Recent evidence indicates that as few as 20% of pregnant smokers in Scotland referred by routine antenatal carers actually engage with conventional specialist smoking cessation services. There is an emerging body of evidence demonstrating the value of financial incentives to recruiting smokers to quit programmes and to supporting abstinence during pregnancy. However, whilst reward-based programmes have been shown to help initiate and support quitting, it is recognised that to realise their full potential there is a need to develop consumer understanding of how incentives can be integrated with other forms of structured support in order to sustain the behaviour. In view of the developing evidence base in 2007, NHS Tayside launched Give It Up For Baby (GIUFB), a scheme specifically designed to help pregnant women living in deprived communities in the Tayside region of Scotland to stop smoking. Following the first 18 months in operation, the Institute for Social Marketing were commissioned to conduct a qualitative evaluation examining participant engagement with the scheme. The results are currently under review and will be used to refine and improve the current intervention and to inform the development of models designed to target new audiences.

ISM Staff: Douglas Eadie and Susan MacAskill

Audits of Smoking Cessation Support in Secondary Care and in Pregnancy
(Commissioned by NHS Health Scotland)

The Institute for Social Marketing recently undertook separate studies to audit smoking cessation support activities in two key target settings in Scotland; namely secondary care and pregnancy. The work was conducted in collaboration with the University of Bath and University of Glasgow. In addition to mapping service provision, there was a particular interest in the interface with local primary care-based smoking cessation services and referral processes (especially secondary care) and in perspectives of a range of professionals about services (pregnancy). The studies explored examples of best practice in these settings in Scotland and elsewhere and the findings facilitated considerations in relation to Scottish Guidelines and the forthcoming NICE guidelines.

Publications:
Smoking Cessation Support in Secondary Care in Scotland
This report outlines findings from a national mapping exercise of smoking cessation support in secondary care in Scotland. The research aimed to map the current extent and nature of cessation support in secondary care, highlighting gaps and also providing examples of promising practice.

Smoking Cessation Support in Pregnancy in Scotland
Findings from this study reveal a number of key learning points for the development and delivery of cessation support in pregnancy.

ISM Staff: Susan MacAskill and Douglas Eadie

The PESCE project aimed to motivate increased smoking cessation interventions by GP's in Europe. As socioeconomic factors have been named in many EU countries as a deterrent to routinely practised smoking cessation interventions, an objective was to develop evidence based policy recommendations and implementation strategies to change the socioeconomic environment through political measures to motivate greater involvement of GP's in cessation interventions. The Centre for Tobacco Control Research conducted an academic literature review to provide evidence of the factors that hinder or promote GP's smoking cessation interventions, and coordinated the collection and review of grey literature from the EU member countries, Norway and Switzerland to complement this. These two reviews fed into the final European report, recommendations and strategies.

CTCR Staff: Martine Stead, Gayle Tait (left 2009) and Kathryn Angus

In 2002, the PATH programme allocated funds to support 10 creative local pilot projects in smoking cessation work over three years with specific target groups of pregnant women and people faced with inequalities, ie. high risk groups that reflect the priorities of the Government's White Paper "Smoking Kills". The external evaluation was conducted in collaboration with the Scottish Centre for Social Research and University of Edinburgh, using both qualitative and quantitative methods. It ran in conjunction with the projects (2003-06) and assessed how each pilot was established, developed and delivered. Project outcomes were evaluated on their relationship with individuals and how they impact on individuals' behaviour and, more widely, their impact on local and national organisations and structures. The evaluation also analysed and interpreted the internal evaluations collected by each of the funded projects. The final report and summary report are now available from the ASH Scotland website.

CTCR Staff: Susan MacAskill, Martine Stead and Kathryn Angus

In the UK, cigarette smoking remains the single largest cause of death and disability. This is particularly the case in Wales where it has been estimated that 7,000 people die each year from tobacco related illnesses, costing the NHS in Wales £70 million per year. In Wales, as in other parts of the country, smoking prevalence amongst adults has declined steadily. Providing encouragement and support in quitting is key to continuing this trend amongst adult smokers. The Better Health Better Wales consultation document and the NHS Plan for Wales, Improving Health in Wales, are committed to providing support and improving quality of health information to assist health promotion in key priority areas such as smoking. These policy initiatives provide the impetus for the development of smoking cessation strategies and resources to support health professionals working with adult smokers wishing to quit.

Qualitative research was conducted to pre-test the smoking cessation booklet 'Stopping Smoking Made Easier'. Eight focus groups were conducted with adult smokers (16-64 year old) in Wales, quota-sampled by age, socio-economic status, gender, cessation experience and geographic location.

The aim of the research was to evaluate the potential impact of the booklet design and content on a cross-section of adult smokers. More specifically, the research sought to assess the content with regard to the target audience's information needs, assess the comprehension and credibility of key messages and offer guidance on style, format, colour, imagery and tone of language.

CTCR Staff: Lynn MacFadyen and Elinor Devlin (left 2005)

Smoking Cessation in Prisons
(Commissioned by the Department of Health and Prison Health)

Around 80% of the UK 's prison population smoke and the prison setting represents an opportunity to access key smoking cessation target groups that are normally hard to reach, for example disadvantaged populations and younger men. This issue has become more salient with the new legislation on Smoke-free areas. A series of research studies have been commissioned by the Department of Health and the Prison Service. An earlier evaluation of pilot interventions in four prisons in conjunction with local smoking cessation services (MacAskill & Eadie 2002) showed substantial quit rates can be achieved, as well as providing insights into barriers and facilitating factors in service delivery. The results informed the content of the toolkit document 'Acquitted', published by the Department of Health in March 2003 (Braham 2003).

A second questionnaire based study mapped tobacco related activity across HM Prison Service and NHS smoking cessation services (MacAskill & Eadie 2003). Results were actively disseminated, including regional road shows aimed to promote 'Acquitted' and to encourage focus on the issue across the PCT and prison service interface at a local level.

The earlier findings contributed to the Department of Health decision to provide £500,000 of ring-fenced funding for provision of Nicotine Replacement Therapy (2003-2006). Our third study gathered insights into the impact of this funding, as well as service models and approaches, and informed policy and practice across the prison estate and PCTs hosting prisons (MacAskill 2006). Findings have been presented at various seminars, including an invited workshop and poster at the UK National Smoking Cessation Conference. Key findings and a 'best practice checklist' have been published and will be 'launched' at a national conference (March 2007) which also addresses Smokefree issues in this setting. All reports are available on the Department of Health Website.

CTCR Staff: Susan MacAskill, Douglas Eadie and Martine Stead

Publications:
MacAskill S and Eadie DR (2002). Evaluation of a Pilot Project on Smoking Cessation in Prisons - Final Report. Glasgow: University of Strathclyde, Centre for Tobacco Control Research.

Braham MW (ed) (2003). Acquitted: best practice guidance for developing smoking cessation services in prisons. London: Department of Health / HM Prison Service.

Report available in PDF format

A mapping exercise was undertaken of current and planned smoking cessation work with prisoners and staff, and of wider prison tobacco-related activities, across NHS smoking cessation services and HM Prison Service. The information was disseminated in seminars held across England and Wales and will facilitate future developments in this key area.

CTCR Staff: Susan MacAskill and Susan Anderson (left 2005)

This study evaluates the impact of Department of Health-funded NRT in prisons from 2003-2005. The research adopts a case study approach, using a mix of quantitative and qualitative methods to explore processes relating to the administration of NRT in the prison context, and to measure smoking cessation outcomes over one year. Projects in a number of prisons in the North West Region in England are being evaluated.

ISM Staff: Susan MacAskill and Douglas Eadie

Publications:
MacAskill S (2005). The Impact of DH Funded Provision of NRT in HM Prisons. Revised Findings. Stirling: Institute for Social Marketing, University of Stirling, November. Available here

MacAskill S and Hayton P (2006). Stop Smoking Support in HM Prisons: The Impact of Nicotine Replacement Therapy - Executive Summary and Best Practice Checklist. Stirling: Institute for Social Marketing, University of Stirling, March. Available here

MacAskill S and Hayton P (2007). Stop Smoking Support in HM Prisons: The Impact of Nicotine Replacement Therapy. Department of Health Online. Available here

This large multi-phased investigation into the prevalence and nature of smoking and smoking cessation in low income communities incorporated five stages of research: literature review; qualitative developmental research (MacAskill et al 1999); pilot study and large postal survey with adult smokers; and further qualitative study exploring smokers' and professionals' response to cessation interventions. It was conducted in four communities in Glasgow with low 'Depcat' scores. Survey findings showed higher smoking prevalence in low income areas compared to the general Scottish population (57%), a distribution across the Stages of Change skewed towards Pre-contemplation, and a strong and consistent relationship between least readiness to quit and material and employment disadvantage. Both stages of qualitative research gave considerable insight into the factors reinforcing continued smoking and inhibiting cessation, as well as potential areas for support. Respondents included members of local community groups, individual participants in services interviewed in their own homes, and workers and professionals in local community and primary care based organisations. Two papers have been published (Stead et al 2001; MacAskill et al 2002). Several conference papers and seminar presentations have been given.

CTCR Staff: Martine Stead, Susan MacAskill and Anne Marie MacKintosh

Publications:
Reece J, MacKintosh AM, Stead M and MacAskill S (2000). An investigation into smoking cessation in disadvantaged communities: Incentivised postal survey - report to The Cancer Research Campaign. Glasgow: University of Strathclyde, Centre for Social Marketing: September.

Stead M, MacAskill S, MacKintosh AM, Reece J and Eadie DR (2001). "It's as if you're locked in": Qualitative explanations for area effects on smoking in disadvantaged communities. Health and Place, 7(4): 333-343.

MacAskill S, Stead M, MacKintosh AM, Eadie DR and Hastings GB (1999). An investigation into smoking cessation in disadvantaged communities: Qualitative focus group research - report to the CRC. Glasgow: University of Strathclyde, Centre for Social Marketing: May.

MacAskill S, Stead M, MacKintosh AM and Hastings GB (2002). "You cannae just take cigarettes away from somebody and no' gie them something back": Can social marketing help save the problem of low income smoking? Social Marketing Quarterly, VIII(1): 19-34.

This two-phase study comprised: 1. A comprehensive literature review of current practice and theoretical developments in the area of adolescent smoking cessation, and 2. A process evaluation of innovative adolescent smoking cessation projects that ran in Wales from October 2001 to March 2002. Young smokers differ from adult smokers in their perceptions of their smoking status, understanding of addiction and motivation to quit. Adult cessation services were judged likely to be inappropriate in this project, which instead tried to work with young people in settings which were familiar to them (schools, colleges and youth centres), using youth work approaches and methods. The aim of the study was to identify factors which helped and hindered the delivery of the projects, assess the comparative success of the various projects, and to make recommendations for best practice for future programmes. The evaluation findings were presented to those connected with the projects and other youth cessation workers in Summer 2002 and informed later stages of work in this area. A roll-out of the project model across several European countries, supported by the EU, is currently in progress. Martine Stead is acting as consultant to the CISHE research group at Cardiff University, who are evaluating the European programme.

CTCR Staff: Martine Stead, Susan MacAskill and Lynn MacFadyen

Publications:
MacFadyen L, MacAskill S, Stead M and Eadie DR (2002). A Review of Adolescent Smoking Cessation. Technical Report No. 3. Cardiff: Welsh Assembly Government. ISSN: 1478-7822.