To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12998 or contact your DHB library, or organisational or local library for assistance.

West, R., et al. (2015). Healthcare interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 29 May [Epub before print].

The authors analysed US and European data and and conclude that "these population-level results reject the hypothesis of hardening as smoking prevalence drops, instead supporting softening of the smoking population as prevalence declines".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1136/tobaccocontrol-2015-052329 or contact your DHB library, or organisational or local library for assistance.

Kulik, M.C. & Glantz, S. (2015). The smoking population in the USA and EU is softening not hardening. Tobacco Control, 24 June [Epub before print]

In the latest issue (attached below): 

Studies in this issue (attached below):

Customs Minister Nicky Wagner says Customs has destroyed over 2.5 tonnes of abandoned tobacco and collected $1.35 million in additional duty and taxes since the drop in tobacco duty free limits last November.

“People seem to be learning about the change. The amount of tobacco abandoned at airports by those not wanting to pay duty is dropping from the 100 kilograms Customs was initially collecting every week,” Ms Wagner says.

“The change was well signalled in advance and advertising to highlight the change continues. Customs’ passenger surveys show most people are aware of and accept the change in regulations.

“Customs recorded over 7,600 individual transactions for people choosing to pay duty, with the total collected in the six months adding to over $1.35 million.

“Nonetheless, 2.5 tonnes of cigarettes and tobacco left at airports is an incredible amount, and I’m pleased Customs is actively supporting the aim of making New Zealand smoke-free by 2025,” Ms Wagner says.

Associate Health Minister Peseta Sam Lotu-Iiga welcomed the reduction in the amount of tobacco being brought into New Zealand through airports.

“The amount, 2.5 tonnes, is staggering. Every time a traveller abandons their tobacco at Customs or decides not to bring it in at all, is a victory for our health system.

“The fact that people appear to be aware of the changes to our duty-free tobacco limits and accept them is confirmation that our Government’s policies are making a real difference.

“We are determined to reduce the harm tobacco causes and the cost to our health system. The new duty-free tobacco limits, together with tax increases on tobacco sold in New Zealand, are pricing tobacco out of reach of many users. This is reflected in the numbers of smokers giving up tobacco,” Mr Lotu-Iiga says.

All articles are available to read in free full text at:  http://tobaccocontrol.bmj.com/content/24/Suppl_3.toc

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

Now available to read in free full text at: http://dx.doi.org/10.1093/ntr/ntv099 

Thompson, T.P., et al. (2015). An exploratory analysis of the smoking and physical activity outcomes from a pilot randomised controlled trial of an exercise assisted reduction to stop (EARS) smoking intervention in disadvantaged groups. Nicotine & Tobacco Research, 11 May [Epub before print]

Seventeen randomised controlled trials were included. The authors conclude form their analysis that "nicotine replacement therapy, behavioural support and combination approaches appear to increase smoking abstinence in those treated for substance use disorders. Higher quality studies are required to strengthen the evidence base".

This is an open access article and is available to read in free full text at:  http://ntr.oxfordjournals.org/content/early/2015/06/10/ntr.ntv127.full.pdf+html

Thurgood, S.L., et al. (2015). A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Nicotine & Tobacco Research, 11 June [Epub before print]

Topics covered:

• Improving Hospital Food and Beverage Environments
• Improving Hospital Physical Activity Environments 
• Improving Support for Breastfeeding Employees 
• Improving Support for Tobacco-Free Hospital Environments
• Hospitals Partner with Public Health to Improve Food Environments:
• Addressing Community Health in Schools, Early Care and Education, and the Clinic 
• Community Benefit: Encouraging Healthy Habits Early
• Children’s Hospitals Working Together to Improve their Food Environments 

To read the issues in this series, go to:  http://www.cdc.gov/nccdphp/dnpao/hwi/resources/hospital_p2p.htm

The recommendations have been developed by an editorial board in consultation with an advisory board of academics and experts, and following feedback from four regional events with local and national tobacco control professionals.

To read the report and associated reports, go to:  http://www.ash.org.uk/current-policy-issues/smoking-still-kills

Smoking Still Kills: Protecting children, reducing inequalities. London, ASH, 2015

Nationally 33% of people with a mental health problem smoke compared to 18.7% in the population as a whole. A PHE and NHS England survey found that smoking rates among service users in mental health units is even higher at 64%. 

PHE and NHS England have published new guidance to help medium and low secure mental health units best implement the NICE recommendation that all NHS funded sites should provide access to on-site stop smoking services and deliver care in an environment free of smoke.

The guidance highlights case studies which show the benefits of completely smokefree mental health units, where service users are provided support to stop smoking. This has resulted in:

• better patient health
• freeing up staff time
• improved ward atmosphere

Alongside the physical health improvements, an increasing body of research is finding that mental health can be improved by stopping smoking. Contrary to the myth, evidence shows that stopping smoking is associated with reduced depression, anxiety, stress and improved positive mood and quality of life.

Evidence also shows that people who smoke often require higher doses of psychotropic medication as smoking increases the metabolism of these drugs.

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

Fetuses of smoking mothers showed a significantly higher rate of mouth-movements compared to fetuses of non-smoking mothers and these differences widened as pregnancy progressed. There were also differences in the rate of fetal facial self-touch that were borderline significant.

The authors  discuss the implication of these findings and note that a "... larger study is needed to confirm these results and to investigate specific effects, including the interaction of maternal stress and smoking". 

This article is now available to read in free full text at: http://dx.doi.org/10.1111/apa.13001 

To read a UK Independent article about this study, go to:  http://www.independent.co.uk/life-style/health-and-families/4d-ultrasound-study-shows-harmful-effects-of-smoking-on-unborn-babies-10128345.html

Reissland, N., et al. (2015). Ultrasound observations of subtle movements: A pilot study comparing fetuses of smoking and non-smoking mothers. Acta Paediatrica, 104(6), 596–603

It draws on the experiences of groups who have already undertaken successful smokefree car promotional and advocacy activities.

In the Tool Kit you will find information, templates, a project plan and evaluation to assist you and your communities to promote the smokefree cars message with your local community within your region.

To download the toolkit from the ASPIRE2025 website, go to:  http://aspire2025.org.nz/smokefree-cars-tool-kit/

The note that the findings of their analysis "... suggest an immediate impact of display bans on youth’s exposure to tobacco pack displays, and likely impacts on smoking-related outcomes. These results suggest that removing tobacco displays from retail environments can positively contribute to the denormalization of smoking among youth".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntu180 or contact your DHB library, or organisational or local library for assistance.

Dunlop, S., et al. (2015). Out of sight and out of mind? Evaluating the impact of point-of-sale tobacco display bans on smoking-related beliefs and behaviors in a sample of Australian adolescents and young adults. Nicotine & Tobacco Research, 17(7), 761-768.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv117 or contact your DHB library, or organisational or local library for assistance.

Hoeppner, B., et al. (2015). How smart are smartphone apps for smoking cessation? A content analysis. Nicotine & Tobacco Research, 4 June [Epub before print]

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv122 or contact your DHB library, or organisational or local library for assistance.

McRobbie, H., et al. (2015). Complementing the standard multicomponent treatment for smokers with de-nicotinised cigarettes: A randomised trial. Nicotine & Tobacco Research, 4 June [Epub before print].

Dr Ramon Pink, Canterbury Medical Officer of Health, says making more outdoor areas Smokefree is an important step towards achieving the Smokefree 2025 goal.

To read the full media release from Canterbury DHB, go to:  http://www.scoop.co.nz/stories/GE1506/S00028/support-for-smokefree-spaces-extension.htm

A bone disease research programme is one of 11 successful University of Auckland applications for health research funding with this round’s grants totalling about $14.65 million.

A research programme that will progress prevention and management of several bone-related conditions has received funding of nearly $5 million over the next five years.
The Health Research Council (NZ) has today announced funding for the ‘Mechanisms and management of musculoskeletal disease’ led by Distinguished Professor Ian Reid from the University of Auckland.

Professor Reid is an endocrinologist specialising in bone disease who will lead the teams involved in the five projects that make up this research programme.
“These studies involve a broad group of researchers including clinicians, scientists, statisticians, nurses and surgeons,” says Professor Reid.  “Some will involve volunteers from the public, some will involve patients with these conditions, and some will be carried out in the laboratory.

“These projects have the capacity to provide a new convenient way of preventing fractures in older women at intermediate fracture risk, re-assess the importance of dietary calcium and calcium supplements in bone health, improve management for severe gout, and develop artificial bone substitutes for use in managing fractures and some bone cancers where there is a need to fill local bone defects,” he says.

The five projects are;

• A random controlled trial (RCT) of zoledronate infusions every 18 months for fracture prevention in women at intermediate fracture risk
• A systematic review of all studies relating calcium intake to fracture risk, to provide a sound basis for advice to practitioners and the public for recommendations in this area
• An RCT of intensive drug treatment of gout, to determine whether this reduces joint damage
• A comparison of bone cell function between people in their 50s and those aged >75 years, to define what changes occur in cell function with age that might contribute to the development of osteoporosis
• Development of bone substitutes that can be used to promote healing of severe fractures or large areas of damaged bone

 
“These studies will increase understanding of why osteoporosis develops in old age and advance its treatment and that of gout, both common musculoskeletal problems in older New Zealanders,” says Professor Reid.
 
A study that follows up on a successful trial of a cheap oral gel for treating low blood sugar levels in newborn babies has also received HRC funding for five years.
Distinguished Professor Jane Harding, a neonatal paediatrician and Vice-chancellor of Research at the University of Auckland, has received more than $1 million for this project.

Professor Harding and her team have provided the first evidence-based strategy to treat low blood sugar levels that affects up to 15 per cent of otherwise healthy babies.
They will follow-up babies treated with an oral glucose gel as newborns at two-years of age to ensure the safety and efficacy of the treatment before it’s introduced into clinical practice.

 “The importance of this work cannot be overstated,” says HRC Chief Executive Professor Kath McPherson. “Such an intervention could prevent brain damage in babies, improve breastfeeding rates and long-term health, prevent major distress for affected families, and save our health system significant costs, potentially revolutionising the management of neonatal hypoglycaemia around the world.”
“Two dollars is all it costs to produce the oral gel which has been shown to prevent brain damage in a newborn. This is a small price to pay, given that treating the 2,100 babies severely affected by low blood sugar levels in the neonatal intensive care unit each year costs the nation $9.4 million,” she says.

The following is a summary of other University of Auckland health research projects that received funding from the HRC in this latest round.
 

• Professor Larry Chamley (Obstetrics and Gynaecology). ‘A healthy life starts with a bio-energetically healthy placenta’, 36 months, $ 1,193,142
• Associate Professor Alan Davidson (Molecular Medicine and Pathology). ‘The role of the Pax-Notch pathway in kidney disease’, 36 months, $1,067,513
• Associate Professor Bronwen Connor (Pharmacology/CBR). ‘Cellular reprogramming: A unique approach to understanding Huntington's disease’, 36 months, $1,190,497
• Dr Bridget Kool (Epidemiology and Biostatistics). ‘Prehospital injury deaths: preventability, service accessibility and equity’, 24 months, $598,181
• Dr Fiona McBryde (Physiology). ‘Hypertension after stroke – therapeutic or pathological?’, 36 months, $1,055,738
• Professor Mark McKeage, (Pharmacology). ‘Lung cancer genetic testing in New Zealand’, 36 months, $1,182,641
• Dr Thomas Proft (Molecular Medicine). ‘TeeVax - a novel vaccine against group A streptococcus?’, 36 months, $1,122,354
• Dr Vanessa Selak (Epidemiology and Biostatistics).  Aspirin harm benefit calculator to guide cardiovascular primary prevention, 24 months, $632,382
• Dr Natalie Walker (National Institute of Health Innovation). ‘The combined use of nicotine replacement therapy and e-cigarettes’, 36 months, $1,199,916

The paper is available to read in free full text at:  http://dx.doi.org/10.5888/pcd12.150012

Momin B, Neri A, Goode SA, Sarris Esquivel N, Schmitt CL, Kahende J, et al. (2015). Factors involved in the collaboration between the national comprehensive cancer control programs and tobacco control programs: A qualitative study of 6 states, United States, 2012. Preventing Chronic Disease, 12:150012. 

"Twenty-two PNs and 15 GPs participated in interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified".

The authors discuss the implications of these findings. 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/fampra/cmv041 or contact your DHB library, or organisational or local library for assistance.

Halcomb, E., et al. (2015). Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: Views of general practitioners and practice nurses. Family Practice, 29 May [Epub before print].

They "... identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies". The authors discuss the implications of their findings for future research.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv104 or contact your DHB library, or organisational or local library for assistance.

Feirman, S.P., et al. (2015). Mathematical modeling in tobacco control research: Initial results from a systematic review. Nicotine & Tobacco Research, 14 May [Epub before print]

They conclude that "the introduction of national smoke-free legislation in England was associated with "11 000 fewer hospital admissions per year for RTIs in children".

To read the full abstract, and for information on how to access the full text, go to: http://erj.ersjournals.com/content/early/2015/05/28/09031936.00014615.abstract or contact your DHB library, or organisational or local library for assistance.

Been, J.V., et al. (2015). Smoke-free legislation and childhood hospitalisations for respiratory tract infections. European Respiratory Journal, 28 May [Epub before print]

Associate Health Minister Peseta Sam Lotu-Iiga is urging smokers to make this Sunday the day they quit for good.

The theme of World Smokefree Day 2015 on Sunday is “It’s about whānau”.

“World Smokefree Day is an excellent opportunity to encourage whānau and friends to get behind those who want to quit smoking to improve their health and the health of those around them,” Mr Lotu-Iiga says.

New Zealand has made real progress in reducing smoking rates over the past few decades. Progress has been slower for Māori and Pacific people. The overall number of adult daily smokers is 15.5 per cent (550,000) but for Māori the figure is 37 per cent (167,000) and for Pacific people 23 per cent (45,000).

“While we are still focused on bringing down the overall smoking rate, we need to redouble our efforts in cutting the smoking rates for Māori and Pacific people,” Mr Lotu-Iiga says.

“Ask your loved ones and your friends to quit. It is never too late to reap the health benefits of becoming smokefree. Set an example for your children and grandchildren. This Sunday provides the perfect opportunity.”

Mr Lotu-Iiga will be supporting World Smokefree Day activities on Sunday at Mt Smart Stadium where the NZ Warriors take on the Newcastle Knights.

Quit Buses will be stationed outside the stadium to encourage those fans thinking about giving up smoking to take that first step.

“Come and visit the Quit Bus on Sunday before you go into the stadium and see how the staff can help you to become smokefree. I will be there to cheer on both you and the Warriors,” Mr Lotu-Iiga says.

The Quit Buses are funded as part of the Pathway to Smokefree 2025 Innovation Fund and provide smoking cessation and support services in the Greater Auckland region.

It is World Smokefree Day this Sunday, and two former smokers have won money by quitting as part of a University of Otago Wellington trial funded by the Ministry of Health.

Top prize of $750 went to Gaylene Strawbridge, who was randomly selected out of all the participants whose abstinence had been biochemically verified over the whole of the 18 week trial. A second prize of $250 was awarded to a randomly selected participant whose abstinence had biochemically verified abstinence during at least one of the checks during the trial.

Senior Research Fellow Dr Brent Caldwell says the trial offered smokers the chance to try a range of nicotine replacement therapies through kiosks in workplaces and community locations, such as malls, throughout the lower North Island.

“They received face-to-face coaching on how to best use the therapies to maximise their enjoyment and minimise side-effects, with the added incentive of being eligible to win money by quitting smoking,

“Smokers could take a free sample of a week’s supply of as many products as they liked, and be supported by expert cessation workers through regular follow-up at the community location or over the phone.”

Dr Caldwell says 1,514 smokers have taken up the spur-of-the-moment chance to try nicotine replacement therapy at the stalls, with the vast majority choosing the nicotine inhalator and nicotine mouthspray.

“The latest international evidence shows that offering smokers financial incentives increases their odds of quitting by 1.43 times. Furthermore, using nicotine replacement therapy increases the odds of quitting by 1.84.

“Quitting smoking is really hard, and although nicotine replacement therapies make quitting easier and double the chance of success, most smokers try to quit cold turkey. We aimed to give them first-hand experience of how helpful these therapies are and how to best use them, in the hope that this would motivate smokers to attempt to quit and increase their chances of success,” Dr Caldwell says.

“Although the government might not be able to afford to give smokers financial incentives to quit, or subsidise new more effective therapies, workplaces might want to do this for their staff and reap the benefits of a healthier workforce. I would encourage smokers to use a combination of nicotine replacement therapies to help them quit on World Smokefree Day.”

The authors conclude from the results that "in type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/S2213-8587(15)00082-0 or contact your DHB library, or organisational or local library for assistance.

Lycett, D., et al. (2015). The association between smoking cessation and glycaemic control in patients with type 2 diabetes: A THIN database cohort study. The Lancet Diabetes & Endocrinology, 3(6), 423-430.

Primary health workers throughout the Whanganui District Health Board (WDHB) area have reason to celebrate as the Minister of Health’s national health targets results show primary care achieving the Better help for smokers to quit target for the first time with a 91 percent result. 
 
The results released today report the performance of DHBs against the six national health targets over the 2014/15 Quarter Three period of January to March 2015. Whanganui GP and national primary care tobacco target champion John McMenamin says he’s delighted to see the primary care Better help for smokers to quittarget reached in Whanganui.
 
“Whanganui health workers have every reason to celebrate. This result reflects the determination of primary health workers to encourage people to quit smoking,” Dr McMenamin says. “It’s a result that is very deserving as well as timely, with World Smokefree Day coming up on 31 May.”
 
While the WDHB narrowly missed out by one percent on achieving the 95 percent smoking target set for hospitals, the consistent results achieved for this target each quarter are a credit to the hospital staff offering advice and support for patients to quit smoking, says WDHB chief executive Julie Patterson.

Emergency Department clinical director Athol Steward is delighted that the WDHB’s hospital-wide efforts to admit, discharge or transfer 95 percent of patients from ED within the six-hour target, have been sustained. Dr Steward says it’s interesting to see the WDHB once again achieving 96 percent. “It shows consistency by the Whanganui Hospital’s entire clinical team and management.”
 
The 2014/15 Quarter Three national health target results show Whanganui district residents continue to enjoy a high access rate to elective surgical procedures with the DHB achieving 103 percent for the 100 percentImproved access to elective surgery.
 
But disappointingly, Whanganui’s result for the 95 percent Increased immunisation target has dropped to 86 percent. Whanganui Regional Health Network chief executive Judith McDonald says in addition to the 181 children who were immunised in this quarter, there were a further 19 children who did not receive their immunisation on time. “And given that the target performance includes families who have made an informed decision to decline immunisations, and, families who despite being offered support have not met the target timeline, the result is not surprising,” Mrs McDonald says.

Meanwhile, Mrs McDonald is delighted that for a third quarter in a row, Whanganui exceeded the 90 percent national target for More heart and diabetes checks by one percent. She says this is down to the dedicated efforts of general practice teams and the Whanganui Regional Health Network’s success in targeting patients who have not had a completed cardiovascular disease risk assessment.
 
Mrs Patterson is pleased with the steady progress being made on the new 85 percent Faster cancer treatmenttarget. This quarter’s 67 percent result is a five percent improvement on the 62 percent result achieved in the October to December quarter. The target asks that 85 percent of patients will receive their first cancer treatment (or other management) within 62 days of being referred as having a high suspicion of cancer. The target will increase to 90 percent by June 2017.

Click here for the full National Health Targets results table for 2014/15 Quarter 3.

The drive over the decade to the nation’s Smokefree 2025 goal must see more smokefree programs tailored to help Māori and Pasifika quit smoking, according to the Auckland Regional Public Health Service.

Ahead of World Smokefree Day on Sunday 31 May, Medical Officer of Health Dr Brad Novak says the country has made stunning progress over the past few years.

“Smokefree environments are now the default setting, and just 13% of Aucklanders at the last census said they were smokers. That means anti-smoking efforts can be more targeted in the future.

“We are seeing progress in Māori and Pasifika. Māori smoking rates have come down from 42% in 2006 to 31% in 2013 according to census data. We have come a long way but smoking among Māori is still twice the Auckland average of 13% and the national average of 15%.”  

Pasifika smoking rates in Auckland dropped from 30% to 22% over the same period.

Dr Novak says smoking is often associated with stress, and most smokers have other big challenges in their lives.

“If you are a smoker trying to quit, keep trying. Smoking is addictive so it can take several attempts but the chances of success are much better with support. I’d even say don’t try to quit alone. Calling Quitline on 0800 778 778 is a good place to start,” he says.

It’s also harder to give up smoking when others around you smoke, which is another reason smoking persists in Pacific and Māori communities. 

The Smokefree 2025 message ‘It’s about whānau’ reminds smokers who want to quit that they are not alone; that others care for them and that quitting will also help the people around them.

Dr Novak says the Auckland Regional Public Health Service (where the Medical Officers of Health are based) also runs a Pacific Quit Smoking programme.

Pacific Quit Smoking Service facilitators visit smokers at home, at work or wherever they prefer. 

“They often involve the family because smoking affects the whole family. A family going smokefree protects future generations.”

Dr Novak says the Pacific Quit service provides a complete package to smokers including information, motivational counselling and free patches, gum or lozenges to break the habit. 

“But the key feature is meeting smokers face to face and making regular contact. They get the help they need to keep moving forward.”

Auckland Regional Public Health Service also ensures compliance with tobacco regulations including smokefree environments, and display and sale of tobacco products, especially to people under 18 years of age.

http://www.cochranelibrary.com/app/content/special-collections/article/?doi=10.1002/(ISSN)14651858(CAT)Freeaccesstoreviews(VI)WorldNoTobaccoDay2015

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

Integration efforts across the Canterbury Health System remain pivotal to Canterbury District Health Board's performance in meeting health targets.

The National Health Targets performance summary quarter three results for 2014/2015 show Canterbury has exceeded the Shorter Stays in ED target achieving 96 percent despite increasing demand and capacity restraints within the hospital.

David Meates, Canterbury DHB chief executive, says the "remarkable" result represents the ongoing integration of services across the health system, particularly for older people to help them stay well in their own homes for longer.

"Although attendance has grown continuously since the February 2011 earthquakes, we are seeing little growth among the older population, which is a reflection of the strategies to care for older people in their own homes and communities being well embedded," Mr Meates says.

He says the biggest growth in attendances remain the younger adult population where there's been a 46 percent increase in non-enrolled patients aged 25-29 presenting to ED.

"We have increased focus on capturing home addresses appropriately and ensuring this group are provided with the right information on where to access primary care rather than defaulting to ED."

Primary care efforts particularly from the 24 Hour Surgery on Bealey Ave, Moorhouse Medical and Riccarton Clinic play a key role in the Canterbury Health System successfully managing acute demand. 

Other impressive results this quarter have been in our Improved Access to Elective Surgery delivering 100 percent of our target delivery (12,851 elective surgeries out of our 17,484 annual target).

"This is really outstanding given the theatre capacity constraints. It is a sign our priorities to improve patient flow, as well as ensuring we are tracking, monitoring and responding to any changes quickly, are working.

Performance exceeded the 'Better Help for Hospitalised Smokers to Quit' target where the Canterbury DHB achieved 97 percent of the 95 percent target.

"There's been a big emphasis on staff education, documentation and referrals. Hospital staff are also being supported to take on roles to support smoking cessation previously held by the Smokefree control team."

Quarter three has been a first for Canterbury in achieving the Increased Immunisation target of immunising 95 percent of eligible children.

"Low opt-off decline rates have contributed to this quarter's performance as well as targeted efforts by primary care."

Canterbury DHB continues efforts towards the meeting the Primary Care Health Targets of Better Help for Smokers (83 percent) and More Heart and Diabetes Checks (78 percent).

"We are committed to working closely with our Primary Health Organisations to actively support the delivery of primary care Health Targets. Initiatives include ongoing education, enhanced clinical engagement, and supporting high risk populations."

*Canterbury received an achieved based on improvement against the quarter two results.  

More information about how Canterbury performed in the health targets can be found on our website.

The West Coast health system has improved its performance in most of the Government’s health target categories thanks to efforts of teams across the Coast health system.

West Coast District Health Board Chief Executive David Meates says the performance improvements across the various targets have resulted from the health system working together on the areas that needed more focus.  A greater awareness of programmes designed to help people take responsibility for their own health has also played a part.

In the emergency department target which requires 95% of patients to be admitted, discharged or transferred from an emergency department within six hours, the West Coast DHB has scored an impressive 99.4%.

The West Coast’s elective surgery target is to deliver 1592 surgeries during the year ending June 30.  The DHB is tracking at 111.3% with 1288 elective surgeries delivered to date.

“With our smoking cessation advice and services, we have met both hospital and primary care targets this quarter.  West Coast DHB staff provided 97.8% of hospitalised smokers with smoking cessation advice and support – exceeding the 95% target with our best result yet,” Mr Meates says.

West Coast Primary Health Organisation Executive Officer Helen Reriti says general practices have reported giving 4,575 smokers advice about stopping, in the 12 months ending March 2015, representing 94% of smokers expected to attend general practice during the period.

“It’s particularly pleasing to have exceeded the 90% target for the first time.  Our clinicians have made huge efforts to tackle this issue, alongside the introduction of new technology to support their initiatives,” Ms Reriti says.

“Likewise, with 90.3% we have met for the first time the 90% target of ensuring the eligible enrolled West Coast population have had a cardiovascular risk assessment in the last five years.  That represents a 7.6% increase on our figures for the last quarter,” she says.

The range of approaches used to increase performance included identifying cardiovascular risk assessment champions within general practices; nurse-led clinics in practices; evening clinics and protected appointment time allocations for checks; Poutini Waiora nurses collaborating with general practices; conducting checks at local events; and using technology to remind patients.

High opt-off and declines continue to be challenging in meeting the immunisation target (95% nationally).  On the West Coast 89% are being immunised, however, we are reaching 100% of “high deprivation children” and 93% of all Maori children. 

This is the second time DHBs have been assessed against the new cancer treatment target and 62.5% of West Coast DHB patients received their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer.

Mr Meates says the Coast’s small population poses a challenge in this area. 

“We are missing this target by just one patient. But work is ongoing to improve the capture and quality of the Faster Cancer Treatment data which will improve our performance over the next few quarters.” 

Full information on the West Coast DHB’s Health Target performance can be found here, and information on the Ministry of Health’s Health Targets site here.

The results for Quarter Three of 2014/15 have been released by the Ministry of Health.

Results indicate that in this quarter, the Taranaki DHB has performed well in improving access to elective surgeries. With results ahead of the national average, the DHB is also paving the way towards the new faster cancer treatment goal, currently ranking fourth in the country for this target. Taranaki DHB has also achieved its target of 95 percent for shorter stays in Emergency Departments.

Taranaki DHB Planning, Funding, and Population Health General Manager, Becky Jenkins said, “A focus on the six key areas is important to continue to improve health, reduce inequalities and improve the quality of health services for local people. This quarter’s results have seen Taranaki DHBs maintain performance in a number of areas.”

Taranaki DHB Chief Operating Officer Gillian Campbell said, “In terms of our hospital services, the results show people in Taranaki have improved access to elective surgery and that we are working hard to ensure patients referred with a high suspicion of cancer are treated in a timely manner.”

The health target results for Taranaki DHB are:

Shorter stays in Emergency Departments: Target 95%, Achieved 95%
95 percent of patients seen in Taranaki Emergency Departments were admitted, discharged, or transferred from the department within six hours.

This result can be attributed to Taranaki DHB and Midland Health Network, the network of 99 percent of General Practitioners (GPs) in Taranaki, working closely together to ensure patients receive the right care, at the right place. That is, the Emergency Department for all emergencies, and their GP for other non-urgent medical needs.

The target was achieved nationally for the first time against a continuing increase in the number of emergency department presentations with 4,481 more people attending this quarter when compared to quarter two.

Improved Access to Elective Surgery: Target 100%, Achieved 120%
Taranaki DHB has again achieved over the target of 100% (for the population) for the improved access to elective surgery target, with a 4 percent increase from quarter two 2014/2015 results. Taranaki DHB has delivered this across a wide range of surgical specialities and is ranked second for its performance.

Assisting in this result has been an ongoing focus on ensuring patients are well prepared for surgery, and a continued reduction in day-of surgery-cancellations. Taranaki DHB is also undertaking a project to increase the surgical day procedure rate. This project is supported by the Ministry of Health.

Significant benefits also continue to be realised from the implementation of the Enhanced Recovery After Surgery (ERAS) programmes.

The national elective surgery health target has been achieved with 123,585 elective surgical discharges provided, against a year-to-date target of 115,588. This is 7997 (6.9 percent) more than planned.

Faster Cancer Treatment: Target 85%, Achieved 72%
This is the second quarter of public reporting of the new faster cancer treatment health target results. Nationally, results increased by 1.6 percent compared with the previous quarter to 67.4 percent overall. Data includes patients who received their first cancer treatment between October 2014 and March 2015. No DHBs have met the 85 percent target.

Taranaki DHB plans to continue this strong performance, and its collaborative relationship with the MidCentral DHB, to continue to work towards the target.

The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90 percent by June 2017. Results cover those patients who received their first cancer treatment between July and December 2014.

Increased Immunisation: Target 95%, Achieved 91%
This quarter, 91 percent of Taranaki eight-month-olds were fully immunised. This is a decrease of 2% from the last quarter. These results are in line with historical expectations for quarter three because of the difficulty in vaccinating children during the summer holidays.

Nationally, the increased immunisation health target, national coverage at eight months was 92.9 percent, an overall decrease of 0.6 percent compared with the previous quarter but 1.5 percent higher than the same quarter in 2013/14.

Taranaki DHB has worked closely with primary care organisations, hospital services, outreach immunisation services, the National Immunisation Register and Well Child Providers on strategies to help improve our immunisation uptake, including early enrolment of new-borns with a GP.

A high level of immunisation coverage (around 95%) is required to prevent community spread of two common infectious diseases - measles and whooping cough. Taranaki DHB and the wider sector are working together to increase activity through to June 2015, with the aim of reaching the 95% target.

Better Help for Smokers to Quit (Hospital Target): Target 95%, Achieved 94%
Taranaki DHB continues to work hard to ensure patients and visitors to its hospitals are given advice about quitting smoking. By supporting smokers to quit, the aim is to improve the health of those around them by reducing exposure to second hand smoke.

A national total of 31,522 hospitalised smokers were offered brief advice and/or cessation support during quarter three, out of a possible 32,980.

Better Help for Smokers to Quit (Primary Care Target): Target 90%, Achieved 86%
Taranaki DHB is committed to working collaboratively with our Primary Care Organisation to continue to strengthen and implement a range of good practices to ensure all patients who smoke are offered or given effective stop smoking support.

More Heart and Diabetes Checks: Target 90%, Achieved 91%
This quarter, 91 percent of the eligible population had heart and diabetes checks. This is a one percent increase on Taranaki’s quarter one results.

Diabetes and cardiovascular disease remains one of the main causes of ill health in Taranaki and Taranaki DHB continues to work hard to provide the best outcomes for these people.

The implementation of a multidisciplinary team to support the care provided by GP practices, and the ongoing education of GP’s and practice nurses in the care and management of diabetic patients in the community, are just two examples.

Results show there were approximately 150,600 more checks provided in the five years to the end of March 2015 compared with the five years to the end of March 2014.

Nearly 500 more people were admitted, discharged or transferred within six hours of presenting to Wellington Hospital’s emergency department between January and March this year, an increase of three percent from the previous three months.

Latest health target results released today show that despite another record increase in the number of presentations to the emergency department in the first quarter of 2015, Capital & Coast District Health Board (CCDHB) has improved its performance against the shorter stays in emergency departments target, and three of the five other targets.

“These results reflect the improvements we’ve made to change how we care for people in hospital and the community, and the tremendous efforts made by our staff to provide high-quality healthcare for our patients,” says chief operating officer Chris Lowry.

“Elective surgery performance has improved and we are on track to meet the target this year as we have done in previous years,” she says.

The DHB is also providing more people with help to quit smoking, rising from 80% in the last quarter to 92% of patients provided with brief advice and support to quit this quarter.

“Quitting smoking is the single best thing a person can do for their health. While we have some more work to do in this area to achieve the target, it is promising to see we are supporting more of our patients to do this, especially at the primary care level,” she says.

CCDHB continues to lead the country in the new Faster Cancer Treatment target, and achieved the national immunisation target as second-highest performer.

“Our goal is to achieve all six targets. These latest results are very promising and reflect the amount of time and effort put in by our staff put in to date,” Ms Lowry says.

The results of the six national health targets across all 20 District Health Boards (DHBs) have been released today for the January to March 2015 quarter.  We sustained our improvements to achieve the goals again this quarter for Shorter Stays in the Emergency Department, and Better Help for Smokers to Quit for patients admitted to hospital.  A summary of our results for all the national health targets this quarter is provided below.

Just under 96% (9520) of 9961 people were admitted, discharged or transferred from the Emergency Department (ED) within six hours of presenting – A small improvement on last quarter and again achieving the national target.  Compared to the same quarter last year when we had a similar number of people presenting to the Emergency Department, 559 more people had shorter stays in ED this quarter – a sizeable improvement that reflects the concerted effort of a large number of staff to ensure better patient flow processes, and, together with our general practice teams, better manage the demand for acute health care services.

We continue to be ahead of target for the number of people discharged following their elective surgery.  Over this quarter, another 1701 patients were discharged following their elective surgery bringing the total number to 5377 patients who have had their elective surgical procedure over the last nine months – delivering 110% of our planned target year to date.  About 11% of our patients have their planned surgery at other hospitals that provide specialist surgery to residents of the wider region, like Wellington for heart surgery, and Hutt Valley for plastic and burns surgery.

The new national target for faster cancer treatment was published for the first time last quarter.  The target is that by July 2016, 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.  Our result this quarter, at 67%, is consistent with last quarter and the same as the national average for this period (results cover those patients who received their first treatment between October 2014 and March 2015).  This target focuses on a sub-set of patients who are referred through a managed, outpatient pathway.  Our aim is to make steady improvements toward this target by examining referral guidelines and pathways to earlier diagnosis and treatment that will ultimately benefit all cancer patients.

The hospital component of the national health target for offering advice and support to quit smoking was achieved for the second consecutive quarter, with a result of 97.0%.  This was a small improvement on the result last quarter and just above the national average (96%).  Of the adult patients admitted to hospital who smoke (about 15% of all admissions), 1111 patients have been offered brief advice and support to quit smoking over the last nine months.

The result for providing better help for smokers to quit in the primary healthcare setting could not be reported in time for publishing this quarter.  This was disappointing, especially as the targeted ‘quit smoking’ campaign that was undertaken over the last few months by our primary health organisation (CentralPHO) and general practice teams is likely to have contributed to a big improvement on our previous results.  We are currently verifying the data and expect that updated data will be published on the health targets website within the next week or so.

Our result for eight-month-old infants being fully immunised on time fell slightly this quarter to 94.4% - just short of the 95% target, which we attained last quarter.  A drop in the rate this quarter is similar to the pattern last year, with the summer holiday period making it a bit more difficult to reach families with infants due for their immunisation.  Our immunisation team, including general practices and outreach services, continue to work together with families to ensure the vast majority of our children are immunised against vaccine preventable diseases.

The proportion of our eligible enrolled population that have had their risk for cardiovascular disease assessed in the last five years was much the same as last quarter.  Although there were another 367 heart and diabetes checks undertaken between January and March, the proportion of the total expected number to have had a risk assessment over the last 12 months fell short of the 90% target, at 85% of the 47,260 eligible enrolled adults.  CentralPHO is continuing to support general practice teams and our Maori and Pacific health providers to enable more people to have a heart and diabetes check to minimise the risk of them having a heart attack or stroke in the next five years.

Chief executive officer Kathryn Cook has thanked staff for their continued efforts to improve on our performance against these targets.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/healthtargets and the 'MyDHB' website.

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

• 96 per cent of smokers in hospitals were offered advice on how to quit.
• DHBs delivered 7,997 more elective surgical discharges than planned.

“DHBs remain focused on reducing waiting times for elective first specialist assessments and treatment,” says Dr Coleman.

“The extra $98 million for elective surgery in Budget 2015 will provide more New Zealanders with timely surgery. The Government is committed to continuing to deliver increases in elective surgery.”

The results also show good progress on other targets, including:

• The more heart and diabetes checks target increased to 88 per cent.
• The primary care component of the better help for smokers to quit target increased to 89 per cent.
• The new faster cancer treatment health target increased to 67 per cent – this is the second time this target has been reported.

The quarter three (January-March 2015) results can be found at www.health.govt.nz.

The results of district health board performance against six health targets for the third quarter 2014/15 has been released.

The results are available at:  http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15

http://aspire2025.org.nz/2015/05/19/slides-smokefree-2025-ten-years-and-counting/

However, health promoters are heartened by their experiences to date, saying that whānau are respecting the kaupapa of the smokefree message. It’s a “major change” from about five years ago, says George Rapana, a Quit Coach at Tui Ora in New Plymouth, and former rugby league administrator.

To read the full media release from Tui Ora, go to:  http://www.scoop.co.nz/stories/GE1505/S00100/local-league-clubs-setting-smokefree-example.htm

This Account focuses on the quality of services Hutt Valley DHB provided during 2013/2014.

Contents include: Health targets; Quality & safety markers; Serious adverse events; Patient experience Receiving care closer to home; Getting in shape before joint surgery; Getting better at home; Helping cancer patients find their way; Encouraging attendance; Community Safety Initiatives HealthPathways; More heart and diabetes checks; Help quit smoking; Disability services; Empowering staff; Giving babies the best possible start; Patient safety initiatives; Open campaign; Care capacity demand management; Electronic whiteboard; Newborn hearing screening; Malnutrition screening & training; Supervisor training; Looking forward; Future Focus.

This Quality Accounts is available to read in full text at:  http://www.huttvalleydhb.org.nz/content/10ff5f6d-fe7e-4a44-8667-5b72672d3214.html

The authors conclude from their results that "incentives appear to boost cessation rates while they are in place. The two trials recruiting from work sites that achieved sustained success rates beyond the reward schedule concentrated their resources into substantial cash payments for abstinence ... Deposit-refund trials can suffer from relatively low rates of uptake, but those who do sign up and contribute their own money may achieve higher quit rates than reward-only participants. Incentive schemes conducted among pregnant smokers improved the cessation rates, both at the end-of-pregnancy and post-partum assessments".

The authors discuss possible directions for future research.

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD004307.pub5

Cahill K, Hartmann-Boyce J, Perera R. (2015). Incentives for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD004307.

The authors conclude that reward-based programmes were much more commonly accepted than deposit-based programmess, leading to higher rates of sustained abstinence from smoking. However, they also note that, while the deposit programme was much less attractive (only 13.7% of participants assigned to the deposit programme chose to enrol; 90% of those assigned to the reward programme enrolled), it was much more effective than the reward-based programme . Group-oriented programmes were no more effective than the programmes for individuals. 

In an editorial about the study, it is noted that "Halpern et al. ended up demonstrating the importance of loss aversion in two different ways. The more obvious is that smokers are far more likely to quit if they stand to lose money if they fail. The more subtle is that the very prospect of incurring losses makes people far less willing to enter a smoking-cessation program. Despite the greater comparative effectiveness of the deposit program, the reward program is likely to be more successful, because far more people will sign up for it".

The article is available to read in full text at:  http://dx.doi.org/10.1056/NEJMoa1414293

The editorial is available to read in full text at:  http://dx.doi.org/10.1056/NEJMe1503200

Halpern, S., et al. (2015). Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine, 13 May [Epub before print]

WHO presents World Health Statistics 2015 as an integral part of its ongoing efforts to provide enhanced access to comparable high-quality statistics on core measures of population health and national health systems.

To download the report, go to:  http://www.who.int/gho/publications/world_health_statistics/2015/en/

789 pregnant smokers were randomised to "six weekly sessions of behavioural support for smoking cessation (control) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations".

The authors conclude from the results that "adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy".

This article is available to read in free full text at:  http://dx.doi.org/10.1136/bmj.h2145

Ussher, M., et al. (2015). Physical activity for smoking cessation in pregnancy: Randomised controlled trial. BMJ, 350; h2145.

‘Quit now – it’s about whānau’ is the message for this year’s World Smokefree Day, and it starts in Southern homes and communities. 

Celebrated globally on 31 May, this year’s World Smokefree Day is about encouraging and supporting friends, families and whānau across New Zealand to create environments where our children are free from exposure to tobacco.

To celebrate World Smokefree Day the smokefree car is on the move and will be at various places around the Southern district gathering support for smokefree cars carrying children. Come along, have your children’s photo taken in the smokefree car cut out and support the cause. 

“Research indicates that children with parents who smoke are three times more likely to become smokers,” explains Bridget Rodgers, Health Promotion Advisor, Southern District Health Board.

“We know that parents, whether they are smokers or not, feel very strongly about not exposing children to smoking”, says Bridget.  

“Parents, whānau and caregivers can make positive changes to the environment children are growing up in, even if they smoke. Talking to their children about smoking and establishing smokefree rules like not smoking around children, keeping the house and car smokefree is a fantastic start and a step in the right direction to protecting their children” says Ms. Rodgers.  

It’s a great opportunity to stand together as a family or a community and show your support to the future of this country and the health of future generations.

“Children see their parents smoke and this has a strong effect on what they perceive as normal.” she says. 

World Smokefree Day is a perfect opportunity to work together to achieve the goal of a Smokefree Aotearoa 2025, encouraging and supporting more people to quit to have a future in which our children and grandchildren will enjoy tobacco-free lives.

“Join with smokers and non-smokers alike, all around the world, and be a role model for the wellbeing of your family in 2015 – it’s about whānau,”  said Bridget.

Come along and find out more about how you and your whãnau can live smokefree.

• For more information on World Smokefree Day, go to: www.worldsmokefreeday.org.nz
• World Smokefree Day was created by the World Health Organisation in 1987. In other countries it is known as World No Tobacco Day.

Photo above: Imanuela Williams-Parima in the smokefree care cut out at Punavai o Le Atamai

Site specific smokefree car promotions will be at:

Central Otago

Thursday 14th May Maniototo Area School Ranfurly 3.00pm-4.00pm

Otago

Mornington Health Centre Monday: 18^th May 1.00 p.m. until 3.00 p.m.

Southland

Southland Hospital 25^th May 11.00am-1.00pm

Invercargill Library 27^th May 10.30am-11.30am

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

To find out more about this event, being held at the Dunedin Centre, go to: http://wired.ivvy.com/event/PHA15/

The authors describe their findings and conclude that "tobacco and alcohol use are by far the most prevalent addictive behaviours and cause the large majority of the harm. However, the quality of data on prevalence and addiction-related harms is mostly low, and comparisons between countries and regions must be viewed with caution. There is an urgent need to review the quality of data on which global estimates are made and coordinate efforts to arrive at a more consistent approach".

This article is available to read in free full text at:  http://dx.doi.org/10.1111/add.12899

Gowing, L. R., Ali, R. L., Allsop, S., Marsden, J., Turf, E. E., West, R., and Witton, J. (2015), Global statistics on addictive behaviours: 2014 status report.  Addiction, 110, 904–919.

A UK population-representative sample of greater than or equal to 50 year-olds (n=6965) was surveyed using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer beliefs (e.g., ‘cancer can often be cured’), and four on help-seeking barriers (e.g., ‘I would be too embarrassed’).
results: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers on four of six items. For example, 34% agreed ‘a cancer diagnosis is a death sentence’, compared with 24% of non/former-smokers (P<0.001).

More smokers (18%) than non/former-smokers (11%) would not want to know if they had cancer (P<0.01). The only barrier to symptomatic help-seeking differing by smoking status was ‘worry about what the doctor might find’ (36% vs 28%, P<0.01). Associations were independent of demographics, self-rated health and cancer experience.

The authors conclude that smokers held more pessimistic and avoidant beliefs about cancer, which could deter early-detection behaviour. A better understanding of these beliefs is needed to increase engagement in early diagnosis by this high-risk group.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1038/bjc.2015.148

Quaife, S.L., et al. (2015). Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership. British Journal of Cancer, 112, 1799–1804

Presented in collaboration with Reuters, this event was organised with the Center for Global Tobacco Control and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health.

To watch this video (approx. 1 hour), go to:  http://theforum.sph.harvard.edu/events/can-e-cigarette-regulation-protect-the-publics-health/

These data represent the activity of, and outcomes achieved, by a number of community based (face-to-face) stop smoking services,

Within most DHB catchment areas, there are multiple stop smoking service providers operating.  The data from all services headquartered within a DHB catchment have been combined to show activity by DHB area. Note that some service providers work across DHB boundaries.

Thirty-seven studies with data on 48 independent samples (n=33,613) were included. 

Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes.

The authors conclude that the evidence supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.

This is an open access article and can be read in free full text at:  http://tobaccocontrol.bmj.com/content/early/2015/05/03/tobaccocontrol-2014-051978.full

Noar, S.M., et al. (2015). Pictorial cigarette pack warnings: A meta-analysis of experimental studies. Tobacco Control, 6 May [Epub before print]

They conclude from their analysis that "while high motivation and determination to quit is necessary to prompt an attempt to quit smoking, demographic factors and level of nicotine dependence are more important for maintaining abstinence".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12972 or contact your DHB library, or organisational or local library for assistance.

Kale, D., et al. (2015). Are predictors of making a quit attempt the same as predictors of 3-month abstinence from smoking? Findings from a sample of smokers recruited for a study of computer-tailored smoking cessation advice in primary care. Addiction, 1 May [Epub before print]

Six of the best stories were chosen to form the online, radio and outdoor campaign, including one from TV presenter and former smoker Jason Fa’afoi.

For more information about the campaign and to view the campaign videos, go to:  http://www.quit.org.nz/198/help-to-quit/helping-pacific-people-quit

• Financial incentives help pregnant smokers quit
• Varenicline enables gradual smoking cessation
• Increasing varenicline dose in smokers
• Do smoking cessation aids change across quit attempts?
• Alcohol and tobacco imagery in YouTube music videos
• Extended run-in bupropion for smoking cessation
• Higher BMI may affect NRT efficacy
• Proactive outreach engages low-SES smokers
• Chemical composition of E-cigs available in NZ
• A brief intervention reduces passive smoking in babies

To subscribe to the Smoking Cessation Research Review, go to: http://www.researchreview.co.nz/

Chantelle Hill works in Waikato Hospital’s Newborn Intensive Unit where small babies are a common sight for a range of reasons – but one of them is very preventable.

“A baby whose mum smoked during pregnancy often can be smaller and needs a bit of help in the beginning. It’s only one of the reasons a baby might be small, but if we can’t see a medical reason, we do ask the mums if they smoked during pregnancy.

For Chantelle, this is an important opportunity to avoid further risks if the baby continues to grow up in a smoking environment at home.

“Becoming a smokefree family reduces the risk of sudden infant death syndrome (SIDS), and also reduces risk of glue ear, asthma and respiratory conditions.

“So talking to mums about that healthy ongoing environment for their baby is a really important part of what we do.”

Chantelle is an associate charge nurse and a smokefree champion for NICU, where she has worked for the past 10 years. That is about to change as Chantelle is currently pregnant herself, due in June.

“I absolutely love it, working with mums and families,” she says.

A lot of the women will encounter smokefree information and support long before they give birth or get to NICU, usually through their midwife or at appointments with the Women’s Health Assessment Unit, as part of Waikato DHB’s Hapū Mama and Hapū Wānanga initiatives. Many women don’t realise that nicotine passes through the placenta into the blood supply. So the baby does get nicotine and all the other nasty chemicals in the cigarette.

But Chantelle understands how hard it can be for a new mum to give up smoking during a stressful time.

“Some of them have been smokefree during pregnancy but have gone back to smoking with the stress of delivering the baby early or because the baby has needed intensive care treatment, so they kind of fall off the perch. It’s a matter of supporting them to get back onto the programme.

“It’s giving them the motivation like, ‘you did so well, you were off smoking for four weeks, I know this is a stressful time but your baby is here now, so let’s work together to keep it healthy and get this baby in the best position to come home to a healthy environment’.”

Chantelle says women come in from as far afield as Taumarunui and Coromandel and often without having much time to prepare. After delivery, they are technically discharged from hospital while their baby is cared for in NICU.

“While they are on the ward we can support them to be smokefree with Nicotine Replacement Therapy (NRT). When discharged, it is harder for them to get to a pharmacy to get more supplies – often they are without transport – and they have to start paying for NRT.”

Lately NICU has been part of a pilot project at the hospital to provide a free month-worth of NRT when a new mum is discharged, which Chantelle sees as a huge plus to keep them on track.

Chantelle says partners are another big factor in keeping new mums smokefree. “If it is an environment where mum smokes and dad smokes, getting them both on board is very important because if someone around you is smoking, you are more likely to slip back to smoking as well.”

If she had one message to give to mothers who smoke it is: “Create a healthy environment for your baby. It is so important for them – much more important than the next cigarette.”

The campaign eschews the gruesome imagery of previous advertisements to focus on the way the quality of life of cancer sufferers is affected".

To read the full story in The Age, go to:  http://www.theage.com.au/victoria/new-quit-campaign-highlights-16-cancers-associated-with-smoking-20150503-1myydi.html

To find out more about the campaign, go to:  http://www.quit.org.au/reasons-to-quit/health-risks-of-smoking/16-cancers

http://www.health.govt.nz/publication/general-practice-toolkit-more-heart-and-diabetes-checks-and-better-help-smokers-quit

There is also an interesting link on this website to the UK video: "How to discuss smoking"

This video demonstrates how to use motivational approaches to discuss smoking with our patients (see below)

Six trials were included and the authors conclude from their analysis that "general practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.3399/bjgp14X676456 or contact your DHB library, or organisational or local library for assistance.

Si, S., et al. (2015). Effectiveness of general practice-based health checks: A systematic review and meta-analysis. British Journal of General Practice, 64(618), e47-53.

Emergency department staff save lives every day, but they still find time to think about the longer term risks to people’s health.

Most people think of Emergency Department as the place that deals with the immediate needs of very sick people, accident victims and those with serious injury. And they do.

But at Waikato Hospital this very busy team of health professionals still finds time to identify people who are thinking about giving up smoking, and give them support.

In fact 90 per cent of people who smoke and who attended Emergency Department in March for a range of injuries and illnesses were offered help to give up smoking. Emergency Department discharged 937 people in March, 127 were identified as currently smoking and of these 112 received support to stop smoking including advice, treatment and referral to stop-smoking agencies.

Kate Dallas, nurse coordinator for the DHB’s smokefree services, said Waikato Hospital ED is one of the departments making the highest number of referrals to community smoking cessation services. “They are not just ticking a box. They are organising follow up in the community for those people who might want to stop.”

Of the 90 referrals the community cessation services received from all Waikato Hospital wards and department in March, 40 came from Emergency Department. “That’s a tremendous achievement,” Kate Dallas said.

Emergency staff know smoking can hinder recovery rates for surgery and wound healing, cause problems for newborn babies, and make people more susceptible to flu and colds, as well as the long-term life-threatening risks associated with cigarette smoking.

Emergency physician Dr Ruth Large knows that at a personal level with two family members who smoke getting cancer. She describes helping people to stop smoking as “one of the most rewarding things I do in Emergency Department.”

You might think that people attending Emergency Department would be too worried about their immediate health problem to think about stopping smoking, but that is often not the case. “A few patients are not interested but most are, and they appreciate us talking about it,” she says. “They might be here for an issue that is made worse by smoking, or will take longer to heal if they smoke, so they can see the personal connection. It makes sense.”

In the end, it’s all about saving lives.

Published studies, those reported smoking abstinence or reduction in cigarette consumption after the use of e-cigarettes, were included. Studies were systematically reviewed, and meta-analyses were conducted.

Six studies were included involving 7,551 participants. Meta-analyses included 1,242 participants who had complete data on smoking cessation. Nicotine filled e-cigarettes were more effective for cessation than those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Amongst 1,242 smokers, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled effect size of 0.20 (95%CI 0.11-0.28). Use of e-cigarettes was also associated with a reduction in the number of cigarettes used.

The authors note some limitations of the study. Included studies were heterogeneous, due to different study designs and gender variation. Whilst we were able to comment on the efficacy of nicotine vs. non-nicotine e-cigarettes for smoking cessation, we were unable to comment on the efficacy of e-cigarettes vs. other interventions for cessation, given the lack of comparator groups in the studies included in this meta-analysis.

They conclude that the use of e-cigarettes is associated with smoking cessation and reduction. More randomised controlled trials are needed to assess effectiveness against other cessation methods.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1371/journal.pone.0122544

Rahman MA, Hann N, Wilson A, Mnatzaganian G, Worrall-Carter L (2015). E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis. PLoS ONE 10(3): e0122544.

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

An environmental scan was conducted and the identified courses were evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. 

A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor’s role, and assessment and evaluation. 

This is an open access article and can be read in free full text at:  http://doi.org/10.2196/jmir.3284

Selby P, et al. (2015). Review and evaluation of online tobacco dependence treatment training programs for health care practitioners. Journal of Medical Internet Research, 17(4):e97

Evidence syntheses, a primary qualitative survey, and discrete choice experiment (DCE) research was undertaken using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout.

The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking.

Twenty-three smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder.

The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives.

A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. 

The authors conclude that incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended and collaborative service-user involvement is important.

This report can be read in free full text at:  http://dx.doi.org/10.3310/hta19300

Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, et al. (2015). Benefits of incentives for breastfeeding and smoking cessation in pregnancy (BIBS): A mixed-methods study to inform trial design. Health Technol Assessment, 19(30).

A total of 22 studies from 16 different prospective cohorts were identified. Primary cigar smoking (current, exclusive cigar smoking with no history of previous cigarette or pipe smoking) was associated with all cause-mortality, oral cancer, esophageal cancer, pancreatic cancer, laryngeal cancer, lung cancer, coronary heart disease (CHD), and aortic aneurysm. Strong dose trends by cigars per day and inhalation level for primary cigar smoking were observed for oral, esophageal, laryngeal, and lung cancers. Among primary cigar smokers reporting no inhalation, relative mortality risk was still highly elevated for oral, esophageal, and laryngeal cancers.

The authors conclude from the results that cigar smoking carries many of the same health risks as cigarette smoking. Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking. 

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12889-015-1617-5

Chang, C.M., et al. (2015). Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health, 15:390.

The pilot study of 50 lower North Island primary and secondary schools found that a third had no smokefree signage. Of the schools that did have signage, only half had a smokefree sign at their main entrance.

The research, which is the first in New Zealand to look at the usage of smokefree signage in schools, was published today in the Australian and New Zealand Journal of Public Health.

Under the 2004 Smoke-free Environments Act, all preschools, primary and secondary schools are required to have smokefree signage ‘prominently displayed’ at every entrance to a school property, as well as at building entrances.

Associate Professor George Thomson says from a health perspective it’s disappointing that a third of all schools surveyed had no smokefree signage visible from the perimeter and that most did not have signs at a main entrance.

“It’s important that schools have smokefree signage, particularly at entrances where parents and caregivers may be waiting, because they are a good reminder.”

The study, by researchers from the Public Health Department at the University’s Wellington campus, used Google Street View to locate larger smokefree signage as well as on-location observations.

The authors identified a "... summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar".

The authors discuss the implications of these findings.

This article is available to read in free full text at: http://dx.doi.org/10.1136/bmj.h1551

 Mons, U., et al. (2015). Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: Meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ, 350:h1551.

The authors conducted a systematic review of clinical interventions to reduce secondhand smoke (SHS) exposure among non-smoking pregnant women.

Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) in today’s Morbidity and Mortality Weekly Report (MMWR). Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students.

This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes. E-cigarettes were the most used tobacco product for non-Hispanic whites, Hispanics, and non-Hispanic other race while cigars were the most commonly used product among non-Hispanic blacks.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar,” said CDC Director Tom Frieden, M.D., M.P.H. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.”

Hookah smoking roughly doubled for middle and high school students, while cigarette use declined among high school students and remained unchanged for middle school students. Among high school students, current hookah use rose from 5.2 percent in 2013 (about 770,000 students) to 9.4 percent in 2014 (about 1.3 million students). Among middle school students, current hookah use rose from 1.1 percent in 2013 (120,000 students) to 2.5 percent in 2014 (280,000 students).

The increases in e-cigarette and hookah use offset declines in use of more traditional products such as cigarettes and cigars. There was no decline in overall tobacco use between 2011 and 2014. Overall rates of any tobacco product use were 24.6 percent for high school students and 7.7 percent for middle school students in 2014.

In 2014, the products most commonly used by high school students were e-cigarettes (13.4 percent), hookah (9.4 percent), cigarettes (9.2 percent), cigars (8.2 percent), smokeless tobacco (5.5 percent), snus (1.9 percent) and pipes (1.5 percent).  Use of multiple tobacco products was common; nearly half of all middle and high school students who were current tobacco users used two or more types of tobacco products. The products most commonly used by middle school students were e-cigarettes (3.9 percent), hookah (2.5 percent), cigarettes (2.5 percent), cigars (1.9 percent), smokeless tobacco (1.6 percent), and pipes (0.6 percent).

Cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco are currently subject to FDA’s tobacco control authority. The agency currently is finalizing the rule to bring additional tobacco products such as e-cigarettes, hookahs and some or all cigars under that same authority. Several states have passed laws establishing a minimum age for purchase of e-cigarettes or extending smoke-free laws to include e-cigarettes, both of which could help further prevent youth use and initiation. 

“In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened,” said Mitch Zeller, J.D., director of FDA’s Center for Tobacco Products. “These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.”

Today’s report concludes that further reducing youth tobacco use and initiation is achievable through regulation of the manufacturing, distribution, and marketing of tobacco products coupled with proven strategies. These strategies included funding tobacco control programs at CDC-recommended levels, increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and sustaining hard-hitting media campaigns. The report also concludes that because the use of e-cigarettes and hookahs is on the rise among high and middle school students, it is critical that comprehensive tobacco control and prevention strategies for youth focus on all tobacco products, and not just cigarettes.

The National Youth Tobacco Survey (NYTS) is a school-based, self-administered questionnaire given annually to middle and high-school students in both public and private schools. NYTS, which surveyed 22,000 students in 2014, is a nationally representative survey.

The 2012 Surgeon General’s Report found that about 90 percent of all smokers first tried cigarettes as teens; and that about three of every four teen smokers continue into adulthood. To learn more about quitting and preventing children from using tobacco, visit www.BeTobaccoFree.gov.

https://blogs.otago.ac.nz/pubhealthexpert/2015/04/17/highlights-of-the-world-conference-on-tobacco-or-health/

The Protocol to Eliminate Illicit Trade in Tobacco Products, negotiated under this Treaty, aims to provide a global response to the illicit trade in tobacco products.

The Government is undertaking consultation to inform decision-making as to whether it should agree to become a party to it.

To find out more, go to:  http://www.health.govt.nz/publication/new-zealand-and-protocol-eliminate-illicit-trade-tobacco-products

To read a related media release, go to:  http://beehive.govt.nz/release/consultation-sought-tobacco-control-protocol

The aims of this study were to measure tobacco use behaviour; previous quit attempts and outcomes; methods used to assist quitting; difficulties experienced during previous attempts; the motives and preferred methods to assist quitting in a future attempt; identify the factors associated with preferences for smoking cessation.

Face-to-face interviews were undertaken with hospitalised smokers enrolled in a smoking cessation trial in the inpatient wards of three Australian public hospitals.

Northern Regional Alliance Limited

Notes that:

The Child Health section of the 2015/16 Northern Regional Health Plan includes the development of a consistent systematic process for risk assessment of Sudden Unexpected Death of Infants (SUDI) in primary care.

Interest in this development has evolved. A group has formed to discuss activity and membership has grown beyond the Northern Region to include Janine Ryland from the Ministry of Health, Dr John McMenamin, GP,  from Wanganui Regional Health Network, Primary Care Advisor Tobacco Team MOH,  and Ken Leech, Health Information Consultant.

Professor Ed Mitchell, SUDI Researcher, has developed a risk assessment tool and has agreed that this can be integrated into existing software for the Public Good.

Discussion has progressed to identify recommendations for pragmatic actions. The recommendations arising from this work to date include:

• Develop a phased approach to implementation. Phase One is in selected Primary Health Organisations (PHOs).
• Developing key simple questions that identify risk that will alert health professionals to the need to have further conversations to manage risks. The risk assessment tool then supports conversations to address modifiable behaviours.
• Embed the SUDI risk assessment tool into primary care patient management systems
• Expansion into all PHOs.
• Expansion of the scope to embed the risk assessment tool into a postnatal six week check for use in a range of primary care settings.
• Explore funding to support both an implementation and an evaluation process

The development of this tool will benefit primary care providers nationally

This working group would like to:

1. Communicate broadly that this work is in progress
2. Welcome conversations with others who are interested in participating or may be considering a similar approach

Pamela Henry

Project Manager Child Health

Northern Regional Alliance Limited

Level 2 650 Great South Road Penrose

PO Box 112147 Penrose Auckland 1642

DDI: 09 5808524 | EXTN: 9724 | MOB: 021 817 345 | FAX: 09 5893901

If you have any questions or comments about this document, or any other questions that could be added, please contact me.

 Dr John McMenamin

Primary Care Advisor Tobacco Team MOH

National Tobacco Target Champion Primary Care

Ph 021334859

The Healthy Families section on the Ministry of Health website describes the programme and its implementation.