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

Access to and use of aids to smoking cessation in the UK. Robert West University College London Austin, Texas February 2007. Outline. UK policy objectives The recent history of policy changes The current smoking cessation landscape The future. Policy objectives.

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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.

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