Projects

Tobacco Control

Fathers Who Smoke and Smoke-free Homes: An Exploratory Study to Inform Future Intervention Development (2019-2020)

(Funded by Cancer Research UK)

 

Enabling parents to create a smoke-free home is one of the key ways that children's exposure to second-hand smoke (SHS) can be reduced globally. Smoke-free home interventions have largely targeted mothers who smoke, highlighted the barriers/facilitators that women experience when attempting to create a smoke-free home, including a lack of agency in changing male smoking behaviours in their household. This may be especially challenging for women who are in vulnerable relationships; for women who lack the confidence/knowledge required to raise the issue effectively, and for pregnant women, who are particularly reliant on support from partners to create a smoke-free home and maintain it postpartum. This study combines public involvement with qualitative research, involving two Dads community groups in disadvantaged areas of Edinburgh and Glasgow from the earliest point to input to research plans and documents. Twenty fathers will be invited to take part in a semi-structured interview, recruited purposively through Early Years Centres and Facebook advertising. The interviews will explore father’s views on their role in creating/maintaining a smoke-free home, and their capabilities, opportunities and motivations associated with their attempts to create a smoke. Interviews will also explore men’s views on effective methods of delivery for a household-based smoke-free homes intervention. 

This work will inform the future development of a tailored approach for father's direct involvement in household attempts to eliminate SHS in the home. 

 

ISM Staff: Rachel O’Donnell and Sean Semple

 

External: Amanda Amos, University of Edinburgh; Lorraine Greaves, University of British Columbia, Canada

What is the Longer-term Response of Smokers and Ex-smokers to Standardised Packaging and how does Standardised Packaging Impact on Health Inequalities?

Adult Tobacco Policy Survey Wave 3 (2019-2020)

(Funded by Public Health Policy Research Unit, Department of Health)

This Adult Tobacco Policy Survey is a longitudinal online survey with a sample of smokers and ex-smokers from across the UK primarily aimed at exploring the impacts of standardised packaging for cigarettes and rolling tobacco. The first wave was conducted in April/May 2016 (just before standardised packaging was phased in), with the second wave in October 2017 (approximately 5 months after standardised packaging was mandatory) and the third wave to be conducted in May/June 2019 (approximately 24 months after standardised packaging was mandatory). The third wave will allow us to explore the medium-term impacts of standardised packaging, as well as any effect on inequalities.

ISM Staff: Crawford Moodie, Martine Stead, Catherine Best and Nathan Critchlow

The Role of E-cigarettes in the Implementation of Smokefree Prisons and Ongoing Management of Prisoner Populations (2018-2020)

(Funded by Cancer Research UK)

 

This study aims to explore the role of e-cigarettes in the implementation of smoke-free prisons and ongoing management of prisoner populations. The study involves interviews with staff and people in custody (prisoners) to better understand perspectives and experiences of e-cigarettes in the prison setting before and after the implementation of a smoking ban. The study will also analyse prisoner spending on items such as tobacco, e-cigarettes and food and drink, against critical stages in the implementation and routine management of smoke-free prisons. This study extends other ongoing research (the Tobacco in Prisons Study, ‘TIPs’) which we are conducting to inform and evaluate the implementation of a smoking ban in Scotland’s prisons.

 

ISM Staff: Kate Hunt, Ashley Brown, Rachel O’Donnell, Douglas Eadie, Richard Purves, Catherine Best and Allison Ford.

 

External: Helen Sweeting, University of Glasgow; Linda Bauld, University of Edinburgh; Scottish Prison Service

 

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): An Effectiveness-implementation Hybrid Study (2018-2020)

The aim of the MCLASS II project is to develop and test the effectiveness and cost-effectiveness of a community-based intervention called ‘Muslims for better Health’, with or without Indoor Air Quality (IAQ) feedback, in reducing exposure to second-hand smoke in homes in Dhaka, Bangladesh.

 

Second-hand Smoke (SHS) is a major public health problem and a priority for policy making in Bangladesh. We have been working with the Islamic Foundation, Bangladesh to develop and test a community-based intervention called ‘Muslims for better Health’ (M4bH) where we will train imams based in mosques to encourage their congregations to make a positive change in their smoking behaviours.

 

We are undertaking a large study to examine how effective and cost-effective the M4bH intervention is, with or without IAQ feedback, in reducing exposure to SHS in homes, frequency and severity of respiratory symptoms, and healthcare service use and in improving quality of life.

 

A pragmatic, three-arm open label, cluster randomised controlled trial (cRCT) with concurrent economic evaluation and process evaluation will be conducted in 45 mosques and their catchment communities in Mirpur area of Dhaka, Bangladesh. The three trial arms are as follows:

 

  1. Arm 1: M4bH intervention and IAQ feedback
  2. Arm 2: M4bH intervention alone
  3. Arm 3: Usual services

 

The primary outcome will be household SHS concentration measured as fine Particulate Matter less than 2.5 microns diameter (PM2.5) at 3 months post-randomisation. PM2.5 will be measured in homes using the Dylos DC 1700 (Dylos, California, USA) a low-cost particulate counter validated for use in domestic settings. Data from previous work in Scotland indicates that a smoke-free home will have PM25 concentrations that are generally about 5-10 times lower than a home where smoking takes place.

 

ISM Staff: Sean Semple and Ruaraidh Dobson

 

External: Led by the University of York

What are the Impacts of Standardised Tobacco Packaging? A Synthesis of Standardised Tobacco Packaging Evaluation Research in the UK (2018-2019)

(Funded by PHRC, Department of Health)

 

Standardised packaging was implemented in the UK between 2016 and 2017.  This review builds on previous reviews [link to/cite here our 2013 article in Plos One and the PHRC report, both of which should be listed under the previous standardised review project para] of the evidence regarding the potential public health benefits of standardised packaging, which were used to inform the UK consultation on the legislation.  In this review we focus on UK studies conducted since the start of the standardised packaging implementation period.  Results are being analysed under three themes: consumer responses, industry responses, and the retail environment.  Findings from the study will feed into the UK government policy post-implementation review to be conducted in 2020, and will be of international interest and significance, particularly for jurisdictions considering introducing similar legislation. 

 

ISM Staff: Crawford Moodie, Martine Stead, Kathryn Angus, Nathan Critchlow and Anne Marie MacKintosh

Tackling Secondhand Tobacco Smoke and E-cigarette Emissions: Exposure Assessment, Novel Interventions, Impact on Lung Diseases and Economic Burden in Diverse European Populations

(Funded by the European Commission)

 

TackSHS is a new research project funded by the European Union’s Horizon 2020 Research and Innovation Programme. TackSHS aims to improve our understanding of second-hand tobacco smoke and e-cigarette emissions and find ways of tackling the health burden caused by exposure to these aerosols.

 

This four-year project led by ICO (The Catalan Institute of Oncology) brings together leading European research centres to work in partnership on a comprehensive and integrated approach to generate significant step-change beyond the current state-of-the-art in understanding second-hand tobacco smoke and electronic cigarette aerosols.

 

The University of Stirling is leading on Work Package 4: “Measuring for change: air quality feedback to reduce SHS exposure in the home”. This work package will examine the efficacy of using personalised air quality measurements in homes of smokers to encourage behaviour-change towards having a smoke-free home environment. Building on recent quantitative and qualitative work by our group which has shown that feedback of second-hand smoke measurement information can help motivate smokers, this WP will develop a targeted intervention for use with socio-economically deprived smokers in four locations (Scotland, Catalonia, Greece and Italy) across the EU. Up to 40 smoking households in each country will be recruited and offered low-cost, simple to operate particle counting instruments to measure and log SHS levels in their home for a period of 30 days. During this time near real-time, personalised feedback will be provided to, and discussed with, the smoker along with target-setting and exploration of suitable methods of behaviour-change. Feedback will be given via text message to mobile phones, emails and personal voice calls. A final visit will gather data on changes made while a proportion of participants (10-20%) in each country will take part in a further qualitative interview by phone to gather data on their experience of the intervention.

 

Study outcomes will include quantitative measures such as changes in average and maximum fine particulate matter (PM2.5) concentrations and self-declared household smoking rules, while qualitative data will be gathered using questionnaire and interview to explore what elements of the intervention were useful/unhelpful, particularly well/poorly understood, and what were the barriers for those who did not make changes. This WP will provide a comprehensive database of baseline measurements of SHS concentrations in home settings from across the EU with the potential to generate several million minutes of measurements of household air quality.

 

The study aims to report by autumn 2019.

 

ISM Staff: Sean Semple, Ruaraidh Dobson and Rachel O’Donnell

Impacts of E-cigarette Regulation Via the EU Tobacco Products Directive on Young People’s Use of E-cigarettes and Tobacco: A Natural Experiment (2017-2019)

(Funded by the National Institute for Health Research)

 

The recent EU Tobacco Products Directive (TPD) has introduced a number of new restrictions on e-cigarettes in the UK. Much advertising is now banned and, since May 2017, all products containing nicotine must carry health warnings on 30% of the surface of the packet. Any product with a nicotine concentration above 20mg/ml needs to be licensed as a medicine.

 

This study is a UK-wide research collaboration which will use routinely collected survey data from England, Scotland and Wales to test effects of TPD legislation on young people’s use of e-cigarettes. Secondary analysis of this survey data will examine whether the current trend toward growth in e-cigarette use among young people is stunted or reversed by this legislation. Additionally, a mixed methods process evaluation is being undertaken, including interviews with young people, e-cigarette retailers, trading standards officers and policy stakeholders and audits of retailers. These have been conducted during the transitional period when unregulated e-cigarettes could still be sold (up to May 2017) and again a year later, after full implementation. The study reports in 2021.

 

ISM Staff: Jennifer McKell, Anne Marie MacKintosh and Douglas Eadie

 

External: Led by Graham Moore, Cardiff University; Linda Bauld, University of Edinburgh

E-cigarettes and Weight Control: An Exploratory Study (2017-2019)

(Funded by Cancer Research UK)

Most people who stop smoking say that they put on some weight. For some people this makes it harder from them to give up cigarettes. One of the most popular things to help people stop smoking is an electronic cigarette. Some people who vape have said that vaping helps them control their weight which helps them stop smoking cigarettes.

This study is a small exploratory study to examine a potential new phenomenon, vaping for weight control. Building on a published commentary identifying relevant literature, questions were add to the existing CRUK funded study of smokers and ex-smokers, and complemented by focus groups with smokers and ex-smokers who have used e-cigarettes (ECs). The data collected and analysed  will inform any relevant recommendations for practice and aim to identify if further research is merited and what this might involve.

ISM Staff: Isabelle Uny

External: Linda Bauld and Fiona Dobbie, University of Edinburgh; Jamie Brown, University College London; Paul Aveyard, University of Oxford; and Marewa Glover, University of Auckland

 

Evaluating Graduated Progress Towards and Impacts of the Implementation of Indoor Smokefree Prison Facilities in Scotland (2016-2019)

(Funded by the National Institute of Health Research)

This project began in 2016.  It is examining the implementation of a new policy, a total smoking ban in Scottish prisons from 30th November 2018. To our knowledge, our study will be the first to evaluate the introduction of a prison smoking ban using data collected throughout a prison system over time.  The first Phase of the project (Phase 1) began well in advance of the policy change, to understand how people living and working within Scotland’s prisons felt about tobacco use and a potential smoking ban. We also measured levels of second-hand smoke in prisons and talked to people who used and provided smoking cessation support. Phase 2 began in July 2017, after the announcement that Scotland’s prisons would become smokefree from 30th November 2018, and was designed to understand if and how things changed in the lead up to the implementation of a smoking ban.  Phase 3 is ongoing and is designed to evaluate the impact of the implementation of a smoking ban.

The study uses a range of methods, across the 3 phases, to examine the process and outcomes of the removal of tobacco from Scotland’s prison system. Specifically, objective measurement of second-hand smoke exposures in all 15 Scottish prisons; online staff surveys and paper prisoner questionnaires; interviews and/or focus groups with prison and healthcare staff and people in custody (prisoners); interviews with personnel in other countries which have introduced prison smoking bans; analysis of routinely collected data; and health economic modelling. The results are being shared on an ongoing basis with key stakeholders to inform decision-making and communication strategies in respect of the implementation of a prison smoking ban in Scotland. This study is being conducted in partnership with the University of Glasgow, and with the Scottish Prison Service.

ISM Staff: Kate Hunt (PI), Sean Semple, Ashley Brown, Douglas Eadie, Richard Purves, Andrea Mohan and Ruaraidh Dobson.

E-cigarette Marketing: Currency Research and Policy (2016)

(Funded by Cancer Research UK)

Electronic cigarettes are currently consumer products in the UK and latest estimates suggest there are more than 2.6 million current users. These products are promoted in a variety of ways through broadcast, print and digital media. Currently marketing is regulated by a framework developed by the Committee on Advertising Practice. This is due to change in May 2016 when the European Tobacco Products Directive will require the UK to introduce a range of restrictions on promotion including prohibiting many current forms of marketing.

This study built on previous work by the applicants for Cancer Research UK. It involved three elements:

  • First, it updated two previous literature reviews on e-cigarette marketing, one for CRUK (2013) and a second for Public Health England (2014).
  • Secondly, it examined the current configuration of the e-cigarette market including the role of independent manufacturers and of the tobacco industry, based on desk based research and available market data.
  • Thirdly, it involved semi-structured interviews with professionals involved in monitoring current e-cigarette marketing and in implementing the Tobacco Products Directive.

ISM Staff: Linda Bauld, Kathryn Angus and Allison Ford

External: Marisa de Andrade, University of Edinburgh

Publications: 
Bauld L, Angus K, de Andrade M and Ford A (2016). Electronic Cigarette Marketing: Current Research and Policy - Executive Summary. Commissioned by Cancer Research UK. E-cig Marketing Exec Summary

Bauld L, Angus K, de Andrade M and Ford A (2016). Electronic Cigarette Marketing: Current Research and Policy - Report. Commissioned by Cancer Research UK. E-cig Marketing Report

Smoke Free Partnership Evaluation (2015-2018)

(Funded by Smoke Free Partnership)

The Institute for Social Marketing conducted an independent evaluation of the Smoke Free Partnership’s (SFP) activities during a three year programme of work (2015-2017). SFP is a network of independent organisations working together to help promote and implement tobacco control in Europe. The evaluation utilised a mixed methods approach over two research phases. Phase 1 of the study comprised an audit of progress towards SFP achieving their objectives at year 1 and comprised telephone interviews with SFP partners and a review of SFP documentation. Phase 2, conducted at the end of the three year programme of work, comprised an online survey and further telephone interviews with stakeholders.

The report provides an overview of what SFP achieved in the years 2015-2017 and feedback on stakeholder perceptions of SFP activities. The findings contributed to future development of SFP activities and funding applications.

ISM Staff: Allison Ford and Martine Stead 

Publication:

Ford A and Stead M (2018). Smoke Free Partnership Evaluation Report. Institute for Social Marketing, University of Stirling: Stirling.

Retail Audit to Evaluate Standardised Packaging and its Impact in the UK (2015-2018)

(Funded by Cancer Research UK)

From May 2016, standardised packaging of cigarette packs and rolling tobacco products were implemented across all four nations of the UK. It was suggested that the implementation of standardised packaging may result in a drop on tobacco prices leading to an increase in consumption, and that there would also be an increase in the amount of counterfeit products on the market.

Based on research conducted in Australia, this study will examine:

  • Whether the price of tobacco products changes during and after the introduction of standardised packs
  • Whether new brands of lower price packs are introduced
  • Whether there is a change in “price per stick” of any brands?

 Two main methods will be used to gather data:

  • Desk based monitoring and analysis of retail marketing and prices.
  • Purchase of price data from a sample of 500 UK retailers.

ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Crawford Moodie, Kathryn Angus, Nathan Critchlow and Linda Bauld

Development of Tools to Measure Norms Towards Ordinary Cigarettes and Nicotine Use (2015-2016)

(Funded by the Public Health Research Consortium, Department of Health)

The aim of the study was to develop a tool to measure norms around smoking ordinary cigarettes (including exposure to second-hand smoke exposure and the tobacco industry) in the UK. The purpose was to produce a tool that would allow the Department of Health (DH) to collect data to monitor norms towards ordinary cigarettes, essentially enabling DH to respond to increases in positive norms. DH was concerned that an increase in positive norms may increase the uptake of ordinary cigarettes, decrease cessation, and increase exposure towards second-hand tobacco smoke.

We assessed norms around nicotine use, and measured norms in both adults (18 years and above) and youth (11-17 years).

This was achieved through, desk review, question development (for the tool), cognitive interviewing and small scale pilot testing.

ISM Staff: Martine Stead and Anne Marie MacKintosh

External: Ann McNeill, King’s College London; Sara Hitchman, KCL; Debbie Collins, NatCen

Tobacco Industry Denormalisation Survey (2014-2015)

(Funded by Cancer Research UK)

ISM provided input around shaping a public opinion survey to provide data to help inform the development of a tobacco industry denormalisation campaign. Specifically ISM provided input/feedback to the survey instrument, cleaned and analysed survey data and prepared and submitted a publication to Nicotine and Tobacco Research.

ISM Staff: Lesley Sinclair and Crawford Moodie

Youth Tobacco Policy Survey / A Monitor of the Tobacco Advertising Ban in the UK (1999-ongoing)

(Funded by Cancer Research UK)

The Youth Tobacco Policy Survey (YTPS) is a long running repeat cross-sectional survey of 11 to 16 year olds across the UK. Since its initiation in 1999, there have been significant advances in tobacco control including the introduction of the Tobacco Advertising and Promotion Act 2002 (2003-2005), a ban on smoking in public places (2006/2007), an increase in the minimum age of purchase to 18 (2007), the inclusion of pictorial warnings on packs (2008) and the implementation of a point-of-sale display ban, first in large stores and then all tobacco selling retailers (2012-2015). From May 2017, the Standardised Packaging of Tobacco Products Regulations and new Tobacco Products Directive (TPD) transformed the appearance of packs of cigarettes and rolling tobacco.

The YTPS aims to monitor young people’s response to tobacco control policies and any form of tobacco marketing, as well as their smoking knowledge, attitudes and behaviour.

This research involves repeat cross-sectional surveys administered to adolescents in Scotland, England, Wales and Northern Ireland. Measures are taken approximately every two years and the first two surveys, conducted in 1999 and 2002 provide baseline measures, collected prior to the new regulations on tobacco advertising and promotions. To date, eight waves of the YTPS have been conducted (W1 – 1999/2000; W2 – 2002; W3 – 2004; W4 – 2006; W5 – 2008; W6 – 2011; W7 – 2014; W8 – 2016) to monitor youth response to these policies.

Key measures within the surveys include, awareness of a range of forms of tobacco marketing, awareness of cigarette brands, perceptions of prevalence of smoking, smoking behaviour and smoking intentions. From 2011, measures have been included on response to tobacco packaging, to enhance understanding of the influence of packaging and provide baseline measures against which response to standardised packaging can be assessed. In 2014, the YTPS was extended to also include measures on e-cigarettes.

A second strand to the research is an audit of the industry's marketing activities which takes place on an ongoing basis. It aims to identify and detail any innovations or changes in tobacco industry marketing to both consumers and retailers.

CTCR Staff: Anne Marie MacKintosh, Crawford Moodie, Allison Ford, Gerard Hastings,

Publications:

Bauld L, MacKintosh AM, Eastwood B, Ford A, Moore G, Dockrell M, Arnott D, Cheeseman H  and McNeill A (2017) Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017. International Journal of Environmental Research and Public Health, 14(9), Art. No.: 973.

Moodie C, MacKintosh AM, Gallopel-Morvan K, Hastings G and Ford A (2017). Adolescents’ Perceptions of an On-cigarette Health Warning. Nicotine and Tobacco Research, 19(10): 1232-1237.

Bauld L, MacKintosh AM, Ford A and McNeill A (2016). E-Cigarette Uptake Amongst UK Youth: Experimentation, but Little or No Regular Use in Nonsmokers (Letter). Nicotine and Tobacco Research, 18(1): 102-103.

Ford A, MacKintosh AM, Bauld L, Moodie C and Hastings G (2016). Adolescents’ responses to the promotion and flavouring of e-cigarettes. International Journal of Public Health, 61(2): 215-224.

Moodie C, MacKintosh AM and Hastings G (2015). Adolescents’ response to pictorial warnings on the reverse panel of cigarette packs: A repeat cross-sectional study. Tobacco Control, 24(e1): e93-e97.

Jones LL, Moodie C, MacKintosh AM and Bauld L (2014). Young people’s exposure to and perceptions of smoking in cars and associated harms in the United Kingdom. Drugs: Education, Prevention, and Policy, 21(3): 225-233.

Moodie C, Angus K and Ford A (2014). The importance of cigarette packaging in a ‘dark’ market: the ‘Silk Cut’ experience. Tobacco Control, 23(2): 274-278. doi:10.1136/tobaccocontrol-2012-050681.

Ford A, MacKintosh AM, Moodie C, Richardson S and Hastings G (2013). Cigarette pack design and adolescent smoking susceptibility: A cross-sectional survey. BMJ Open, 3(9): Art No: e003282.

Ford A (2012). The Packaging of Tobacco Products. London: Cancer Research UK. 

MacKintosh AM, Moodie C and Hastings G (2012). The association between point-of-sale displays and youth smoking susceptibility. Nicotine and Tobacco Research, 14(5): 616-620.

Brown A, Moodie C, Hastings G, MacKintosh AM, Hassan L and Thrasher JF (2010). The association of normative perceptions with adolescent smoking intentions. Journal of Adolescence, 33(5): 603-614.

Moodie C, MacKintosh AM and Hammond D (2010) Adolescents’ response to text-only tobacco health warnings: Results from the 2008 UK Youth Tobacco Policy Survey. European Journal of Public Health, 20(4): 463-469.

Moodie C, MacKintosh AM and West R (2010). Adolescents’ awareness of, and involvement with, illicit tobacco in the UK (Letter). Tobacco Control, 19(6): 521-522.

Grant IC, Hassan L, Hastings G, MacKintosh AM and Eadie D (2008). The influence of branding on adolescent smoking behaviour: Exploring the mediating role of image and attitudes. International Journal of Nonprofit and Voluntary Sector Marketing, 13(3): 275-285.

Hastings G, MacKintosh AM, Holme I, Davies K, Angus K and Moodie C (2008). Point of Sale Display of Tobacco Products. London: Cancer Research UK, August.

MacKintosh A, Harris F and Hastings G (2008). Measures to assess the effectiveness of restrictions on tobacco marketing communications. In IARC Handbooks of Cancer Prevention, Tobacco Control, Volume 12: Methods for Evaluating Tobacco Control Policies. Lyon, France: IARC.

Moodie C, MacKintosh AM, Brown A and Hastings G (2008). Tobacco marketing awareness on youth smoking susceptibility and perceived prevalence before and after an advertising ban. European Journal of Public Health, 18(5): 484-490.

Devlin E, Anderson S, Borland R, MacKintosh AM and Hastings GB (2006). Development of a research tool to monitor point-of-sale promotions. Social Marketing Quarterly, XII(1): 29-39.

MacKintosh AM, MacFadyen L and Hastings GB (1999).  Developing a methodology to monitor the impact of the tobacco advertising and sponsorship ban in the UK.  Social Marketing Quarterly, V(3): 40-46.

Electronic Cigarettes: Tobacco Industry Business Plans or Strategies (2015-2016)

(Funded by Cancer Research UK)

The aim of the project was to systematically examine the business strategies being deployed in the UK e-cigarette market by both tobacco multinational and independent companies. Specifically, to compare their respective business approaches; targeting strategies; positions on harm reduction and health claims; and marketing plans.

In collaboration with: Dr Marisa De Andrade (Primary Investigator), University of Edinburgh

ISM Staff: Gerard Hastings and Kathryn Angus

Young Adult Smokers’ Perceptions of Dissuasive Cigarettes and Pack Inserts (2015-2016)

(Funded by NHS Health Scotland)

Cigarette pack inserts are an inexpensive means of communicating with smokers, and widely used by tobacco companies, however, few studies have explored how they could be used to communicate health messages. Similarly, while cigarettes are an increasingly important promotional tool for tobacco companies, the potential to use them to deter use has been overlooked until recently. This online survey explored young adult (16-34 years) smokers’ perceptions of cigarette pack inserts with positively framed messaging and standard and dissuasive cigarettes (an unattractively coloured cigarette and a cigarette displaying a health warning).

ISM Staff: Crawford Moodie and Linda Bauld

External: Rosemary Hiscock, University of Bath

Publication:
Moodie C, Hiscock R and Reid G (2018). Perceptions of cigarette pack inserts promoting cessation and dissuasive cigarettes among young adult smokers in the United Kingdom. Stirling, Scotland: Centre for Tobacco Control Research, University of Stirling.

Adult Tobacco Policy Survey (2014-2018)

(Joint funded by Cancer Research UK and the British Heart Foundation)

The Adult Tobacco Policy Survey is a longitudinal web-based survey with adult smokers. It will explore the impacts of forthcoming tobacco control policies among smokers and recent ex-smokers in the UK, with a particular focus on tobacco packaging.

CTCR Staff: Crawford Moodie, Anne Marie MacKintosh and Allison Ford

External: Sara Hitchman and Ann McNeill, King's College London

Consumer Perceptions of Tobacco Companies in the UK (2014-2015)

(Funded by Cancer Research UK)

This study involved an online cross-sectional survey with adults to explore perceptions of, and attitudes towards, tobacco companies. This included awareness of tobacco companies, views on tobacco companies’ practices (targeting the most vulnerable, encouraging smoking to replace those who quit or die, making cigarettes more addictive) and values (honesty, ethics, interest in harm reduction), perceptions of regulation of tobacco companies (whether tobacco companies have the same marketing rights as other companies, should be allowed to promote cigarettes, be required to sell cigarettes in plain packs, and pay for associated health costs), and locus of responsibility for health problems caused by tobacco use.

ISM Staff: Lesley Sinclair, Crawford Moodie and Linda Bauld

External: Emily Power, Cancer Research UK

Publications:
Moodie C, Sinclair L, MacKintosh AM, Power E and Bauld L (2016). How tobacco companies are perceived within the United Kingdom: An online panel. Nicotine and Tobacco Research, 18(8): 1766-1772. doi:10.1093/ntr/ntw024

Local Champions and Community Snowballing: Applying Principles of Co-production in Deprived Neighbourhoods (2014)

(Funded by NHS Greater Glasgow and Clyde)

The project aimed to:

  1. Test co-produced social marketing messages on the use of illicit tobacco in deprived communities in Glasgow.
  2. Move from theory to practice by testing whether NHS Greater Glasgow and Clyde employees, systems and partners were applying asset-based approaches and co-production.

This study identified potential barriers and enablers for working in this way, and provided insights and direction for a toolkit to facilitate related service improvements.

ISM Staff: Marisa de Andrade

UK Centre for Tobacco and Alcohol Studies (UKCTAS) (2013-2018)

The UK Centre for Tobacco and Alcohol Studies is a network of 13 universities (12 in UK, 1 in New Zealand) funded by the UK Clinical Research Collaboration, which builds on the work and success of its predecessor, the UK Centre for Tobacco Control Studies (UKCTCS). 

The UKCTAS is now a leading international centre of tobacco and alcohol research and policy excellence with an extensive research programme. We have established a cohort of early career researchers, provide a teaching programme to train and engage the wider research and policy community in tobacco and alcohol research. We facilitate policy development by informing policy makers of the latest scientific research on tobacco and alcohol use, and thus contributing to the nation's public health.

The UKCTAS aims to deliver an international research and policy development portfolio, and build capacity in tobacco and alcohol research. UKCTAS work will include developing strategies for behaviour change in tobacco and alcohol use, assessing risks, identifying measures to reduce harm, monitoring the tobacco and alcohol industries, and developing effective public policies to improve public health and wellbeing.

ISM Staff: Linda Bauld and Gerard Hastings for University of Stirling

Innovative Packaging Measures to Communicate Health Risk/Cessation Messages to Smokers (2013-2015)

(Funded by Cancer Research UK)

Tobacco companies creatively exploit packaging to communicate with consumers, through the pack graphics, pack structure (shape, style of opening) and other pack elements such as the tear-tape, cellophane, inner foil, barcodes and also through the cigarette itself. This project explored other ways, beyond the on-pack health warnings, that packaging could potentially be used to communicate health risk and cessation messages. A number of in-depth interviews were conducted with marketing and packaging experts to inform this. The objective was to explore how smokers responded to a range of novel packaging measures (pack inserts, dissuasive cigarettes, cigarette packs with audio messages, etc).

ISM Staff: Crawford Moodie, Richard Purves, Jennifer McKell and Marisa de Andrade

Publications:
Moodie C (2016). Novel ways of using tobacco packaging to communicate health messages: Interviews with packaging and marketing experts. Addiction Research and Theory, 24: 54-61.

Female Perceptions of Cigarette Packaging and Product Design (2013-2014)

(Funded by Cancer Research UK)

Packaging is a unique marketing tool that plays a key role in how consumers are attracted to and experience a product. Similarly, the cigarette itself is becoming an increasingly important advertising medium for tobacco companies. However, there remains a lack of research exploring the extent to which the appearance of cigarette packaging and the cigarettes themselves influence perceptions of appeal, taste and harm. We aimed to explore the perceptions of pack and product appearance among young females, aged 12-25 years, a key target group for public health.

CTCR Staff: Crawford Moodie, Allison Ford and Anne Marie MacKintosh

Publication:
Ford A, Moodie C, Purves R and MacKintosh AM (2016). Cigarette pack design: Female perceptions of superslims packaging. BMJ Open, 6: e010102.

Moodie C, Ford A, Mackintosh AM and Purves R (2014). Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatised and capsule cigarettes. Health Education Research, 30: 1-12. doi: 10.1093/her/cyu063.

Illicit Tobacco: Using an Asset-based Approach and Co-production to Explore Tobacco Related Health Inequalities in NHS Greater Glasgow and Clyde (2013)

(Funded by NHS Greater Glasgow and Clyde)

The research aimed to deliver and record the process involved in co-producing a social marketing campaign to tackle illicit tobacco use across NHS GGC.

Objectives

  • To demonstrate innovation in methodology to achieve the research aim.
  • To retain principles of co-production as core to the process, achieving meaningful engagement with participants of workshops who expressed a desire to be involved in this process across the 3 identified communities.
  • To utilise the outcomes of previously conducted mixed methodology findings (questionnaire responses, focus groups and radio workshops) to inform the development process.
  • To produce a Communications Plan providing direction for the campaign.

The project directly addressed calls by the Scottish Government to use asset-based approaches and were used as a case study for public health professionals and health boards.

ISM Staff: Marisa de Andrade

The Policy Challenges of Tobacco Control: Implications for Public and Global Health (2013-2015)

(Funded by ESRC)

ESRC Seminar Series - ES/L001284/1.

In collaboration with: J Collin, A Amos, C Holden, J Pearce, C Rooke and K Smith.

ISM Staff: Linda Bauld, Marisa De Andrade and Gerard Hastings

The Marketing of Electronic Cigarettes in the UK: Direct and Indirect Promotion through Traditional, Digital and Social Media (2013)

(Funded by Cancer Research UK)

This project analysed how electronic cigarettes (e-cigarettes) are being marketed in UK newspapers and magazines; retail trade press; tobacco journals; company press releases; through television clips and other traditional communication channels and sources. It also investigated marketing on online social network sites.

ISM Staff: Marisa de Andrade, Gerard Hastings, Kathryn Angus, Richard Purves and Diane Dixon

Publications:
Aveyard P, Lindson-Hawley N, Hastings G and de Andrade M (2014). Should smokers be advised to cut down as well as quit? British Medical Journal, 348: g2787. doi:10.1136/bmj.g2787

de Andrade M, Hastings G and Angus K (2013). Promotion of electronic cigarettes: Tobacco marketing reinvented? British Medical Journal, 347: f7473. doi:10.1136/bmj.f7473.

de Andrade M, Hastings G, Angus K, Purves R and Dixon D (2013). The Marketing of Electronic Cigarettes in the UK. Commissioned by Cancer Research UK. Stirling: Institute for Social Marketing, November.

Tobacco Harm Reduction and Nicotine Containing Products: Research Priorities and Policy Directions (2013)

(Funded by Cancer Research UK)

This report identified issues associated with tobacco harm reduction and nicotine containing products in order to establish a comprehensive and unified research agenda for the tobacco control (TC) community. It expanded on existing research questions posed by various health bodies and TC experts; identified and presented additional research questions; outlined evidence gaps in the knowledge base; and gathered insights to address related policy and research implications.

ISM Staff: Marisa de Andrade and Gerard Hastings

Something to Declare? Gathering Perceptions of Illicit Tobacco Through Radio (2013)

(Funded by NHS Greater Glasgow and Clyde)

This project used innovative methods to explore how illicit tobacco was viewed by deprived communities in Scotland. Unlike the usual survey or interview-based approach, the NHS Greater Glasgow and Clyde (GGC) funded study enabled participation via workshops on radio production and broadcasting skills. Whilst engaged in this training, participants were encouraged to discuss their perceptions of illicit tobacco and prepare radio programmes. Guided by an assets based approach, it empowered participants by teaching essential skills to improve employability and encourage creativity in communities. Findings were used to inform the development of a social marketing campaign across the NHS Greater Glasgow and Clyde area.

ISM Staff: Marisa de Andrade

Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) Study (2012-2017)

(Funded by the NIHR Public Health Research Programme and carried out in collaboration with the Faculty of Health Sciences and Sport, University of Stirling; the Faculty of Health Sciences and Sport, University of Edinburgh; Child and Adolescent Health Research Unit (CAHRU), University of St Andrews; and, Scottish Centre for Social Research)

This study aims to assess the impact of measures in The Tobacco and Primary Medical Services (Scotland) Act 2010 (that ban point of sale (POS) tobacco displays and advertising) on young people’s exposure to tobacco advertising, their attitudes towards smoking and ultimately their smoking behaviour. Data will be collected for five years in a number of communities selected to reflect two levels of urbanisation (urban vs. small town) and two levels of social deprivation (high vs. medium, low).

There are four main components to the study:

  1. Tobacco retailer mapping study;
  2. Tobacco retailer marketing audit of tobacco retailers (ISM Lead);
  3. Survey of secondary school children;
  4. Focus groups with secondary schoolchildren

The study will examine the relationship between changes in the prevalence and density of POS tobacco advertising and exposure to POS advertising, and the relationship between POS exposure and awareness of point of sale advertising; cigarette brand awareness; perceived ease of access to cigarettes; attempts to purchase cigarettes; perceived youth smoking prevalence; pro-tobacco attitudes and the uptake and prevalence of smoking (from the Faculty surveys). The qualitative data will contextualise and enable interpretation of the Faculty survey and retailers audit findings, as well as identifying any unexpected or unintended consequences associated with the legislation.

ISM Staff: Douglas Eadie, Anne Marie MacKintosh, Martine Stead, Laura Macdonald (left 2013) and Richard Purves

Publications:
Stead M, Eadie D, Purves RI, Moodie C and Haw S (2017 Online). Tobacco companies’ use of retailer incentives after a ban on point-of-sale tobacco displays in Scotland. Tobacco Control, online 31st July. doi:10.1136/tobaccocontrol-2017-053724

Stead M, Eadie D, MacKintosh AM, Best C, Miller M, Haseen F, Pearce JR, Tisch C, Macdonald L, MacGregor A, Amos A, van der Sluijs W, Frank JW and Haw S (2016 Online). Young people’s exposure to point-of-sale tobacco products and promotions. Public Health, online 10th May. doi:10.1016/j.puhe.2016.03.032

Eadie D, Stead M, MacKintosh AM, Murray S, Best C, Pearce J, Tisch C, van der Sluijs W, Amos A, MacGregor A and Haw S (2016). Are retail outlets complying with national legislation to protect children from exposure to tobacco displays at point of sale? Results from the first compliance study in the UK. PLoS One, 11(3): e0152178. doi:10.1371/journal.pone.0152178

Best C, Haseen F, van der Sluijs W, Ozakinci G, Currie D, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Frank J and Haw S (2016). Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study. BMC Public Health, 16: 310. doi:10.1186/s12889-016-2968-2

van der Sluijs W, Haseen F, Miller M, MacGregor A, Sharp C, Amos A, Best C, Stead M, Eadie D, Pearce J, Frank J and Haw S (2016). ‘It looks like an adult sweetie shop’: point-of-sale tobacco display exposure and brand awareness in Scottish secondary school students. Nicotine and Tobacco Research, online Feb 16th. doi: 10.1093/ntr/ntw032

Best C, van der Sluijs W, Miller M, Haseen F, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Miller M, Frank J and Haw S (2016).Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study BMJ Open 2016;6:e008734. doi:10.1136/bmjopen-2015-008734

Eadie D, Stead M, MacKintosh AM, Macdonald L, Purves R, Pearce J, Tisch C, van der Sluijis W, Amos A, MacGregor A and Haw S (2015). E-cigarette marketing in UK stores: An observational audit and retailers’ views. BMJ Open, 5(9):e008547, doi: 10.1136/bmjopen-2015-008547.

Haw S, Amos A, Eadie D, Frank J, Macdonald L, MacKintosh AM, MacGregor A, Miller M, Pearce J, Sharp C, Stead M, Tisch C and van der Sluijs W (2014). Determining the impact of smoking point of sale legislation among youth (Display) study: A protocol for an evaluation of public health policy. BMC Public Health, 14(1): 251. doi:10.1186/1471-2458-14-251

Addictions and Lifestyles in Contemporary Europe - Reframing Addictions Project (ALICE RAP) (2011-2016)

(Funded by the European Commission)

ALICE RAP aims to study and analyse the development and place of well-acknowledged and new addictions as a major societal trend in Europe in relation to governance and public policies and responses. The study involves 67 research institutions from 25 European countries covering the humanities, social sciences and biological and medical sciences. Its scientific objectives are:

  1. To describe the ownership of addictions through an historical study of addiction over the ages, an analysis of public and private stakeholder views and through image analyses, of professional and citizenship views.
  2. To study how addictions are classified and defined, followed by estimates of their health, social and economic impact.
  3. To investigate determinants of addiction through a coordinated and cohesive social, economic and biological analysis of initiation, transition into problem use and transition into and out of dependence.
  4. To analyze the business of addiction through studies of revenues, profits and participants in legal and illegal trade, the impact of suppliers on addictive substance use and behaviours, and analyses of webs of influence on policy responses.
  5. To study addictions governance by describing the views and forces that determine the ways societies steer themselves and by stock taking of present governance practices to old and emerging addictions.
  6. To analyze youth as customers through considering the impacts of new technologies on promoting and mitigating use, by studying the interrelations of culture and biology, and by determining features that promote resilience and nudge young people to reduce problematic use.

ISM is contributing specifically to Objectives 1 and 4. 

ISM Staff: Martine Stead, Kathryn Angus, Richard Purves, Gerard Hastings, Anne Marie MacKintosh and Crawford Moodie

Publications:
Stead M, Dobbie F, Angus K, Purves RI, Reith G and Macdonald L (2016). The online bingo boom in the UK: A qualitative examination of its appeal. PLoS ONE, 11(5): e0154763. doi:10.1371/journal.pone.0154763

McLeod J, Gell L, Holmes J, Allamani A, Bjerge B, Bühringer G, Forberger S, Frank V, Lingford-Hughes A, Meier P, Neumann M, Room R, Baumberg B, Eiroa-Orosa FJ, Lees R, Meerkerk G-J, Schmidt L, Stead M, van de Mheen D, and Weirs R (2016). Determinants of risky substance use and risky gambling.  Chapter 3 in:  Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press, pp35-76. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0003

Gell L, McLeod J, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa J, Forberger S, Frank V, Lingford-Hughes A, Meerkerk G-J, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Weirs R, and Withington P (2016).  Determinants of harmful substance use and gambling. Chapter 4 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0004

McLeod J, Gell L, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa FJ, Forberger S, Frank V, Lingford-Hughes A, Meerkerk GJ, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Wiers R and Withington P (2016). Determinants of transitions from harmful to low-risk substance use and gambling. Chapter 5 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0005

Gell L, Bühringer G, Room R, Allamani A, Eiroa-Orosa FJ, Forberger S, Holmes J, Lingford-Hughes A, McLeod J, Meier PS and Stead M (2016). Discussion and Integration of Key Findings. Chapter 6 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0006

Young Adult Women Smokers’ Response to Using Plain Cigarette Packaging: A Naturalistic Approach (2011-2012)

(Funded by Cancer Research UK)

In the UK, smoking prevalence among women is in long-term decline but prevalence remains particularly high for young women. The high smoking rates among young women represents a significant future burden of both mortality and morbidity should this trend not be reversed. As bans on tobacco advertising, promotion and sponsorship have accentuated the importance of packaging as a marketing tool, and given that past research and tobacco industry documents suggest that women are more concerned than men about the aesthetic appeal of tobacco packaging, plain packaging may have a role to play in helping young women smokers change their smoking behaviour. This study explored young women’s experiences using plain cigarette packaging, rather than their own fully branded packaging, as they went about their everyday lives.

CTCR Staff: Crawford Moodie, Anne Marie MacKintosh and Gerard Hastings

Publications:
Moodie C, Bauld L, Ford A and MacKintosh AM (2014). Young women smokers’ response to using plain cigarette packaging: Qualitative findings from a naturalistic study. BMC Public Health, 14: 812. doi:10.1186/1471-2458-14-812.

Moodie C and Mackintosh AM (2013). Young adult women smokers’ response to using plain cigarette packaging: A naturalistic approach. BMJ Open, 3:e002402. Article

The Packaging of Tobacco Products / Novel Ways of using Tobacco Packaging to Communicate Health Risks (2011-2012)

(Funded by Cancer Research UK)

Packaging is an important multi-functional marketing and communications tool. The report provided a summary of the marketing function of packaging for consumer goods, including tobacco products. It also outlined how packaging is perceived and used by the tobacco industry. This was done in two ways: 1) a review of research exploring tobacco industry documents in respect to tobacco packaging; and, 2) a summary of all changes to tobacco packaging mentioned in the retail press from 2009 to 2011. Focus groups were also conducted, exploring young people’s perceptions of packaging for consumer products, including tobacco packaging and also plain packaging.

Given the importance of the packaging as a communications tool, for not only tobacco companies but also governments, a second set of focus groups were conducted with young women smokers to explore novel ways of using tobacco packaging to communicate the health risks associated with smoking. These included pack inserts with health messaging, cigarettes displaying a health warning on the cigarette paper, packs with Quick Response barcodes (which when scanned with mobile phones directed them to a stop-smoking website) and packs that played audio health messages when opened.

ISM Staff: Allison Ford, Crawford Moodie, Anne Marie MacKintosh and Gerard Hastings

Publications:
Moodie C, Purves R, McKell J and de Andrade M (2015). Novel means of using cigarette packaging and cigarettes to communicate health risk and cessation messages: A qualitative study. International Journal of Mental Health and Addiction, 13: 333-344.

Moodie C, Purves R, McKell J and de Andrade M (2014). Young women smokers’ perceptions of counterfeit cigarettes: Would plain packaging make a difference? Addiction Research and Theory, 22: 263-270. doi:10.3109/16066359.2013.836505

Centre for Tobacco Control Research (2012). The Packaging of Tobacco Products. Stirling: Centre for Tobacco Control Research, University of Stirling.

Plain Tobacco Packaging: A Systematic Review (2011-2012)

(Commissioned by the Department of Health)
 
This project was commissioned by the Department of Health via ISM's involvement in the Public Health Research Consortium. Colleagues from the University of Nottingham and the EPPI Centre at the University of London were also involved. The project consisted of a systematic review of all the available published evidence on standardised (or 'plain') packaging of tobacco products. The review set out to answer the following questions:

What effect, if any, does plain packaging have on:

  • the appeal of packaging or product
  • the salience and effectiveness of health warnings
  • perceptions of product strength and harm

It also set out to identify any other potential benefits, whether the effects differ between groups and what the facilitators and barriers to impact are.

The review included studies from 1980 and from over 4,000 initial citations, 37 studies met the inclusion criteria.

ISM Staff: Crawford Moodie, Martine Stead, Linda Bauld, Kathryn Angus, Gerard Hastings, Richard Purves and Stuart Bryce (left 2011).

Publications:
Stead M, Moodie C, Angus K, Bauld L, McNeill A, Thomas J, Hastings G, Hinds K, O’Mara-Eves A, Kwan I, Purves RI and Bryce SL (2013). Is consumer response to plain/standardised tobacco packaging consistent with Framework Convention on Tobacco Control guidelines? A systematic review of quantitative studies. PLoS One, 8(10): e75919. doi:10.1371/journal.pone.0075919

Moodie C, Bauld L and Stead M (2013). UK government’s delay on plain tobacco packaging: how much evidence is enough? BMJ, 347: f4786. doi:10.1136/bmj.f4786

Final report: Moodie C, Stead M, Bauld L, McNeill A, Angus K, Hinds K, Kwan I, Thomas J, Hastings G and O’Mara-Eves A (2012). Plain Tobacco Packaging: A Systematic Review. Available: https://www.phrc.online/assets/uploads/files/PHRC_006_Final_Report.pdf 

Protocol: Moodie C, Hastings G, Thomas J, Stead M, Angus K and Bauld L (2011). Protocol for plain tobacco packaging: a systematic review. Available: https://www.phrc.online/assets/uploads/files/PHRC_006_Protocol.pdf 

Young People’s Access to, and Use of, Tobacco in Scotland (2011-2012)

(Funded by SHEFCE)

This study was funded by SHEFCE through the Scottish School of Public Health. The research explored the views of between 70 and 80 14-16 years olds in three disadvantaged areas of Scotland regarding use of and access to tobacco, with a focus on current smokers and those who had tried smoking. The interviews with young people were put in the context of tobacco supply and tobacco control efforts in these communities as perceived by professionals who were also interviewed as part of the study.

ISM Staff: Linda Bauld and Douglas Eadie

Piloting the Use of Plain Packs in a Real Life Environment: Experiences of Young Adult Smokers (2010)

(Funded by Cancer Research UK) 

Despite bans on tobacco advertising in many countries, the tobacco industry has shown both remarkable resilience and marketing ingenuity to continue promoting their wares, and offset the loss of prohibited marketing channels by creatively exploiting unregulated marketing channels; most notably packaging. Plain tobacco packaging, which involves removing all branding (including logos, trademarks, colours) from tobacco packs, would perform three key functions according to research in this area: (1) prevent the use of misleading colours, which consumers often equate to product safety; (2) remove the promotional appeal of the pack; and, (3) prevent health warnings being undermined. This study explored adult smokers' perceptions of packaging and plain packaging using a mixed methods approach, comprising focus groups, interviews and, for the first time, naturalistic research - that is smokers using plain cigarette packs rather than their normal branded packs in everyday settings, for a period of two weeks. 

CTCR Staff: Crawford Moodie, Anne Marie MacKintosh and Gerard Hastings 

Publications:
Moodie C, Hastings GB and Joossens L (2012). Young adult smokers’ perceptions of illicit tobacco and the possible impact of plain packaging on illicit tobacco purchasing behaviour. European Journal of Public Health, 22: 251-253.

Moodie C, Hastings GB, MacKintosh AM and Ford A (2011). Young adult smokers’ perceptions of plain packaging: A pilot naturalistic study. Tobacco Control, 20: 367-373.

Moodie C and Ford A (2011). Young adult smokers’ perceptions of cigarette pack innovation, pack colour and plain packaging. Australasian Marketing Journal, 19: 174-180.

Prisons and Tobacco Control (inc Smoking Cessation)

Part of DH Tobacco Control Health Inequalities Pilot Projects Programme (2010-2011) 

(Funded by the Department of Health)

This project aimed to develop and share knowledge and learning in relation to smoking cessation in prisons and broadening this out to other organisations across the criminal justice system that also had the potential to contribute to quitting and to generic services. It encompassed broad target groups such as offenders, families and staff within the criminal justice system. It aimed to develop functioning systems for provision of support and care pathways, in prisons, on release, across the CJS, and into the community, which resulted in enhanced engagement and quit rates. A Regional Criminal Justice System (CJS) Tobacco Control Coordinator was appointed to look toward the organisational/systems perspectives across prisons, probation services, police and courts in relation to tobacco control and stop smoking support and treatment, and full process and outcomes evaluation was conducted. This was part of an overall bid coordinated by UKCTCS covering six settings in all.

CTCR Staff: Susan MacAskill, Douglas Eadie and Jennifer McKell

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.

Tobacco Taxation in Europe (2010-2012)

(Funded by the European Commission)

This project was funded by the European Commission and led by the European Smokefree Partnership. Stirling’s input was to conduct a process evaluation of the programme. Tobtaxy is a capacity building programme that involves developing material and delivering training about tobacco taxation as a tobacco control measure to public health, advocacy and government employees from across the EU.

ISM Staff: Linda Bauld, Susan Murray and Martine Stead

Evaluating the North of England Illicit Tobacco Programme (2009-2011)

(Funded by Fresh (together with North West and Yorkshire and the Humber) 

The Institute for Social Marketing (ISM) acted as an advisor to the UK Centre for Tobacco Control Studies to evaluate the development and impact of a complex community initiative, ‘The North of England Tackling Illicit Tobacco for Better Health' Programme, which aimed to reduce smoking prevalence in the North East, North West, and Yorkshire and Humber regions by reducing demand and availability of illicit tobacco (both cigarettes and loose). The 18 month evaluation employed a mixed methods approach, combining quantitative, qualitative research exercises as well as review and analysis of secondary data and materials. ISM had a specific interest in advising on the social marketing components of the programme.

CTCR Staff: Douglas Eadie

A Brief Review of Plain Packaging Research for Tobacco Products (2009)

(Funded by the Public Health Research Consortium) 

The aim of this project was to produce a report which reviewed the evidence base on plain packaging, does it support a move to plain packaging, and what are the gaps in the literature and areas where research could be improved? According to the literature there are three ways in which plain packaging might be expected to deliver health benefits: (1) by making health warnings more prominent and therefore stronger; (2) by reducing the promotional power of the pack (and therefore the amount of tobacco promotion); and, (3) by preventing the use of colour to deceive consumers and potential consumers about the dangers of smoking. Although there are some areas where research could be improved, the consistency of findings from many countries point to the potential benefits of plain packaging. This document was used to help inform the Department of Health's tobacco control strategy.

CTCR Staff: Crawford Moodie, Gerard Hastings and Allison Ford

Publications: 
Moodie C, Hastings G and Ford A (2009). A brief review of plain packaging research for tobacco products. Report for the Department of Health.


Available here

Independent Retailers and the Demise of Smoking: A Scoping Study (2009)

(Funded by the Department of Health) 

This project aimed to assess the potential for recruiting independent and local retailers to assist public health manage tobacco sales decline in the UK. The study comprised three stages: (1) a literature and market review clarifying the current state of knowledge regarding local and convenience retailing, focussing specifically on tobacco, and covering possible retail-focused solutions to aid decline and enhance health promotion; (2) interviews conducted with a range of retailers (n=14 across the UK) to understand the possibilities for change; and (3), from these two data collection exercises, ideas were developed for working with retailers via an iterative process within the project team.

CTCR Staff: Douglas Eadie, Kathryn Angus and Gerard Hastings; and Leigh Sparks from the Institute of Retail Studies, the University of Stirling

UK Centre for Tobacco Control Studies (UKCTCS) (2008-2013)

The Centre is a strategic partnership of nine UK universities in England and Scotland (Nottingham, Bath, Birmingham, Edinburgh, Stirling, Queen Mary, UCL, York and Bristol) involving leading tobacco control researchers from a range of disciplines.

Each institution will work together to deliver a programme of original research, policy development, advocacy, teaching and training.

UKCTCS is part of a £20 million investment into public health research, funded by the UK Clinical Research Collaboration (UKCRC) comprising the Economic and Social Research Council, The British Heart Foundation, Cancer Research UK, the National Institute for Health Research and the Medical Research Council.

CTCR Staff: Gerard Hastings and Abraham Brown (left 2012)

Publications:
Ford A, Moodie C and Hastings GB (2012). The role of packaging for consumer products: Understanding the move towards ‘plain’ tobacco packaging. Addiction Research and Theory, 20: 339-347.

Review ‘Forever Cool: The Influence of Smoking Imagery on Young People' (2007-2008)

(Funded by the British Medical Association Board of Science)

This report considers the effect of smoking imagery on young people (under 25 years) in the UK. It begins by examining trends in smoking prevalence and initiation, goes on to review the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people. It concludes by exploring effective ways of reducing young people's exposure to positive images of smoking – and increasing their exposure to positive images of health. A number of recommendations for reducing the influence of pro-smoking imagery on young people are given.

CTCR Staff: Gerard Hastings and Kathryn Angus

Qualitative Study of Changes in Smoking (and Drinking) Behaviour following Implementation of the Prohibition of Smoking in Enclosed Public Places (2005 - 2008)

(Funded by NHS Health Scotland / Scottish Executive)

Following the introduction of smoke-free legislation in Scotland in March 2005, researchers at the Institute for Social Marketing were commissioned by the Scottish Executive, under the direction of NHS Health Scotland, to undertake a community level study examining the impact of the legislation on smoking and drinking behaviour in bars and in the home. The study, the first of its kind, employed a pre- post design, combining in-depth qualitative interviewing and covert observation techniques. The study was in collaboration with the University of Strathclyde. The results were reported in Autumn 2007 as part of the NHS Health Scotland CLEAN Collaboration, a consortium of research projects examining different a range of outcomes, including economic, behavioural and cultural impacts of the ban in Scotland.

CTCR Staff: Douglas Eadie

Publications: 
Eadie DR, MacAskill SG, Heim D and Hastings GB (2010). Responding to change:  How did bar workers adapt to the smoke-free legislation in Scotland? International Journal of Environmental Health Research, 20(1): 13-26.

Heim D, Ross A, Eadie D, MacAskill S, Davies JB, Hastings G and Haw S (2009). Public health or social impacts? A qualitative analysis of attitudes towards the smoke-free legislation in Scotland. Nicotine and Tobacco Research, 11(12): 1424-1430.

Eadie D, Heim D, MacAskill S, Ross A, Hastings G and Davies J (2008). A qualitative analysis of compliance with smoke-free legislation in community bars in Scotland: Implications for public health. Addiction, 103(6): 1019-1026. Article

Petticrew M, Semple S, Hilton S, Creely KS, Eadie D, Ritchie D, Ferrel C, Christopher Y and Hurley F (2007). Covert observation in practice: Lessons from the evaluation of the prohibition of smoking in public places in Scotland. BMC Public Health, 7: 204.

Smoking Cessation

A Qualitative Study of Factors Influencing Adherence Among Pregnant Women Attempting to Stop Smoking with the Aid of Electronic Cigarettes (2019-2020)

(Funded by Cancer Research UK)

This project will investigate approximately 30 women’s views on and experience of adherence to an electronic cigarette (EC) intervention during the first randomised controlled trial (RCT) of ECs for smoking cessation in pregnancy (PREP trial). The overall aim of the study is to explore the factors affecting adherence to an EC intervention during pregnancy from a patient perspective, and to determine the best strategies to maximise adherence. The specific objectives are to: (i) interview women with different smoking status and various levels of adherence to the EC intervention to explore the factors influencing their adherence; (ii) analyse the interview data in order to produce a theoretically-based description of the factors influencing adherence; and  (iii) specify strategies which can address the factors reducing adherence and use this information to inform clinical practice and further intervention development.

ISM Staff: Michael Ussher, Allison Ford and Isabelle Uny

Exploring the Uptake and Use of Electronic Cigarettes Provided to Smokers Accessing Homeless Centres: A Feasibility Study (2019-2020)

(Funded by the National Institute for Health Research)

This feasibility cluster randomised controlled trial aims to evaluate the effectiveness of supplying free e-cigarette starter kits for smoking cessation to smokers accessing four homeless centres across the UK (n=120). Participants allocated to the e-cigarette group will be given an e-cigarette starter kit and four weeks supply of e-liquid and support to use it. Those in the usual care group will be given information about quitting smoking and how to access their local stop smoking service. Follow up assessments in both groups will be conducted at 4, 12 and 24 weeks. Nested within the trial, a qualitative process evaluation with a sample of study participants (n=24) and homeless centre staff (n=12) will explore views on the delivery and perceived value of the intervention. The study findings will help inform the decision to proceed to a larger trial and how best to design a future trial. ISM is responsible for managing the Edinburgh homeless site and conducting the UK-wide process evaluation.

ISM Staff: Allison Ford and Isabelle Uny

External: Led by London South Bank University

The NeSCi Study - Neonatal unit Smoking Cessation intervention development (2019 - 2020)

(Funded by NIHR Research for Patient Benefit)

This study will adapt existing smoke-free home interventions to develop a specific package of support for parents of babies on neonatal intensive care units, including advice, guidance and support towards a smoke-free home. This will be achieved by:

  1. Revising a generic systematic review of smoke-free home interventions, to identify effective interventions that may be adapted to NICU.
  2. Qualitative work with parents, NICU and community health professionals to ascertain views on intervention components, targeting, timing and intensity.
  3. Working one-to-one with the target population to pilot the modified intervention.

 

ISM Staff: Michael Ussher

External: Led by Caitlin Notley, Norfolk and Norwich University Hospitals NHS Foundation Trust

Evaluation of the Greater Manchester Smokefree Pregnancy Programme (2018-2021)

(Funded by Greater Manchester)

The GM smokefree pregnancy programme involves smoking cessation support based on NICE guidelines, plus a financial incentives scheme and enhanced risk perception intervention, for women during pregnancy and postpartum. The evaluation involves four work packages: (i) Service evaluation of the smoke-free pregnancy programme. We will analyse routinely collected longitudinal data for before and after introducing the intervention. (ii) Qualitative evaluation of risk perception intervention: we will interview participating women about their experience of the RPI. (iii) We will conduct a randomised controlled trial in which 900 women who are confirmed as abstinent at end of pregnancy will be randomised to no financial incentives, financial incentives for 3 months or incentives for 12 months. We will assess how many women in each group maintain abstinence through to 12 months postpartum. (iv) qualitative evaluation of the RCT: we will interview participants in the RCT and hold a focus group with stop smoking service staff about their experiences of the trial.

ISM Staff: Michael Ussher, Catherine Best and Jennifer McKell

External: Linda Bauld, University of Edinburgh

We Can Quit 2: A cluster randomised pilot trial of a community-based smoking cessation intervention for women in disadvantaged areas of Ireland (2017-2020)

(Funded by Health Research Board (Ireland))

Smoking rates remain high in Ireland despite considerable progress being made to reduce them in recent years. Ireland ranks second highest for smoking-related causes of death in the EU. Lung cancer, which is strongly linked to smoking, is now the most common cause of death for women in Ireland particularly those living in more disadvantaged areas. Due to this, the Irish Cancer Society developed a new stop smoking programme for women in 2012 called ‘We Can Quit’ (WCQ) which was established following a review of the literature conducted by members of the research team. The team also undertook a small study to look at initial outcomes from WCQ when it was first set up.

This current research is for a pilot of ‘We Can Quit 2’. A randomised controlled trial will be conducted comparing WCQ2 with existing stop smoking services in Ireland. The study will comprise of the pilot trial, a process evaluation, an economic study to look at costs and a look at recruitment and dissemination.

ISM Staff: Project now in Edinburgh

External: Led by Trinity College Dublin; Linda Bauld and Fiona Dobbie, University of Edinburgh

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 Northern 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

Attitudes to and use of Electronic Cigarettes: A Multi-centre Longitudinal Cohort Survey of Smokers and Recent Ex-smokers during Pregnancy and Postpartum (2017-2019)

(Funded by Cancer Research UK)

To aims to (i) estimate prevalence of electronic cigarette (EC) use before, during and after pregnancy; (ii) describe and compare characteristics of women who use or don’t use ECs; (iii) examine women’s attitudes to ECs in pregnancy and postpartum; and (iv) identify barriers and facilitators to using ECs for smoking cessation in pregnancy and postpartum. We will recruit 800 pregnant women who smoke, are recent ex-smokers and/or who use ECs from hospital antenatal clinics at a range of locations in the UK. Participants will be asked to complete three questionnaires: at 8-24 weeks gestation, 34-36 weeks gestation and 3 months postpartum.

ISM Staff: Michael Ussher

External: Led by Sue Cooper, University of Nottingham; Linda Bauld and Lesley Sinclair, University of Edinburgh

Promoting Smoking Cessation During Pregnancy (2017 - 2019)

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

(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

Adult Smokers’ Perceptions of Pack Inserts with Positive Messaging about Cessation: A Naturalistic Study (2017-2020)

(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 providing 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

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

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

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 McKel

Attitudes to Electronic Cigarettes: A Qualitative Study of Women who are Pregnant or have Recently Given Birth (2015-2016)

(Funded by Cancer Research UK)

This study aimed to elicit views and experiences of electronic cigarettes (ECs) among UK pregnant or recently pregnant women, who were current or recent ex-smokers. We conducted semi-structured telephone interviews, using topic guides, with women recruited from stop smoking services, antenatal and health visitor clinics, a pregnancy website and an informal network. Participants were 15 pregnant and 15 postpartum women, including nine current EC users, 11 ex-users, and 10 never-users. Audio data was transcribed verbatim and framework analysis was applied. Five main themes emerged: motivations for use (eg. for stopping or reducing smoking), social stigma (eg. avoiding use in public, preferring ‘discrete’ NRT), using the EC (eg. mostly used at home); consumer aspects (eg. limited advice available), and harm perceptions (eg. viewed as less harmful than smoking; concerns about safety and addiction). In conclusion, ECs were viewed positively by some women and seen as less harmful than smoking and useful as aids for reducing and stopping smoking. However, due to perceived social stigma, some women feel uncomfortable using ECs in public, especially during pregnancy, and had concerns about safety and nicotine dependence. Evidently, health professionals and designers of EC interventions need to provide women with up-to date and consistent information and advice about safety and dependence, as well as considering the influence of social stigma.

ISM Staff: Michael Ussher

External Staff: Linda Bauld and Lesley Sinclair, University of Edinburgh

Publication:

Bowker K, Orton S, Cooper S,  Naughton F, Whitemore R, Lewis S, Bauld L, Sinclair L, Coleman T,  Dickinson A and Ussher M (2018). Views on and experiences of electronic cigarettes: a qualitative study of women who are pregnant or have recently given birth. BMC Pregnancy and Childbirth, 18: 233.

SCIPS (Smoking Cessation in Pregnancy and Social Networks) (2014-2015)

SCIPS (Smoking Cessation in Pregnancy and Social Networks): Developing Social Network Support to Improve Smoking Cessation Outcomes for Pregnant Women Living in Disadvantaged Areas

(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 (2013-2015)

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

(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 and 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

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.

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

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 

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

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 

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 the University of Stirling. 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:
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 and 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 (2010-2011)

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

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 

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.

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 

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

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.

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

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 and 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

Smoking Prevention

Using an Asset-based Approach and An Innovative Methodology to Evaluate Smoking Awareness Campaigns in Fife Schools (2014)

(Funded by NHS Fife)

This project applied the principles of asset-based approaches and co-production to explore the impact of health education and promotion programmes in primary and secondary schools in Fife. In particular, it assessed two interventions used to reduce the uptake of smoking:

  1. Smoke Free Class (S1 competition), which aimed to delay or prevent the onset of smoking; prevent young people who were experimenting with tobacco becoming regular smokers; and de-normalise smoking and promote a 'smoke-free' message.
  2. Smoke Factor (Primary 5/6, 6 and 7 intervention), which was an evidence based tobacco education initiative designed to compliment the 'Curriculum for Excellence'.

An innovative methodology was used so pupils could engage through co-produced radio news quizzes, factual programmes and dramas.

ISM Staff: Marisa de Andrade

Publications:
de Andrade M, Angus K and Hastings G (2015 Online). Teenage perceptions of electronic cigarettes in Scottish tobacco-education school interventions: co-production and innovative engagement through a pop-up radio project. Perspectives in Public Health, online 5th November. doi:10.1177/1757913915612109

A Process Evaluation of the Implementation of ASSIST Scotland (2014-2017)

(Funded by Scottish Government Chief Scientist Office (CSO))

What is ASSIST?

ASSIST (A Stop Smoking in Schools Trial) is a school based programme to prevent smoking in young people aged 12-13. It works by training students to become ‘peer supporters’ who then talk to their friends about the risk of smoking and the benefits of not smoking. ASSIST has been evaluated by a randomised controlled trial funded by the Medical Research Council. The trial found ASSIST to be effective in reducing weekly smoking prevalence over a two year period (odds ratio, 0.78 (95% CI: 0.64-0.96), as well as reducing smoking frequency among pupils who had ever smoked before. Based on a 21.7% prevalence of weekly smoking in the control group at 2-year follow-up, this effect, adjusted for baseline differences and other potential confounders was equivalent to a reduction in prevalence of 10% (Campbell et al, 2008).

What’s the point of the process evaluation? 

ASSIST has been delivered in several schools in England and Wales but none in Scotland. The Scottish Government committed to support a pilot of ASSIST in Scotland as part of their Tobacco Control Strategy. As noted above, ASSIST is already an evidence-based programme, so the purpose of this research was to evaluate the implementation rather than the effectiveness of the newly funded ASSIST in Scotland. The results from this study will be used to ensure that the necessary structures and relationships are in place if the scheme is extended to ensure any effects are as large as possible and sustained.

What does the evaluation involve?

The process evaluation was conducted over two and a half years with a sample of 20 schools. The research design was mixed method and consisted of three elements: 1) evaluating the implementation planning process; 2) evaluating delivery in schools and; 3) documentary review and assessment of costs. A range of stakeholders (school staff, trainers; people who work in health and education and students) were consulted via in-depth interviews, paired interviews, mini focus groups and observation along with a before and after survey to gather data from students.

ISM Staff: Linda Bauld, Fiona Dobbie and Richard Purves

Publications:
Final Report
Research Findings

Preventing Uptake of Smoking in School-aged Children (2013-2016)

(Funded by the National Institute for Health Research) 

Cigarette smoking is the biggest preventable cause of illness and death in the UK. Most smokers start smoking when they are still at secondary school. Smokers who start at this early age are less likely to quit and more likely to be affected by smoking-related illness during their lives. It is therefore important to try to prevent children taking up smoking. Following a period of development work we trialled a smoking prevention package which combined educational resources for use in schools with materials for use with children’s families or caregivers to reinforce the anti-smoking message.

The project was run by researchers at the University of Nottingham, in collaboration with ourselves, University of Birmingham, University of York, King’s College London, and Kick It, the Hammersmith and Fulham Stop Smoking Service.

ISM Staff: Linda Bauld

A Review of Young People and Smoking in England (2008-2009)

(Funded by the Public Health Research Consortium) 

The aim of this project was to produce a report which outlined and reviewed the evidence base on young people (11-24 years) and smoking, particularly in relation to smoking prevention, in order to help inform the Department of Health's consultation process and subsequent policy development. It addressed three key questions: What are the current patterns and trends in smoking in young people in England by key socio-demographic variables?; What is known about why young people start and continue to smoke?; What is the current tobacco control policy context and future policy options on smoking prevention and cessation for young people in England and their likely effectiveness? The project collected and reviewed relevant information primarily from national surveys and recent national and international reviews. Towards the end of the project an expert workshop brought together around 20 experts in young people and smoking to consider the draft report, identify any significant gaps in the research review and consider the evidence on the likely effectiveness of future policy options.

Reports available:

CTCR Staff: Gerard Hastings and Kathryn Angus

HELP Campaign (2005-2010)

(Funded by Ligaris/LBC Consortium, European Commission) 

'Help - for a life without tobacco' is one of the largest public health awareness-raising initiatives in the world and was launched in 2005 by the European Commission in the fight against smoking. It is a large media campaign aimed at encouraging young people in EU countries to resist smoking. Addressing the key issues of prevention, passive smoking and cessation, Help employs an integrated approach targeting Europeans between the age of 15 and 34 years through national media, television and web-based campaigns.

CTCR Staff: Gerard Hastings, Laura McDermott (left 2008), Louise Hassan (left 2007), Joanne Freeman (left 2008) and Gayle Tait (left 2009) 

Publications:
Walsh G, Shiu E and Hassan LM (2014). Cross-national advertising and behavioural intentions: A multilevel analysis. Journal of International Marketing, 22(1): 77-97.

Hassan LM, Shiu E, Walsh G and Hastings G (2010). HELP - for a life without tobacco: A case study on demarketing across two levels. Marketing, Intelligence and Planning, 27(4): 486-502.

Hassan L, Walsh G, Shiu E, Hastings G, Harris F (2007). Modeling persuasion in social advertising: A study of responsible thinking in antismoking promotion in eight Eastern EU member states. Journal of Advertising, 36(2): 13-28.