Smoking Cessation

The Smoking Cessation in Pregnancy Incentives Trial (CPIT): A Phase III Randomised Controlled Trial (2017-2020)
(Funded by Cancer Research UK, Chief Scientist Office Scottish Government, Health and Social Care Northern Ireland, Chest Heart and Stroke Society Nothern Ireland, Lullaby Trust, Scottish Cot Death Trust, and in collaboration with the University of Glasgow (lead))

This 39 month study will compare the smoking cessation rate when offering pregnant smokers financial incentives in the form of shopping vouchers, in addition to usual care, with usual care to engage with stop smoking services and/or to quit smoking. The aim is to show that, within a range of usual care situations, the addition of financial incentives provided in a simple transferrable format, increases smoking cessation; that stopping during pregnancy leads to prolonged cessation to at least six months after birth and that the addition of financial incentives is cost effective, and well below the threshold set by NICE to recommend widespread deployment of a new intervention.

ISM Staff: Linda Bauld, Lesley Sinclair, and Jennifer McKell


Adult Smokers’ Perceptions of Pack Inserts with Positive Messaging about Cessation: A Naturalistic Study (2017)
(Funded by Cancer Research UK)

From May 2017 the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive will require all cigarette packs to be very similar in appearance, with an unappealing base colour, large pictorial warnings on the principal display areas and additional health messages on the lateral surfaces. These changes are predicted to reduce the appeal of the pack, help the warnings to stand out more, and limit the ability of pack colour and shape to suggest that some brand variants are less harmful than others. However, there is clearly more scope for using the packaging to communicate with consumers. For instance, in Canada tobacco companies are required to include inserts inside cigarette packs, with messaging highlighting the benefits of quitting or prvoding tips on how to do so, to supplement the health warnings on the outside of packs. However, very few studies have explored how smokers respond to the use of pack inserts with this style of messaging.

This project aims to explore the impacts, if any, that the inclusion of pack inserts with messages aimed at encouraging quitting and promoting self-efficacy to do so has upon smokers’ perceptions and feelings about smoking and cessation-related thoughts and behaviours.

ISM Staff: Crawford Moodie and Richard Purves


Promoting Smoking Cessation During Pregnancy: A Combined Feasibility and Pilot Trial of a Theory-based Intervention using Narrative, Images and Embedded Behaviour Change Techniques, Delivered via Text-messaging (2017 - 2019)
(Funded by the Chief Scientist Office, Scottish Government)

This project is led by Helen Cheyne, Faculty of Health Sciences and Sport. An intervention was developed that aims to help pregnant women to stop smoking by sending text messages as part of an engaging story with pictures, from early in their pregnancy until after they give birth.

The aim of the study is to conduct a feasibility/pilot study to test the trial methods and then a large scale trial to find out if the intervention works in helping them to quit. This will be done in two phases. Phase 1 will involve refining and finalising the intervention, and working with smoking cessation services, midwives, mothers and local communities to determine the best methods for recruiting pregnant smokers to the study.  Phase 2 will involve 70 pregnant women who smoke, half will get standard NHS smoking cessation help and half will also get the new intervention. Assessment will then be made on the acceptability and likely impact of the intervention and the feasibility of conducting a future large scale trial. 

ISM Staff: Linda Bauld

External Department: Led by Helen Cheyne, Faculty of Health Sciences and Sport


Baby Be Smoke Free - A Quit Smoking Service for Young Mums-to-be (2016 - 2017)
(Funded by Department of Health through Tommy’s)

Building on Tommy's Baby Be Smoke Free pilot, Tommy’s will develop a stop smoking intervention that is: targeted specifically at young pregnant women, non-judgemental, convenient and cost-effective, and sustainable.

ISM staff will undertake the evaluation portion of this project.

ISM Staff: Linda Bauld, Fiona Dobbie and Nathan Critchlow

External: Tommy’s (lead)


360 Selfie: Capturing Social, Physical and Environmental Triggers Relating to Smoking Cessation (2016 - 2017)
(Funded by Cancer Research UK)

Cancer continues to be among the leading causes of morbidity and mortality worldwide. Smoking remains the biggest preventable cause of cancer. Stop Smoking Services (SSS) are an important part of a wider network of policies aimed to reduce smoking rates. However, the number of people setting a quit date through SSS has been declining. A greater understanding of individual risk factors could improve the effectiveness of smoking cessation services. Exposure to various cues within the social and physical environment can undermine attempts to quit by increasing craving.

To carry out the study, participants (aged 18+) setting a quit date will be trained to use a 360 camera to take a single 360 degree image capturing their environment from all angles every time they experience a craving, and will also complete a short survey after taking the image, recording the extent of their craving, mood, and whether they have relapsed. Once the image capturing period is complete, participants will complete a ‘cultural probe’ and take part in a reflective interview to validate, review and reflect on the identified cues. Qualitative interviews with SSS advisors will also be conducted to explore the feasibility and acceptability of incorporating this data into future smoking cessation services.

ISM Staff: Richard Purves and Nathan Critchlow

External: Milica Vasiljevic, University of Cambridge (Joint lead); Grace Okoli, King’s College London; Chris McGinley and Maneesh Juneja


Helping People Cope with Temptations to Smoke to Reduce Relapse: A Factorial RCT (2016 - 2019)
(Funded by National Institute for Health Research)

Extended stop-smoking medicine use can help prevent relapse but uptake and long-term use is low. New vaporised nicotine (VN) products, eg. e-cigarettes and other fast acting nicotine products may be more attractive for long-term use and hence useful as relapse prevention interventions (RPI). While several behavioural RPI have been found ineffective, recent data show that an online Structured Planning and Prompting Protocol (S3P), started at the beginning of the quit attempt, reduced relapse between 1-26 weeks from 71% to 61%.

This study aims to examine if two RPI, pharmacological (a choice of fast-acting nicotine products) and behavioural (an online Structured Planning and Prompting Protocol), individually and/or synergistically, can reduce rates of relapse between 4 weeks and 12 months post quit date (PQD) in those that receive the RPI compared to usual care.

ISM Staff: Linda Bauld

External: Hayden McRobbie (lead), University of Nottingham


Feasibility and Acceptability of Electronic Cigarettes as an Aid to Smoking Cessation for Lung Cancer Patients (2016 - 2017)
(Funded by Roy Castle Lung Cancer Foundation)

Few lung cancer patients who are smokers are able to give up during their treatment. This is despite the fact that stopping smoking improves cancer treatment outcomes, recovery and quality of life. This is particularly the case amongst those diagnosed with stage IV cancer. These patients may have tried to stop smoking many times in the past, including with established smoking cessation aids, but failed. Electronic cigarettes, while not currently licensed as medicines, may provide a more attractive alternative to these patients and help with stopping smoking during treatment.

This study is exploring how acceptable, feasible and useful they are for lung cancer patients by interviewing patients diagnosed with lung cancer, their families and healthcare staff. Patients who agree to aim to stop smoking and are interested in trying an electronic cigarette (EC) are provided with a starter kit and initial supply of e-liquid in line with new Cancer Research UK guidelines on the use of ECs in research. They are provided with support on use and followed up at 4 weeks and 4 months to assess a range of measures including whether they are smoking.  Smoking status is being verified using a carbon monoxide breath test.

ISM Staff: Linda Bauld, Lesley Sinclair and Jennifer McKell


SCIPS (Smoking Cessation in Pregnancy and Social Networks): Developing Social Network Support to Improve Smoking Cessation Outcomes for Pregnant Women Living in Disadvantaged Areas (2014-2015)
(Funded by Cancer Research UK)

Smoking rates in pregnancy in the UK remain high and continue to be an important public health issue. The smoking cessation literature tells us that the attitude and smoking behaviour of social networks (eg. partners, family and friends) are recognised as important barriers to cessation However, drawing on social networks to help smoking cessation has mainly centred on the general adult population and remains under researched in pregnancy.

The aim of this development study is, therefore, to design an intervention to help pregnant women stop smoking using support from their social network. An ‘action’ research design will be used where each phase of the research will inform the next. First, a rapid literature review and stakeholder interviews will be conducted. This will then be followed by consultation with pregnant women and their social networks to co-design the intervention. Lastly, a stakeholder workshop will be held where learning from the previous stages will be shared with key stakeholders, who will then help finalise a logic model which will describe the proposed intervention and how it can be evaluated if pilot funding is secured. In terms of impact the ‘products’ of this development study have the potential to improve the quit attempts of pregnant women and maintain abstinence post-partum. A secondary impact is to assess the utility of using social networks to facilitate behaviour change in other risk facts associated with cancer (diet, exercise, alcohol).

ISM Staff: Fiona Dobbie, Lesley Sinclair and Kathryn Angus


Cancer Diagnosis as an Opportunity for Increasing Uptake of Smoking Cessation Services among Families: An Exploratory Study of Patients’, Family members’ and Health Professionals’ Views (2013-2015)
(Funded by the Chief Scientist Office)

Smoking after a diagnosis of cancer is associated with significantly worse morbidity and mortality, therefore uptake of effective smoking cessation services is particularly important for people with cancer. Evidence suggests that cancer diagnosis can be a powerful catalyst to behaviour change. However, the influence of family members and health professionals at this highly emotive time is likely to be important, and there is considerable evidence to suggest that opportunities to discuss smoking cessation with patients and families are currently under-used. This qualitative study explores the experiences and views of patients, family members and healthcare professionals in relation to smoking and smoking cessation around the time of a cancer diagnosis, in order to identify whether and how recently diagnosed cancer patients and their close family members can effectively and appropriately be encouraged to engage with smoking cessation services. Findings will be used to identify a number of potential approaches to improve uptake of existing smoking cessation services in the context of a cancer diagnosis, and consensus will be established through a nominal group technique, using an expert group comprised of health care professionals and patient advisors.  For further information contact Mary Wells

ISM Staff: Linda Bauld

Research Team: Mary Wells, Brian Williams, Gozde Ozakinci, Alastair Munro, Vikki Entwistle, Sally Haw, Andrew Radley, Fiona Harris


BME Feasibility and Ethnographic Study in Deprived Areas in the Southside of Glasgow (2013-2014)
(Funded by NHS Greater Glasgow & Clyde (GGC))

This is a scoping and feasibility study in deprived areas in the Southside of Glasgow, which will build on previous work on the black and ethnic minority ethic (BME) population in the area, focused on smoking cessation and health inequalities. It will provide baseline data for NHS GGC and a policy-oriented report with recommendations for further research, projects and interventions in these communities using an assets based approach.

ISM Staff: Marisa de Andrade


We Can Quit (2013-2014)
(Funded by the Irish Cancer Society)

Through this project we will work with the Irish Cancer Society who wish to commission an action research project to develop and implement innovative community based approaches to support smoking cessation among women from socially and economically disadvantaged communities. The project aims to identify the supports and barriers to quit smoking for women in lower socioeconomic groups and to add to the evidence base about the mechanisms of quitting.

ISM Staff: Linda Bauld, Fiona Dobbie and Douglas Eadie


Barriers and Facilitators to Smoking Cessation in Pregnancy and Following Childbirth (2013-2015)
(Funded by the National Institute for Health Research (NIHR))

This study will explore the barriers and facilitators to smoking cessation in pregnancy through reviewing relevant literature, conducting qualitative research and developing proposals for future interventions. A qualitative study design will combine 3 systematic reviews and 3 exploratory studies conducted over a two year period. A set of literature reviews of barriers and facilitators to cessation in pregnancy and following childbirth will be taken.

ISM Staff: Linda Bauld, Lesley Sinclair, Jennifer McKell, Kathryn Angus and Allison Ford

Bauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, McKell J, McCaughan D, Hopewell S, Angus K, Eadie D and Tappin D (2017). Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Health Technology Assessment, 21(36): 1-158. doi:10.3310/hta21360

Wells M, Aitchison P, Harris F, Ozakinci G, Radley A, Bauld L, Entwistle V, Munro A, Haw S, Culbard B and Williams B (2017). Barriers and facilitators to smoking cessation in a cancer context: A qualitative study of patient, family and professional views. BMC Cancer, 17: 348. doi:10.1186/s12885-017-3344-z

Wells M, Aitchison P, Harris F, Ozakinci G, Bauld L, Entwistle V, Munro A, Haw S, Williams B and Radley A (2016). Barriers and facilitators to smoking cessation: A qualitative study of patients’, family members’ and professionals’ views in a cancer context. [Conference abstract] Psycho-Oncology, 25(Suppl 3): 169. 10.1002/pon.4272

Flemming K, Graham H, McCaughan D, Angus K, Sinclair L and Bauld L (2016). Health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research. BMC Public Health, 16: 290. doi:10.1186/s12889-016-2961-9

Flemming K, Graham H, McCaughan D, Angus K and Bauld L (2015). The barriers and facilitators to smoking cessation experienced by women’s partners during pregnancy and the post-partum period: a systematic review of qualitative research. BMC Public Health, 15: 849. doi:10.1186/s12889-015-2163-x

Flemming K, McCaughan D, Angus K and Graham H (2015). Qualitative systematic review: Barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth. Journal of Advanced Nursing, 71(6): 1210-1226. doi: 10.1111/jan.12580. Epub 2014 Nov 28.


BIBS: Benefits of Incentives for Breastfeeding and Smoking Cessation: A Platform Study for a Trial (2012-2013)
(Funded by NIHR HTA and in collaboration with the University of Aberdeen (lead), University of Central Lancashire, Newcastle University and Yorkhill Hospital)

The aim of this research is to find out which incentives (financial or non-financial), if any, are most likely to help women to stop smoking in pregnancy (and not restart) and to breastfeed their babies until 6 months, to benefit the health of both mothers and babies. This project is led by Professor Pat Hodinott from Nursing and Midwifery. We will start by finding research studies and reports about the different types of incentives that have been used. We will see whether they work, how much incentive is needed, the timing and how best to deliver it. We will produce a classification and summary of different types and combinations of incentive, how they work and how they fit with all the other pros and cons or motivating factors for breastfeeding and smoking. This will produce a short-list of the most promising incentives.

ISM Staff: Linda Bauld and Susan MacAskill

Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D and Campbell M (2015). Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technology Assessment, 19(30): 1-522. doi:10.3310/hta19300

Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P; on behalf of the BIBS team (2014). Unintended consequences of incentive provision for behaviour change and maintenance around childbirth. PLoS One, 9(10): e111322. doi:10.1371/journal.pone.0111322

Hoddinott P, Morgan H, MacLennan G, Sewel K, Thomson G, Bauld L, Yi D, Ludbrook A and Campbell MK (2014). Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public. BMJ Open, 4: e005524. doi:10.1136/bmjopen-2014-005524


Effectiveness and Barriers/Facilitators Reviews: Smokefree Secondary Care Settings (2011-2013)
(Funded by NICE and in collaboration with the University of Nottingham)

The aim of the study was to conduct two systematic reviews on:

  1. The effectiveness of smokefree strategies and interventions in secondary care settings (for acute, maternity and mental health settings); and
  2. The barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings (for acute, maternity and mental health settings) from the users’ and the providers’ perspectives.

The purpose was to support the development by NICE of their Public Health Guidance (November 2013) covering smoking cessation in secondary care in acute, maternity and mental health services. The reviews provided the best available evidence on smokefree strategies and interventions in these settings. The reviews were led by the Institute for Social Marketing in partnership with the University of Nottingham and collaborators from the EPPI-Centre at the Institute of Education and the NCSCT Community Interest Company.

ISM Staff: Kathryn Angus, Douglas Eadie and Laura Macdonald

Angus K, Murray R, Macdonald L, Eadie D, O’Mara-Eves A, Stansfield C and Leonardi-Bee J (2013). Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. London: National Institute for Health and Care Excellence. Review 

Eadie D, Macdonald L, Angus K, Murray R, O’Mara-Eves A, Stansfield C and Leonardi-Bee J (2012). Review 7: A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings.  London: National Institute for Health and Care Excellence. Review 


Improving the Effectiveness and Reach of NHS Support for Smoking Cessation in Pregnancy (2011-2013)
(Funded by the National Institute for Health Research (NIHR))

This project is part of a large NIHR programme grant led by Professor Tim Coleman at the University of Nottingham. The overall aim of all projects combined is to increase the uptake and effectiveness of the NHS Stop Smoking Services for Pregnant women (SSSP) by determining when and how NHS cessation support is best offered in pregnancy; refining and testing 'self-help' cessation methods which are attractive to and, therefore, likely to be used by the vast majority of mothers who do not currently access SSSP and investigating how 'self-help' support is best delivered by the NHS.

ISM Staff: Linda Bauld

Fahy SJ, Cooper S, Coleman T, Naughton F and Bauld L (2014). Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS stop smoking services for pregnant women. BMC Health Services Research, 14(1): 107. doi:10.1186/1472-6963-14-107


Evaluating Longer Term Outcomes of NHS Stop Smoking Services (ELONS) (2011-2013)
(Funded by NIHR HTA and in collaboration with the Universities for Bath, Nottingham, UCL, Birmingham and Queen Margaret University)

This 30 month study began on 1st October 2011 and is funded by the NIHR HTA. It aims to examine longer term outcomes from smokers accessing NHS stop smoking services in England. The study involves secondary analysis of routine data from 60 Primary Care Trusts who use the North51 (QuitManager) database followed by a prospective cohort study that will recruit 5000 smokers who will be followed up at four weeks and one year post quit date. In particular, the study aims to examine the efficacy of different models of support to stop smoking and the relationship between individual client characteristics, service features and outcomes.

ISM Staff: Linda Bauld, Fiona Dobbie, Susan Murray and Richard Purves

Dobbie F, Hiscock R, Leonardi-Bee J, Murray S, Shahab L, Aveyard P, Coleman T, McEwen A, McRobbie H, Purves R and Bauld L (2015). Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technology Assessment, 19(95): 1-156. doi:10.3310/hta19950 


Financial Incentives for Smoking Cessation in Pregnancy (CPIT): A Phase II Randomised Trial (2011-2013)
(Funded by the Chief Scientists Office, Glasgow Centre for Population Health, NHS Greater Glasgow and Clyde, and in collaboration with the University of Glasgow (lead))

Smoking during pregnancy causes low birth weight, prematurity and ill health later in life. Pregnancy is an opportunity to help women to quit smoking before their own health is permanently compromised, but few use effective support of the kind offered by NHS smoking cessation services. Financial incentives may increase participation and engagement in cessation programmes and help women stop smoking. This is a Phase II RCT to examine whether adding incentives will increase engagement with specialist smoking cessation services and subsequent quit rates during pregnancy. It will also identify factors that need to be considered for a design of a Phase III trail. Professors Linda Bauld (University of Stirling) and David Tappin University of Glasgow are joint PIs. The Trial Manager (Lesley Sinclair) is managed from Stirling University. Data collection commences December 2011 and the aim is to recruit and follow-up 600 pregnant women who smoke and who express an interest in support to quit, randomised individually to intervention or control status. Control participants will continue to receive standard cessation services.  Incentives in the form of vouchers will be given at key stages during the pregnancy dependant on setting a quit date and remaining quit.  Susan MacAskill and Jennifer McKell (University of Stirling) will also conduct process research to contribute to understanding of the feasibility and acceptability of incentives to quit among pregnant women and staff, together with issues around trial participation.

ISM Staff: Linda Bauld, Lesley Sinclair, Susan MacAskill and Jennifer McKell

McConnachie A, Haig C, Sinclair L, Bauld L and Tappin DM (2017). Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis. Trials, 18: 337. doi:10.1186/s13063-017-2053-x

Berlin N, Goldzahl L, Bauld L, Hoddinott P and Berlin I (2017). Public acceptability of financial incentives to reward pregnant smokers who quit smoking: a United Kingdom-France comparison. The European Journal of Health Economics, online 23rd June. doi: 10.1007/s10198-017-0914-6

Bessing B, Bauld L, Sinclair L, Mackay DF, Spence W and Tappin DM (2016). Representativeness of the participants in the smoking Cessation in Pregnancy Incentives Trial (CPIT): a cross-sectional study. Trials, 17: 426. doi:10.1186/s13063-016-1552-5.

Boyd KA, Tappin DM and Bauld L (2016). Cost-effectiveness of financial incentives for smoking cessation in pregnancy [letter]. Addiction, 111(6): 115-117. doi:10.1111/add.13374

Tappin D, Bauld L, Purves D, Boyd K, Sinclair L, MacAskill S, McKell J, Friel B, McConnachie A, de Caestecker L, Tannahill C, Radley A and Coleman T for the Cessation in Pregnancy Incentives Trial (CPIT) Team (2015). Financial incentives for smoking cessation in pregnancy: Randomized controlled trial. [Conference abstract]. Obstetrical & Gynecological Survey, 70(5): 297-298. 10.1097/01.ogx.0000466333.20683.0c

Hoddinott P, Morgan H, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D and Campbell MK (2014). The push me, pull you of financial incentives and health inequalities: a mixed methods study investigating smoking cessation in pregnancy and breastfeeding. [Conference abstract]. The Lancet, 384(Special Issue, Suppl 2): S37. doi:10.1016/S0140-6736(14)62163-2

Bauld L and Sinclair L (2015). Rewarding smoking cessation in pregnancy - will women cheat to gain incentives? Addiction, 110(4): 689-690. doi:10.1111/add.12851

Tappin D, Bauld L, Purves D, Boyd K, Sinclair L, MacAskill S, McKell J, Friel B, McConnachie A, de Caestecker L, Tannahill C, Radley A, Coleman T; Cessation in Pregnancy Incentives Trial (CPIT) Team (2015). Financial incentives for smoking cessation in pregnancy: randomised controlled trial. BMJ, 350: h134. doi:10.1136/bmj.h134

Tappin DM, Bauld L, Tannahill C, de Caestecker L, Radley A, McConnachie A, Boyd K, Briggs A, Grant L, Cameron A, MacAskill S, Sinclair L, Friel B and Coleman T (2012). The Cessation in Pregnancy Incentives Trial (CPIT): Study protocol for a randomized controlled trial. Trials, 13: 113-123.


Evaluation of Smokefree Northwest Smokefree Pregnancy Reward Scheme (2011)
(Funded by NHS Sefton and in collaboration with Smokefree Northwest)

This study involved secondary analysis of routine data collected by 24 Primary Care Trusts in the North East of England who were participating in an incentive scheme to help women stop smoking during pregnancy. Women who were CO validated as quitters at four weeks were eligible to join the programme and receive behavioural support, NRT and a small cash incentive (in the form of store vouchers) during pregnancy and up to two months post partum. This regional pilot aimed to respond to the research recommendation from NICE for the need for more UK evidence regarding the effectiveness of financial incentives for smoking cessation in pregnancy.

ISM Staff: Linda Bauld and Jennifer McKell


Smoking Cessation in Pregnancy
Part of DH Tobacco Control Health Inequalities Pilot Projects Programme 
(Funded by the Department of Health and in collaboration with the University of Bath, University of Glasgow, University of Nottingham and University of Bristol)

This study was funded by the Department of Health and was one of six tobacco control and inequalities pilots for England. One of the other pilots, on prisons, is also being conducted by ISM.

The project involved the implementation and evaluation of an opt out referral pathway between maternity services in two case study sites in England and the local stop smoking service. Pregnant women entering the pathway were asked about their smoking status and given a carbon monoxide test to confirm smoking status. Those who self reported as smokers or had a CO reading of more than 4ppm are automatically referred to the stop smoking service. In addition, a subsample of women in each area provided a urine sample which was tested for cotinine in order to ascertain whether self report, CO or cotinine provided the most accurate indicator of smoking in pregnancy. The pilot aimed to implement new smoking cessation in pregnancy NICE guidance in full so should provide useful learning for policy and practice.

ISM Staff: Linda Bauld

Bauld L, Hackshaw L, Ferguson J, Coleman T, Taylor G and Salway R (2012). Implementation of routine biochemical validation and an 'opt out' referral pathway for smoking cessation in pregnancy. Addiction, 107(Suppl 2): 53-60. Online 


Testing the Feasibility of Nicotine Assisted Reduction to Stop in Pharmacies - The Redpham Study (2009-2012)
(Funded by the Medical Research Council and led by the University of Birmingham) 

Nicotine assisted reduction to stop (NARS) means treating smokers who do not want to stop smoking but are prepared to reduce smoking with NRT. Trials in highly controlled circumstances showed this increased smoking cessation, but there were doubts about whether similar findings would occur in the NHS. A trial was funded to examine, in a naturalistic setting, whether pharmacists could be trained to implement NARS, how well they do so, and how this is received by smokers and by pharmacists. This also acted as a pilot to prepare for a definitive trial that would answer two other questions; firstly, whether behavioural support adds to the effectiveness of NARS programmes and, secondly, whether short or standard length NARS programmes were more effective.

Susan MacAskill is a member of the Trail Steering Group on this project.

ISM Staff: Susan MacAskill

Farley A, Tearne S, Taskila T, Williams RH, MacAskill S, Etter JF and Aveyard P (2017). A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists - The RedPharm study. BMC Public Health, 17(1): 210. doi:10.1186/s12889-017-4116-z

Taskila T, MacAskill S, Coleman T, Etter J-F, Patel M, Clarke S, Bridson R, Aveyard P (2012). A randomised trial of nicotine assisted reduction to stop in pharmacies – The RedPharm Study. BMC Public Health, 12: 182.


Action Research: Smoking in Disadvantaged Communities in Nottingham (2009-2010)
(Led by UK Centre for Tobacco Control Studies (UKCTCS)) 

Nottingham had a higher level of smoking than the national average, with smoking prevalence being above 40% in some deprived areas. This study used action research to identify and develop effective interventions for reducing smoking in a disadvantaged community in Nottingham. The study was led by the UK Centre for Tobacco Control Studies (UKCTCS), a UK Centre of Public Health Research Excellence, of which CTCR is a partner.

Its objectives were:

  • Objective 1: to characterise smoking norms and attitudes to quitting in the community, including consideration of trends as a result of national and local developments. 
  • Objective 2: to detail areas of consensus and contention between professional and lay views with regard to knowledge and values about smoking and quitting.  
  • Objective 3: to actively explore and test effective approaches to reducing smoking in these communities, which included consideration of how social networks and rules could be harnessed; the potential of a harm minimisation approach; the potential of linking reducing smoking to other lifestyle behaviour changes (reducing obesity and alcohol misuse; increasing physical activity) and the role of public sector and community resources.

Methods included:

  • An initial scoping exercise to gain insight and understanding of the area characteristics and issues, including observation of the area and informal ‘street interviews'. 
  • Semi-structured interviews with health professionals and other informants holding key positions within the community. 
  • Focus groups with community residents including smokers, ex-smokers and those living with smokers.

A mini-review of interventions/initiatives that have been carried out in communities facing similar challenges to this one to consider whether there may be transferable learning and to develop recommendations for interventions which could be carried out in a further phase of the project.

ISM Staff: Susan MacAskill and Martine Stead 


Process Evaluation of 'Give It Up For Baby' - An Incentive-based Smoking Cessation Programme in Tayside, Scotland (2009)
(Commissioned by NHS Tayside) 

Evidence indicated that as few as 20% of pregnant smokers in Scotland, referred by routine antenatal carers, actually engaged with conventional specialist smoking cessation services. There was 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 had been shown to help initiate and support quitting, it was recognised that to realise their full potential there was a need to develop consumer understanding of how incentives could 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 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 

Radley A, Ballard P, Eadie D, MacAskill S, Donnelly L and Tappin D (2013). Give it up for baby: Outcomes and factors influencing uptake of a pilot smoking cessation incentive scheme for pregnant women. BMC Public Health, 13: 343-355. 


Incentives to Engage Pregnant Smokers with Specialist Smoking Cessation Services: Feasibility Study in NHSGGC (2008)
(Commissioned by Glasgow Centre for Population Health) 

Over 20% of pregnant women smoke in Scotland, rising to over 30% in Glasgow, in spite of risks to mother and baby, making this a priority issue. Specialist cessation support in pregnancy services are well established in NHSGGC, but with variable levels of referral and low levels of engagement. There was evidence that incentives could increase engagement with smoking cessation services, but there was a clear need for robust evidence of the impact of incentives in UK settings. A feasibility study was commissioned by Glasgow Centre for Population Health to identify and help resolve key issues related to the implementation of the proposed intervention and a Phase II RCT. It was largely based on extensive discussions with key informants, where considerable support for the Phase II trial was expressed.

ISM Staff: Susan MacAskill and Douglas Eadie 


Audits of Smoking Cessation Support in Secondary Care and in Pregnancy (2007)
(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.

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 


PESCE (General Practitioners and Economics of Smoking Cessation in Europe) (2006-2008) 
(In collaboration with a number of European partner organisations; funded by the European Commission & Cancer Research UK) 

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.

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



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