Better Help for Smokers to Quit – Tobacco Health Target

Helen Troke-Thomas

Tobacco Policy and Implementation TeamMinistry of Health

People who smoke want to stop

• 72% of 15-19 year-old that smoke would not if they had their life again

• 69% tried to quit in last 5 years

• 44% tried to quit at least once in last year

• Māori, Pacific and young people are as likely to have tried to quit

MoH. NZTUS 2006

Health Effects of Smoking• Cause of approximately 5000 deaths a year in New Zealand

• Societal costs, costs to health service, lost productivity

• Loss of on average 15 years of life

• Second hand smoke

• High rates of smoking amongst Maori and Pacific

Why Brief Advice?

• Proven efficacy

• Relatively small effect (1-3%)*

• Useful when delivered to a large population of people that smoke

*Silagy C, Stead LF. Physician advice for smoking cessation. Cochrane Database Syst Rev

Health Target -Better help for smokers to quit

• 2009/10 - 80% of hospitalised smokers will be provided with advice and help to quit by July 2010

• 2010/11 - 90% of hospitalised smokers will be provided with advice and help to quit by July 2011

Health Target -Better help for smokers to quit

But there are Challenges…..

The Target requires:

• Systems Change

• Behaviour Change

16.6% of

hospitalised smokers provided with brief advice and help to quit

Quarter 1 2009/10

DHB Activity

• Training

• Systems development and Implementation

• Clinician buy-in

• Promotion of ABC

Health Target Results 2009/10

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hutt Valley

Waitemata

Taranaki

Capital & Coast

Counties Manukau

South Canterbury

Northland

Auckland

MidCentral

Nelson Marlborough

Otago

Bay of Plenty

West Coast

Whanganui

Canterbury

Lakes

Hawke's Bay

Southland

Tairawhiti

Waikato

Wairarapa

% of hospitalised smokers offered advice and help to quit

Quarter 1 Quarter 4

TARGET July 2010

17,800Smokers offered Brief Advice and or cessation support in Q4 of 2009/10

Progress in 2009/10

• Over 37,400 offers of brief advice in 2009/10. It is estimated that 1 in 40 of these smokers will have a successful quit attempt = approximately 935 successful quit attempts will occur because of this activity.

• Note that this is the minimum as many hospitalised smokers will also will receive NRT/cessation support which increases the quit success rate.

Progress in 2009/10

• Behaviour change amongst clinicians and cultural change in the hospital setting.

• Change in the profile of smoking status in the hospital setting – a clinical ‘vital sign’.

• Significant work and commitment to get systems and processes in place to make this happen.

Considerations

Disclosure and Target Gap

• Prevalence – not all smokers identified.

• Target Gap – not all smokers that are identified are provided with brief advice and help to quit.

Considerations Cont...

Ethnicity

• Vital that all smokers are receiving ABC and that there are not ethnic disparities.

• Initial analysis gives us confidence that Maori and Pacific smokers are being offered brief advice as often as others.

• Ministry now collecting data from DHBs to undertake further ongoing analysis.

Based on what we have learned from 2009/10…….

….key predictors of success for health target achievement include:

•Commitment and Leadership from Senior Management and Senior Clinicians

•Training of staff

•Appropriate and accurate systems to record and report results

•Sustainability

Smoking is too BIG to ignore