Ir Med J. 2008 Nov-Dec;101(10):319.

Sir,
Smoking is a risk factor for heart disease, stroke and cancer and contributes to an estimated 21% of deaths.^1-3 The SLAN survey (2007) showed overall smoking rates at 29%.⁴ However, smoking prevalence remains high in areas of deprivation and smoking has been identified as the principal reason for the inequalities in death rates between rich and poor.⁵ The aim of this project was to establish the prevalence of smoking in areas of high deprivation in the former NEHB health board. A further aim was to offer and introduce a community based and community led smoking cessation programme to smokers and to determine whether this community programme reduced the rates of smoking among this population.

This study design was a community based and community led prospective comparative controlled before and after trial. Six areas were chosen to receive the intervention and three areas were chosen as control areas. The control areas matched the intervention areas in terms of deprivation and demographics. Furthermore, in order to ascertain that this service was being offered to those who do not usually attend the existing smoking cessation services, a review of client attendance on existing smoking cessation services was also carried out.

At baseline (June 2004) 1,101 households were targeted in nine estates (6 intervention, 3 controls) and of these 1,053 completed a questionnaire (response rate 95.6%). At baseline, current smoking prevalence in all of the estates was high at 55.9% and similar in intervention and control areas, (55.9% vs. 58.7%, p>0.05). One year post-intervention, there was a non-significant reduction of -0.6% (95%CI -4.2%- 5.4%, p>0.05) in the proportion of current smokers in the intervention area compared to a non-significant increase of 0.8% (95% CI -7.5% to 9.2%, p>0.05) in the control areas.

A total of 213 clients from the intervention area attended the community based smoking cessation services. A 12 month followup showed that of the 213 clients who were smokers at baseline, 21 (9.9%) clients who had attended the clinic 1 year ago were still quit at 12 months. Although quitting was by self-report and not CO or cotinine validated, it has been shown validation exercises on self reported data have generally confirmed that people tell the truth about their smoking status in population studies.⁶

In the current climate where smoking rates have shown a slight increase since 2002 it is reassuring that the initiative in the Northeast has in fact led to a slight decrease in smoking rates in the intervention area.

R Lowry, A O’Farrell, D Bedford, N Eldin
Dept of Public Health, North Eastern Area, Railway Street, Navan, Co. Meath
Email:[email protected]

References

1. Peto R, Lopez AD, Boreham J, Thun M, Clarke Heath Jr. Mortality from smoking in developed countries 1950-2000. Oxford University Press, New York, 1994.
2. Trichopoulos D, Kalandidi A, Sparros L, MacMahon B. Lung cancer and passive smoking. Int J Cancer 1981;27: 1-4.
3. Office of Environmental Health Hazard Assessment. Health effects of exposure to environmental tobacco smoke. Final report September 1997. Sacramento: California Environmental Protection Agency, 1997.
4. Morgan K et al, SLAN 2007 – Main Report. Department of Health and Children (2008)
5. Wilkinson RG. Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? BMJ, 314(7080): 591-595.
6. Strecher VJ, Becker MH, Clark NM, Prasada-Rao P. Using patients; descriptions of alcohol consumption, diet, medical compliance and cigarette smoking. The validity of self-reports in research and practice. J. Gen. Intern. Med., 1989 4: 160-166.