ROY CASTLE LUNG CANCER FOUNDATION. Smoking Gun Armed Forces Look After Your Lungs Project Report

Transcription

1 Smoking Gun Armed Forces Look After Your Lungs Project Report

2 Project Advisory Group Lt Col Tony Rock, Army Headquarters Staff lead for Health Promotion Eileen Streets, Director of Tobacco Control, Roy Castle Lung Cancer Foundation Helen Armson, Project Lead AFLAYL, Roy Castle Lung Cancer Foundation Jude Robinson, Reader in the Anthropology of Health and Illness, Liverpool University Annie Owens, AF Stop smoking service co-ordinator 2

3 Introduction The Roy Castle Lung Cancer Foundation (RCLCF) is the only charity in the UK wholly dedicated to defeating lung cancer. The Foundation aims to give help and hope to people affected by lung cancer. The charity has a dual focus: 1. Saving lives by: Funding research; prevention activities helping people to quit smoking & encouraging young people not to start smoking; campaigning for better outcomes for lung cancer patients by raising awareness of the importance of early diagnosis 2. Supporting people living with lung cancer by: Providing information materials to the NHS; running lung cancer support groups across the UK; supporting nurses; providing patient relief grants and offering telephone and online support. We work for anyone affected by lung cancer & all those at risk. UK Armed Forces In the UK Armed Forces, there was a year on year reduction in smoking rates between 2004 and 2008 (AF Smoking Prevalence ).There has been an increase in smoking prevalence in the Army and the Royal Air Force from 2008, and in all services from 2010, which prompts the question why might that be. Despite the introduction of some smoking restrictions and the development of smoking cessation initiatives, smoking remains part of service life and smoking is strongly associated with drinking alcohol in many social situations. We should not be surprised if individuals smoke more during deployment. We should consider: Pre-deployment education What can be done to support soldiers to stop smoking when they return. Concerns have been expressed that conventional messages around health, fitness and life expectancy may not work with this population. The Armed Forces Look After Your Lungs project (AFLAYL) is a programme of research led by the Roy Castle Lung Cancer Foundation in partnership with Army Headquarters (Health Promotion) and Liverpool University. The project has been funded by a charitable donation to The Roy Castle Lung Cancer Foundation (RCLCF) from Pfizer UK Foundation. The donation is not conditional on, nor related to, any support of any Pfizer products. 3

4 The burden of smoking More than a quarter of young people between the ages of years (27%) have tried smoking at least once, while 5% smoke regularly (defined as smoking at least one cigarette a week). Young people classified as regular smokers smoke an average of 37 cigarettes a week (just over 5 per day). 1 The prevalence of smoking varies markedly between socio-economic groups. People in deprived circumstances are not only more likely to take up smoking but generally start younger, smoke more heavily and are less likely to quit smoking, each of which increases the risk of smoking-related disease. 2 The risk of heart disease reduces to about half that of a continuing smoker within a year or so of stopping smoking, while the risk of lung cancer reduces to almost the same as the risk for people who have never smoked within years. 3 Overview of the research methodology We engaged with service personnel using their natural vocabulary to capture briefly and accurately, key aspects of smoking behaviour at particular points relevant to the Army. We wanted to understand the intersections between smoking, occupation, rank, gender and wider social environment to understand complexity and patterns of smoking. The collected data provides the Army with credible and meaningful data to inform and contribute to the wider agenda of rates of smoking within their context. We took a mixed methods approach to data collection, and used: (i) questionnaires; (ii) focus groups and (iii) interviews to elicit data. While the qualitative element of this project involves relatively few participants, the results cannot be generalized across the Army and to other Services. Qualitative research has consistently and convincingly shown that many of the common themes that result from depth qualitative research strongly resonate with wider populations, and to the findings from comparable research projects (Popay, Rogers et al. 1998).This data is likely to provide an invaluable insight into smoking in the Armed Forces. Questionnaires Pre-training Questionnaires Post training Focus Groups Winchester in 6 groups Catterick in 7 groups Pirbright in 5 groups Questionnaires Post Deployment Colchester in 8 groups 10 wives in 1 group 4

5 Outcomes set in context 1) 76% of cohort male under 25 years of age Smoking is responsible for a larger proportion of deaths among men than women. In England in 2009, an estimated 23% of all deaths among men aged 35 and over were attributed to smoking, compared with 14% of all deaths among women. The number of deaths in 2009 that were attributed to smoking was 49,100 among men and 32,300 among women. 4 The MOD can significantly influence these outcomes by positive smokefree strategies. 2) Smoking rates across cohorts (31% 59%) Smoking prevalence amongst adults is highest among those aged 20-24, and gradually declines with age, through quitting or dying. In England, almost a third (28%) of people aged were smokers in The lowest level of smoking (14%) was among people aged 60 and over. 5 In our study the lowest smoking rate within the cohorts at best is 3% higher than the England average for year olds. At worst it is 30% higher. 6) 50% 59% want to stop smoking 7) 63% - 91% know where to go for support to stop smoking 8) Cold turkey is identified as the most frequent previous attempt to quit Cold turkey is recognised as having the lowest quit rate success at less than 1% (West 2006) If soldiers want to stop smoking and know where to go to receive support we have to determine why they are not using the service. In a pilot study by RCLCF offering soldiers telephone support a 57% quit rate was achieved with an average of 5 interventions. DH monitoring guidance reports a 64% telephone quit rate in England based upon a service offering with a minimum of 10 interventions. 3) Many smoking for at least 5 years (11-41%) 4) Many smoking in excess of 100 cigs per week (33-84%) 5) Many smoking first cigarette within an hour of waking (57-69%) According to the recommendations of the World Health Organization (WHO) a heavy smoker is classed as a smoker with a daily cigarettes consumption of more than 20 pieces. 6 Outcomes 3, 4 and 5 indicate a pattern of heavy smoking as calculated on the Fagerstrom scale of nicotine dependency. 5

6 Key themes 1) The service currently provided may not suit armed forces personnel and should be reviewed. 2) Smoking prevalence may be higher than reported due to a high number of social smokers, and incidences of recruits and soldiers restarting smoking after quitting 3) Many soldiers have been smoking since they were as young as 12yrs, their tobacco consumption rates are high and they need to smoke within an hour of waking. These factors indicate high levels of nicotine addiction 4) Smoking is both a personal and a social behaviour, and is used by recruits and soldiers to negotiate the particular challenges of army life 5) Soldiers report smoking in times of stress, but also in times of routine work, waiting around and boredom 6) The cost of smoking is not seen as an issue by recruits and younger smokers, and if they run out of cigarettes they can depend on others to help them out 7) Fitness is a priority for all recruits and soldiers, but a high level of fitness can be achieved by soldiers who continue to smoke, and some nonsmokers do not achieve the same levels of fitness 8) Non-smokers tolerate the smokers, as long as they get the job done and don t take too many fag breaks, break any rules (training) and generally act as one of the team 9) Consequences of drinking too much are seen as a greater risk than smoking, as this may lead to additional disciplinary action 10) Soldiers say they know where to go for help if they want to give up smoking, but may have difficulty managing their appointments (recruits) and feel they have limited treatment options within the military context. Recommendations 1) The MOD must actively engage with primary care stop smoking services. The period prior to joining the army following recruitment is key. 2) Smokefree practices should be consistent across all MOD sites and be well understood by the chain of command and all soldiers. Soldiers should not expect to be free to smoke on site. 3) The Service must positively celebrate those soldiers who successfully stop smoking by recognising the achievement within personal development portfolio s 4) A review should be undertaken of the current stop smoking provision within the Armed Forces. This must consider recruitment, training and ongoing development of advisors; service access and availability for soldiers; data collection and performance outcomes. The Roy Castle Lung Cancer Foundation is prepared to commission the scoping work in recommendation 4. 6

7 References: 1 and 2: Smoking, drinking and drug use among young people in England : London Health Observatory. Smoking in England. January : Statistics on smoking: England, : Statistics on smoking: England, : Federal Health Monitoring System sprache=e&p_suchstring=7974 7

8 Roy Castle Lung Cancer Foundation 4-6 Enterprise Way Wavertree Technology Park Liverpool L13 1FB Tel: Fax: Registered office: The Roy Castle Lung Cancer Foundation, 4-6 Enterprise Way, Wavertree Technology Park, Liverpool L13 1FB. Company Limited by Guarantee Regd. No England & Wales. Registered charity No. England & Wales Scotland SC Supported by the Pfizer UK Foundation (an initiative of Pfizer Limited)