Transcript Smoking prev 15–64 years

Smoking cessation in
New Zealand
Hayden McRobbie
MB ChB (Otago) PhD (London)
Faculty of Health and Environmental Sciences, Auckland University of Technology
Wolfson Institute of Preventive Medicine, Queen Mary University of London
Smoking in people aged 15–64
Percent
30
25
20
15
10
5
26.6
25.2
20.0
21.3
19.2
2007
2008
2009
0
1997
1998
1999
2000
2001
2002
2003
Year
Source: 2009 New Zealand Tobacco Use Survey
2004
2005
2006
Do smokers want to smoke?
• 4 in 5 smokers said that they
would not smoke if they had
their life over again
• Females were significantly more
likely than males to say this
• 3 in 5 had tried to quit in the last
5 years
Source: 2009 New Zealand Tobacco Use Survey
What are we up against?
• The addictive nature of tobacco
• The tobacco industry
• Optimism and over confidence of
smokers
• “It won’t happen to me”
• “I’ll be able to give up when the time
comes”
Tension, Triggers, Treatment
• Tension and triggers
•
•
•
•
•
•
•
Maximising smokefree norms
Raise the price of tobacco
Restrict the supply
Regulate tobacco
Remove temptations to smoke
Continue with fear arousing messages
Populate the smokers’ world with QUIT NOW messages
• Provide evidence based treatment
Policy and treatment
• ITC project: in first year after recruitment
UK
Australia
Canada
US
Visited a doctor or other HCP
55%
72%
68%
71%
Got advice to quit
55%
48%
57%
69%
Made 1 or more quit attempts
37%
41%
43%
39%
Got additional help
20%
6%
9%
10%
Got meds and behavioural support
19%
8%
9%
10%
• Odds of quitting for a month
Odds ratio
95% confidence
interval
UK
Australia
Canada
US
1.0
0.59
0.72
0.51
referent
0.49-0.71
0.61-0.87
0.42-0.62
Reid et al 2010 Nicotine & Tobacco Research 12 (supl 1) S20-S33
Stop smoking services
• Do not have a large effect on smoking prevalence
Offer a life saving
treatment for
those smokers
who want to use it
NZ Smoking Cessation
Guidelines
•
•
•
•
Screen for tobacco use
Brief advice to quit smoking
Offer help to quit
Behavioural support
• Face-to-face and telephone cessation
support
• Setting a quit date and providing multisession behavioural support
• Medication
• Nicotine replacement therapy
• Bupropion & Nortriptyline
• Varenicline
Put simply…
• A - ask whether a person
smokes
• B - give brief advice to
quit to all people who
smoke and
• C – make an offer of,
and provide or refer for
cessation treatment
Treatment of
Tobacco Use
Treatment Works
Data from Cochrane reviews; bars represent 95% CIs based on risk ratios versus placebo (for
medications) or brief advice/no treatment (for BehSup)
Slide courtesy of Prof Robert West, UCL, London
Smoking Cessation in NZ
Frontline
Healthcare
Professionals
Individual Counselling
•Pregnancy services
•DHB services
Proactive Telephone
Counselling
Group Counselling
Web and text based
support
Pharmacotherapy
✔ Bupropion
✔
Nicotine Replacement
✔
✔
✔
✖
✖
Patch
Gum
Lozenge
Microtab
Inhaler
✔
Nortriptyline
✔
Subsidised
✖
User pays
Varenicline
NRT
•
Roughly doubles the chances of
quitting long-term
•
Safe to use in ALL people who
smoke
•
Patch, gum and lozenge fully
subsidised
•
Combination therapy
recommended
•
Available on prescription or via
a QuitCard
Stead, L. F., Perera, R., Bullen, C., Mant, D. & Lancaster, T. (2008) Nicotine replacement therapy for smoking cessation, Cochrane Database Syst Rev, CD000146.
Quit Card Providers
• Registered Healthcare Professionals can
become quit card providers by doing a 30
minute online training module
• www.smokingcessationabc.org.nz
• Face-to-face training for other healthcare
workers
Varenicline (Champix)
• Partial agonist of nicotinic
acetylcholine receptors
• At least doubles chances of quitting
• Able to be used my most smokers,
BUT need to fulfill special
authority criteria
• Prescription only
• Nausea and vivid dreams are
common side effects
Cahill, K., Stead, L. F. & Lancaster, T. (2008) Nicotine receptor partial agonists for smoking cessation, Cochrane Database Syst Rev, CD006103
Champix available on
prescription
• Special authority
• The patient is part of, or is about to enroll in, a comprehensive
support and counseling smoking cessation programme, which
includes prescriber or nurse monitoring AND
• The patient is not pregnant AND
• The patient has tried but failed to quit smoking after at least two
separate trials of nicotine replacement therapy, at least one of
which included the patient receiving comprehensive advice on the
optimal use of nicotine replacement therapy OR
• The patient has tried but failed to quit smoking using bupropion or
nortriptyline
Nortriptyline
• Tricyclic antidepressant
• Doubles chances of quitting
• Not suitable for some
smokers
• Prescription only
• Dry mouth, blurred vision
are common side effects
Zyban
• Atypical antidepressant
• Roughly doubles the chances of
quitting
• Number of contraindications,
cautions, and drug interactions
to consider
• Prescription only
• Side effects: headache, dry
mouth, insomnia, seizure (rare)
Is the ABC approach working?
Smokers ‘ABC’d’ in past year
Percent
60
50
40
30
20
10
25.3
30.7
32.1
31.9
39.2
35.7
34.9
15Š19
20Š24
25Š29
30Š39
40Š49
50Š59
60Š64
0
Age group (years)
Source: 2009 New Zealand Tobacco Use Survey
The Tobacco Health Target
• “Eighty percent of
smokers will be
provided with advice
and help to quit by
July 2010; 90 percent
by 2011; and 95
percent by July 2012.”
Health Target Results – 2009/10
Wairarapa
Waikato
New Zealand District Health
Boards
Southland
Tairawhiti
Hawke's Bay
Canterbury
Lakes
West Coast
Whanganui
Bay of Plenty
Q4 Results
Otago
Q1 Results (%)
Nelson Marlborough
MidCentral
Auckland
Northland
South Canterbury
Capital & Coast
Counties Manukau
Taranaki
Waitemata
Hutt Valley
0
10
20
30
40
50
60
70
80
Percent provided with advice and/or help to quit
90
100
What are
smokers doing?
Tried to quit in the last year
Percent
60
50
40
30
20
10
44.9
40.0
41.8
40.4
36.9
33.7
21.8
15Š19
20Š24
25Š29
30Š39
40Š49
50Š59
60Š64
0
Age group (years)
Source: 2009 New Zealand Tobacco Use Survey
Going cold turkey?
• No – almost 40%
of recent quit
attempts involved
advice or smoking
cessation products
• Quitline
• NRT
Cessation Support
Source: 2009 New Zealand Tobacco Use Survey
Where are they getting their NRT?
Percent
60
50
40
30
20
10
48.3
13.1
Quitline
GP
3.7
14.2
2.2
0
Subsidised source of NRT
Source: 2009 New Zealand Tobacco Use Survey
Hospital doctor
Pharmacy
Supermarket
Full price over-the-counter NRT
Where to from here?
• A range of support that best fits the person (and the
health care system)
• Need to maximize access
• Priority populations
• Go to where the people are
• People want choice and the service that fits THEM
• Innovative, effective, and safe ways to manage
tobacco dependence
Quality of treatment services
• Its not just about
throughput, outcome is
also important
• Service user feedback and
input
• Monitoring and
improvement (as opposed
to evaluation)
Novel approaches
• ‘Drop-In’ clinics
• Halls, shopping centres
• Outside working hours
• No appointments, multi-session,
• Potential use of ‘lay’ community
members to
• Promote and ‘sign post treatment
• Provide support
Different Routes to Quitting
• UK NHS Stop Smoking Service is
considering implementing different options
for smokers
•
•
•
•
Abrupt quitting (status quo)
Rapid reduction to quit
Slow reduction to quit
Harm reduction
Conclusions
• Smoking cessation treatment is part of a
comprehensive tobacco control strategy
• For many smokers, smoking cessation will be lifesaving
• ‘ABC’ is part of ‘core practice’ for healthcare
professionals
• New Zealand has a good range of options for
smokers who wish to quit, but we need to improve
utilisation of these