Ayrshire and Arran Tobacco Control Strategy Volume 2 - (Fact File) 2012 2021
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Ayrshire and Arran
Tobacco Control Strategy
Volume 2
(Fact File)
2012 - 2021
“Moving Towards a Smoke Free Ayrshire
and Arran”Contents
Page
1. Introduction 3
2. Demography of Ayrshire & Arran 4 - 10
3. National Policy Drivers 11 - 15
4. Local Policy Drivers 16 - 20
5. Tobacco Related Data 21 - 38
6. Prevention and Education 39 - 43
7. Provision of Smoking Cessation Services 44 - 50
8. Health Protection 50 - 57
9. Stakeholder Involvement 58
10. Performance Management 59
11. Conclusion 60
12. Appendix 1 61 – 65
13. Appendix 2 661. Introduction Facilitating a reduction in the proportion of the population who smoke has been a priority for a number of years, at both a national and local level. The benefits of achieving this reduction are well established, with smoking being described as the number one cause of preventable death in Scotland (Beyond Smoke Free, 2010). In the current financial climate, the incentives and benefits of reducing the number of people who smoke could not be more apparent, with smoking related illnesses costing the NHS around £400 million a year (Scottish Government, 2010). While the financial implications of tobacco make the benefits of reducing smoking rates extremely advantageous, the number of deaths due to smoking related illnesses (13,500 Scots per year, Scottish Government, 2010) and the number of hospital admissions caused by smoking (33,500 admissions per year, Scottish Government, 2010) makes a reduction in tobacco consumption an imperative. This document, aims to provide an overview of the evidence which supports the production and need for the actions outlined in Volume I of the Ayrshire and Arran Tobacco Strategy. This will be achieved by highlighting information on the following key areas: - The demography of Ayrshire and Arran - The national tobacco policy drivers - The local tobacco policy drivers - Tobacco related data - The main approaches to tobacco control - Second Hand Smoke (passive smoking) - Protection and Controls - Stakeholder Involvement - Performance Management. This report will form a crucial part of an evidence base which will be used to inform and drive the work of a multi-agency Tobacco Strategy Group.
2. The Demography and Epidemiology of Ayrshire and Arran
2.1 Ayrshire and Arran is located in mid south central Scotland and is surrounded by
Inverclyde and East Renfrewshire in the North, by Lanarkshire in the East and
Dumfries and Galloway in the South.
Figure 1: Map of NHS Ayrshire and Arran
Source: http://www.scotland.gov.uk/Publications/2007/03/07153942/4
NHS Ayrshire & Arran covers an area of 750,464 square hectares in the south west of
Scotland, from Skelmorlie in the north to Ballantrae in the south and Muirkirk in the east.
The area covers a mix of rural and urban development with an overall population
density of 0.56 people per square hectare, slightly below the national average. Out of
the total population of 367,510 people1, around 80% live in community settlements of
over 500 people.
1
2008 VPS survey2.2 Population profile for Ayrshire and Arran
Ayrshire and Arran is comprised of three locality areas: North, East and South Ayrshire,
which all vary in population size (Figure 2). The mid-year population estimates for 2009
indicate that North Ayrshire has the largest population of 135,510, compared to 120,210
in East Ayrshire and 111,440 in South Ayrshire. Within each of the three areas, there
are more females than males.
Figure 2: Overview of estimated mid year population for East, North and South Ayrshire
and for Scotland, 2009
East North South Scotland
Population size - All 120,210 135,510 111,440 5,194,000
Females 62,065 71,229 57,995 2,678,712
Males 58,145 64,281 53,445 2,515,288
Source: General Register Office of Scotland (GROS) 2010
Based on the mid-2008 population estimates2, the key settlements within Ayrshire and
Arran are:
Irvine (North Ayrshire) 32,920
Kilmarnock (East Ayrshire) 44,390
Ayr (South Ayrshire) 46,070
The age profile for each area in Ayrshire and Arran are similar (Figure 3) with North
Ayrshire having the highest number of individuals in each age group apart from the over
75 age group where the number of people in South Ayrshire is greater. In 2009, there is
a noticeable difference in the population age profiles that can be seen in the oldest age
group (75+), where the number of people in South Ayrshire is greater than that found in
East and North Ayrshire. In all other groups the number of people within East Ayrshire
is greater than South Ayrshire apart from the 55-64 age group where they are both
similar.
Figure 3: The number of people within each age group in East, North and South
Ayrshire, mid-year estimates 2009
2
http://www.gro-scotland.gov.uk/files2/stats/population-estimates/08mye-localities-table1.xls30,000
25,000
Number of Persons
20,000
15,000
10,000
5,000
0
Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75+
Age Group
East Ayrshire North Ayrshire South Ayrshire
Source: General Register Office of Scotland (GROS) 2010
Other settlements with a population of over 10,000 include: Kilwinning, Prestwick,
Troon, Saltcoats, Largs and Ardrossan. Cumnock in the east has a population of just
over 9,000 people. There are also eight settlements with under 1,000 residents.
NHS Ayrshire & Arran boundaries are coterminous with those of the three local
authorities, North, South and East Ayrshire Councils.
2.2 Demography of Ayrshire and Arran
Comparison between the census results of 2001 with that of 1991 indicated a reduction
in the Ayrshire and Arran population of 1.03%, compared to an increase in the national
average of 1.27%. The Voluntary Population Survey (VPS) in 2008 indicated a further
fall of 0.2%.
The population in North Ayrshire has declined by under 0.7% between 1991 and 2008,
while in South Ayrshire, the reduction was 0.9%. Over the same period however, the
population of East Ayrshire has decreased by 2.1%.
Within settlements the changes are even more significant: Comparisons between 1991
and 2001 indicate changes ranging from a 20% reduction in population in Bellsbank and
New Cumnock to a 26% increase in Coylton and a 58% increase in population in
Loans3.
3
http://www.scrol.gov.uk/scrol/analyser/analyser?topicId=1&tableId=&tableName=Usual+resident+population&selectedTopicId=&aggregated=fa2.3 Minority Ethnic population
The 2001 Census4 indicated that the proportion of the population in ethnic minority
groups in Scotland was 2% in comparison to 1.3% in 1991. For Ayrshire and Arran, the
corresponding figures were 0.68% in 2001 in comparison to 0.49% in 1991.
Nevertheless, NHS Ayrshire & Arran has the fifth lowest non European population in
Scotland, with East, South, and North Ayrshire Council areas having the 5-7th lowest
rates among the 32 local authorities.
The largest ethnic groups in Ayrshire and Arran are fairly similar throughout Ayrshire
and Arran’s localities: Chinese (0.18%) and Indian (0.16%). However, there is slight
variation in East Ayrshire compared to the other council areas with an Indian population
of 0.07% compared to a Pakistani cultural population of 0.14%.
NHS Ayrshire & Arran provides documentation and translation in any language, and
interpreters, when required.
2.4 Religious affiliation in Ayrshire and Arran
In the 2001 census, 53% of the population described themselves as being allied to the
Church of Scotland. This level is the third highest of any Health Board area in Scotland.
The proportion of people allied to the Church of Scotland is another confirmation of the
cultural homogeneity of the Ayrshire and Arran population. Slightly over 24% of the
population described themselves as having no religion, the fifth lowest in Scotland.
2.5 Socioeconomics of Ayrshire and Arran
Scottish Index of Multiple Deprivation (SIMD) data, indicates that there are significant
differences in socio-economic status and deprivation levels throughout Ayrshire; with
areas of significantly high poverty close to areas of very low poverty. It is recognised,
furthermore, that most people who are dependent on income related benefits or who are
otherwise socially excluded live out with recognised areas of poverty.
lse&subject=&tableNumber=&selectedLevelId=&postcode=&areaText=&RADIOLAYER=&actionName=view-
results&clearAreas=&stateData1=&stateData2=&stateData3=&stateData4=&debug=&tempData1=&tempData2=&tempData3=&tempData4=&a
reaId=052&areaId=031&areaId=055&areaId=085&areaId=045&areaId=032&areaId=042&areaId=086&areaId=044&areaId=120&areaId=096&
areaId=082&areaId=081&areaId=077&areaId=094&areaId=050&areaId=057&areaId=058&areaId=040&areaId=051&areaId=036&areaId=103
&levelId=9
4
http://www.gro-scotland.gov.uk/files1/stats/key_stats_chareas.pdfFrom the 2009 SIMD data5, there are 480 recognised data zones in Ayrshire and Arran
(out of a Scottish total of 6505). Of these, a total of 28 are in the 5% most deprived
areas of Scotland and another 28 in the 10% most deprived areas. In contrast, there
are three areas in Ayrshire and Arran that are among the 5% least deprived in Scotland
and another 18 in the 10% least deprived6.
Figure 4 displays the significant inequalities between the most deprived areas in
Ayrshire and Arran and the least deprived.
Figure 4: Percentage Population by data zone (%)
Local Authority Area
East North South Ayrshire and Arran
Rate Ayrshire Ayrshire Ayrshire total
5% most deprived 7% 6% 4% 6%
5-10% most
deprived 6% 7% 3% 5%
10-5% most
affluent 2% 1% 8% 4%
5% most affluent 1% 0% 1% 1%
Grand Total 100% 100% 100% 100%
Breaking down the proportion of the Ayrshire and Arran population living within quintiles
1-5 of employment deprivation (using SIMD 2009) (Figure 5).
Figure 5: Ayrshire and Arran total (%) residing in quintiles 1-5 of employment
deprivation
1- least 5- most Total
2 3 4
deprived deprived population
Total population 17% 15% 27% 19% 22% 100%
Working age
population 17% 15% 27% 19% 22% 100%
The employment status domain7 gives an indication of the level of deprivation of people
of working age and shows that a total of 29 zones are in the 5% most deprived areas of
Scotland and another 26 in the 10% most deprived areas (Figure 6). In contrast there
are five zones in Ayrshire and Arran that are among the 5% most affluent in Scotland
and another 18 in the 10% most affluent.
Figure 6: People of economic deprivation by data zone
5
Scottish Index of Multiple Deprivation http://www.scotland.gov.uk/Resource/Doc/289599/0088642.pdf
6
Scottish Index of Multiple Deprivation http://www.scotland.gov.uk/Resource/Doc/933/0090601.xls
7
http://www.scotland.gov.uk/Topics/Statistics/SIMD/background4employment2009SIMD Local Authority Area
Employment East North South Ayrshire and
Domain Rank Ayrshire Ayrshire Ayrshire Arran total
5% most deprived 10 13 6 29
5-10% most
deprived 7 16 3 26
10-5% most
affluent 4 5 9 18
5% most affluent 1 2 2 5
Grand Total 154 179 147 480
In total, 15% of the population of North Ayrshire, 14% of the population of East Ayrshire
and 12% of the population of South Ayrshire are employment deprived (Figure 7). The
highest levels being within the most deprived data zones in Ardrossan, Irvine,
Kilmarnock (Altonhill South, Longpark and Hillhead), and Ayr (Lochside, Braehead and
Whitletts). The areas with the lowest level of employment deprivation were in the most
affluent data zones in Stewarton East, Largs and Ayr (Alloway and Doonfoot).
Figure 7: Percentage of working age population who are employment deprived within
identified data zones
SIMD Local Authority Area
Employment East North South Ayrshire and Arran
Domain Rank Ayrshire Ayrshire Ayrshire total
5% most deprived 32% 34% 32% 33%
5-10% most
deprived 26% 74% 26% 41%
10-5% most
affluent 3% 3% 3% 3%
5% most affluent 2% 3% 2% 2%
Grand Total 14% 15% 12% 14%
21% of East Ayrshire, 22% of North Ayrshire and 16% of South Ayrshire are defined as
Income Deprived. The level of income deprivation range from 70% (Kilmarnock) and
66% (Ayr) – the most deprived, to 1% (Kilmarnock) and 2% (Ayr) - the least deprived8.
This information on the demographics of Ayrshire and Arran highlights the significant
levels of economic and multiple deprivation. The inequalities between the most affluent
and most deprived are striking, demonstrating the need to continue targeting those
living in the most deprived areas in the attempt to reduce health inequalities.
8
http://www.scotland.gov.uk/Resource/Doc/933/0090944.xlsFor additional information on the socioeconomics of Ayrshire 7 Arran, please see appendix 1.
3. National Tobacco Policy Drivers
The drive for a reduction in the consumption of tobacco has been widely supported
across the political landscape of Scotland since devolution. Successive governments
have recognised the economic and health related benefits that can be reaped from a
reduction in Scotland’s high smoking rates.
3.1. ‘A Breath of Fresh Air for Scotland’ (Scottish Executive, 2004) was the first tobacco
strategy introduced to Scotland. This outlined Scotland’s ambitions and commitments
for the reduction in tobacco consumption, providing an action plan which covered
prevention and education, protection and controls and the expansion of smoking
cessation services. This document committed ring fenced monies for smoking
cessation services up to 2008, which was subsequently extended to 2011. ‘A Breath of
Fresh Air for Scotland’ also addressed passive smoking, highlighting the impact that
smoking in public places has on the publics’ health. This document paved the way for
the ‘Smoking, Health and Social Care (Scotland) Act’, by actioning a public consultation
on the impacts of a ban on smoking in public places, an act that was passed in 2005.
3.2. The Smoking, Health and Social Care (Scotland) Act (2005) prohibits smoking in
enclosed spaces with a few exemptions. These include designated rooms in residential
accommodation, adult hospices or designated laboratory rooms. An extensive
evaluation measured the outcomes of the smoking ban in terms of; compliance with the
legislation; secondhand smoke exposure; smoking prevalence and tobacco
consumption; tobacco-related morbidity and mortality; knowledge and attitudes; socio-
cultural adaptation; economic impacts on the hospitality sector; and health inequalities
(Haw, 2010). This evaluation outlined the benefits of this legislation and showed that as
a result, there had been;
a 17 per cent reduction in heart attack admissions to nine Scottish hospitals.
This compares with an annual reduction in Scottish admissions for heart attack of
3 per cent per year in the decade before the ban
a 39 per cent reduction in second hand smoke exposure in 11-year-olds and in
adult non-smokers
an 86 per cent reduction in secondhand smoke in bars
an increase in the proportion of homes with smoking restrictions
no evidence of smoking shifting from public places into the home
high public support for the legislation even among smokers, whose support
increased once the legislation was in place.
This act has clearly benefited the health of the nation and acts as support for continued
investment in smoking prevention and control measures.
3.3. In 2006, ‘Towards a Future Without Tobacco: The Report of the Smoking
Prevention Working Group’ was published by the Scottish Executive. This report
provided key recommendations which aimed to protect and dissuade all young people
in Scotland from starting to smoke and to deter adults from encouraging or enablingthem to smoke. The report makes 31 separate recommendations - summarised within
the report on pages seven to ten - to protect or dissuade young people from starting to
smoke and to deter adults from encouraging or enabling them to smoke. These
recommendations are grouped under the broad headings of targets, research, reducing
availability, discouraging young people from smoking, encouraging and enabling young
regular smokers to stop, and making it happen. The working group conducted a
thorough investigation of smoking related issues and provided a strong evidence base
for action. The recommendations from this working group formed the basis for
Scotland’s smoking prevention action plan, described below.
3.4 Scotland’s Future is Smoke-Free: A Smoking Prevention Action Plan (2008)
Highlights the Scottish Governments strategic objective for a healthier Scotland which
states that, ‘We will help people to sustain and improve health, especially in
disadvantaged communities, ensuring better, local access to health care’ (Scottish
Government, 2008). The actions being taken to discourage young people from smoking
as recommended by the Smoking Prevention Working Group tie in closely with this
objective. The actions are compiled under five headings – Health Education and
Promotion, Reducing the Attractiveness of Tobacco Products, Reducing the Availability
of Tobacco Products and Reducing the Affordability of Tobacco Products.
- Health Education and Promotion – This section describes the actions currently
underway that aim to raise awareness of the dangers of smoking, including
smoking education within schools, national media campaigns and activities
undertaken by NHS boards as part of their tobacco control programmes. Health
education and promotion also includes Schools (Health Promotion and Nutrition)
Scotland Act 2007 which ensures that health promotion has a central and
continuing focus in education. Actions included in this section include developing
advice, guidance and proposals aimed at helping schools and authorities to
achieve the benefits sought through Curriculum for Excellence, Scotland’s
curriculum for 3-18 year olds.
- Reducing the Attractiveness of Tobacco Products – This section highlights and
addresses the influence that marketing and promotion of tobacco products has
on consumers. It outlines the restrictions on tobacco marketing that had already
been introduced, including televisual, press and billboard advertising along with
the introduction of hard hitting health warnings on all cigarette packs. This
section then highlights further action includes the restriction of displaying tobacco
products at the point of sale, the desirable move to plain packaged tobacco
products and recommends to all agencies in contact with children to enforce a no
smoking policy in all areas frequented by children e.g. playgrounds.
- Reducing the Availability of Tobacco Products – The Scottish Government plans
to work closely with the Convention of Scottish Local Authorities (COSLA) and
Local Authorities to ensure a stricter enforcement of tobacco control laws. Along
with this, a system of licensing is proposed to make tobacco enforcement
procedures more robust.
- Reducing the affordability of tobacco products – It is well established that
reducing the affordability of tobacco products results in a marked decrease in
tobacco consumption. It is made clear that the Scottish Government will
continue to encourage the UK Government to continue using taxation of tobaccoproducts as a tool to lower tobacco consumption. It is explained that the Scottish
Government will also work closely with Her Majesties Revenue and Customs to
reduce illicit sales of tobacco products in Scottish communities.
The smoking prevention action plan goes on to explain how these actions will be
implemented. The Scottish Ministerial Working Group on Tobacco Control oversees the
implementation of this action plan and an additional £1.5m was allocated to NHS Health
Boards to support the implementation of this action plan. The evaluation of this action
plan is included in the wider tobacco control research and evaluation programme for ‘A
Breath of Fresh Air for Scotland’.
3.5. In 2010, A guide to smoking cessation in Scotland was produced by Action on
Smoking & Health Scotland (ASH Scotland), NHS Health Scotland, The Royal College
of General Practitioner and the Scottish Government. The purpose of this guide is to
inform NHS policy and practice in smoking cessation by bringing together up-to-date,
evidence-informed, advice on helping people to stop smoking. This guide is split into
two components. The first component acts as a guide for health and health related
practitioners, providing an outline of the importance of brief interventions in helping
people in Scotland to stop smoking as well as highlighting the pathway for smokers
quitting. The second component acts as a guide for strategic approaches to smoking
cessation and is more applicable to tobacco policy makers. This follows on from the
smoking cessation guidelines and the smoking cessation update.
3.6. The Curriculum for Excellence aims to achieve a transformation in education in
Scotland by providing a coherent, more flexible and enriched curriculum from 3 to 18
years old. The curriculum includes the totality of experiences which are planned for
children and young people through their education, wherever they are being educated.
Curriculum for Excellence explains that the health and wellbeing framework are the
responsibility of all adults, working together to support the learning and development of
children and young people. The health and wellbeing framework included in Curriculum
for Excellence begins with describing features of the environment that will nurture and
support the health and wellbeing of children and young people. It stresses the
importance of delivering health information early in life because these lessons are
applicable throughout life. The need for positive and productive partnership working in
developing effective tobacco prevention measures is made explicit.
3.7. The competencies required to give brief advice and in providing specialist support
were outlined in the Scottish National Training Standards: Stop-Smoking Support, 2003,
updated in 2004, 2007 and 2009. The Smoking Cessation Training Standards were
produced to ‘enhance the consistency and quality of all smoking cessation work across
Scotland’, and these were reflected in the local competency requirements of Ayrshire
and Arran’s smoking prevention and cessation team (Fresh Air-Shire). The training
standards outline the skills and knowledge that would be gained by participants on
completion of courses.
These were specified at different levels:A training for brief advice
B training for an introduction to stop smoking support
C part one training for specialist stop smoking support
D part two for specialist stop smoking support
3.8. State of the Nation: measuring progress towards a tobacco free Scotland (2010) –
This document, produced by ASH Scotland, reviews key targets set by the Scottish
Government in working towards a tobacco free society. Using the same format as the
government’s ‘Scotland Performs’1 assessments, it shows what we have achieved, and
what more there is to do.
3.9. A HEAT (Health Improvement, Efficiency, Access and treatment) health
improvement target was set for smoking cessation which required that each NHS
Board should,’ through smoking cessation services, support 8% of each Board’s
smoking population to successfully quit (at one month post quit) over the period 2008 -
11.
Nationally, targets for tobacco were set within ‘Towards a future without tobacco’, these
targets are:
Reduce the prevalence of smoking among adults (16+) in Scotland from 26.5%
(2004 baseline) to 22% by 2010-11-15.
Reduce the percentage of women who smoke during pregnancy from 29 %
(1995 baseline) to 20% by 2010.
Reduce the prevalence of regular smoking among 13 year old girls (defined as
smoking one or more cigarettes per week) form 5% (2006 baseline) to 3% in
2014 and among 13 year old boys from 3% to 2%.
Reduce the prevalence of regular smoking among 15 year old girls (defined as
smoking one or more cigarettes per week) from 18% in 2006 to 14% in 2014,
and among 15 year old boys from 12% to 9%.
Reduce the prevalence of smoking among 16 to 24 year olds from 26% ( 2006
baseline) to 22.9% in 2012.
3.10. In England, the National Institute for Clinical Excellence (NICE) produced a
guideline for smoking cessation services in primary care, pharmacies, local authorities
and workplaces. The guidance is for NHS and other professionals who have a direct or
indirect role in – and responsibility for – smoking cessation services. The document
lists four recommendations that have been identified as key priorities for
implementation, on the basis of: impact on health inequalities, impact on health of the
target population, cost effectiveness, balance of risks and benefits, ease of
implementation, speed of impact. Other NICE guidelines relating to tobacco include
‘Brief interventions and referrals for smoking cessation’ and the soon to be published
‘Smoking cessation services for people using smokeless tobacco’.4. Local Policy Drivers
Key Strategy Documents
The ultimate aim of NHS Ayrshire & Arran’s Tobacco Strategy and Local Tobacco
Control Action Plan 2006- 20109 was that ‘Ayrshire and Arran can live smoke-free and
have access to support to realise this ambition’. It aimed to achieve this through:
Working in partnership with an holistic approach to ensure that an integrated
approach is adopted to address tobacco prevention, control and cessation issues
Sustaining the continuing downward trend in smoking rates through targeted
action in communities and nationally identified target groups to reduce the impact
that smoking has in contributing to health inequalities
Reducing the impact of passive smoking by supporting the introduction of the
ban on smoking in enclosed public spaces and through raising awareness of its
harm and reducing contact of non-smokers to smoke in private spaces
Supporting the continued implementation of tobacco control measures.
The key publications underpinning the direction and targets of the action plan were ‘A
Breath of Fresh Air for Scotland’10, Reducing Smoking and Tobacco Related Harm: A
Key to Transforming Scotland’s Health11 and Towards a Healthier Scotland12 (4).
These papers highlighted four fundamental areas that were essential for an effective
tobacco strategy to focus on:
1) Prevention and Education (particularly aimed at young adults)
2) Provision of Smoking Cessation Services (aimed at adults including pregnant
mothers)
3) Passive Smoking (raising awareness)
4) Protection and Control (particularly around educating and preparing for the ban
on smoking in public places)
NHS Ayrshire & Arran’s Tobacco Strategy and Local Tobacco Control Action Plan 2006-
2010 developed actions in each of these key areas aiming to ‘develop a clear and
concise, phased local plan of action which is outcome focused, evidence based and
robustly monitored and evaluated’ (NHS Ayrshire & Arran , 2006). A new national
action plan to guide local tobacco work is due to be released by the Scottish
Government in 2011. This will build on the previous action plan and aims to provide a
comprehensive tobacco prevention action plan to tie in with local strategies such as the
9
Tobacco Strategy and Local Tobacco Control Action Plan 2006-2010 (2006) NHS Ayrshire and Arran
10
A Breath of Fresh Air for Scotland- Improving Scotland’s Health: The Challenge Tobacco Control Action Plan (2004) The Scottish
Government: Edinburgh.
11
Reducing Smoking and Tobacco Related Harm: A key to transforming Scotland’s Health (2003). NHS Scotland and ASH
Scotland, Edinburgh
12
Towards a Healthier Scotland: A White Paper on Health (1999) Great Britain. Scottish Office. Dept. of HealthNHS Ayrshire & Arran Tobacco Strategy. In anticipation of this Tobacco Control
Strategy, Action on Smoking and Health (ASH) has produced recommendations for
what should be included13. The recommendations maintain the four key themes
previously used and break down the objectives into short, medium and long term ones.
In Spring 2011 the Scottish Government is also due to release guidelines for mental
health service providers to assist them in achieving smoke-free mental health services14
and this is likely to for a key objective for the new strategy in Ayrshire and Arran.
HEAT Targets
The HEAT target for Ayrshire and Arran requires that 6201 smokers should have
achieved a four week quit over the period April 2008 to March 2011. At September
2010, Ayrshire and Arran had achieved 76% (4713) of the 4 week quits required to meet
the target.
A new HEAT target has been set for the three year period following the end of March
2011. This target will have a greater emphasis on achieving 60% of 4 week quits from
the most deprived areas. This target has been balanced by a lower overall target of
7.5% of the smoking population to have a 4 week quit. For Ayrshire and Arran this will
require 5907 quits to be achieved over this period, of which 3544 should be from the
40% most deprived areas.
Business Plans
NHS Ayrshire & Arran’s Public Health Department delivers action in response to an
annual business plan15 and the organisations Health Improvement Work Programme16.
This is an organisation wide plan. Actions in relation to tobacco is contained in both
plans. These plans are key drivers for this tobacco strategy and all of the actions within
the strategy must compliment these plans.
Some of the main actions relating to tobacco in the Health Improvement Work
Programme are:
- Targeting interventions at specific groups (young women, pregnant
women, looked after and accommodated young people, people with
mental health problems, people with sensory impairment and/ or
learning disability, deprived communities, homeless, prisoners)
- Prevention Programmes targeting the most vulnerable groups
13
Beyond Smoke free: Recommendations for a Scottish Tobacco Control Strategy (2010) ASH Scotland, Edinburgh
14
http://www.scotland.gov.uk/Topics/Health/health/Tobacco
15
Public Health Department Business Plan: 1st April 2010- 31st March 2011 (2010) Public Health Department, NHS Ayrshire and
Arran
16
14 NHS Ayrshire and Arran Population Health Work Programme 2009-2012 Version6.0 (2010) Public Health Department, NHS
Ayrshire and Arran- Delivering training programmes to build capacity within NHS
communities and other organisations to deliver smoking cessation
support and prevention approaches
- Provide cessation support in a range of settings (NHS, communities,
prison, homeless accommodation, educational establishments and
workplaces)
The annual business plan breaks the actions into what is expected to be achieved in the
year to come in line with current HEAT targets as well as focusing on policy and
strategy development as well.
SOAs and Partnership working
Ayrshire and Arran’s public health work relies on effective partnership working with the
three local authorities and other agencies. It is crucial that the aims and objectives of
the local authorities parallel those of the tobacco strategy. Figure 9, below shows each
Community Planning Partnership’s targets in relation to health and how smoking levels
will be monitored to ensure local work is in line with the National Objective.
Figure 9 – SOA outcomes/indicators associated with tobacco
Relevant Locality Relevant Local Relevant Data Source
National Outcome Indicator(s)
Outcome
‘We live North Health and well- - Percentage of - North Ayrshire
longer, Ayrshire being smokers aged People’s Panel
healthier throughout life 16 years and Survey Report
lives’ have improved over - Scottish Schools
Adolescent
- Percentage of Lifestyle and
15 year olds Substance Use
who are regular Survey
smokers - Smoking at
Booking
- Percentage of
women smoking
during
pregnancy
East Health and well - Percentage of - East Ayrshire
Ayrshire being of the adults smoking Community
local population Planning Residents’
improved Survey
South People in South - Smoking - East Ayrshire
Ayrshire Ayrshire enjoy Prevalence in Community
the best Adults Planning Residents’
possible health Surveythroughout
their lives
(Sources: http://www.north-
ayrshire.gov.uk/Documents/CorporateServices/ChiefExecutive/CommunityPlanning/SOA%20-%20Part%202%20-
OutcomesandIndicators.pdf,
http://www.eastayrshirecommunityplan.org/portal.asp?P_ID=32&URL=/cats/Single%20Outcome%20Agreement/SOA
%20Archive%20Documents/Final%20SOA%20Appendix%201.pdf and http://www.south-
ayrshire.gov.uk/documents/SingleOutcomeAgreement2009-12.pdf)
As can be seen each local authority includes lowering the level of smoking in their area
as a target within their SOAs to achieve the national outcome relating to health.
Test Purchasing
Each Local Authority’s Trading Standards Department in Ayrshire and Arran now adopts
test purchasing to establish if local retailers are selling tobacco products to under-age
customers in order to reduce the accessibility of tobacco products to young
people17,18,19. East Ayrshire council found their test purchasing programme was very
successful and out of the 39 retailers tested under 8% resulted in illegal sales in 2008-
09. This percentage was amongst the lowest of any council in Scotland carrying out
test purchasing23. South Ayrshire council used test purchasing and advisory visits and
carried out 42 test purchases resulting in 12 illegal sales in 2008-0924. The success of
the programmes has encouraged both councils to continue test purchasing for tobacco
products and to use this technique for testing illegal sales of fireworks.
Smoking Policies
As described in section 3.2, in March 2006, the Smoking, Health and Social Care
(Scotland) Act 2005 came into effect banning smoking in public places and guidance for
businesses was published in 2005 to assist them with planning for this change 20. NHS
Ayrshire & Arran has developed have developed smoking policies in line with this
legislation, as have the three of Ayrshire and Arran’s Local Authorities. Guidance in
developing these policies was provided from a national level in the document ‘Smoke-
free Scotland: Guidance on smoking policies for the NHS, local authorities and care
service providers’.
The Healthy Working Lives Award Scheme is a national programme that assists and
encourages employers to ‘implement a smoking policy and provide access to smoking
cessation support’ as part of their most basic award criteria. It also encourages
employers to develop the policy through consultation with employees. The Scottish
17
http://www.north-ayrshire.gov.uk/BusinessAndTrade/TradingStandards/TradingStandards-
InspectionTestingAndEnforcement/TradingStandards-UnderAgeSales.aspx
18
http://www.east-ayrshire.gov.uk/corpres/ppr/ppr2008-09.pdf
19
www.south-ayrshire.gov.uk/documents/?file=Trading%20Standards%20Activity%20Report%202008-09.pdf
20
Helping to get your business or organisation ready for the new law on smoking: A guide for employers, managers and those in
control of premises, published by the Scottish Executive(2005)Public Pensions Agency and British Gas are two examples of businesses who hold this award21. More information on smoking policies can be found in section 7.2. Local Strategies NHS Ayrshire and Arran’s Draft Maternity Strategy 2010-2015 sets out the actions of the maternity service, along with key outputs22. One of these outputs is ‘the maternity service will ensure that mothers, partners and babies are supported to adopt healthy lifestyles’ and in order to achieve this one of the actions in place for maternity services is to make onward referrals to smoking cessation services for pregnant women who smoke so this action crosses over with the aims of the tobacco strategy for NHS Ayrshire and Arran. Other local strategies that include tobacco actions are the Child Health Strategy, Health and Homelessness Strategy and Towards a Mentally flourishing Ayrshire and Arran. NHS Ayrshire & Arran Strategic Objectives - The Strategic Objectives of NHS Ayrshire and Arran are the key drivers for developing and improving the organisation. These should be considered throughout the development and implementation of the Ayrshire and Arran Tobacco Strategy. The strategic objectives of NHS Ayrshire & Arran can be seen in appendix 2. 21 http://www.healthyworkinglives.com/award/criteria.aspx#checklist 22 http://www.nhsayrshireandarran.com/uploads/7295/Paper02app1.pdf
5. Tobacco Related Data 5.1 Epidemiology of Smoking in Scotland The data presented in this section are taken from the Scottish Household Survey. This survey is designed to provide accurate, up-to-date information about the characteristics, attitudes and behaviour of Scottish households and individuals on a range of issues. The Scottish Health Survey uses a large data pool, when compared to the local profiles provided earlier in this document. Local profiles are still useful for providing data at a postcode level. Data from the Scottish Household Survey show a downward trend in Scottish smoking rates. At present, 24.3% of adults over the age of 16 years in Scotland are smokers (Figure 10), and there are slightly more men (26%) than women that smoke (23%)23. There appears to be a gradual decrease in the number of adults reporting that they smoke between 1999 and 2009 in Scotland (Figure 10). 23 Scottish Government. Scotland’s People – Annual Report: results from 2009 Scottish Household Survey. 2010.
Figure 10: Percentage of adults in Scotland that smoke by year
120
100
80
% of adults
69.3 70.7 71.2 71.6 71.9 73.1 73.3 74.6 74.3 74.8 75.7
60
40
20
30.7 29.3 28.8 28.4 28.1 26.9 26.7 25.4 25.7 25.2 24.3
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Yes No
Source: Scottish Government. Scotland’s People – Annual Report: results from 2009 Scottish Household Survey.
2010.
Younger people are more likely to smoke than those over 60, and there are more young
men that are smokers than young women. Smoking prevalence is highest in males in
the age group 16-59. There is a reduced smoking prevalence in people aged between
60 – 74 years of age, where the proportion of smokers is down to 1 in 5. This is further
reduced to slightly over 1 in 10 in the 75 and over age group15 (Figure 11).Figure 11: Percentage of adults in Scotland that smoke by age group
35
33
32
30
28
27 27
26 26
25
% of adults that smoke
25
23 23
20
20
17
15
11
10
10
5
0
16 to 24 25 to 34 35 to 44 45 to 59 60 to 74 75 plus All
Age group
Male Female
Source: Scottish Government. Scotland’s People – Annual Report: results from 2009 Scottish Household Survey.
2010.
If the Scottish data are compared to the figures for Ayrshire and Arran (Figure 12), this
decrease is also observed in the East and South Ayrshire figures; however, both
noticed a rise in the 2003/2004 reporting period. During this period (2003/4), East
Ayrshire had the third highest smoking rate of any other council area in Scotland24. The
number of adults that smoke in North Ayrshire decreased from 1999 – 2004; however,
from 2005 – 2008 the numbers have increased.
24
NHS Health Scotland, ISD Scotland and ASH Scotland. An atlas of tobacco smoking in Scotland
(2007). Edinburgh: NHS Health Scotland.Figure 12: Percentage of adults that smoke in Scotland and the localities of Ayrshire
and Arran, 1999-2008
% of adult % of adult % of adult % of adult
population population population population
Year
smoking in smoking in smoking in smoking in
Scotland East Ayrshire North Ayrshire South Ayrshire
1999/2000 30 33 32 26
2001/2002 28 28 25 22
2003/2004 27 35 25 29
2005/2006 26 26 27 26
2007/2008 25 25 31 21
Source: Scottish Government. Scotland’s People – Annual Reports: results from the Scottish Household Surveys
(1999-2008). http://www.scotland.gov.uk/Publications
The local smoking data extracted from the GP data system (GPASS) from 1999 to 2009
show that East and North Ayrshire have higher adult smoking rates than South Ayrshire
(Figure 13). These data are based on those being recorded as a smoker by their
General Practitioner. A limitation of these data is that it depends on self reporting from
patients and will not account for populations who are not registered with a GP. It is also
apparent that in the year 2007/8, South Ayrshire has a lower smoking prevalence than
the national average, East Ayrshire has the same smoking prevalence as the Scottish
average and North Ayrshire has a higher smoking prevalence.Figure 13: Percentages, at 1 Jan 1999, 2004 and 2009 of patients in Ayrshire and
Arran who are smokers among all patients with smoking status recorded by their GPs,
by CHP area (51 of 59 local practices)
Sourc
Percentage of patients recorded by GPs as smokers
40.0% e: GP
surgeri
35.0% es in
Ayrshi
re and
30.0%
Arran
utilisin
25.0% g
GPAS
20.0% S (51
out of
59
15.0%
surgeri
es)
10.0%
5.0%
Toba
0.0% cco
1999 2004 2009
use
East Ayrshire 35.6% 31.8% 27.6%
has
North Ayrshire 34.8% 32.7% 28.2%
been
South Ayrshire 30.8% 28.5% 24.9%
incre
asingly associated with social disadvantage. In lower socio-economic and
disadvantaged groups, smoking is recognised as a major contributor to health
inequalities. The percentage of adults that smoke by economic status is shown in
Figure 14. The adults that are unable to work due to short term ill-health (59%) most
commonly smoke; this is followed by adults that are unemployed and seeking work
(51%), and those that are permanently sick or disabled (48%). The group that least
commonly smoke are those at school (3%), followed by those permanently retired from
work (16%) and those in higher/further education (16%).Figure 14: Percentage of adults in Scotland that smoke by economic status
70
59
60
51
% of adults that smoke
50 48
40
36
30
24 24 24
22
20
16 16
10
3
0
0
employment
employment
Self employed
Unemployed and
Permanently sick
retired from work
Higher/further
Other
Looking after
due to short term
All
At school
home/family
Unable to work
Part time
Full time
seeking work
education
Permanently
or disabled
ill-health
Source: Scottish Government. Scotland’s People – Annual Reports: results from the Scottish Household Surveys
(1999-2008). http://www.scotland.gov.uk/Publications
Despite the downward trend in Scottish smoking rates, data show that smoking rates
are highest in areas of deprivation. There is a link between deprivation and smoking
rates from the 10% most deprived to the 10% least deprived with more adults in the
most deprived areas reporting that they smoke (Figure 15).
Compared to the rest of Scotland, adults in the 15% most deprived areas (41%) are
more likely to report that they are current smokers, compared to 21% in the rest of
Scotland. It is important to highlight that this can increase health inequalities and
suggests a focus of resources in these deprived communities.Figure 15: Percentage of adults in Scotland that smoke by Scottish Index of Multiple
Deprivation centile
50
45 43
41
40
36
35
% of adults that smoke
31
30 28
25
25 24
22
21
20
20
17
15 13
10 9
5
0
15% Rest of 10% 2 3 4 5 6 7 8 9 10% All
most Scotland most least
deprived deprived deprived
Source: Scottish Government. Scotland’s People – Annual Reports: results from the Scottish Household Surveys
(1999-2008). http://www.scotland.gov.uk/Publications
5.2 Local smoking prevalence
Service user demographics
In 2009, a total of 3090 clients living in Ayrshire and Arran were in contact with local
smoking cessation services. This section presents a demographic analysis of these
clients.
Area of residence
Analysis by Community Health Partnership (CHP) area shows that the majority of
clients were from East and North Ayrshire (Figure 16).Figure 16: Percentage of smoking cessation clients by CHP area, 2009
22.9%
32.1%
East Ayrshire
North Ayrshire
South Ayrshire
44.0%
Gender
In 2009, 61.7% of clients were women and 38.3% were men.
Age
The peak age of clients in 2009 was 35 to 44 years (Figure 17). This age group
accounted for approximately 1 in 4 clients. The next two groups that were well
represented was the 45 to 54 years age group with slightly under 1 in 5 clients, followed
by the 25 to 34 years age group (over 1 in 5 clients). The under 16 and 75 years and
over age groups were less well represented.Figure 17: Age of clients using local smoking cessation services in Ayrshire and Arran,
2009
800
752
700
654
600 572
Number of clients
500
454
400
310
300
254
200
100
34 39
0
Under 16 16 – 24 25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 75 +
Age group of clients
Ethnicity
In 2009, 91.4% of clients were white; the vast majority of these (83.9%) were ‘White:
Scottish’. Two clients (0.06%) reported their ethnicity as ‘Asian: Pakistani’, one client
(0.03%) as ‘Asian: Indian’, one client (0.03%) as ‘Other ethnic group: Arab’, 253 (8.2%)
clients as ‘unknown’ and two clients (0.06%) as ‘other’. Eight clients (0.3%) did not
disclose their ethnicity.
Employment status
Almost one fifth (19.9%) of smoking cessation service clients in 2009 were unemployed
(n=615), while 44% were in paid employment (n=1360).
Of the unemployed clients, nearly half (47.6%) were from North Ayrshire, almost a third
(31.5%) were from East Ayrshire, and 20.2% were from South Ayrshire25.
25
The CHP area status of two unemployed clients (0.3% of total sample) was unknown and two clients were
from outside Ayrshire and Arran.The employment status of the other clients was as follows:
Full time student (n=113)
Homemaker/full time parent or carer (n=127)
Permanently sick or disabled (n=127)
Retired (n=408)
Other (n=97)
Unknown (n=238)
Not given (n=5)
Service Utilisation
In 2009, 79% of smoking cessation clients used pharmacies, while the remaining 21%
used specialist smoking cessation services.
Among all clients utilising pharmacies (n=2,440), 1,114 (45.7%) used services in North
Ayrshire, 784 (32.1%) used services in East Ayrshire, and 530 (21.7%) used services in
South Ayrshire. This reflects where people live (see Figure 16 above).
Among specialist services utilised, those with more than 10 clients were as follows:
- North Ayrshire CHP (n=240)
- East Ayrshire CHP (n=243)
- South Ayrshire CHP (n=87)
- Crosshouse Hospital (n=15)
- Toll Pharmacy Pilot (n=30)
- Workplace – NHS (n=10)
- Unspecified (n=15).
Specialist services with under 10 clients each, included Ailsa Hospital (n=2), Ayr
Hospital (n=4), Ayrshire Central Hospital (n=1), Biggart Hospital (n=1) and a specialist
group from mental health service MHNA (Mental Health Needs Assessment) (n=2).
There are higher numbers of clients aged 34 to 64 years using the specialist services
compared to younger clients (under 34 years) and older clients (65 years and over)
(Figure 18). There are more females (59.7%) using the specialist services than males
(40.3%).Figure 18: Percentage of clients using specialist services by age group, 2009
180
164
159
160 150
140
120
Number of clients
100
84
80
58
60
40
24
20 11
0
0
Under 16 16 -24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 +
Age group of clients (years)
Daily cigarette consumption
Overall daily smoking pattern
In 2009, the majority (46.8%) of clients in contact with smoking cessation services
smoked between 11 and 20 cigarettes per day, and 30.4% of clients smoked between
21 – 30 cigarettes per day. The percentage of heavy smokers (>30 cigarettes per day)
was 12.3% and light smokers (10 or less cigarettes per day) was 10.5%. The numbers
are given in Figure 19.
Figure 19: Percentage of clients by number of cigarettes smoked, 2009
Number of cigarettes Number of clients Valid percent
smoked in a day
10 or less 321 10.5%
11 – 20 1436 46.8%
21 – 30 931 30.4%
More than 30 378 12.3%
Total 3066 100%
Unknown or missing 24
Total 30905.3 Tobacco related mortality and morbidity Tobacco is known to cause a wide range of diseases, most commonly those affecting the heart and lungs, and to be responsible for around 24% of all deaths in Scotland. Smoking is a major independent risk factor for coronary heart disease, including heart attacks, cerebrovascular disease (stroke), chronic obstructive pulmonary disease and cancer (notably those of the lung, mouth, larynx and pancreas). The effects depend on how much someone smokes, for how long and what type of tobacco product –with high tar content and unfiltered cigarettes causing disease most frequently. The World Health Organisation estimated that tobacco caused 5.4 million deaths worldwide in 2004. In Ayrshire and Arran in 2000-04, smoking accounted for 25% of male deaths and 22% of female deaths in people aged 35 and over, and it was estimated that people aged 35- 69 years were dying 21 years earlier through smoking related illnesses.26 However the life expectancy gap between smokers and never-smokers is greater than the gap between the higher and lower social classes27 Non-smokers can also be affected by passive smoking, which is associated with lung cancer, asthma, and chronic pulmonary and heart disease. Stopping smoking completely at any age reduces the risk of premature death. 5.3.1 Coronary heart disease Data for coronary heart disease and lung cancer are presented here as the highlighted causes of morbidity and mortality from tobacco. Coronary heart disease (CHD) and lung cancer cause the largest number of deaths, with around 20% of CHD deaths in people aged less than 75 years attributed to smoking28. Figure 20 shows the trend in coronary heart disease mortality, with the decline due in large part to reductions in smoking prevalence. From 1995 to 2010 the overall percentage decrease is 62.7% whilst the gender differences are marked and reflect the national picture, with men experiencing higher mortality rates from CHD. The reduction in the mortality rate for women over the period is 70.8% and for men 59.9%. 26 NHS Health Scotland, ISD Scotland and ASH Scotland. An atlas of tobacco smoking in Scotland (2007). Edinburgh: NHS Health Scotland. 27 Tobacco smoking in Scotland: an epidemiological briefing (2008) NHS Health Scotland 28 Smoking and tobacco statistics factsheet (2007). ASH Scotland
Figure 20 Coronary heart disease mortality rates in people aged under 75 years, NHS
Ayrshire & Arran, 1995-2010
200.0
180.0
160.0
140.0
Rate per 100,000 Population
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male European Age Standardised Rate of Mortality
Female European Age Standardised Rate of Mortality
Source: www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/Mortality/
There has been a 30% decline in incidence rate of coronary heart disease over the past
decade (Figure 21). The incidence rate is the number of new cases (hospital
admissions or deaths with no previous hospital admission for CHD in the previous
decade) per 100,000 population.Figure 21 New cases of coronary heart disease in people aged under 75 years, NHS
Ayrshire and Arran and Scotland, 2001-2010
450
400
Standardised rate per 100,000 pop'n
350
300
250
200
150
100
50
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Males Females Both Sexes Scotland both sexes
Source: www.isdscotland.org/Health-Topics/Stroke/Topic-Areas/Incidence/
Figure 22 shows estimated prevalence of CHD in males by geographic locality within
Ayrshire and Arran. East Ayrshire has the highest prevalence of CHD for males aged
45-64 years at 6.3% and for males aged 65-74 years at 18.0%. The rate per 100 for
males aged 45-64 in North and South Ayrshire is 5.7 and 5.4 respectively however
Scotland has a lower rate at 5.3. The pattern for 65 -74 year old males in North and
South Ayrshire and Scotland is similar to the 45-64 year olds with North Ayrshire slightly
higher.
Figure 23 shows that East Ayrshire has the highest prevalence of CHD for females
aged 45-64 at 2.9% and for females aged 65-74 at 9.6%. The lowest rates for females
aged 45-64 are the Scotland and South Ayrshire rates at 2.3% with the North Ayrshire
rate at 2.6%. North Ayrshire has the lowest CHD prevalence rate for women aged 65 -
74 years old at 8.1%, the Scotland rate is 8.3% and the rate for females in South
Ayrshire in this age group is 8.6%.
Coronary heart disease remains a major cause of illness and death for the population of
Ayrshire and Arran.Figure 22 Coronary heart disease estimated prevalence for males by CHP locality,
2007
20
18
Crude prevalent rate per 100 pop'n
16
14
12
10
8
6
4
2
0
Males aged 45-64 Males aged 65-74
East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP Scotland
Source: www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/Prevalence/
Figure 23 Coronary heart disease estimated prevalence for females by CHP locality,
2007
12
10
8
Crude prevalent rate per100 pop'n
6
4
2
0
Females aged 45-64 Females aged 65-74
East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP Scotland5.3.2 Lung cancer
In people over the age of 35 years, smoking is responsible for 90% of lung cancer
deaths. The risk of developing lung cancer is higher, and the probability of surviving
lung cancer is lower, among people living in areas of socioeconomic deprivation29.
Figure 24 shows that Ayrshire and Arran is highest in Scotland in the number of deaths
from lung cancer for both males and females, and sits at second out of the 14 health
boards for the incidence of lung cancer. More than 4,000 deaths a year are attributed to
lung cancer and whilst the rates are declining in men – by almost 15% in the past
decade – rates in women continue to rise, reflecting more recent smoking behavioural
trends.
In the period 1985 to 2010, the mortality trend for lung cancer in Scotland reduced by
31.7% and by 27.1 % in Ayrshire and Arran. The rates however for Scotland as a whole
are higher than for Ayrshire and Arran and this is shown in Figure 24.
Figure 24 Mortality rates for lung cancer, Scotland and NHS Ayrshire & Arran, 1985-
2010
90.0
80.0
European age-standardised rate per 100,000 person years at
70.0
60.0
50.0
40.0
risk
30.0
20.0
10.0
-
Scotland Trend NHS A&A Trend
Source: www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Lung-Cancer-and-Mesothelioma/
29
Tobacco smoking in Scotland: an epidemiological briefing (2008) NHS Health ScotlandWhilst the overall trend is declining (Figure 25), in Ayrshire and Arran the trend in male
lung cancer rates has shown a reduction of 51% between 1985 and 2009, whereas the
rate in females has shown an increase of 34.6%, and is now close to that for males.
This gender difference is reflected nationally for lung cancer. However, the male rate in
Ayrshire and Arran has decreased more than the male rate for Scotland by 4% and the
female rate for Scotland has increased more than that for Ayrshire and Arran by 4.2%.
Figure 25 Trends in lung cancer mortality in Ayrshire and Arran, 1985-2010
140
European age-standardised rate per 100,000 person years at risk
120
100
80
60
40
20
0
A&A Males A&A Females
Source: www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Lung-Cancer-and-Mesothelioma/5.3 Prevention and Education
The primary approach to tobacco control within Ayrshire and Arran is through NHS
Ayrshire and Arran’s Fresh Air-shire Service. This service aims to provide a range of
smoking prevention and cessation services in a flexible and non-judgemental manner.
The service is provided by a team which includes Specialist Smoking Cessation
Advisors in smoking cessation and prevention and Support Officers and offers a
specialist service to support those smokers who find it hardest to quit and who have
tried to quit previously, often on several occasions. The service is targeted at areas of
high smoking prevalence and operates across a range of settings. Community
Pharmacy Advisors are aligned to the Fresh Air-shire team and work with community
pharmacists to support their smoking cessation services and provide a link between
both services. This facilitates greater joint working and development of complementary
roles.
Based on the national objectives, the following local objectives were included in the last
strategy:
Develop innovative prevention initiatives for young people which reflect differing
circumstances and social mores and which contribute to the evidence base.
Build on the school based smoking prevention programme within South Ayrshire
and roll out across Ayrshire and Arran, ensuring that the work is fully integrated
within the health promoting school framework and becomes part of a wider
programme that addresses alcohol, drug and tobacco use and the tobacco
industry within the school and community.
Develop and research gender specific smoking prevention programmes,
particularly focusing on teenage girls and those in circumstances of vulnerability
and disadvantage and teenage boys who use cannabis.You can also read
