A series of practical resources to enable leaders and professionals with direct reach to communities and an established, trusted relationship, for example community leaders, social prescribing link workers and faith leaders, to support their communities to reduce their risk of becoming seriously ill from Covid-19

1. Date 8th October 2020
Unhealthy habits: Smoking
Speakers:
Vicky Salt – Action on Smoking on Healthy (ASH) Policy Manager
Louise Ross- Quit for Covid Twitter
Syeda Akhtar /Rachel Hill- Birmingham Public Health Leads for
Smoking Cessation
Cassie Lowbridge- Smoking in Pregnancy - Senior Project Support
Officer -Birmingham Women & Children's NHS Foundation Trust
Richard Kennedy- Medical Director- Birmingham Women & Children's
NHS Foundation Trust
Part of the BHealthy webinar series

2. Agenda
12:30 – 12:35
Welcome, introductions and housekeeping -
Stacey Gunther
Public Health, Birmingham City Council
12:35 – 13:20
Speakers:
Vicky Salt – Action on Smoking on Healthy (ASH) Policy Manager
Louise Ross- Quit for Covid Twitter
Syeda Akhtar/ Rachel Hill - Birmingham Public Health Leads for Smoking
Cessation
Cassie Lowbridge- Smoking in Pregnancy - Senior Project Support Officer -
Birmingham Women & Children's NHS Foundation Trust
Richard Kennedy- Medical Director- Birmingham Women & Children's NHS
Foundation Trust
13:20 – 13:30
Q&A and Discussion – all speakers

3. HOUSEKEEPING
Please stay muted and turn your cameras off during this webinar.
Please turn off any VPNs (e.g. Netmotion, Cisco, etc.) to save bandwidth.
Please use the chat function to ask questions for the Q&A or you can email
your questions to healthybrum@birmingham.gov.uk
To make this webinar available to those that are unable to join us, today’s
webinar will be recorded. The recording, with both audio and visual will be
shared next week via email and online platforms.

4. BHealthy
A series of practical resources
to enable leaders and
professionals with direct
reach to communities and
an established, trusted
relationship, for example
community leaders, social
prescribing link workers and
faith leaders, to support their
communities to reduce their
risk of becoming seriously ill
from Covid-19
Webinar bookings via:
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-
19/2247/bhealthy

5. Quit for Covid
Evidence and campaign
Vicky Salt, ASH

6. COVID-19 what we know
• The evidence about smoking and COVID-19 remains uncertain
and is still evolving
• Evidence suggests that:
• Current smokers who receive a test in the community are
less likely to test positive than non- smokers
• Smokers hospitalised with COVID have slightly worse
health outcomes than non-smokers
• Hypothesis that nicotine may be acting as a protective factor.
This is unproven.
• The known risks of smoking mean it is always better to quit
BUT possible additional incentive to use products like nicotine
replacement therapy
QuitforCovid FAQs: https://smokefreeaction.org.uk/wp-content/uploads/2020/04/QuitforCovidFAQs1.pdf

7. Looking ahead to winter
Smokers are at
• 5 times influenza risk
• 2 times pneumonia risk
Smoking is a leading cause of heart
disease, chronic obstructive
pulmonary disease and diabetes
which are all COVID risk factors
In 2018/19 there were over 508,000
smoking attributable hospital
admissions.

8. Motivating and supporting smokers to quit now:
• Reducing the burden of ill health now: quitting
reduces risk of smoking related illness and may
reduce risks from COVID-19.
• Tackling lockdown legacy: health inequalities look
set to widen, tackling smoking is a key part of the
solution.
• Improving treatment outcomes: Smokers who quit
following cancer diagnosis improve survival
chances, important in context of later diagnosis.
• Building a healthy economy: Smoking poses great
costs on local economies and almost all money
spent leaves the community. Higher rates of quitting
can particularly boost economic prospects of poorer
communities
The case for action:

9. Directly in response to COVID-19:
 A quarter of smokers say they are more likely to
quit
Around 20% of smokers are smoking less
Approximately 1 million people in the UK quit
during lockdown
 Including approx. 99,500 in the West Midlands
Motivation to quit is up
Findings from the YouGov Covid Tracker

10. Without support it will be a missed opportunity for
many:
Nearly 1 in 10 smokers in England have tried to
quit for COVID but were unsuccessful = over half
a million smokers
Around a quarter of smokers are smoking more
and 1 in 10 are smoking indoors more than usual
Smokers with respiratory health conditions
appear no more likely to quit than other smokers
But not all are succeeding
Findings from the YouGov Covid Tracker

11. • Smokers with existing mental health problems are:
• More likely to have quit in lockdown: 10% of ex-smokers
compared to 7%
• More likely to report they have started using an e-cigarette
14% compared to 8%
• If not quit, smokers with mental health problems:
 Smoking more: 40% of smokers with mental health
problems smoking more compared to 26%;
 Smoking more indoors: 18% of smokers with a mental
health problem are smoking more inside compared to 12%
of those without.
But not all are succeeding
Findings from the YouGov Covid Tracker

12. Communications campaigns
#QuitForCovid and Today is the Day

13. Resources to support you

14. Resources to support you

15. Additional
resources
https://ash.org.uk/local-
resources/local-toolkit/
https://ash.org.uk/ash-local-
toolkit/local-alliances-roadmap/

16. How the pandemic brought new
opportunities and what we should do
to make the most of them
QuitforCovid and beyond
Delivered by Louise Ross

17. Declaration
Louise Ross was the Stop Smoking Service Manager for Leicester City Council, England,
until March 2018
She is Business Development Manager for the Smoke Free app
She ran the QuitforCovid Twitter clinic with Sheffield's Maggie Milne
She does freelance clinical consultancy for the National Centre for Smoking Cessation and
Training (NCSCT) www.ncsct.co.uk
Louise is also Vice Chair and mental health lead at the New Nicotine Alliance
http://nnalliance.org/
She receives no financial reward from the tobacco industry, the pharmaceutical industry
or the e-cigarette industry
lou_ross@yahoo.co.uk
louise.ross@smokefree.ai
lou.ross@ncsct.co.uk
@grannylouisa

18. Smoking: the reality of people’s lives
 Started smoking at a young age
 Live in families where most people
smoke
 Feel uncomfortable about quitting
(see F. Thirlway re Smoking Cessation
as Class Betrayal)
 Don’t necessarily buy at shop prices
 Think getting help is a sign of
weakness
 When they quit, they miss cigarettes
like they’ve lost a best friend
 They miss the ‘Me-Time’ of smoking
 Often have other dependency issues
or mental health problems

19. The effect of quitting is remarkable
 Financial
 Wellbeing
 Influencing others
 General health
 Effect on smoking-related illness
 Ambition to improve lifestyle

20. QuitforCovid: what we learned
 Communicating to frontline staff that
smokers can still get help to stop smoking
was really important
 People thought smoking might protect
them
 People were willing to do whatever it
takes to protect themselves from Covid
 Twitter isn’t the go-to place for stop-
smoking advice
 Frontline staff carry the message really
well

21. What can frontline workers suggest?
 Use of pharmacies and GPs
for help to stop smoking
 Go to a vape shop
 Use an app
 Frontline workers are very
welcome to use these
suggestions too, if they still
smoke

22. Does nicotine have a protective effect?
 For Covid?
(It may do)
 For relapsing?
(Most
definitely)

23. Countering misinformation about vaping
‘Fire-hosing inundates us
with so many wild opinions
that it becomes exhausting
to continually disprove
them’ Prof Linda Bauld
We are dealing with medics
whose advice on vaping
may push patients back to
smoking – who should they
believe??

24. I’d love to see…..
 People who smoke making
at least one attempt every
year to stop smoking
 All frontline staff nudging
people to try this
 All stakeholders realising
that this isn’t about
nagging, it’s about better
quality of life, a better bank
balance, a brighter outlook,
for the people of
Birmingham
Thank you for
listening

25. Unhealthy habits: Smoking
Local provision
Syeda Akhtar/ Rachel Hill- Birmingham City Council Public Health Senior Officer

26. COVID-19 and the impact on smokers:
 Coronavirus (COVID-19) is a respiratory infection that affects the lungs and
airways
 evidence suggests that smoking damages lungs and weakens immune system
 smokers are twice as likely to get pneumonia and five times more likely to get flu
then non-smokers
 smoking of any kind, not just cigarettes, but shisha, cannabis or any other
substances will also increase health risks such as heart disease, respiratory
disease and cancer at a time when the NHS is under strain from COVID-19
 smokers are more likely to have complications if they are unwell and their
recovery time will be longer
 exposing members of your household to second-hand smoke can also mean they
are less protected against COVID-19 and a great risk to children and those with
existing health conditions.
PAGE 26

27. Second-hand smoking (SHS):
 breathing other people’s smoke is called passive, or SHS.
 80% of SHS is invisible and contains harmful poisons and over 4,000 toxins
 puts people at risk of asthma, meningitis, bronchitis and pneumonia, sudden
infant death syndrome (SIDS) in babies, heart disease and cancer
 it has been estimated that domestic exposure to SHS in the UK causes around
2,700 deaths in people aged 20-63 and a further 8,000 deaths a year among
people aged 65 years and older
 children who live with smokers are twice as likely to become smokers themselves
 pets also sometimes swallow cigarettes and other tobacco products causing
nicotine poisoning which can be fatal
PAGE 27

28. Quit smoking:
 there are approximately 138,095 smokers in Birmingham
 now has never been a better time to quit smoking, to protect you and others and
reduce the pressures on NHS
 quitting smoking is an important way for individuals to reduce their risks from
coronavirus (COVID-19)
 smoking increases the risk of lung infections, smokers are twice as likely to get
pneumonia and five times more likely to get flu than non-smokers
 quitting smoking rapidly reduces your risks of other health problems such as
heart problems, strokes and cancer
 it’s never too late to quit smoking, with the right support you’re 3 times more likely
to quit for good.
PAGE 28

29. SUPPORT AVAILABLE FOR STOP SMOKING

30. NHS Smokefree
The NHS have created a range of
resources, including their
Smokefree app which is free.
You can also get support from
social media groups, daily emails
and the National Smokefree
Helpline.
For further information please visit:
https://www.nhs.uk/smokefree
PAGE 30

31. Quit with Bella app
Launched in July 2020 to ensure smoking cessation
services is accessible to all smokers in Birmingham.
The app can be used as and when needed without
any face to face appointments.
‘Bella’ is your personal stop smoking robo-coach
who will support you whenever you need it.
You will be able to access free nicotine
replacement therapy (NRT)/e-cigarette.
(Subject to T&Cs apply)
You can find Quit with Bella on the App Store and
on Google Play – and don’t forget if you’re a
Birmingham City resident, it’s completely FREE!
PAGE 31

32. GPs, pharmacies and independent vape shop
If you live or work in Birmingham, you can get
support from your local GP practice or
pharmacy.
Visit Birmingham City Council website for a list
of current Stop Smoking providers:
https://www.birmingham.gov.uk/directory/46/sto
p_smoking_services
If you want to make the switch from smoking
cigarettes to vaping, visit PharmaStrat Ltd:
https://stopsmokingclinic.co.uk/birmingham/
PAGE 32

33. Benefits from quit smoking
There are many benefits linked with stop smoking:
 improve personal health and wellbeing
 non-smokers are less likely than smokers to get gum disease and prematurely lose
their teeth
 stopping smoking has been found to slow facial ageing and delay the appearance of
wrinkles
 when you stop smoking, your senses of smell and taste get a boost
 non-smokers find it easier to get pregnant as quitting smoking improves the lining of
the womb
 smokefree home protects your loved ones and your pets
 more money in the pocket
 reduces unnecessary pressure to NHS.
PAGE 33

34. Final thoughts…
 give smoking cessation a go, you may not quit at your first attempt but keep
persevering and you will get there
 join in the #QuitforCovid twitter conversation held daily at 7.30pm-8.30pm by
Louise and Maggie: https://twitter.com/lancsquitsquad
 Stoptober campaign- encourage the nation’s smokers to make a quit attempt
for the month of October and beyond
 please get in touch with us on how we can help your community to quit
smoking for good and make positive lifestyle choices:
P.H.PrimaryCare@birmingham.gov.uk
PAGE 34

36. Smoking in Pregnancy
Richard Kennedy – BUMP Medical Director
Cassie Lowbridge – BUMP Senior Project Officer
Birmingham and Solihull Maternity and
Newborn Partnership (LMS)
8 October 2020

37. Smoking in Pregnancy – Global Perspective
Birmingham= 10-12%

38. Stillbirth and Perinatal Mortality in Birmingham
Stillbirths Perinatal mortality
3.2
3.4
3.6
3.8
4
4.2
4.4
4.6
2013 2014 2015 2016 2017 2019
England
Birminghgam
STP
0
1
2
3
4
5
6
7
2013 2014 2015 2016 2017 2019

39. Smoking in Pregnancy

40. Smoking in Pregnancy - Risks

41. Smoking in Pregnancy - Risks
Smoking status Small for gestational
age
Childhood obesity
No smoking N=190873 N=92434
Only first trimester 0.99 (NS) 1.17(NS)
</=4 0.96 (NS) 1.02 (NS)
5-9 0.90 (NS) 1.37 (NS)
>/=10 0.88 (NS) 1.42
Continued smoking 2.15 1.42
</=4 1.57 1.30
5-9 2.40 1.42
>/=10 2.93 1.55

42. Fetal growth measurements and effects of smoking
Abraham et al. PLoS One 12 (2) 2017

43. Smoking in Pregnancy
Smoking during pregnancy
contributes annually to:
2,200 premature births
5,000 miscarriages
300 perinatal deaths
It adds to the risk of complications
during pregnancy and later life:
Low birth weight
ear, nose and throat problems
Respiratory conditions
Diabetes
Obesity

44. Smoking in Pregnancy

45. Smoking in Pregnancy
Stopping smoking during
pregnancy is the single most
effective thing that a pregnant
woman can do to protect the
health of herself and her unborn
child

46. Smoking in Pregnancy
Smokers at booking appointment
LMS 11.1% of pregnant women booked identified as a smoker (Jun 20)
Birmingham 15% of adults are smokers (2019)
Smokers at delivery
LMS 10.8% of pregnant women at delivery identified as smoker (Jun 20)
England: average of 10.4% of women were smokers at the time of delivery
Birmingham & Solihull Local Maternity System
Targets
Dept. of Health Tobacco Control Plan
Reduce the prevalence of smoking in pregnancy from 10.5% to 6% or less by 2022
BUMP – BSOL LMS
Reduce infant mortality by 20% in 2020 and reducing smoking rates is a crucial part of the strategy
Characteristics
Younger women and those from a lower socio-economic background are more likely to smoke

47. Saving Babies Lives v2
A Care Bundle for Reducing Perinatal Mortality
• Reducing still births and perinatal deaths is a key government target
• Saving Babies Lives Care Bundle brings together guidance and best practice to address this through
5 key elements
Element 1 is Reducing Smoking in Pregnancy
• Offering carbon monoxide (CO) testing for all women as a minimum at the booking and
36 wk appointments to identify smokers (or those exposed to tobacco smoke)
• Offer an ‘opt-out’ referral for support from a trained stop smoking advisor
• All maternity staff to be trained in delivering ‘very brief advice’ on smoking in
pregnancy
• Reducing smoking impacts positively on the other care bundle elements to reduce instances of
fetal growth restriction, intrapartum complications and preterm birth.
• This element also reflects the wider prevention agenda, impacting positively on long term
outcomes for families and society.
Element 1 is Reducing Smoking in Pregnancy
• Offering carbon monoxide (CO) testing for all women as a minimum at the booking
and 36 wk appointments to identify smokers (or those exposed to tobacco smoke)
• Offer an ‘opt-out’ referral for support from a trained stop smoking advisor
• All maternity staff to be trained in delivering ‘very brief advice’ on smoking in
pregnancy

48. Smoking Cessation Pilot - Erdington
Quit rates at 4 and 12 weeks were much higher in the BUMP pilot
when compared to all pregnant women in Birmingham who engaged
with smoking cessation services via their GP surgeries and pharmacies
(over the same period)
BUMP Pilot Across Birmingham
4 week Quit 53% 27%
12 week Quit 13% 8%

49. Stop Smoking in Pregnancy Service
Referral received from Midwife – contact made within 24hrs to confirm take-
up of support
1st appointment booked within 5 days - provide personalised advice and
guidance, review barriers and agree ‘quit date’
On-going appointments – agree frequency of meetings (min 4 and 12
weeks post quit date) and type of contact i.e. face-to-face, phone, text
NRT prescriptions – support worker provides vouchers which are
emailed directly to pharmacies
Behavioural support – motivational techniques, referral to other
resources, group activities
Wider health messages – support offered on health & wellbeing
messages and referral to other support services if required
Work alongside community midwives – feedback to midwives on progress
made and support required, share case notes

50. Smoking in Pregnancy – Get in touch
bwc.STOPSMOKINGBWC@nhs.net
Bwc.STOPSMOKINGUHB@nhs.net

51. Participants discussion
How can you support your
communities to quit smoking?

52. PAGE 52

53. PAGE 53

54. KEEPING IN TOUCH
BHealthy handouts can be found on our website
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy
The full list of BHealthy webinars
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy/2
For support with BHealthy or general enquires email
healthybrum@birmingham.gov.uk
or for Covid enquires email
BCCCovid19@birmingham.gov.uk