As health professionals, we routinely witness the devastating effect of smoking on our patients’ health.
Every year, smoking is responsible for approximately 100,000 premature deaths in the UK and smoking-related ill-health costs the social care system in England £1.4bn annually. Globally, smoking remains the leading cause of premature, preventable death.
The UK has come a long way in recent years with the implementation of major tobacco control measures, such as the 2007 smoking ban and eradication of most forms of tobacco advertising. Despite this, one in six (14.1% of adults) were still smoking in 2019, equating to around 6.9 million people in the population. Wednesday 9 March marks ‘No Smoking Day’, an annual campaign to help smokers quit, and the theme this year is the role of health professionals.
The campaign emphasises that smokers are more likely to try and quit if advised to by a trusted health professional and given advice about effective ways to do so. Doctors have always been trusted by smokers to provide health messages, and in the current environment, health professionals can have an even bigger effect.
Many doctors may get a sense of futility, giving the same message repeatedly, often to the same patients. But it is estimated the average smoker takes 30 quit attempts to succeed, so it’s important that we don’t give up helping them. Around 40% of smokers try to quit every year in England but only a quarter will succeed. Every quit attempt should be seen as progress and an opportunity to learn.
We are often concerned that our patients will be hostile to behaviour change advice, but evidence demonstrates otherwise. Even very simple, brief interventions increase the likelihood of a person staying ‘quit’ a year later. Something such as asking what the drivers are for continued smoking, whether it be the taste, the ritual or just the addiction, and then suggesting tailored replacements in the form of gum, e-cigarettes, or nicotine replacement therapy, can have a huge impact. Research shows that providing advice on how to quit and assistance to do so is more likely to lead to a successful quit attempt than simply advising smokers to quit on medical grounds.
No opportunity should go to waste; whether it be the primary care visit, approaches such as ‘stop before the op’, or even in the acute setting of pneumonia, MI or stroke.
There are several key messages for us, as health professionals, to remember when communicating with patients trying to stop smoking.
The single best thing a smoker can do to improve their health is to stop. Quitting can add as much as a decade to life expectancy, and adds quality to those years
Smokers expect you to talk to them about their smoking; they know it’s bad for them and most want to quit
Raising the issue of smoking, and advising people on how to stop, can take as little as 30 seconds. The NCSCT provides a free online training module on how to do this well
What we say to smokers matters. Even if they don’t stop immediately, our advice will influence their future attempts
Informing smokers about the most effective ways to quit is the best way to help them. If they are referred to a stop smoking service, advised to use medications like NRT or encouraged to use an e-cigarette to quit, they are more likely to succeed
Many smokers experiencing deprivation, mental health conditions or other challenging life circumstances still want to stop smoking. The barriers they face to achieve this goal can add to this burden – but we can connect them to the best resources to help them succeed.
Action for Smoking and Health, who the BMA work with closely on tobacco policy, have put together a toolkit, which provides more information about how you can support No Smoking Day.
David Strain, BMA board of science chair