NTClinical

p23 p26 p28 p30 p32 UPDATE practical guided development RESEARCH informs you of procedures learning shows how nurses are presents research changes in clinical illustrates procedures. includes online CPD. developing practice. papers. This week: practice. This week: This week: assessing This week: surgery This week: delegating patient views prevalence consciousness and haemophilia consent-taking of MRSA

update

SMOKING BAN IN HAS A DRAMATIC IMPACT ON PREVALENCE New research suggests that the smoke-free legislation introduced in England a year ago has encouraged more people to give up smoking. Nerys Hairon reports

The in England, which came Meanwhile, a survey of high school spectrum (West, 2008). Based on these into effect in July 2007, has helped more children in has shown that pupils findings, the researchers estimate that at smokers to quit than ever before and will who experience positive and inclusive social least 400,000 people quit smoking as a help prevent an estimated 40,000 deaths in environments in schools are less likely to result of the ban on smoking in public the next 10 years, according to research take up smoking (Medical Research Council, places (CRUK, 2008). (Cancer Research UK, 2008; West, 2008). 2008; Henderson et al, 2008). The Smoking Toolkit Study, presented The new research (West, 2008; Henderson aids at the UK National Smoking Cessation et al, 2008) has implications for practice and The study also asked participants about the Conference in Birmingham last week, school nurses. Practice nurses are vital in use of smoking cessation aids in the past interviewed more than 32,000 people in encouraging patients to quit smoking and year. It found that around 50% of quit England before and after the smoke-free law signposting them to services that can help. attempts involve the use of a cessation aid, took effect and found smoking prevalence It is also important for school nurses to be and this is mostly nicotine-replacement fell significantly after its introduction. In aware of those factors that may make therapy (NRT) bought over the counter. Use addition, the research found that NHS Stop schoolchildren more likely to start smoking. of smoking cessation drug varenicline is Smoking Services are ‘highly effective’ in rising but still low (West, 2008). The research helping smokers to quit (West, 2008). SMOKING BAN found that 5–10% of quitters (3% of The study is the first in the world to The Smoking Toolkit Study, funded by smokers) use NHS Stop Smoking Services examine in detail the impact on smoking CRUK, McNeil, Pfizer and GlaxoSmithKline, and the rate has not changed significantly. rates solely from smoke-free legislation interviewed 32,454 adult participants over The research also explored trends in without the influence of any other the nine months before and nine months certain groups. Smokers aged over 35 are control measures. The findings suggest after the smoke-free law came into effect in more likely to use medications and the smoking ban is encouraging people to England. It found that the law has had a behavioural support. In addition, those from quit. This is mirrored in Scotland, which dramatic effect on smoking prevalence, with lower socioeconomic groups and women introduced its ban in March 2006, while an impressive 5.5% decline in the nine are more likely to use NRT on prescription, Plaid Cymru has just released figures months after its introduction, compared with although there is no difference in the use of showing a decrease in cardiac emergency a 1.6% fall in the previous nine months. This behavioural support. admissions in since the country’s ban is the largest fall ever recorded and the Interestingly, the study found that those began in April 2007. effect has been similar across the social attending NHS Stop Smoking Services were

NT 8 July 2008 Vol 104 No 27 www.nursingtimes.net 23 clinical

update Keywords public health smoking cessation quit attempts

three times more likely to be successful than Scotland has also reported positive results references those not attending (West, 2008). since the introduction of its ban. The Smoking reduction was also examined. Scottish Government (2008) reports that Cancer Research UK (2008) Smoking Over half (57%) of smokers report trying to 40,000 people tried to quit smoking in the ban triggered the biggest fall in smoking cut down, and one-quarter (25%) of those previous year across the country (see www. ever seen in England. Press release, 30 reported using NRT. Patches and gum are scotland.gov.uk/home for more information). June 2008. London: CRUK. the most popular forms. The study found no Innovative schemes to encourage smokers www.cancerresearchuk.org difference in the use of NRT for reduction by in deprived communities to quit are also gender or social class but smokers aged being introduced. NHS Tayside in Dundee Henderson, M. et al (2008) What explains between-school differences in rates of over 35 were more likely to use it. has announced an incentive scheme for smoking? BMC Public Health; 8: 1, 218. In summary, the study found that use of smokers, set to start in the autumn of this aids is similar across the social spectrum in year, which will offer participants money for Medical Research Council (2008) quit attempts. However, smokers from lower fresh food and groceries (excluding alcohol Supportive schools can help reduce socioeconomic groups are more likely to and cigarettes), in exchange for staying student smoking. Press release, 20 June use prescription NRT. The average short-to smoke free. 2008. www.mrc.ac.uk/index.htm medium-term cessation rate is 6%, and this is much higher in more affluent groups. PREVENTING SMOKING Plaid Cymru (2008) Heart attacks drop in The study also examined peak times for In addition to helping people quit smoking, Wales after smoking ban. Press release, 1 quit attempts and cessation. When an important aspect of public health July 2008. www.plaidcymru.org/content. participants were asked about attempts to promotion is preventing young people from php?lID=1 stop smoking in the past month, the study taking up smoking. Henderson et al (2008) found the major peaks were at the start of investigated whether school characteristics The Scottish Government (2008) Second the year, with minor peaks in March–April can account for differences in smoking rates anniversary of Scotland’s smoking ban. and when the smoking ban took effect. This between schools. Press release, 25 March, 2008. was also the case for quitting. The survey, led by the MRC and based on www.scotland.gov.uk/Home These findings indicate the most popular 5,092 secondary school pupils in 24 aids to help people quit smoking, as well as Scottish schools, found that school-level West, R. (2008) Key Performance Indicators on Smoking Cessation in the impact on likelihood of success of NHS characteristics have an impact on both male England: Findings from the Smoking Stop Smoking Services. Practice nurses can and female pupils’ rates of smoking up to Toolkit Study. Last updated 6 June 2008. signpost patients to these services for help 15/16 years of age. The size of the ‘school www.smokinginengland.info and support (see www.gosmokefree.nhs.uk effect’ was greater for boys at this age. The for more information). research found that the social environment in schools – particularly the quality of waleS and scotland teacher-pupil relationships, pupils’ attitudes either regularly or occasionally smoked. Figures from Plaid Cymru (2008) show a to school and the school’s focus on caring The MRC (2008) says that teachers who reduction in hospital treatment for MIs since and inclusiveness – can influence both boys’ succeed in creating a positive environment the ban was introduced in Wales. There was and girls’ smoking. in school may be responsible for their pupils a 13% reduction in cardiac emergency The MRC says that this research is staying smoke free. The authors conclude admissions in the period October–December particularly important because the that the findings provide support for the 2007 compared with the same period in decreases in adult smoking witnessed in school-wide or ‘health promoting school’ 2006. In these three months in 2007, there recent years have not so far been matched approach to smoking prevention. were 4,669 cardiac-related emergency in adolescent smokers. The survey found admissions, compared with 5,339 in the that, on average, 25% of males and 39% of CONCLUSION same period in 2006 and 5,452 in 2005. females aged 15–16 reported that they The new research on smoking prevalence in England demonstrates the dramatic impact of the smoke-free legislation introduced a key messages for practice year ago. The study also highlights the most effective and most popular methods of This is the first study in the world to NHS Stop Smoking Services are smoking cessation aids. Nurses can use this examine in detail the impact on smoking highly effective in helping smokers to knowledge in further public health rates solely from smoke-free legislation quit successfully. promotion, to encourage even more patients without the influence of any other tobacco Around half of quit attempts involve to quit smoking. n control measures. the use of some form of aid but use of The smoking ban in England has had a NHS Stop Smoking Services is low and For more clinical information dramatic effect, leading to the largest fall not increasing. subscribers can log on to nursingtimes.net and click on ever recorded. Source: West (2008) to NT Clinical and Archive

24 NT 8 July 2008 Vol 104 No 27 www.nursingtimes.net