Access to and use of aids to smoking cessation in the UK - PowerPoint PPT Presentation

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Access to and use of aids to smoking cessation in the UK

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  1. Access to and use of aids to smoking cessation in the UK Robert West University College London Austin, Texas February 2007

  2. Outline • UK policy objectives • The recent history of policy changes • The current smoking cessation landscape • The future

  3. Policy objectives Public Service Agreement Targets: • To reduce adult smoking prevalence in England from 26% in 2002 to 21% by 2010 • To reduce smoking prevalence in ‘routine and manual’ occupational groups from 31% in 2002 to 26% by 2010

  4. Recent history of policy changes Increasing access to effective methods to aid cessation is an important element of the strategy 1998: Government ‘White Paper’ sets up national network of NHS Stop Smoking Services 2000: Zyban made available on NHS prescription 2001: NRT fully available on NHS prescription and on ‘general sale’ 2002: National Institute for Clinical Excellence recommends use of NRT and Zyban 2006: Changes to NRT licence expanding range of allowable use

  5. 2006 NRT licensing changes • Extended use • Concurrent use of different forms of NRT • Use by cardiac patients • Use by pregnant smokers • Use by young smokers • ‘Cut Down Then Stop’

  6. Extended use • Evidence from clinical trials has not supported the effectiveness of extending use of nicotine patch beyond 8 weeks but … • a substantial minority of users of gum and other products feel vulnerable to relapse after 8-12 weeks • there is evidence for an increase in relapse rate on termination of use • there are no major safety concerns about extended use

  7. Concurrent use • Evidence from clinical trials indicates that combinations are more effective on average than single forms but … • the evidence is not completely conclusive • it is not clear whether some combinations are better than others or than specific individual forms of NRT • there are no significant safety concerns

  8. Use by cardiac patients • NRT has not been shown specifically to be effective in this patient group and the pharmacology of nicotine suggests a theoretical risk but … • there is a reasonable presumption of efficacy given data from healthy smokers • it appears to have been safe to use in cardiac patients • the imperative to stop smoking in this group is high

  9. Use by pregnant smokers • NRT has not been shown to be specifically effective in this group and nicotine has been shown to be teratogenic but … • there is a reasonable presumption of efficacy given data from healthy smokers • there is a reasonable presumption that NRT is much safer than smoking • the imperative to stop smoking in this group is high

  10. Use by young smokers • NRT has not been shown to be specifically effective in this group but … • there is a presumption that it may have some effect in young smokers that are clearly nicotine dependent • there are no major safety concerns

  11. Cut Down Then Stop • Clinical trials have shown that gum or inhalator use in smokers wanting to stop but who do not feel ready or able to make a quit attempt in the near future results in approximately 4% more of them stopping smoking within the next 12 months but … • it is not clear what the effect this will have when rolled out to the smoking population as a whole

  12. The current landscape: smoking prevalence Source: www.smokinginengland.info

  13. Prevalence estimates relating to cessation Percentages for attempters use all those who smoked in the last year as a base; percentages for quitters use all those who attempts in the time period specified as a base Source: www.smokinginengland.info

  14. Use of aids to cessation in past year Source: www.smokinginengland.info

  15. Use of aids to cessation in past month Source: www.smokinginengland.info

  16. Use of NRT for reduction Percentages for cutting down use current smokers as a base; percentages for use of NRT products use those cutting down as a base Source: www.smokinginengland.info

  17. NRT for reduction and cigarettes per day * * * Source: www.smokinginengland.info

  18. Inflow and outflow of adult smokers in a given week Dying 3k 1k Smokers immigrating 3k Smokers reaching 16+ Smokers: 12m 4k Starting to smoke 120k 114k Quitting Relapsing This amounts to a reduction in prevalence of ~0.2% per year

  19. Drivers of smoking prevalence in 2006 During 2006 End 2006 6 million Adult smokers continuing 5.2 million Smokers quitting and relapsing -150K Smokers dying Smokers: 12 million -700K Smokers quitting +400K Ex-smokers relapsing +150K Smokers reaching age 16 yrs +200K New adult smokers

  20. The future • Increasing the numbers of smokers attempting to quit and reducing relapse are by far the largest targets for reducing smoking prevalence • Even in the UK there appears still be scope for increasing usage of effective methods to aid cessation including psychological support and medication • However a radical increase without loss of efficacy would be needed to have a detectable effect on prevalence in any one year.