Smoking Cessation Scotland

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Smoking Cessation Scotland

• Dr Llinos Roberts
• January 2006

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• Barstaff put on frontline in fight to enforce
  smoking ban - Scotsman 5/1/06
• Now even smoking outside could be banned -
  Scotsman 2/1/06
• Smoking ban could extend to parks and school
  entrances - Telegraph 2/1/06
• Scottish smokers urged not to light up in their
  own homes - Scotsman 21/12/05

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Barstaff put on frontline in fight to enforce
smoking ban - Scotsman 5/1/06
Scottish smokers urged not to light up in their
own homes - Scotsman 21/12/05
Smoking ban could extend to parks and school
entrances - Telegraph 2/1/06
Now even smoking outside could be banned -
Scotsman 2/1/06
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Background

• Jan 2004 - Scottish Exec published tobacco
  control action plan - A Breath of Fresh Air for
  Scotland Improving Scotlands Health the
  Challenge.
• Research shows that
• 13,000 people in Scotland die every year from
  the effects of smoking
• Of those 1000 deaths could be attributed to
  passive smoking
• 35,000 are treated every year for smoking
  related diseases in Scotland

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• Dec 2004 - Smoking, Health and Social Care
  (Scotland) Bill introduced to parliament which
  proposed that smoking should be banned in
  enclosed public places such as workplaces, pubs
  and restaurants.
• New Act comes into force
• 06.00hrs March 26th 2006

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Smoking - the facts

• Exposure to ETS is associated with
• Acute respiratory illness in early childhood
• Chronic cough, phlegm, and wheeze in
  children
• Chronic middle ear effusions in children
• Reduced levels and growth of lung function
  in children
• Increased risk of sudden infant death
  syndrome (SIDS)
• Increased bronchial hyper-responsiveness in
  asthmatics
• Increased lung symptoms in asthmatics
• Decreased lung function in asthmatics
• Increased risk of lung cancer heart
  disease with long-term
  exposure
• Effect on fertility

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Whats happening elsewhere?

• Numerous countries already have a smoking ban in
  place, e.g
• Ireland - April 2004
• Norway - June 2004
• Sweden - July 2005
• Netherlands - Jan 2004
• 5 states in USA
• 11 of the 13 provinces in Canada
• New Zealand - Dec 2004

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Legislation for smoke-free workplaces and health
of bar workers in Ireland before and after
studyBMJ. 2005 Nov 12331

• Objectives - To compare exposure to secondhand
  smoke and respiratory health in bar staff in the
  Republic of Ireland and Northern Ireland before
  and after the introduction of legislation for
  smoke-free workplaces in the Republic.
• Enrolled 329 bar staff in baseline study
• 249 were followed up at 1 year
• Of these 158 were non-smokers

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• Outcome measures
• Salivary cotinine concentration
• Self reported exposure to secondhand smoke
• Respiratory and sensory irritation symptoms
• Results
• Salivary cotinine levels ? by 80 in RI after ban
  compared with 20 in NI
• Changes in self reported exposure were consistent
  with cotinine concentrations
• Reporting of respiratory symptoms ? by 16.7 in
  RI but not in NI

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Health gain from ban

• Smoking rates in NY fell by 2 within a year
• In Ireland 7000 people are thought to have quit
  smoking in first 6 months
• Cigarette sales have dropped by 13 in NY 16
  in Ireland

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• Help to quit smoking ahead of ban
• BBC News 4/1/06
• Record levels of funding to help people kick the
  habit have been made available prior to the
  introduction of Scotland's smoking ban, according
  to ministers.
• An additional 2million has been allocated to
  health boards in 2006/2007 bringing the total
  amount for the year to 11million
• Scottish Ministers believe that the ban should be
  an incentive for people to stop smoking
• More than 58,000 smokers in Scotland are
  attempting to kick the habit ahead of next year's
  public smoking ban, latest figures show. BBC
  News 4/12/05

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Smoking Cessation Guidelines

• Thorax 1998
• NICE 2002 (Reviewed 2005)

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Nicotine Replacement Therapy

• NRT doubles cessation rates compared with
  controls
• All 4 NRT products have similar success rates
• Bupropion is also an option
• Contraindications to NRT
• Pregnancy
• Cardiovascular disease

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Which product?
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Bupropion (Zyban)

• Licensed for smoking cessation in UK
• Also used as an antidepressant in USA
• Selective inhibitor of the neuronal re-uptake of
  dopamine noradrenaline
• Dose 150mg od for 1st 6 days then 150mg bd for
  6-8 weeks. Aim to stop smoking day 7-14

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• Contraindications
• Epilepsy / history of seizures
• Eating disorders
• History of bipolar disorder
• Pregnancy / breast-feeding
• Side effects
• Seizures
• Hypersensitivity reactions (0.1)
• Dry mouth, GI disturbance, Insomnia
• 3 suffer rash, pruritis, urticaria

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Bupropion Vs NRT

• Double blind, double dummy, randomised placebo
  controlled trial comparing Bupropion Vs NRT patch
  with a combination of Bupropion NRT patch.
• Odds ratio at 12 months for continuous
  abstinence
• Bupropion Vs patch 2.07 (CI 1.22-3.53)
• Bupropion patch 1.28 (CI 0.82-1.99)

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