Section 2 - Brief Intervention What and Why?
This section covers:
- Smoking facts
- Smoking prevalence
- Smoking and the law
- Definition of brief intervention
- Evidence for effectiveness of brief intervention
- Situations where appropriate to deliver brief intervention
- Barriers in delivering brief intervention
- Example barriers
- Key points
Smoking facts
Let’s begin with some key facts about smoking prevalence in Scotland:
- Smoking is a major cause of oral cancer.
- Smoking remains the biggest single cause of preventable chronic illness, disability and premature death in Scotland. reference 1
- Almost 13,500 people die each year in Scotland as a consequence of smoking. This is the equivalent of around 260 deaths per week. reference 2
- Smoking causes more deaths each year than alcohol and illegal drugs such as heroin and cocaine. For more information on this, see:
www.drugscope.org.uk/resources/faqs/faqpages/how-many-people-die-from-drugs - Around half of all long-term cigarette users will eventually be killed by the habit. reference 3
Smoking prevalence
More key facts about smoking prevalence in Scotland:
- Adult smoking has been decreasing over recent years in Scotland from 31% in 1999 to 25% in 2008. reference 4. Despite this, tobacco remains the most common cause of preventable illness and premature death.
- Adult smoking rates in Scotland have remained consistently higher than those in England and Wales.
- Areas with higher levels of deprivation have higher rates of smoking and increased levels of ill-health. reference 15
- Adult smoking rates can vary from as high as 45% in deprived areas, compared with 11% in the least deprived areas. reference 2
- Nearly 7 out of 10 smokers in Scotland say that they would like to give up smoking. reference 3
Smoking and the law
What is the law relating to tobacco use in Scotland?
- Tobacco is a legal substance in the UK, however it is subject to a number of restrictions. Smoking is not permitted in certain areas and the sale of tobacco is subject to age restrictions.
- The Smoking Health and Social Care (Scotland) Act 2005 came into effect in March 2006 and as a result, Scotland became the first part of the UK to legislate against smoking in enclosed public places. This Act banned smoking in most enclosed public places such as bars, restaurants, schools, offices, hospitals, cinemas and many more buildings.
- This legislation aims to protect people against the effects of second hand tobacco smoke and will make a significant contribution to improving the public health of Scotland.
- The minimum age to be sold tobacco was recently increased from 16 years old to 18 years old. This legislation was implemented in October 2007 and aims to help reduce tobacco use among young people.
Definition of brief intervention
A Guide to Smoking Cessation in Scotland 2010: reference 1Planning and providing specialist smoking cessation services defines brief interventions as:
Opportunistic discussion, negotiation or encouragement, and referral to more intensive treatment where appropriate. They are commonly used in many areas of health promotion and are delivered by a range of primary and community care professionals.
You may also hear the term 'brief advice' rather than 'brief intervention' being used - the Guide recognises that these terms are often used interchangeably, and definitions can vary. For smoking cessation, brief interventions typically take between 5 and 10 minutes.
It is recommended that practitioners deliver the most comprehensive intervention which time allows but it is recognised that sometimes it will only be possible to offer a shorter version due to time constraints. If time does not allow for a detailed brief intervention, benefits will still be gained.
Brief interventions may include one or more of the following:
- Passing on simple, relevant, factual information when the opportunity arises
- Assessing the person's readiness to quit
- Making the person aware of pharmacotherapy and/or behavioural support which is available locally
- Provision of self-help material
- Referral to more intensive support from a specialist stop smoking service.
People who want to stop smoking are at least 4 times more likely to quit when combining support from stop smoking services with the use of medications such as NRT, Zyban® or Champix®. reference 5 You will learn more about this later in this module.
Typically, members of the dental team would not prescribe pharmacotherapy for smoking cessation but would encourage patients to seek this help from other sources such as specialist services or pharmacists.
It is recommended that brief interventions are delivered by those who have undergone a training course such as this one. On-going support to actually aid and assist with a quit attempt is best delivered by trained, specialist staff such as smoking cessation advisers.
Evidence for effectiveness of brief intervention
- Brief advice to stop smoking has been found to be a very effective type of intervention.
- Studies have found that when a GP delivers brief advice to quit smoking, smokers are more likely to make an attempt to quit and between 1% and 3% will quit smoking for 6 months or more reference 6
- Smoking cessation services are relatively inexpensive to run and cost far less to the NHS than the cost of treating a smoker each year.
- Compared to other life saving interventions, brief advice is also one of the most cost effective methods and costs just approximately £182 per year of life gained reference 1.
Note:
At the moment, most of the evidence relating to the effectiveness of brief advice refers to when it is delivered by GPs or hospital physicians. reference 5 There is emerging evidence for the effectiveness of brief advice delivered by members of the dental team and other healthcare professionals.
It has been suggested that a professional's level of training and commitment to providing brief advice may be more important that their actual professional discipline.
All health professionals therefore have an important role to play in encouraging smokers to stop and promoting local services that can help. reference 1
Situations where appropriate to deliver brief intervention
Brief interventions are opportunistic and therefore can potentially be delivered anywhere with anyone at any time. It is therefore difficult to define exactly when brief advice is appropriate as this depends on each individual and each situation. There are however, some situations and ways of raising the issue which are better suited than others.
For some people, a diagnosis of periodontal disease or a potentially malignant lesion may be the right time to discuss their smoking. For others it is not! It is therefore important that each situation is considered individually and it is important that you are guided by the individual you are speaking with.
A Guide to Smoking Cessation in Scotland 2010 reference 1 states that;
As a general rule, healthcare professionals should:
- advise and encourage all current smokers to quit, and offer them help to do so, unless there are exceptional circumstances (for example, occasionally it might be judged inappropriate to do so because of a presenting medical condition or other personal circumstances).
- if an individual who smokes presents with a smoking-related disease, the advice to stop smoking may be linked to their medical condition.*
- offer advice to stop smoking that is sensitive to the individual's preferences, needs and circumstances. Note: there is no evidence that the 'stages of change' model is more effective than any other approach.
* The Guide advises that this action is appropriate for health professionals only.
Your role in delivering a brief intervention is to:
DELIVER the message that smoking is harmful to health and oral health and that stopping is worthwhile.
OFFER factual information about health effects and risks and benefits of quitting.
ALLOW the person to make their own individual choice as to whether they want to quit smoking.
RECOMMEND that if they do want to stop smoking they seek support from a local health board smoking cessation service.
Barriers in delivering brief intervention
If done appropriately and sensitively brief advice can be delivered at anytime. However there can be situations where barriers may be present which can prevent the most effective delivery of brief advice.
Barriers can change with time and situation and what you consider a barrier in one situation, may not be in another. It is therefore important to consider each individual situation separately.
Example barriers
Some examples of barriers to raising the issue of smoking include:
- Lack of confidence or knowledge in providing brief advice.
- The individual is emotionally upset.
- The setting/environment (eg the dental surgery) may not be appropriate.
- Attitudes and beliefs e.g. He's old so he won't be interested in stopping smoking.
- The discussion does not allow the topic to be raised.
- Your own judgement tells you its not the right time.
- Language.
- High noise levels.
Key points
- Smoking rates have declined over recent years, however tobacco still causes the most deaths each year compared to any other lifestyle factor.
- Most smokers are aware of the health risks and want to quit, however many adults continue to smoke due to their addiction to nicotine.
- Reducing smoking rates and exposure to second-hand smoke is key to improving the health and oral health of people in Scotland.
- All healthcare professionals will come into contact with people who smoke and are effectively placed to have a role in providing brief advice on smoking.
- Just raising the issue of smoking with an individual could lead to someone seeking support and quitting smoking forever!
- Reducing the number of people that smoke will improve the overall health of the people of Scotland. reference 1
- A reduction in tobacco use will lead to a decrease in oral cancer and smoking related oral diseases.
- Identify some situations or scenarios where you feel it would be appropriate for you to deliver brief advice with someone as part of your job.
- How would you know if another health professional has recently discussed smoking with the individual? Can you think of questions you could ask to find out?
- Providing brief advice is not about telling someone they should stop smoking, rather it is about advising them of the risks and that stopping smoking is desirable. However the end decision is up to the individual and their right to choose whether or not they want to stop smoking should be respected.
You can now proceed to section 3