Reflections on the 10th Anniversary of the introduction of the Smoke Free Law in England (Part 6) Further progress
The Smoke Free Law in England came into force on 1st July 2007. Hilary Wareing; Ian Gray and Paul Hooper of iPiP’s Tobacco Control Collaborating Centre had various connections with the development and implementation of the law we have now.
These are our reflections.
The smoke free law was seen by many as the end of the work but of course there were many people still smoking and much more work to be done to reduce smoking prevalence. In October 2007, the age of sale was increased to 18 years and we have also seen changes in the law relating to packaging; health warnings and displays in shops. Many of these may not have happened if the Smoke Free Law had not been successful.
A more recent change in the law relating to not smoking in cars when children are present have extended the places where people are protected from other’s smoke and there are increasing moves to make certain outside areas smoke free such as children’s playgrounds and beaches.
One of the most surprising changes has been the introduction of E-Cigarettes. Again, it was thought that when they were introduced as expensive poorly manufactured cigarette substitutes that they would not catch on. But now they are a major part of the push to reduce the number of people who smoke. Whilst they are not ‘safe’ they do not pose as significant a threat to the health of either smokers or those who choose not to smoke.
As designs have changed the problem of them being mistaken for actual cigarettes has reduced.
Smoking in Pregnancy has been a topic of concern for many areas. In June 2010, The National Institute for Health and Clinical Excellence (NICE) produced guidance on how to stop smoking in pregnancy. NICE stated that all pregnant women who smoke and all those who are planning a pregnancy or who have an infant aged under 12 months should be referred for help to quit smoking.
Across England the extent to which the guidance (and the more recently published NICE guidelines, PH48) is being implemented varies significantly and this is reflected in the referrals to Stop Smoking Services and subsequently the numbers engaging with the services and going on to successfully quit smoking.
The TCCC identified all the elements required to ensure all pregnant smokers are offered effective support and developed babyClear, an initiative which includes:
- CO screening for all pregnant women
- An opt out referral system
- Briefing sessions for midwifery staff and other relevant health professionals
- Protocols and care pathways reflecting the evidence base and NICE guidance
- Advanced skills training to support Stop Smoking Advisors to work effectively with pregnant women
- Ways to reach out to those pregnant smokers who currently do not engage with the Stop Smoking Services (risk perception)
- Administrative / call centre staff training to increase the number of women accepting appointments
- Awareness raising and engagement with all health professionals involved with pregnant smokers
- A performance management system
- Monitoring and evaluation of effectiveness
In February 2017, the results of a study undertaken across the North East of more than 40,000 ‘mothers to be’ was published in Tobacco Control Journal. Since implementing babyClear, smoking at the time of delivery rates have fallen in the North East since 2009/10 when 22.2% of women smoked at the time they gave birth, down to 16% in 2016.
For more thoughts see Part 7
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