UK health policy and ‘underage’ smokers: The case for smoking cessation services

Is it Time to Quit? Smoking Persistence and Self-Rated Health

This study evaluates the impact of smoking on self-rated health using a British cohort born in 1970 that was followed through adult life. Records were taken for this dataset many times; individual self-rated health was first recorded in 1996 at age 26, and afterward at ages 30, 34, and 42. The smoking rate over time determined membership in the groups of current-smokers, never-smokers, and former-smokers. Estimates showed that the current-smokers group produced an increase in the probability of being in poor health with respect to never-smokers of about 10 percentage points in the long term. This result was also consistent when we used former-smokers as the control group, or other model specifications. The baseline estimates were not contradicted by robustness checks and policy implications of these results were discussed.

Hospital readmission in first-time admitted patients with schizophrenia: smoking patients had higher hospital readmission rate than non-smoking patients

OBJECTIVES

To consider smoke-free policies for the patients with schizophrenia, the present study examined how smoking behavior is related to hospital readmission among patients with schizophrenia.

METHODS

A retrospective study was conducted in 2007 on 460 discharged patients with schizophrenia who voluntarily admitted in the participating psychiatric hospitals at first time. We reviewed smoking status, readmissions, and other variables including socio-demographic characteristics, process of care, and social functioning at discharge using the Global Assessment of Functioning scale (GAF).

RESULTS

The rate of cigarette smoking in this study was 42.2%. The rate of smoking was significantly higher in males (56.1%) than in females (26.2%). Mean GAF score at discharge was slightly higher in smoking patients than non-smoking patients (g = 0.18). Cox proportional hazard model revealed that hospital readmission rate was significantly higher in smoking patients than non-smoking patients after controlling for all other variables (HR = 1.78).

CONCLUSIONS

Non-smoking patients had fewer hospital readmissions than smoking patients. This finding could be a reason to promote cessation of smoking which might provide positive influences on prognosis of schizophrenia.

A Scotland-wide pilot programme of smoking cessation services for young people: process and outcome evaluation

AIM

To conduct an independent, external evaluation of a Scotland-wide youth cessation pilot programme, focusing upon service uptake and effectiveness.

INTERVENTION

National Health Service (NHS) Health Scotland and Action on Smoking and Health (ASH) Scotland funded a 3-year (2002-2005) national pilot programme comprising eight projects which aimed to engage with and support young smokers (aged 12-25 years) to quit.

DESIGN, PARTICIPANTS AND MEASUREMENTS

Process evaluation was undertaken via detailed case studies comprising qualitative interviews, observation and documentary analysis. Outcomes were assessed by following project participants (n=470 at baseline) at 3 and 12 months and measuring changes in smoking behaviour, including carbon monoxide (CO)-validated quit status.

FINDINGS

Recruitment proved difficult. Considerable time and effort were needed to attract young smokers. Advertising and recruitment had to be tailored to project settings and educational activities proved essential to raise the profile of smoking as an issue. Thirty-nine participants [8.6%, 95% confidence interval (CI) 5.0-11.2%] were CO-validated quitters at 3 months and 11 of these (2.4%, 95% CI 1.90-3.8%) were also validated quitters at 12 months. Older participants were more likely to be abstinent at 3 months.

CONCLUSIONS

The overall quit rate was disappointing. As a result of low participant numbers, it was impossible to draw conclusions about the relative effectiveness of different project approaches. These findings give little support to the case for developing dedicated youth cessation services in Scotland. They also highlight the difficulties of undertaking 'real-world' evaluations of pilot youth cessation projects. More action is needed to develop environments which enhance young smokers' motivation to quit and their ability to sustain quit attempts.