Transcript Smoking: No Butts... Action to cut smoking rates and

May, 2015
Smoking: Reducing the harm
Quitting smoking is always the best option however, some smokers are not
yet ready or willing to quit and continue to inflict harm on themselves and the
people around them. The NICE Guidance on Harm Reduction PHG52 offers an
alternative approach to working with these smokers through:
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•
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Long term provision of licensed nicotine containing products (NCP) for
smokers not able to quit in one step
Cutting down to quit using nicotine containing products
Temporary abstinence from smoking to protect others and improve
outcome of medical interventions
Half of all long term smokers will die prematurely, losing on average 10 years of life. The
best thing smokers can do to protect their health is to quit now, completely and forever.
However, not all smokers are ready to take that step.
Many smokers are not yet ready to quit
While most smokers want to reduce the harm they do to themselves and others, many
are not ready to quit. Two thirds of people who smoke say they want to stop but only a
little over a third of smokers will try to quit in a given year . (ONS, Smoking-related
behaviour and attitudes, 2009)
Prior to May 2013 and the publication of the NICE Guidance on Harm Reduction there
were few options available to health professionals to offer these smokers.
Deprived communities have most to gain
Smokers who live in communities with high smoking prevalence find it harder to quit
than others. They have fewer friends and family members who have successfully quit
smoking and are more likely to be heavily addicted, which can undermine successful
quit attempts. There are particularly high smoking rates among many disadvantaged
groups including those on low incomes and those with mental health problems.
Sick from smoking but unable to quit
Even when diagnosed with a serious health condition such as heart disease, lung
cancer or COPD smokers can still find it hard to quit. People living with long term
medical conditions which are exacerbated by their smoking sometimes need additional
support to enable them to abstain from smoking either completely or at the time of
specific medical interventions such as surgery. Supporting people to abstain in this way
improves medical outcomes and reduces complications.
Poor understanding about Nicotine Containing Products
Among smokers, health professionals and
the general public there are misconceptions
about the harm which pure nicotine products
can cause. While people smoke for the
nicotine it is the tar in tobacco which kills
people. A better understanding of the safety
of pure nicotine products could improve their
level of use which will lead to better
outcomes for those trying to quit or cut
down.
According to what you know or believe, what
30% portion of the health risks of smoking comes
from nicotine in cigarettes?
25%
20%
15%
10%
5%
0%
None or
very
small
risk
Some Around Much Nearly
but well half the more
all the
under
risk than half risk
half the
the risk
risk
Don’t
know
What councils can do
The NICE Guidance on Harm Reduction is among the first
attempts in the world to set out a structured approach to
offering smokers for whom quitting in one step has not
been a success an alternative approach. Its purpose is to:
1.
2.
3.
4.
Raise awareness of nicotine containing products
and ensure that the public and health professionals
know the licensed products are effective and safe to
use.
Provide materials for the public about harm
reduction to ensure smokers are aware of the
benefits of harm reduction.
Provide support to stop smoking services on the
delivery of harm reduction while ensuring that their
work to support people to quit in one step is not
undermined.
Highlight the training needs for health staff
particularly in relation to their awareness of nicotine
containing products and how to support smokers in
different circumstances.
The NICE Guidance on Harm is supported by separate
ASH briefings on; health inequalities, quitting, children,
and permitting e-cigarette use on your premises,
Implementation of the guidance
This is an emerging area for public health and practice continues to be developed.
There are many things which could be done to implement the guidance over time but
several measures which local areas could implement immediately these include:
1. Ensure that stop smoking services retain their core role supporting people to quit
2. Provide information to the public, stop smoking service staff, health and council
staff.
3. Ensure local stop smoking services welcome smokers who have been
independently using harm reduction approaches and provide them with advice in
line with NICE Guidance.
4. Target specific high prevalence groups with additional support in line with NICE
guidance.
5. Embed a harm reduction approach to work on smokefree homes to ensure
children are protected from secondhand smoke and that fire risks are reduced.
Electronic cigarettes
Electronic cigarettes are currently unlicensed and as such NICE says their “effectiveness,
safety and quality cannot be assured”. They also acknowledge they are likely to be less
harmful than cigarettes. (NICE, Harm reduction approaches to smoking, 2013).
Electronic cigarettes are growing in popularity and
many smokers find them helpful. When considering
electronic cigarettes, it is important to take the
“relative risks” into account. Smoking tobacco is the
largest preventable cause of premature mortality in
the UK. Electronic cigarettes are not smoked and
they do not contain tobacco.