Health in Scotland 2001
The Size of the Problem
Smoking is a major contributor to ill health in Scotland especially in women, increasing the risk of many diseases. Thirty-four per cent of men and 32 per cent of women in Scotland are cigarette smokers. It is disappointing that smoking has not reduced to the same extent in women as in men. Smoking rates for women in Scotland are amongst the worst in Europe.
Smoking and Deprivation
There is a strong correlation with deprivation. Forty-nine per cent of men and 43 per cent of women from the most deprived areas of Scotland smoke. Between the 1995 and 1998 Scottish Health Surveys the smoking rates in the least deprived have changed very little. There has been a small increase in the percentage of men from the most deprived areas smoking, and a small decrease in women from the most deprived areas.
The White Paper 'Smoking Kills' was published in 1998 and set out three aims
to reduce smoking in children and young people
to help adults, particularly the disadvantaged, to give up smoking
to help pregnant women give up smoking.
to reduce smoking in Scots adults from an average of 35% to 33% by 2005. This has already been met, although it is too early to say whether it will be sustained. The target to further reduce adult smoking to 31% by 2010 remains
to reduce the proportion of pregnant women smoking to 23% by 2005 and 20% by 2010
to reduce the percentage of schoolchildren aged 12-15 who smoke to 11% by 2010.
In 2001 continuing progress was made to implement the comprehensive and coherent package of action set out in the White Paper which included:
Two significant developments in 2001 are:
There are around 1.4 million smokers in Scotland and surveys suggest that up to 70% of them want to give up. However, unaided quit rates are only about 2% per year while those using NRT and cessation services can achieve a 10-20% quit rate. Smokers, whatever their age, who successfully quit will substantially reduce their risk of future smoking-related diseases.
Smoking and Young People
Important progress is shown in the fact that smoking rates have fallen from 11% to 8% among boys (aged 14-15). However, a disappointing trend is that the number of girls smoking remains unchanged at 13%. The Executive is working with HEBS to reverse this trend in girls through robust health education campaigns building on the successful STINX advertisement.
Aspire to Stop Smoking - pack for use in Primary Care
Aspire to Stop Smoking, a package of materials to help smokers stop and stay stopped, was launched jointly by HEBS and ASH in December 2001. Principally for use in Primary Care the pack provides evidence-based advice for professionals and support materials for patients. The information pack has been complemented and supported by the creation of the Tobacco Unwrapped sub-site on the HEBS web ( www.hebs.com ). The resources can also be accessed on ( www.ashscotland.org.uk).
Following a research review, a series of pilots have been commissioned to try different approaches to smoking cessation for young people. Work was started on extending Smokeline, developing more specific services for:
minority ethnic groups.
An audit of Local Authority Smoking Policies undertaken in partnership by HEBS, ASH Scotland and CoSLA was published at the end of 2001. Plans are underway for this to be followed up by the production in 2002 of good practice guidelines for councils and a repeat audit in 2003.
Tackling Illegal Sales of Tobacco to Children and Young People
The Executive is also keen to improve enforcement of the prevention of illegal sales of tobacco to children and young people and has been working closely with key interests including Scottish Chief Trading Standards Officers and CoSLA. An important development during 2001 was the Lord Advocate's decision, following a review of prosecution policy, to allow a pilot scheme to assess whether test purchasing by children, of age restricted goods would work safely and effectively in Scotland. It is anticipated that these pilots will be established by autumn 2002.
Pilot youth card schemes, in which proof of age is an integral part, in Glasgow, Edinburgh, Argyll and Clyde and Angus, in conjunction with CoSLA and Young Scot also offer ways to cut down on sales to young people.
Forth Valley: Young People and Tobacco
Young people in Forth Valley have actually increased smoking in the past 4 years. Previously it was the middle-aged adult who smoked most. As Figure 1.5 shows, young men and women are now smoking more than any other age group.
Fig. 1.5 Smoking prevalence (by age group and survey year)
The major fall in smoking in Forth Valley has been largely due to fewer people starting to smoke rather than people giving up smoking (Table 1.1).
Table 1.1 Smoking type by year
Given up smoking
The major challenge is supporting young people not to start and to support those who have established addictive habits.
Forth Valley: The Smoke-Free Class Competition
To tackle this issue in secondary schools a successful pilot, "The Smoke-Free Class Competition", has been trialled and is now being rolled out in other secondary schools in the area.
The competition has been run successfully in several European countries for over 10 years with the support of the Europe Against Cancer organisation. It has been shown to decrease smoking amongst the young people involved and to delay the onset of smoking in young people. In Forth Valley the first and only Scottish pilot took place involving all second year pupils at Lornshill Academy, Alloa (8 classes in total).
This initiative involved the Health Promotion Officer for Smoking and Young People delivering sessions within the Personal and Social Education class once a month. These sessions gave factual information about smoking as well as teaching young people the skills needed to remain a non-smoker.
Each month each pupil used a carbon monoxide monitor, the "Smokerlyzer", which determines whether they have been smoking. This information is recorded as classes are only allowed to continue in the competition if they have less than 10% smokers.
The aims of the competition are:
to encourage pupils to remain smoke-free by discouraging experimentation with tobacco
to reduce the prevalence of cigarette smoking amongst the target group
to clearly show that not smoking is acceptable
to explore the benefits of remaining "smoke-free".
The 6 month Lornshill pilot concluded in March 2001 and results showed that
between 1 and 2 people per class actually stopping smoking. The success of the pilot has been attributed to using peer pressure in a positive way.
Grampian: Smoking Advice Service
The Smoking Advice Service has been developed as part of Grampian's response to the white paper " Smoking Kills". Although centrally co-ordinated the service is provided at a venue convenient to the client across Grampian. It has been able to reach those from disadvantaged areas with 14% of clients from deprivation category 7. Seventy per cent of clients are referred by their GP and client satisfaction with the service is high. The service represents cost effective use of NHS resources with an estimated cost per life year gained between 277 to 623.
Tobacco and Older People
Around a quarter of the 65-74-year-old age group smoke regularly. However, as stated in the Report of the Expert Group on the Healthcare of Older People Adding Life to Years recent evidence endorses the fact that it is never too late to give up. Stopping smoking leads to health gain at any age.
The Size of the Problem
As identified in last year's report " Health in Scotland 2000" the Scottish Health Survey shows that:
since 1995 there has been an increase in alcohol consumption among women aged 16-64; the proportion exceeding 14 units a week has increased from 13% to 15%
among men aged 16-64 alcohol consumption showed little change over this period; the proportion of men exceeding 21 units a week was 33% in both 1995 and 1998.
The year 2000 target was a 20% reduction in adults exceeding weekly limits. This was not met as excess drinking is on the increase especially in women.
The current targets are:
to reduce the incidence of adults exceeding weekly limits from 33% to 31% for men between 1995 and 2005 and to 29% by 2010; and from 13% to 12% for women between 1995 and 2005 and to 11% by 2010
for young people, to reduce the frequency and level of drinking from 20% of 12-15-year- olds to 18% between 1995 and 2005 and to 16% by 2010.
Last year's report referred to the Executive's consultation on a Plan for Action on Alcohol Problems aimed at reducing alcohol-related harm in Scotland. Extensive consultations took place during the first half of 2001. Over 160 responses were received from a wide variety of sources including medical networks, the police, academics, drug and alcohol agencies, health education bodies, the drinks industry and licensed trade, children and young people's and service user groups. In addition, several pieces of work were commissioned to add to the evidence base for the Plan. The Scottish Advisory Committee on Alcohol Misuse, which co-ordinates all key interests: health, local authority, the police, the drinks industry and the licensed trade provided valuable advice.
Plan for Action on Alcohol Problems
The Plan for Action on Alcohol Problems was published in January 2002 and sets out action for a range of bodies and individuals including the Executive, NHS Boards, local authorities, the police, the drinks industry and the licensed trade, businesses and the voluntary sector. The success of the Plan will depend upon partnership working. The aim of the Plan is to reduce alcohol-related harm in Scotland. Key priorities are:
The wide range of action proposed under the Plan gives some indication of the complexity of the issues which need to be addressed in tackling alcohol problems. Action falls into four broad areas:
changing culture surrounding drinking
prevention and education
treatment and support for people with alcohol problems
the protection of individuals and the wider community.
Some of the action proposed under the plan includes:
challenging attitudes to binge drinking through a new national campaign
a framework for treatment and support services to assist those who plan and commission services to assess local needs and improve services
new resources/ways to help parents talk to children about alcohol
promotion of training and responsible practice for those serving and selling alcohol
more support for local alcohol action teams
improved training for staff in services addressing alcohol problems.
The Committee which was set up to review all aspects of liquor licensing met for the first time in August 2001 and is making good progress. The Committee is expected to report by the end of 2002.
HEBS advertising campaigns have thrown the spotlight on the risks of alcohol and drug misuse.
The Think About It integrated campaign was aimed at teenagers and included a focus on the risks and consequences of alcohol and drugs.
The Drinkwise Campaign was supported by HEBS, the Scottish Executive, and other national and local organisations.
Other HEBS research included a study for the Scottish Executive on perception of factors
that promote and protect against alcohol misuse. This was to assist in the development of
the new alcohol misuse strategy and was published on the Scottish Executive website in August 2001.
Grampian Youth Lifestyle Survey
The Grampian Youth Lifestyle Survey 1998 shows that amount and frequency of alcohol consumed has increased in the Grampian youth population. The ADAT (Alcohol and Drug Action Team) action plans include a range of activities to tackle this challenging area, including "Double Vision", a hard-hitting play about family alcohol misuse and its effects. An alcohol advisor attends each performance and the outcomes of the work being done in schools and communities arising from this initiative are very encouraging. This has been a fruitful partnership across three local authorities and three Action Teams involving five Alcohol Drug and HIV Forums and delivering to approximately 2,400 people of all ages in a variety of venues.
Alcohol and Older People
Many older people enjoy sensible social drinking, but excessive drinking increases the risk of:
Older people are more likely to drink alcohol on a regular basis rather than to binge and are more likely to conceal their drinking. Around 6% of men and 1.5% of women in the 65-74 age group are estimated to be problem drinkers.
The Size of the Problem
As identified in last year's report " Health in Scotland 2000" injecting figures have risen, year on year, from 33% in 1995/96 to 39% in 1999/2000. Thirty-nine per cent of new problem drug misusers seen by services and notified to the Scottish Drug Misuse Database (SDMD) reported injecting "in the last month" (SDMD 1999/2000).
It is known that:
37% of new problem drug users in 2000/01 who had injected drugs "in the previous month" reported sharing needles and syringes "in the previous month" (Scottish Drug Misuse Database 2001).
The proportion of injecting drug users who had a named HIV test who were positive for Hepatitis C antibody has fallen from 62% in 1997/98 to 48% in 1999/2000 based on tests from the four main testing centres in Glasgow, Tayside, Edinburgh and Grampian (SCIEH Survey 2000).
Drugs and Deprivation
A report by the Social Inclusion Housing and Voluntary Sector Committee: Inquiry into Drug Misuse and Deprived Communities (2000) concluded that problem drug use is strongly linked to social deprivation. The roll out of the new resources and much other action under the drug strategy are in line with the Committee's main conclusions. In the broader field of Social Justice Strategy, we have now set targets that will impact on poverty, unemployment and disadvantage. They include milestones coinciding with national drugs targets aimed at reducing the incidence of drug misuse in general, and of injecting and sharing needles in particular. This approach will help to save lives and prevent the spread of blood-borne viruses such as Hepatitis C and HIV.
Strategic Direction and Implementation
Tackling drug misuse has been identified by the Executive as a priority crosscutting issue. The Scottish Executive's Annual Report on Drug Misuse, published in November 2001, set out progress in implementing strategy ( Tackling Drugs in Scotland: Action in Partnership: March 1999) and action plan ( Protecting our Future: May 2000) and described future plans. This included information on what the additional resources of 100 million over the 3 years from 2001-2 for tackling drug misuse, would buy. In June 2001, the Executive announced further resources to tackle drug misuse over the same 3 year period, which brought the additional investment package to just under 130 million.
The new resources are funding activity on a range of fronts, in line with the four pillars of the drugs strategy:
Drug Action Teams
Drug action teams are the focal point for local action. They bring together:
They are required to sign off jointly agreed plans to ensure that services on the ground
are delivered in an integrated way and in line with national objectives and locally
To measure progress, in 2001 the Executive published challenging national targets for tackling drug misuse across all four pillars. Examples are:
all schools to provide drug education to every pupil and to have written procedures for managing incidents of drug misuse, in line with national advice, by 2002
to reduce the proportion of young people under 25 who are offered illegal drugs significantly and heroin use by 25%, by 2005
to reverse the upward trend in drug related deaths and reduce the total number by at least 25% by 2005
to increase the number of drug misusers in contact with drug treatment and care services in the community by at least 10% every year until 2005
to increase the number of drug seizures by 25% by 2004.
New expenditure included the provision of some 13 million over the 3 year period to help in achieving the target of increasing the number of people being seen by drug treatment services. In addition, NHS Boards have extra funding for their work on preventing the transmission of blood-borne viruses, including HIV and Hepatitis C. This includes work to reduce injecting and the sharing of needles by drug users.
Considerable work is now underway across the NHS and Scotland's local authorities to improve drug treatment service provision utilising the additional resources. This covers a broad range of service provision including dual diagnosis clinics, services for young people, criminal justice treatment services, outreach and rehabilitation, including those incorporating training and employment opportunities.