Giving up smoking is a huge challenge, but for smokers this is the single best thing they can do to protect their health. Smoking-related illnesses claim the lives of 90 000 people in the UK every year. Between 2016 and 2018, 77 600 deaths were attributable to smoking per year in England, while for Wales the figures were 5000 deaths, for Scotland 10 000 deaths and for Northern Ireland 2300 deaths (Office for National Statistics (ONS), 2020). The habit accounts for more years of life lost than any other modifiable risk factor.
Smoking also impacts on an individual's quality of life. It not only causes lung diseases such as chronic obstructive pulmonary disease, but also contributes to exacerbating existing lung conditions, with smokers seeing their GPs more than a third more often than non-smokers.
This month, mass quitting event Stoptober is under way for the tenth year running—and since 2012 it has helped 2.3 million people in England to quit smoking.
While the number of smokers in the UK has been declining since 1974 and huge progress has been made in stubbing out the habit, around 14% of the population aged 18 years and over continue to smoke (ONS, 2020). Rates also remain significantly higher among lower socioeconomic groups, with half the difference in life expectancy between the richest and poorest in society attributed to smoking (Jha et al, 2006).
Mixed news
The importance of good lung health to protect against the effects of COVID-19 has driven some smokers to try to quit, with numbers of those trying to do so at their highest in a decade. This is great news in view of the findings of a recent study analysing data on hospitalisations and smoking, which suggested that smokers are 60%-80% more likely to be admitted to hospital with COVID-19, as well as being more likely to die from the disease (Clift et al, 2021).
At the same time, however, 45% of smokers have increased their intake since the start of the pandemic, while smoking among the under-35s has risen from 18% to 24% since 2019 (Public Health England, 2021).
Clearly, there is more to do, but around 50% fewer people are supported to quit their addiction than was the case 5 years ago as the result of funding cuts to local authorities' smoking cessation services (NHS Digital, 2015). This means that the government's ambition of making England ‘smoke free’ by 2030, reducing the current 14% smoking prevalence to 5% across the adult population aged 18 years and above, looks unlikely to become a reality (All Party Parliamentary Group on Smoking and Health, 2021).
Without a significant increase in anti-smoking work, the government will not hit its 5% target until 2037 and, for the poorer fifth of the population, the situation is likely to be worse. This group will not reach a 5% smoking prevalence until the mid-2040s (Cancer Research UK, 2020).
Cost-free approach
The government is planning to introduce a new Tobacco Control Plan by the end of this year (UK Parliament, 2021) and, by 2023-2024, all people admitted to hospital who smoke will be offered NHS-funded treatments to tackle their tobacco dependency (Cilia de la Corte, 2020).
But there are simple, cost-free ways that healthcare staff working in hospitals can already support patients to overcome tobacco addiction and fulfil the duty of care to patients outlined in National Institute for Health and Care Excellence (NICE) guidelines, which includes helping smokers to quit the habit (NICE, 2013; 2018).
An intervention does not need to be time-consuming to be effective. The best way is to use the very brief advice (VBA) format. This involves taking the ‘ask, advise and act’ approach and, if done properly, will only take 30 seconds. This approach is recommended by NICE and is known to be effective at triggering an attempt to quit smoking.
First, the nurse or other health professional, should ask the person whether they smoke. If the answer is ‘yes’, there is no need to ask directly whether they want to quit—the health professional can move immediately to the advice step, by explaining to the person that the best way to quit is via a combination of medication and support.
The third step is to act, that is, to signpost the patient to local stop-smoking services and to their GP for a prescription for smoking-cessation medication. If you or a colleague are a nurse prescriber, you can do this yourselves in order to speed up the process. If there are no local stop-smoking services in your area, you can still refer the patient to their GP, and you also can point them to the British Lung Foundation website (https://www.blf.org.uk/support-for-you/smoking), which offers a great number of useful resources.
‘Very brief advice is a simple model that does not preach to people—it simply enables nurses and other health professionals to say that they can help and to support the smoker who wants to quit’
Sticking to the short VBA structure cuts out conversations about risk, how many cigarettes a day the person smokes and other peripheral issues, which means that the nurse can use their time with the patient in the most effective way—and that is by encouraging a quit attempt.
Once the patient has been seen by a stop-smoking adviser, they will be able to discuss the other issues in more detail, something that is frequently not practical in a busy ward or clinic.
If the person is not interested in quitting smoking, simply respond by saying ‘that's OK’, but say that you are available to help when they are ready to do so. It is generally accepted that most quit attempts result in failure; it is also accepted that the more attempts are made the more likely the chances of eventual success, so you do need to keep asking people and continue to offer smokers support.
Simple, but effective
The VBA format may seem very simple, but it really does work—and the more you use it, the more naturally you will weave the VBA approach into your conversations with patients.
Nurses who do not feel confident using the VBA format can access free training.
There are also excellent free 30-minute online courses available from the following organisations:
- National Centre of Smoking Cessation and Training: Very Brief Advice training module (https://tinyurl.com/VBA-ncsct)
- Royal College of General Practitioners: Behaviour Change and Cancer Prevention (https://tinyurl.com/RCGP-prevention)
- Health Education England: Alcohol and Tobacco Brief Interventions (https://tinyurl.com/HEE-interventions).
VBA is a simple model that does not preach to people—it simply enables nurses and other health professionals to say that they can help and to support the smoker who wants to quit. We know that smokers expect to be asked about their smoking by health professionals and, when time is short, VBA is definitely the best way to do that.
People who take up a prescription of stop smoking medication are 68% more likely to quit, while those who take up behavioural support are more than twice as likely to quit, so you can really make a difference—and save a life—in 30 seconds.