Public Health

The Sheffield approach to tobacco

A few weeks ago someone said to me ….. but there’s nothing happening around smoking. patently untrue, but that person wasn’t directly involved and didn’t have insight into what, for them ,was a black box.

Many will have seen the recent ONS Smoking prevalence data, and updated tobacco control profiles.

There seems a striking reduction of smoking prevalence in Sheffield y 4.5% in overall prevalence and a 7% fall in routine and manual groups, ie a flattening of inequality.

Press release here. NB there are significant data caveats; whilst we WANT it to be true it is a massive fall in prevalence over a short time period. We will see what the next data point tells us and whether we are managing to sustain this seeming progress.

Sheffield and Tobacco Control strategy

Tobacco control board. Chaired by DPH. Responsible for tobacco control strategy.

Budget = c£1.1m. £1m SCC, £90k CCG

The Sheffield strategyis based on a comprehensive needs assessment, and interventions based on the WHO MPOWER model. There are six strands and our approach is based on these:

– stopping the promotion of tobacco;

– making tobacco less affordable;

– effective regulation of tobacco products;

– helping tobacco users to quit;

– reducing exposure to second-hand smoke;

– effective communications for tobacco control.

WE know Countries and states that have implemented comprehensive tobacco control programmes i.e. the MPOWER model, have the lowest smoking prevalence in the world e.g. USA, specifically New York 13.9% (2014) and California 11.6% (2014) and Australia 14% in 2016.

We are aiming to reduce smoking prevalence by 2025 to:

All adults (10%)

Routine & manual (21%)

Children (4%)

Pregnant women (7.5%)

Mental Health (5% by 2035 in line with Stolen Years)

The £1million annual investment in tobacco control has been maintained however a total of £220k has now been moved out of stop smoking services and been invested in preventing children from starting to smoke and population level policy based approaches.

Shifting upstream

We are shifting away from a focus solely on individual behaviour change and focuses on delivering more population level interventions, policy and prevention alongside traditional stop smoking service provision and marketing and communication campaigns. The reasoning for this shift to upstream interventions is based on well recognized evidence. Recent work in Wakefield analysed the cost and benefit of all the main chunks of the spend in tobacco. Specialist stop smoking took 80% of the available spend and delivered c 35% of the total benefit”. Media cost c5%ish of available spend and delivered 30% of the available benefit”.

It should be noted that this line of argument isn’t an argument against stop smoking support, this remains a cornerstone of effective tobacco control. Other studies highlight that about 15% of the annual fall in prevalence is due to the impact of stop smoking interventions. We know that the vast majority of smokers who do stop do so with no external support and we are exploring ways to maximize the quite rate in this group, media interventions are considered important here.

The main interventions in our strategy

Screening – to identify smokers in all settings delivery of Very Brief Advice (VBA) and referral to SSS – training frontline staff in VBA.

Providing Stop smoking Services – for adults (focus on high prevalence groups), children and pregnant women. Throughput to the stop smoking service – 1,400 4 week quite in 16/17, 1800 commissioned for 17/18 (18/19 – 1000 12 week quits and 800 4 week quits).

Supporting self quitters. The vast majority who quit do so by themselves and we are working through models of how we support those to increase quite rate in those self quitters. Only around 5% of the smoking population ever attend Stop Smoking Services

Smoking at time of delivery is good news story in Sheffield. Pushing on this currently.

All our major public institutions are, or in process of becoming smoke free. Policy change to shift social norms and protect health (Smokefree Sheffield – social movement – focus on NHS, SCC and Universities). We are working with the two universities.

Push on illegal and illicit tobacco. Tackling sale and availability of cheap and illicit tobacco. We have a significant programme here We must ensure taxes are effective by maintaining the price- illicit impacts on the poor most. Preventing Children from starting smoking – schools programme- peer to peer model/SF environment – onsite quit support. Social norms campaigns, Peer education and resistance skills Secondary and primary schools. As well as youth settings.

Media –focused on specific cohorts and attitude shifting, educating on the harms of tobacco, sets the agenda for discussion, changing beliefs, increasing quit intentions and nudging towards quitting Targeted interventions and focused campaigns – getting the message straight re: e cigs, benefits of quitting during pregnancy, stopping children from starting, Smokefree Sheffield. Campaigns aim for high reach and consistent exposure over time with mix of positive and negative approaches. Important investment as part of comprehensive tobacco control programmes as influence population level quits outside of the service.

• Ensure consistent advocacy on lobbying pressure on government for a range of national policies. Work through our local MPs would be helpful there

Swapping to Vaping – Harm Reduction – for those who can’t/don’t want to stop smoking

Increasing Smokefree environments city centre spaces such as the peace gardens, bus and train stations