Smoking remains the single biggest preventable cause of ill health and premature death in Wales
[1]
, and a significant cause of health inequality. Pembroke Dock, a town in south-west Wales, has a population of around 10,000 people. The town has a higher than average rate of unemployment, and around 28% of its secondary school pupils live in the 20% most deprived areas in Wales[2]
. Pembroke Dock has a smoking rate of 22% — higher than the Welsh national average at 16.1%[3]
; this higher than average trend for smoking is reflected in secondary school-aged pupils. Individuals from this socioeconomically disadvantaged background are less likely to access the available smoking cessation services, which are over four times more effective in achieving a successful quit attempt than going it alone[4]
.
The smoking cessation service at Hywel Dda University Health Board was contacted by a secondary school in Pembroke Dock to offer support to a cohort of year 10 pupils (aged 15–16 years) who smoked on the school premises. The school had planned a move to a new site, in time for the new academic year, where the no-smoking rule would be strictly enforced.
We — the members of the smoking cessation service team — thought the most favourable results would be achieved by adopting a multi-agency approach and utilising the skills of different disciplines, so we involved the Healthy Schools team from Public Health Wales; smoking cessation practitioners from Stop Smoking Wales: the Hospital Smoke Free Support Service and a local community pharmacy; as well as representatives from the school’s management teams. These groups were coordinated by a pharmacist.
We decided, in addition to our support for the year 10 pupils who already smoke, we would aim to reduce the smoking rates of future year 10 pupils, so we also visited a feeder primary school. We delivered smoking cessation-related activities with the pupils and offered an eight-week smoking cessation programme, run on the school site, for smoker parents, grandparents and friends of the school. We hoped that more smokers would access this than the conventional local services.
The Hospital Smoke Free Support Service took the lead with the secondary school pupils. The smoking cessation advisor met with the pupils individually, offered them brief intervention counselling and supplied nicotine replacement therapy in the form of patches and lozenges. The service did not necessarily aim for abstinence; instead, it worked to aid the pupils’ transition to not smoking on the school site without forcing them into nicotine withdrawal. Nicotine withdrawal is associated with feelings of anger, irritation and frustration, as well as difficulty concentrating, headaches and low mood — all of which would have an adverse effect on their ability to learn and their behaviour in class.
The support service was successful. The pupils responded to the external input and the school commented on the improved relations they had with them. Additionally, two of the five pupils counselled attempted to quit smoking and managed to stop for more than four weeks. They later relapsed, but have since quit smoking.
Stop Smoking Wales led the smoking cessation sessions offered to the parents in the school. We ran weekly group sessions over two months with brief intervention counselling and dual-therapy nicotine replacement therapy supplied by a local pharmacy. We had a total of nine potential clients, with a >40% quit rate among those enrolled.
Although the numbers in this pilot are small, the figures are in line with the Welsh Government’s target of 40% of clients enrolled on a smoking cessation programme being successfully carbon monoxide-validated as quit at four weeks.
Recent data show that 70% of smokers in Wales would like to quit smoking and more than 40% have made a quit attempt in the past year[5]
, but the established smoking cessation services are not seeing the anticipated number of clients. The two pharmacies offering the Level 3 Community Pharmacy programme for smoking cessation in the local area have seen 35 clients, leaving an untapped pool of smokers looking for help.
Although offering the service on school grounds may pose a barrier to some potential clients, having the school actively promote the service will help publicise it to those smokers looking for help. If this model of smoking cessation was rolled out on a larger scale, it could have the potential to reach more of the 70% of smokers in Pembroke Dock — almost 1,540 people who want to quit smoking.
Dave Edwards, pharmacist and smoking cessation advocate, Hywel Dda University Health Board, Wales, on behalf of the smoking cessation service team
References
[1] Public Health Wales Observatory. Mortality in Wales 2002 to 2016. 2018. Available at: http://www.publichealthwalesobservatory.wales.nhs.uk/mortality (accessed January 2019)
[2] Estyn (Her Majesty’s Inspectorate for Education and Training in Wales). A report on Pembroke School, Bush, Pembroke, SA71 4RL. 2012. Available at: http://www.estyn.gov.wales/inspection/inspection-report-pembroke-school-2012-english-only (accessed January 2019)
[3] Office for National Statistics. Adult smoking habits in the UK: 2017. 2018. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017 (accessed January 2019)
[4] Public Health England. Health matters: stopping smoking — what works? 25 September 2018. Available at: https://www.gov.uk/government/publications/health-matters-stopping-smoking-what-works/health-matters-stopping-smoking-what-works (accessed January 2019)
[5] Public Health Wales. 70% of smokers in Wales would like to stop for the sake of their family. 2014. Available at: http://www.wales.nhs.uk/sitesplus/888/news/34238 (accessed January 2019)
