Runners up in the Guidelines in Practice Cardiovascular Disease Award, Dr Lee Casey’s team encouraged smoking cessation in young people to reduce cardiovascular effects


Dr Lee Casey and his team from the Oakleaf Medical Practice, Derry City, Northern Ireland, were joint runners up in the Guidelines in Practice Cardiovascular Disease Award 2007. This was an innovative scheme, which was set up to help young people quit smoking. The rationale for the project was set out by the Department of Health, Social Services and Public Safety for Northern Ireland guideline A Five Year Tobacco Action Plan,1 and Priorities for Action2 policy documents from the Department of Health, which aim to reduce smoking prevalence in Northern Ireland by 7% (from 31% to 24%) by 2008.1,2

The initiative was designed to educate young adults about reducing their overall cardiovascular disease (CVD) risk by quitting smoking, eating healthily, and exercising regularly.

How smoking affects cardiovascular risk

Smoking accelerates atheroma formation in all vessels, leading to an increased risk of angina and stroke. The effects of smoking are easier to reverse if cessation is effected at any earlier age, and the risk from myocardial infarction is reduced immediately when smokers quit. Those who have been abstinent for 10 years reduce their risk of developing lung cancer by 50%.

Setting up the clinic

A series of clinics were set up for young people who smoked. The clinics took place over a period of 7 weeks and participants were recruited by: approaching local schools; writing to young people registered at the practice who were aged 12 to 18 years old; and through adverts in the local media. The clinic was run by a GP and two smoking cessation nurses.

The basic premise of the clinics was to promote healthier lifestyles to the young people attending, by using a social learning theory model that emphasises the importance of observing and modelling the behaviours, attitudes, and emotional reaction of others.3

The focus of each weekly clinic was different. Topics covered in the seven sessions were:

  1. discussing participants’ smoking habits and their reasons for smoking; setting quit dates; and explaining nicotine replacement therapy options
  2. coping with cravings; dealing with peer pressure; and identifying positive role models
  3. learning about the health benefits of regular exercise
  4. discussing how young people can improve their diet and the health benefits of eating well
  5. highlighting safe alcohol limits and the effects of alcohol on a teenager’s cognitive function
  6. revision quiz on everything covered in weeks 1–5
  7. summarising important lessons learnt and the achievements of individuals; presentation of certificates by the local mayor.

During the weekly sessions participants were asked to give feedback to the group on their attempts to stay off cigarettes. Successful quitters were highlighted as good role models, with emphasis being placed on successful techniques. A brief presentation was also given on the focal health topic for that session.

Attendance incentives

During the 7 weeks, participants were sent motivational text messages and text reminders about the clinics twice a week. Average attendance at the clinic was 26 people during the first 7-week programme and 14 during the second programme. Incentives to attend included free weekly gym sessions, free fruit smoothies at the clinic each week, free shopping vouchers for attendance at five of the seven sessions, and the female participants received free ‘pamper sessions’ from the beauty department at the North West Institute of Higher Education.

Outcomes of the clinics

Young smokers set a quit date during week 1 of the clinics, which was followed up at 4 weeks, and again at 3 months after that date. Continued abstinence from smoking was confirmed by carbon monoxide monitoring.

The 4-week quit rates were 50% and 70% for the first and second series of clinics respectively (see Table 1). We hope to follow-up all participants after 1 year by text to ask them to inform us if they have stopped smoking. Non-responders will be assumed still to be smokers.

Table 1 Comparative results from the two clinic series

 
Average attendance
No. setting quit date
4-week quit rate (%)
3-month quit rate (%)
Clinic series 1
28
26
50
11
Clinic series 2
14
11
70
70

Continuing the work

The project could easily be replicated in other areas around the country, with costs estimated to be £75 per participant (£50 gym membership, £25 shopping vouchers), not including GP locum costs if GP input is available.

Following the success of the initial project, with all participants rating the clinics as either ‘excellent’ or ‘good’, the Oakleaf Medical Practice plans to operate this type of clinic on a tri-annual basis, with frequency dictated by cost considerations.

Summary

An innovative approach to smoking cessation in young adults is essential to maximise engagement and to achieve practice quit rates comparable to those in adult smoking cessation programmes. Quit rates from the Maudsley Hospital specialist smoking cessation clinic,4 for example, are in the region of 15–25%.

The team would like to acknowledge the assistance of Mervyn Ramage in allowing us to use the ‘Nerve Centre’ for the clinics, and would also like to thank Eugene Gallagher, Head of Primary Care, Western Area Trust for funding and support.

 

  1. Department of Health, Social Services and Public Safety. A Five Year Tobacco Action Plan 2003–2008. Belfast: DHSSPNI, 2003.
  2. Department of Health. Priorities for Action 2007–2008. London: DH, 2007.
  3. Bandura A. Social Learning Theory. Engelwood Cliffs, NJ: Prentice Hall, 1977.
  4. www.slam.nhs.uk/services/servicedetail.aspx?dir=1&id=616G