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

https://www.york.ac.uk/healthsciences/research/trials/research/trials/cpit-iii/

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

Publications:
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.

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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

Publications:
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

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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

Publications:
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 

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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

Publication:
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

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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

Publication:
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 

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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

Publications:
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.

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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

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Smoking Cessation in Pregnancy
Part of DH Tobacco Control Health Inequalities Pilot Projects Programme 
(2010-2011)
(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

Publication:
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 

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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

Publications: 
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.

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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 

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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 

Publications:
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. http://www.biomedcentral.com/1471-2458/13/343 

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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 

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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.

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 

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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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Evaluation of the PATH (Partnership Action on Tobacco and Health) Support Fund on Smoking Cessation Services for Pregnant Women and People Facing Inequalities (2003-2006) 
(Funded by the Scottish Executive and managed by ASH Scotland; in collaboration with Scottish Centre for Social Research and University of Edinburgh) 

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.

ISM Staff: Susan MacAskill, Martine Stead and Kathryn Angus

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Pre-test of Smoking Cessation Booklet 
(Commissioned by The National Assembly for Wales (NAW), Public Health Strategy Division) 

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, were committed to provide support and improve quality of health information to assist health promotion in key priority areas such as smoking. These policy initiatives provided 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) 

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Tobacco-Related Work in Prisons (2003)
(Commissioned by Prison Health and the Tobacco Policy Team at the Department of Health)

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.

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

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Follow-Up Study Of DH Funded Provision of NRT in HM Prisons (2003-2005)
(Commissioned by Prison Health and the Tobacco Policy Team at the Department of Health)

This study evaluated the impact of Department of Health-funded NRT in prisons from 2003-2005. The research adopted 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 were 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 (2007). 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 

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Smoking Cessation in Prisons (2001-2002)
(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. The Department of Health and the Prison Service commissioned an evaluation of pilot interventions in four prisons in conjunction with local smoking cessation services (MacAskill & Eadie 2002). This showed substantial quit rates could 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 were 'launched' at a national conference in March 2007 which also addressed Smokefree issues in this setting.

ISM Staff: Susan MacAskill, Douglas Eadie and Martine Stead

Publications:
Eadie D, MacAskill S, McKell J and Baybutt M (2012). Barriers and facilitators to a criminal justice tobacco control coordinator: An innovative approach to supporting smoking cessation among offenders. Addiction, 107(Suppl2): 26-38.

MacAskill S, Lindridge A, Stead M, Eadie D, Hayton P and Braham M (2008). Social marketing with challenging target groups: Smoking cessation in prisons in England and Wales. International Journal of Nonprofit and Voluntary Sector Marketing, 13(3): 251-261.

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. 

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Adolescent Smoking Cessation: Literature Review and Evaluation of Pilot Projects (2000-2001)
(Commissioned by The National Assembly for Wales)

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 project model was rolled-out across several European countries, supported by the EU. Martine Stead acted as consultant to the CISHE research group at Cardiff University, who were evaluating the European programme.

ISM Staff: Martine Stead, Susan MacAskill and Lynn MacFadyen

Publication:
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.

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An Investigation into Smoking Cessation in Disadvantaged Communities (1998-2000) 
(Funded by Cancer Research UK) 

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 from this research (Stead et al 2001; MacAskill et al 2002) and several conference papers and seminar presentations 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 Place7(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 QuarterlyVIII(1): 19-34.

 

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