Smoking causes a range of health issues and diseases in people particularly Cardiovascular diseases, chronic obstructive pulmonary disease (COPD), lung cancer and a range of other cancers, peptic ulcer and various other medical conditions. (National Health Service, 2010)The survival rates are low even after the person undergoes surgery. Post operative Complications may also develop which causes delays in recuperation and often people experience respiratory issues due to this. (National Institute of Clinical Excellence, 2010).
Further, it can cause complications in pregnancy and labour among women who smoke during their pregnancy period, including ectopic pregnancy, bleeding, premature detachment of placenta and premature rapture of membranes. These women also suffer from a high risk of miscarriages in comparison to those who do not smoke. Also, the babies born to such mothers carry a lighter weight (average 200-250 gm) than women who do not smoke. (NICE, 2010). This can reduce the immunity system of children and place them at risk of developing diseases in childhood or death. It has been found that Smoking in pregnancy increases infant mortality by about 40 percent. (NICE, 2010).
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The number of deaths attributed to smoking were estimated to be 83,900 in adults aged 35 and above in 2008. Among these deaths, 23,200 resulted from respiratory diseases (mainly obstructive lung disease) and 37,000 accounted for cancer conditions (lung cancer, Cancer of the Oesophagus). (HSCIC, 2009) Given the varied benefits of stopping smoking and adopt healthy lifestyle, some smokers are willing to quit smoking and 70 percent of them make efforts to quit at least once in their lifetime. At present, the self reported rates of smoking in England is 21 percent among adults aged 16 and above. Despite the trends of reduction in smoking prevalence, it is still considered as a serious public health concern in England (Allender et al, 2008).
NHS Stop smoking services
It is reported that over two third (67%) of the smokers in the English population attempt to quit every year (ONS, 2009). However, smokers are often require to put in repeated efforts and attempts towards quitting smoking before succeeding (NHS, 2010). To support smokers who want to quit smoking and help them succeed in their quit efforts, National Health Service (NHS) founded a unique initiative program called as NHS Stop Smoking Services (NHSsss) in 1999. This national programme came into being following the White paper on 'Smoking kills' published by Government in 1998.This policy guidance expressed strong commitment to address the serious health consequences of smoking and tackle the growing concern of rising prevalence rate of smoking in the population. It laid down plans for the development of a special national unit, Smoking Cessation Services) along with other initiatives (implementation of advertisement ban, ban of smoking at work and public places). NHSSS forms the part of the wider Tobacco Control program run by Government to reduce the prevalence of smoking among the local population. Their primary role is to provide and deliver a high- quality clinical smoking cessation services to smokers who are motivated to quit smoking.
Since its establishment, NHS Stop smoking services (SSS) have supported over two million people to quit smoking in the short run and 500,000 people to quit smoking in the long run without relapse. In total it has saved 70,000 lives uptill now. Even though smoking rates have dropped down since 1990's the progress has been slower in the last decade among the Routine and Manual workers population. It has been estimated that the dropping rate of smoking is 0.4 percent a year. (NICE, 2010). This suggests that health inequalities exist between different socio- economic groups. There have been expectations that SSS will make significant contributions in reducing the gap of smoking prevalence between these groups. This issue was taken up as one of the main priority in NHS Operating Framework and treatments and support were offered by Primary Care Trusts (PCTs) to people who were willing to stop smoking in deprived localities of England. (Low et al, 2007). However, quit rates among socially disadvantaged groups remain low. Currently, out of the total smoking population, smoking rates among Routine and Manual workers are 26 percent. Also, the smoking rate is high among people who belong to ethnic minority groups in the UK population. Studies conducted in various ethnic minority communities have reported that people from these populations do not access the services offered by NHS SSS due to limited information about the accessibility and effectiveness of smoking cessation interventions.
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Thus, to maximise the potential of NHS Stop Smoking Services, a high and effective level of intervention is essential to target this public health concern and reach people from all socio economic and ethnic minority groups who are willing to stop smoking and benefit from it.
NHS Stop Smoking Cessation Services- Delivering of interventions
NHS Stop smoking support are offered and delivered in range of ways. The treatments are provided to people in a separately or a combined manner. Recommended treatments that have shown evidence to be effective over the years comprise (NICE, 2010):
Brief interventions given by GP, nurses or other health practitioners practicing in the local community in the form of advice, self help materials or referrals for further clinical treatment.
Individual Behaviour counselling in a one to one sessions
Group Behaviour therapy ( Also known as Closed Groups)
Pharmacotherapies ( providing alternate medications like Nicotine Replacement therapy, Buropion or Vareniclin)
Self help materials (leaflets, quick kits)
Telephone counselling and quitlines
Media campaigns to spread awareness of smoking related ill health and interventions available to stop smoking. The sources of mass media campaigns include a combination of television, radio, newspaper advertising.
Smokers who are willing to discontinue smoking are offered the above range of treatments options so that they can chose the one which suits them the most. The health professionals may provide, as appropriate, a combination of interventions that are sensitive to the needs, preferences and ethnic diversity of their local smoking population and at the same time being mindful of bridging the gap between health inequalities. These interventions are considered to be cost effective way of reducing ill health and prolonging life. So every smoker should be advised to stop smoking and offered help if they feel like wise in doing so. (NHS, 2010)
All the interventions provided under Stop Smoking Services Clinics share some common properties. Such as Behavioural support offered in both individual and group therapies by health professionals and they normally advise the usage of Nicotine and Nicotine- based therapies along with it. (NHS, 2010). This clinical service is provided over multiple sessions to the smoker and a quit target date is set at a follow up of 4 weeks.
Success ranges of quit rates by smokers depends upon the type of intervention received by them. Interventions that combine group support with Nicotine reduction therapy are more effective in achieving 4 weeks quit rates (71 percent) in comparison to individual support given in clinical settings. (Bauld et al, 2009). Though both types of intervention implement complimentary modes of action, the quit rates maintained over long term differ considerably. Other interventions like counselling support and information provided over quit lines, internet and mobile phones may be easily accessible by wide smoking population but may be less intensive and effective in comparison to the support given in clinical settings (NHS, 2010).
Aims of this Research:
This research is designed to meet the following aims:
To assess the effect of the different interventions and support offered by Smoking cessation services to help achieve success rates of smoking abstinence over long period of time.
To make a comparison between the studies that have evaluated the effectiveness of interventions undertaken by the smoker with the assistance of self help interventions in comparison to the clinical treatments provided under NHS stop smoking cessation services over the last decade. The comparative assessment will be done between the following:
Self help materials (leaflets, information kits); Mobile phone and Web based support, Smoking Quitlines
Brief advice offered by GP's and other health professionals
Brief GP advice + Nicotine reduction therapy, Bupropian and Vernaciline;
Attending a smoking clinic and receiving Behavioural support +NRT, Bupropian and Vernaciline
Highlight those interventions among the clinical and less clinical interventions which are more likely to produce successful quit rates at 4 weeks follow up.
Rationale for conducting this Literature review Research
Disease Burden from smoking: Smoking imposes a huge burden on the country's economy. It imposes direct costs on National Health Service for health care and indirect costs on loss of productivity (ASH, 2010). It has been estimated that National Health Service spends approximately 2.7 billion on treatments and control this public health issue. In addition, it puts the smoker and their families and others through discomfort, pain and suffering. Among them, the cost of bereavement and consequent emotional and social distress, the payment of social security and benefits is given to the dependants of those who die as a result of smoking related disease. Also, it has been suggested that total number of deaths associated with smoking has not changed much in the last 10 years (Allender et al, 2008)
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Thus, given the expenditure spent by NHS in providing interventions under its National Program, it becomes highly important to deliver treatments that are evidenced based and help in maintaining consistent quit rates of between 35% and 70% in the population and meet the PSA target of reducing smoking prevalence rate by 21% or less by 2010 (NHS, 2010). This research will make a comparative assessment and provide information and insight of the effectiveness of the both highly clinical and less clinical interventions which will help in the meeting the current NHS targets for 2010.
Knowledge transfer: For the purpose of achieving the third aim, the author has a personal interest in highlighting it. The author here wishes to gain wider information about the most effective smoking cessation intervention with the objective of transfer knowledge. The author of this dissertation belongs to India and she wanted to make an international comparative assessment of the effectiveness of national smoking cessation interventions between England and India. However, due to the limited published documents of current trends and related literature, it has not been possible to examine and make comparisons with India on this topic.
But the author found some useful information from a national report produced under Ministry of Health and Social Welfare (MOHSW, 2004) raised awareness about the widespread production, consumption and resulting impact of ill health impinging on Indian population and its economy. So the author would like to transfer knowledge by sharing the results and outcomes of this research with the health professionals with the main purpose of sensitising Indian health care system; and promoting most effective tobacco cessation interventions based on the examples of English Stop Smoking Cessation services; and minimize the economic burden on Indian government. (MOHSW, 2004)
Thus, Tobacco Control programmes worldwide are designed with the aim of reducing the burden of disease, disability and death related to the consumption of tobacco. In order to determine the effectiveness of such programmes in England, it is essential to describe the smoking cessation interventions; document implementation and show results and outcomes to guage their contribution towards bringing down the smoking rate in the population.
Hence, The next section, Preliminary Literature review will discuss in detail the workings of NHS Stop smoking services; different Smoking Cessation treatments, and manner of implementation with statistical facts to support their contribution in bringing down the smoking rate in English population.