Last year, smoking rates in England fell to a record low of 15.5 per cent, with one in 12 smokers quitting in 2016. However, there are still about nine million adult smokers in the UK and smoking is responsible for half the difference in life expectancy between rich and poor. One in four people in routine/manual jobs continues to smoke, compared with one in 10 in managerial positions, and there is also concern that rates of smoking in pregnancy remain at 10.5 per cent. There’s no room for complacency.
The government’s new Tobacco Control Plan, Towards a Smokefree Generation, aims to reduce smoking to 12 per cent or less by 2022, cut the number of 15-year-old smokers to three per cent or less and reduce the number of pregnant smokers to six per cent or less.
Action on Smoking and Health (ASH) says that England is one of the best places for smokers who want to quit, with a number of policies in place to encourage them.
Nicotine is highly addictive and most smokers find it hard to quit on their own. Only five per cent of unaided quit attempts succeed long term, but effective support increases the chances four-fold, says ASH. “Pharmacies can play an important role, both in the instigation of quit attempts and offering services,” says Hazel Cheeseman, director of policy at ASH. “This can include signposts to local services as well as providing in-house support. Studies repeatedly show that face-to-face support significantly improves a smoker’s chance of successfully quitting.”
Support from a stop smoking service increases the success of a quit attempt – 51 per cent of smokers who use one are smoke-free after four weeks, says ASH. However, local funding cuts mean access to these services has fallen in the past few years.
“Smokers from all backgrounds are more likely to quit if they use a stop smoking service,” says Ms Cheeseman. “If we allow these expert services to disappear from our communities, we will face an uphill battle to reduce the inequalities caused by smoking.”
Pharmacies play a valuable role in their communities by offering smoking cessation advice and providing customers with support such as smoking cessation aids. “Community pharmacy is perfectly placed to support people to make a change and live a healthier life,” says Alphega Pharmacy member Abdool Kureeman at Buckley Pharmacy. “Typically, patients can access their local pharmacy quicker than they can their GP. In addition, they don’t always think about seeing their GP to talk specifically about stop smoking, while in our pharmacy we actively promote this service. We offer it to all smokers and use MURs, NMS as well as health checks to signpost them to our service.”
Many smokers know they should give up, and may have tried to do so already. “The addition of personalised support from pharmacy teams in the heart of the community significantly increases their chances of success,” says Jane Devenish, pharmacist at Well. “A greater proportion of smokers now fall into the hard-to-reach categories, but the key has to be regular brief interventions, which have been proven to be an effective way to support people to stop smoking.”
Smoking cessation is a support-driven category, which is why pharmacy is in such a strong position to help patients overcome their addiction. “Products may be cheaper and more accessible in a supermarket, but customers aren’t able to access the advice available to them in a pharmacy,” says Numark marketing co-ordinator Cathy Crossthwaite.
NiQuitin is running a marketing campaign through the ‘New Year New You’ period, running until early March. Holly Turner, senior marketing director at Perrigo, commented: “Many of us set new goals in January, so it is inevitably a big moment in the year for people to try and give up smoking. NiQuitin aims to provide pharmacists with the knowledge and materials to offer customers the best solution throughout their journey to quit, not just in January, but throughout the year.”
Lunts Pharmacy in Shrewsbury has been offering a Help2Quit clinic for 10 years. It’s a 12-week programme, with weekly consultations for the first month, then fortnightly visits.
“Most of our customers who use the service come by word of mouth, though we have posters and leaflets to advertise,” says Yvonne Martin, who runs the service. “It’s important to approach them sensitively. We advise our customers to take it day by day, not to look long term at first as this can seem daunting if you talk about quitting for good from the outset.”
She says it’s important to treat each customer individually. “While you have guidelines to stick to, you need to see how each customer responds and adapt accordingly,” she says. “They don’t want to be preached at; they know smoking is bad for them.”
The smoking cessation market increased in value last year by about four per cent, according to Mintel, to about £132 million, driven by new product development and greater advertising spend. The e-cigarette sector is estimated at £230 million, up six per cent on the previous year.
“E-cigarettes are not used in isolation as a smoking cessation method,” says Mintel. “Indeed, 25 per cent of vapers have used/are using non-prescription NRT products, suggesting potential for traditional NRT brands to couple with licensed e-cigarette brands.”
Some 2.9 million adults now use e-cigarettes, says ASH, up from 700,000 in 2012. For the first time, more ex-smokers (1.5 million) use them than current smokers. The main reason for use is to give up smoking. The message is now to convince dual users to switch completely from tobacco to e-cigarettes, says ASH.
However, research shows that the public are confused. Only 13 per cent of people believe that e-cigarettes are less harmful than smoking. Similarly, only a third of smokers believe that NRT is much less harmful than smoking.
There is much more of an emphasis on using multiple products in quit attempts than even a few years ago, with customers using patches to keep overall physical cravings down, but wanting another product for additional support to break the psychological habit of smoking when the desire to smoke is strong,” says Ms Devenish.
For the first time this year, stop smoking campaigns, including PHE’s Stoptober campaign, have included e-cigarettes in their information to consumers as a way of quitting.
There are strong links between smoking and mental health, with about three million of the UK’s smokers having a mental health condition, says ASH. It’s not known whether smoking is the cause or effect of mental conditions. As a result of high smoking rates – about 33 per cent of people with a mental health condition smoke – people with mental health conditions have a high mortality rate. It’s thought smoking is the largest single contributor to their 10- to 20-year reduced life expectancy.
For smokers with a mental health condition, the dopamine rush from smoking is more pronounced. However, the relief from nicotine withdrawal is temporary, and increasing levels of nicotine are needed to relieve it, so they’re more likely to become heavy smokers.
“It’s a myth that stopping smoking increases stress levels,” says Ms Cheeseman. “Quitting can actually improve mood and reduce anxiety. Some people who take anti-psychotic medicines can often reduce the dose of their medication after quitting. Surveys show that up to two-thirds of smokers with a mental health condition want to quit. While people with mental health conditions don’t necessarily need different support, they are often more highly addicted and face more barriers to quitting. As such, they may need higher doses of medication for longer and may need face-to-face support over a longer period.”
Pharmacists interested in doing more to support smokers with mental health conditions should read NICE guidance PH48 (5) and PH45 (6).
“Think about the different problems smokers encounter when trying to quit and offer a variety of products to fit individual patient circumstance,” says Ms Devenish. “Ensure that colleagues are confident and aware of the benefit of offering proactive support and brief interventions.”
“Team briefings are essential with any campaign and service you’re trying to promote,” says Mr Kureeman. “For example, before our Stoptober campaign, we had a team meeting on smoking cessation to bring everyone up to speed on the latest products and advice, making sure they are talking about the benefits of signing up to our service. We also signpost patients to additional support such as the free NHS Smokefree app, which gives daily tips and motivation.”
“We encourage member pharmacies to support customers by offering a range of NRT products of different strengths and formats to support them through the various stages of their quit period,” says Ms Crossthwaite. “Consider running a stop smoking service to offer patients one-to-one support on an ongoing basis. The customer will feel they have a shoulder to lean on and you will gain loyalty and patient satisfaction.”
“Running a health promotion campaign to help customers understand the health risks to their body if they smoke and informing them of the support available to them through pharmacy will help catch customers who are entering your pharmacy for unrelated reasons,” she concludes.
Thorrun Govind, locum pharmacist, North West England “This is a popular category, particularly in January. Our local smoking cessation clinics in Bolton aren’t available any more so people have to come to pharmacies, and as a result we are getting a lot more traffic. The pharmacies I work in have smoking cessation advisors, and I am trained myself. There are so many different types of products available in the NRT category that you can have a chat with the patient and explain the different products. I think this helps them buy into the concept of stopping smoking because they find a way that suits them – so you’re not forcing it on them. There’s the whole debate around e-cigarettes, but personally, I’m much happier recommending that people use NRT products for which we have a lot of medical evidence.”
Sarina Mughal, professional services pharmacist, Day Lewis Plc “We get stop smoking queries every day, and as well as getting involved with Stoptober, Day Lewis runs a stop smoking campaign in March. Most Day Lewis pharmacies run a smoking cessation service and this has been very successful, so for us, smoking cessation is extremely important. We make sure that we stock a wide range of products, such as Nicorette, NiQuitin, patches, gum, mouth sprays, the list goes on – patients find it difficult to quit for different reasons, so we try to accommodate all patients’ needs. Regarding e-cigarettes, my professional and personal opinion is that they are not what I would recommend first, just in terms of safety and clinical effectiveness. However, these are products that people like to use.
Tolu Adams, pharmacist, Day Lewis Camberwell “In my previous pharmacy, people weren’t really bothered when it came to getting off cigarettes, but in my current store I would say the population is very enthusiastic about wanting to give up. People are constantly asking about different products, including some about vaping. We have a smoking cessation clinic starting up with the LPC, and there are a lot of people interested in getting on board, which is great to see. There are various products we can recommend – it depends on the patient and what is going to be most effective for them. While some people have concerns, vaping is better than smoking, and NRT is certainly better than smoking.”