Scottish Government

A BREATH OF FRESH AIR FOR SCOTLAND IMPROVING SCOTLAND'S HEALTH: THE CHALLENGE TOBACCO CONTROL ACTION PLAN

CHAPTER 7: MEASURING PROGRESS

The Challenge

7.1 Earlier chapters of this Plan have said how a number of different organisations and interests will take action to contribute towards our desire for a non-smoking Scotland. At national level, the Executive will play a major role in delivery as will other national bodies such as ASH Scotland, NHS Scotland, PATH and the Scottish Tobacco Control Alliance. For our part we will disseminate and promote the Plan widely; ensure appropriate systems are in place to measure its success; and identify resources as in Chapter 4. At local level, NHS Boards and their community planning partners will be responsible for ensuring delivery.

Current activity

7.2 The current tobacco targets were set in the White Paper Towards a Healthier Scotland¹² in 1999: These are:

Headline target

• Reduce smoking among young people (aged 12-15) from 14% to 12% between 1995 and 2005 and to 11% by 2010.

• Reduce the proportion of women who smoke in pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010.

Second rank target

• Reduce smoking among adults (16-64) from an average of 35% to 33% between 1995 and 2005 and to 31% by 2010.

7.3 Until 2002, young people's smoking targets were monitored through a UK biennial survey. The last such survey, Smoking, drinking and drug use among young people in Scotland in 2000¹³ reported 10% of pupils who were regular smokers - the lowest prevalence since measurements were first taken in 1982. Partly because of the need for disaggregated local data to inform service planning, a new survey, Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS),¹⁴ designed to monitor substance misuse prevalence among 13 and 15 year olds was introduced in 2002. SALSUS continues the biennial series of surveys used to monitor national trends in Scotland since 1982 for these two age groups and also incorporates items of health, lifestyle and social factors for the first time. SALSUS 2002 reported that 8% of 13 year olds and 20% 15 year olds were regular smokers. In both age groups girls were more likely to be regular smokers than boys. Although there is an apparent decrease in smoking among 13 year olds since 1998, these changes were not statistically significant. Smoking prevalence in 15 year olds has also decreased since its peak in 1996 (30%) but it is only among boys that the change was statistically significant.

7.4 Maternal smoking is monitored through data from Maternity Inpatient and Day Case records (SMR02). Latest figures from Information Services Division (ISD) report that in 2002 27% of Scottish pregnant women smoked in early pregnancy.

7.5 Adult smoking rates are monitored through several data sources. Latest available figures from the 2002 Scottish Household Survey ¹⁵ show 31% of men (aged 16-64) were current smokers which is a small decrease from the 1995 figure of 34% from the Scottish Health Survey. The percentage of women (aged 16-64) smokers decreased from 36% in 1995 Scottish Health Survey ¹⁶ to 32% in the 2002 Scottish Household Survey. However, in 2001, people living in most deprived areas (Carstairs Quintile 5) were twice as likely to smoke as people living in most affluent areas (Carstairs Quintile 1) in Scotland, ie 41% and 18% respectively. However, a percentage of smokers - 70% overall - were in the lower socio-economic groups.

Future direction

7.6 While these figures suggest we are moving in the right direction in terms of these targets, it needs to be borne in mind that the decline in smoking rates over the past 30 years has been mainly among more affluent people. The trend in young girls smoking is also disappointing.

7.7 We will judge success of this Plan by continuing to measure performance against the three targets, on children smoking, adults smoking and smoking in pregnancy. However, to reflect action in this Plan, we now propose to adjust the adult target to 29% by 2010. Moreover, primarily in order to drive progress in reducing smoking levels among more disadvantaged groups, we propose to revisit all the national targets in light of the results of SALSUS 2002, the latest Scottish Household Survey and the Scottish Health Survey 2003. We will also require NHS Boards and their partners in health improvement to set and monitor local targets to underpin achievement of the national targets set. This process will be informed by the Smoking Atlas of Scotland, to be published by the end of March 2004, which is a source of guidance to NHS Boards, local authorities and MSPs on the level of smoking and related harm in their area and the consequent scale of the challenge they face in reducing it.

7.8 At local level, Joint Health Improvement Plans will be the focus for tobacco control activity. Local action will continue to be monitored through the Performance Assessment Framework which contained four smoking indicators relating to pregnant women and adult smoking rates. However, we will also continue to explore other possible means to monitor smoking rates and other proxy indicators which might be used also to measure progress.

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