CO monitored at booking. Referrals to smoking cessation services are at 93 per cent. New fi gures show a small increase in the number of pregnant women stopping smoking tobacco.
CONCLUSION
‘The evidence shows the positive impact of tobacco policy, ranging from the display ban which put tobacco out of sight in small shops and supermarkets to the introduction on smoke free NHS grounds,’ said Dr Garth Reid, Principal Public Health Adviser at NHS Health Scotland and one of the review’s authors. ‘Yet, levels of smoking are still highest in Scotland’s most deprived areas, with thirty fi ve per cent of people living in the most deprived areas smoking compared to ten percent in the most affl uent areas. It is clear that further action to reduce inequalities in smoking is necessary if the aim of making Scotland tobacco free by 2034 is to be achieved.’ •
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