2010-04-09
A follow-up of the work by county councils and regions on tobacco prevention policies in 2009.
The 2009 follow-up of the work of the county councils and regions (hereafter called county councils) to introduce and develop tobacco prevention policies indicates a positive trend. Development is progressing in most of the areas
covered by the survey.
• All county councils currently have some type of politically mandated policy. Eight of 21 county councils have policies that also regulate the staff’s use of snuff (snus).
• A growing number of county councils (19 compared with a previous 16) has adopted nonsmoking working hours and the staff refraining from smoking during working hours has been implemented in practice among more than half the staff in 18 county councils. Four of the county councils have decided to implement
no-tobacco working hours (i.e. snuff use prohibited as well).
• The majority of county councils currently have clear markings of where one may smoke in the health and medical care areas, and smoking rooms have been removed with the exception of around half of the county councils having occasional smoking rooms left for patients in institutional psychiatric care.
• The sale of tobacco products is also on the way out from the premises of the county councils, and has been completely removed in 11 county councils.
• Almost all county councils also have personnel with overall responsibility for tobacco cessation treatment (20 county councils) and for coordinating the provisioning of cessation treatment for patients (17 county councils).
• Half of the county councils (10, as many as before), say that there is a special unit in the county council responsible for developingtobacco prevention work, and all county councils (21) have contact people for tobacco prevention, which is an improvement (from a previous 17).
• Nearly all county councils (20) also consider themselves to have fully implemented the task of having people charged to continuously work with tobacco prevention and 14 county councils have some extent of funding earmarked for
tobacco prevention. In a few – but strategically important – areas of tobacco prevention, some deterioration can be noted.
• Only five county councils consider themselves to have fully implemented an adequate proportion of the staff being given training in tobacco cessation treatment methodology (formerly 8) and
• only five estimate that they have adequate resources for the patients’ needs for cessation support (formerly 6).
• Even fewer (3 county councils compared with a previous 4) consider it to be fully implemented that patients who use tobacco are offered cessation support and
• three consider it fully implemented that the patients’ care diagnoses are supplemented with information regarding tobacco use, although the latter shows an increase (formerly 1).
Between 56 and 73 per cent of the local healthcare centres offered tobacco cessation treatment in 2009, but generally with a very low intensity. The tobacco cessation therapists only worked two hours per week with cessation therapy on
average. The primary healthcare centres help an average of 23 patients per year to stop using tobacco, but with a large degree of local variation.
Multiplied by the number of primary healthcare centres that offer tobacco cessation treatment according to the survey responses (521), this means that a maximum of approximately 12,000 people per year receive treatment for their
tobacco dependence at primary healthcare centres.
An equal number receive help through the National Quitline. However, this does not suffice by far since 300,000 people are estimated to want help to quit using tobacco (Swedish National Institute of Public Health, 2009).
Questions have also been asked in the survey about what kind of support the primary healthcare centres would need to be able to offer tobacco cessation treatment. The most common responses are training and supervision, more time
and personnel, and financial reimbursement for the work.
• Twelve county councils indicate that they have special incentive programmes for working with tobacco prevention/cessation support, often of a financial nature. This is a clear increase (formerly 7 county councils).
• Of the hospitals, 47 percent can offer tobacco cessation treatment somewhere in their operations and the “smoking cessation prior to operation” method is also applied in a growing number of county councils (18), at least at some hospitals.
• Long-term planning for the development of the tobacco cessation treatment activities is conducted by 15 county councils.
If all responses to the county council survey’s 30 main questions are combined to thereby provide a “total score” for each county council, Jönköping has the top score, followed closely by Kalmar, Västerbotten and Örebro. The county councils where work has been developed the most since 2006 are Östergötland, Kalmar, Västmanland and Sörmland.
Based on the information presented in this report, it can be estimated that the county councils invest just over SEK 43 million per year in tobacco prevention and cessation efforts. Of this figure, a total of less than SEK 10 million comprises
funding earmarked for tobacco prevention in five county councils and the rest goes to salaries for county council tobacco prevention coordinators and tobacco cessation therapists at primary healthcare centres and hospitals.
The figure of SEK 43 million is less than one fourth of one thousandth of the total healthcare costs in the country, which can be considered a small effort keeping in mind that
• smoking accounts for the largest proportion of the total burden of disease,
• costs Swedish society SEK 30 billion per year,
• that the majority of our 900,000 daily smokers want to quit and that
• tobacco cessation treatment is considered to be one of healthcare’s most cost-effective measures (Swedish National Institute of Public Health, 2009).
updated Thursday, August 12, 2010
