APPENDIX 22
Memorandum by Tyne and Wear Health Action
Zone (TB 53)
We fully support the national health policy
which links action at three levels: Government, Local and Individual,
but for this to be achieved, greater integration is needed between
the levels and across agencies. "Joined-up" action at
Government level is much needed and particularly a consistent
view to limit the influence of the Tobacco Industry.
1. SMOKING IN
PUBLIC PLACES
Smoking in public places is an issue where we
need more Government support.
There are four specific issues we would like
to raise:
(a) Magistrates have, in the past, issued
no-smoking conditions to children's certificates for licensed
premises.
However, the Magistrates' Association has recently
published a "Good Practice Guide" which offers guidance
against applying such conditions, claiming they are unnecessary
regulations and contrary to Government Policy. (See attachment
1a)[21]
Without this fiscal measure, there can be little
drive to alter the "norm" of smoking in pubs and further
local action is ineffective.
(b) We are concerned about the lack of progress
with the Hospitality Trade industry-led scheme to badge establishments
since Saving Lives was published.
(c) ACoP on passive smoking in workplace
(HSE): the cost benefit analysis is flawed and we have concerns
about reported views of the Cabinet Office.
(d) At a local level, we are planning an
initiative around passive smoking and attach a paper outlining
approaches, especially targeted at children, both in the home
and public places. (See attachment 1d.)
2. REDUCING ILLEGAL
TOBACCO SALES
Government action to date has been helpful.
However, further intervention is needed.
(a) Please find attached a copy of the full
report of the qualitative evaluation of the (RITSY) campaign.
This was a local initiative involving Local Authorities and Health
Authorities in the former Northern Region, and not just Tyne and
Wear HAZ. (See attachment 2a.)
The use of young children to assist with the
test-purchase process places great demand on staff time and resources.
As a consequence, the priority given to this area of enforcement
varies considerably between authorities. A co-ordinated approach
across all the authorities within the HAZ area could be achieved
with the resources to provide a dedicated team.
(b) The mode of illegal selling is changing.
In Tyne and Wear, sales are particularly through ice-cream sellers,
private houses, etc, and enforcement techniques therefore need
to develop to combat this. The use of covert surveillance equipment
to gather evidence of persistent offending may well be inhibited
with the introduction of the Human Rights Act.
Training at both national and local level of
Magistrates is essential so that they can fully understand their
role in the enforcement process.
(c) Contraband tobacco is a major factor
for new smokers and continuing smokers. Government needs to take
more action to reduce smuggled tobacco through Customs, Police,
etc and by action against tobacco industry (recent revelations
of organised smuggling by BAT).
3. EXTERNAL ISSUES
(a) Please find attached papers from Dr Richard
Edwards:
4. HAZ SMOKING
CESSATION SERVICES
The main points to consider are:
(a) The current monitoring system is inadequate
and focuses service monitoring on use rather than effectiveness
of service (ie smokers who stop long term).
(b) Nicotine Replacement Therapy
The cost of NRT is a substantive deterrent for
the majority of smokers in this area.
The attempt to tackle this by providing a week's
free supply is welcomed, but it is not sufficient. One week is
not an adequate course, and it cannot be assumed that the money
saved by not buying cigarettes in the first week will be used
to buy NRT in the second and so on.
Limiting the free NRT to those eligible for free
prescriptions excludes a large number of people on low income.
Although the rationale behind this is understood, it is seen by
many to be unfair (the Advisors have been receiving a lot of complaints
about this).
There is a strong view that, because smoking
is such a substantial public health risk, NRT should be available
on NHS prescription, or that it should be provided free of charge
(in the same way as contraceptives) for up to 12 weeks treatment.
However, NRT should only be provided free of
charge or on prescription if combined with smoking cessation support.
There are problems in promoting NRT as an aid
to smoking cessation within some target groups because of the
contra-indications to NRT, which include severe cardiovascular
or cerebrovascular disease and pregnancy. NRT is not licensed
for children and the reasons are understood, but the risks of
smoking outweigh the adverse effects of NRT. Urgent research is
required to establish acceptable practice.
(c) Timescale: we cannot deliver an effective
smoking cessation programme in timescale set—constraints
are not enough trained personnel, etc. This is a long-term issue
and funding is needed for 10 years plus.
(d) Please find attached copies of posters
used in the Tyne and Wear HAZ Smoking Campaign Give It Up, Live
It Up. (See attachment 4d)
5. TARGETED GROUPS(a) Smoking
and Young People
A co-ordinated programme of research is needed
to: evaluate the cost effectiveness of initiatives aimed at young
people; investigate the reasons why some young people take up
smoking and others do not and why some become dependent on tobacco.
Anti-smoking educational programmes in general, do not address
personality/risk factors (personal values, preferences and self-efficacy)
that influence young people to smoke. More evidence-based examples
of good practice are needed.
We know that over 40 per cent of young people
would like to stop smoking, yet NRT is not available to young
smokers. We would recommend that NRT be made available to young
people who are regular smokers.
The highest levels of smoking are found in the
16-24 age group which is the hardest group to reach, as there
are few formal points of contact. This is particularly true of
the young unemployed. As these young adults are highly resistant
to anti-smoking messages, more information is needed on how to
influence and engage this group. (We are planning some local research
aimed at this group, using social marketing techniques.)
Evidence shows a clear relationship between
smoking, alcohol and experimentation with drugs (HBSC 1997). In
addition, being bullied and bullying other people were more common
amongst those who smoked. We are putting in place programmes which
incorporate an empowerment/self esteem model, to raise children
and young people's confidence, and develop their social and coping
skills. An holistic approach will also be incorporated in strategic
plans such as DAT.
The Healthy Schools Award is an excellent vehicle
for discussing smoking with young people in the school setting.
However, trying to develop from this specific stop-smoking initiatives
within the school itself is problematic, due to time in the school
curriculum and time and attitudes of professionals.
(b) Cardiac Rehabilitation Services in the
West End Health Resource Centre
Our experience of working with adult smokers
is that holistic programmes dealing with wider problems, eg social,
economic, lifestyle issues, such as exercise, are needed. To do
this, more interventional studies are required to establish what
is good practice. Secondly, more resources are needed. The HAZ
has been enabled to appoint Smoking Cessation Advisers through
special short-term funding. We believe this is essential and such
a service is long overdue. However, the size of the problem is
great and effective support to smokers in their 40s and 50s will
require widespread services, such as those available at the West
End Health Resource Centre. Resources are insufficient at present
to do this.
February 2000
21 Attachments not printed. Back
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