Local and regional action to tackle the harms of smoking in County Durham

Smoking prevalence in County Durham is estimated to be 16.2%, well above the rate for the northeast region (14.8%) and the national average for England of 13.0%[i]. Every year around 900 people die in County Durham from causes linked to smoking, 16% of all adult deaths[ii]. Smoking is the leading driver of local health inequalities with the greatest harms falling on the poorest and most vulnerable individuals and communities.

Partners in the County Durham Tobacco Control Alliance have an ambition to reduce smoking prevalence in the county to 5% or less by 2030. The shared vision is for a tobacco free generation, such that a child born today in any part of County Durham will reach adulthood breathing smokefree air, being free from tobacco addiction and living in a community where smoking is unusual. All Alliance partners maintain a clear focus on priority groups including pregnant smokers, people with serious mental health conditions, routine and manual workers, and communities with high levels of deprivation.

Durham County Council and the Tobacco Control Alliance seek to support local smokers to quit while also promoting the conditions that incentivise quitting and prevent smoking uptake. Much of the latter task is led by Fresh, the tobacco control programme for the North East region. Durham County Council is the lead commissioner for Fresh among the region’s local authorities.

Stop Smoking County Durham, delivered by ABL Health, offers a specialist community-based stop smoking service throughout the county. Specialist advisors provide behavioural support and stop smoking medications either face-to-face in GP surgeries or by telephone. Level 2 support is also available in GP and pharmacy settings.

Embedding the provision of behavioural support within deprived communities is vital to reaching smokers in these communities. This is enhanced by targeted communications and engagement with community stakeholders. The service also has a presence within the Drug and Alcohol Recovery Service.

Recently, the stop smoking service has had to cope with the lack of availability of Varenicline and Bupropion, core clinical interventions used to help smokers quit. There have also been difficulties sourcing enough Nicotine Replacement Therapy (NRT) to meet demand. In response, ABL Health developed four e-cigarette pilots within the Drug and Alcohol Recovery Service. Those who want to quit smoking are offered a 12-week free supply of e-cigarettes as an option to support their quit attempt, delivered instead of, or alongside, other products such as NRT.

Traditionally, the service would focus on 4 week quits, but in these pilots wider metrics have been used including the number of smokers engaged, the number taking up the e-cigarette option, the number who have reduced their cigarette use, and the number who quit. Following the pilot phase, the e-cigarette offer will be incorporated into the wider stop smoking service as part of its strategy to address health inequalities.

Honestly, I’ve had so much helpful advice from my advisor. I struggled a bit at first to stop smoking completely but she was really patient with me and kept pushing me forward and she really made me think about my smoking habits." She said: ‘If you can go whole days without smoking, the vape must be working so have you realised that you are choosing to smoke on other days? This helped me reduce my smoking."

Fresh undertakes a wide programme of work within and beyond the North East region including capacity-building, advocacy and research. It is best known for its award-winning mass media campaigns such as Don't Wait, Quit 16, Don't be the 1 and Keep It Out. These campaigns have explored the impact of smoking-related diseases on family members; the links between smoking, cancer and COPD; the risks of second hand smoke to children; and the benefits of quitting. They also signpost smokers to the many ways to quit. Fresh’s work ensures that people in the North East are regularly exposed to messages about the harm of tobacco and benefits of not smoking. Evidence shows that campaigns not only trigger new quits but can also make quitting more successful. Durham has also supported the Don’t Wait campaign, using local budgets to maximise regional advertising.

Fresh has played an important role in reducing the availability and supply of illegal tobacco and the supply of legal tobacco to children. The long-standing Keep It Out campaign uses the latest insight from local communities across the North to reduce demand and generate intelligence for trading standards, resulting in raids and seizures and reduced comfort levels around illegal tobacco. Fresh also co-ordinates the Illicit Tobacco Partnership, an alliance between Fresh, Action on Smoking and Health and the UK Centre for Tobacco and Alcohol Studies working with local authority trading standards teams, police and HMRC.

Fresh supports the development of stop smoking services across the region and since 2017 has worked with the NHS to enable the creation of tobacco dependency treatment services. As a major partner in the North East and North Cumbria Integrated Care System, Fresh was instrumental in ensuring that commitment to a 5% smoking prevalence for the region was included in the new Integrated Care Strategy.

The e-cigarette pilot has increased the flexibility of the stop smoking service in supporting people with multiple and complex needs. The products are a valuable tool when used within an approach focused on reducing harm and tobacco dependency.

Durham County Council’s long-term support for a regional tobacco office has ensured that the stop smoking service is backed by a wide programme of work that sustains smokers’ motivations to quit and prevents smoking uptake among young people.