Smoking Patterns In Ireland: implications For Health Policy And Services Ruair Brugha, Nuala Tully, Patrick Di

1. Smoking Patterns In Ireland: implications For Health Policy And Services Ruair� Brugha, Nuala Tully, Patrick Dicker, Emer Shelley, Mark Ward, Hannah McGee

3. SL�N 2007 Methods Age N Response _____________________________________ Main survey 18+ 10,364 62% _____________________________________ BMI/WC 18-44 967 58% _____________________________________ Physical exam 45+ 1,207 66%

5. Overall smoking prevalence rates in SL�N surveys 1998: 33% 2002: 27% 2007: 29% men 31% women 27% In 2005, following the 2004 smoking ban, Ireland was in 1st place among 30 European countries in WHO�s Tobacco Control Survey By 2007, Ireland had fallen to 2nd place

6. Percentage of smokers in 2007, by age, gender and social class

7. Opportunities for intervention? TARGETTED Young women, social class (SC) 5-6, after leaving school 36% prevalence in women 15-17 yrs (HBSC 2002) 55% prevalence in women 18-23 yrs (Slan 2007) Occupational groups (see later) PRIMARY CARE 74% of SL�N 2007 respondents (72% of current smokers) had attended a GP in the previous 12 months Only 38% of current smokers reported that 'a doctor or health professional' had discussed ways of giving up smoking with them during the previous 12 months

8. Smokers who received advice about quitting smoking from a health professional (1)

9. Smokers who received advice about quitting smoking from a health professional (2) Smokers holding a medical card were more likely (45%) to have had a discussion about quitting smoking than those without a medical card (34%) Being in social Class 5-6 and having a medical card were strongly correlated Having a medical card was associated with receipt of advice on smoking cessation, independent of social class in a multiple logistic regression model (p = 0.06) Which means that a fee-paying patient is less likely to receive smoking cessation advice from his / her doctor ..

10. Factors influencing GP mediated interventions with patients (PESCE 2008) GPs� own smoking behaviours GPs� perceptions: are the available interventions effective? Is this a good use of my time? Is this my job? GPs� concerns around the doctor-patient relationship Patient factors � smoking history and clinical presentations GP knowledge and skills Structural factors: GP-patient contact time Resources and reimbursement Funding agencies setting smoking control targets for GPs

11. Smokers� occupations adapted from Janet Singh

12. Where now for smoking control in Ireland?

13. A. Better utilisation of primary care opportunities for smoking cessation? Disseminating the evidence that primary care interventions work 23% of men and 16% of women have quit smoking (Slan 2007) 50,000 patients availed of nicotine replacement treatment in 2002 combination of NRT + support is most effective (20-30% - Bobak) Short-term options Let GPs know comparative benefits: low numbers needed to achieve quitting (NNT) compared with prescription of statins and hypertensives Enable primary care teams to improve cessation support skills Make smoking cessation clinics easier to access through primary care Structural options Utilise existing GMS card system to incentivise primary care providers to intervene, esp with smokers from poorer socio-economic profiles Set and reimburse primary care smoking cessation targets The end of the rainbow . . . . universal patient linkage in primary care

14. B. Targeted approaches UK recommends employer based interventions with occupational groups (NHS NICE April 2007) Need for new � innovative � approaches with high risk groups Young women and social class 5-6? More people falling into categories of �unemployed and currently looking for work� (49%) and �state training schemes� (43%) Might targeted approaches have a stigmatising effect on some smokers, eg those in lower social classes? Hypotheses to explain socio-economic differences in smoking rates : Lower social class smokers have less knowledge of the risks of smoking They have less self-efficacy and a lower propensity to quit smoking They experience a functional use from smoking: �measures of economic resources and enduring economic and social difficulties� account for the largest differential in smoking rates across social classes. (Layte and Whelan, 2008):

15. C. What is the feasibility and potential of applying targeted and population wide strategies? Evidence from SL�N 2007 points to missed (and potential) primary care opportunities for implementing smoking cessation interventions Are population-wide health service smoking control approaches feasible, given current structure and funding of primary care in Ireland? WHO reports that population health approaches work: Increasing tobacco taxes by 10% decreases smoking by 4% (WHO 2008) In Ireland, tobacco price increases have been < 10%, 1999 to 2009 Making subsidised or free primary care delivered nicotine replacement therapy + other interventions could be budget neutral But tax measures in the RoI require cross-border harmonised approaches

16. Email epi@ rcsi.iewww. slan07.ie