Public Health Wales Research to support the Wales national health improvement programme review

1. Public Health Wales Research to support the Wales national health improvement programme review Key research findings on quitting smoking Adam Blunt adam@beaufortresearch.co.uk 029 2037 6743 Client contact jo.black@wales.nhs.uk 02920 827638 29 January 2013 BBQ01259

2. Agenda Background, objectives, method summary Measuring awareness, knowledge, impact of certain smoking cessation programmes Motivations / barriers to quitting smoking Support with quitting smoking, preferred approach

3. Research method Wales Omnibus Survey - 1,000 adults aged 16+ living in Wales, interviewed in-home • Questions measured awarenessof, overall familiarity with, programmes across all 1,000 adults • And also among those likely to be eligible for programmes • Then focused on Stop Smoking Wales • Gauge whether or not programme had made any impact on respondents aware of them 2 focus groups, 4 in-home interviews • Mix have / haven’t attempted to quit recently • C1C2DE • South East and North West Wales September – October 2012

4. Overall awareness, knowledge, impact of programmes

5. Awareness of smoking related programmes much higher than for other programmes Stop Smoking Wales Smokers Helpline Wales 65% 70% Around 1 in 4 adults ‘know reasonable amount’ about Stop Smoking Wales Around 1 in 5 adults ‘know reasonable amount’ about Smokers Helpline Wales

6. Almost quarter aware of Stop Smoking Wales have taken some action as result of programme Has the Stop Smoking Wales programme encouraged you to do any of these things? % Base: those aware of Stop Smoking Wales (704)

7. Almost quarter aware of Stop Smoking Wales have taken some action as result of programme Has the Stop Smoking Wales programme encouraged you to do any of these things? % Base: those aware of Stop Smoking Wales (704)

8. Motivations / barriers to quitting smoking

9. Several factors emerge as barriers to quitting smoking Engrained behaviour Mood changes Lack of coping strategies Family members, friends Addictive nature Weight concerns Enjoyment Life events Not interested

10. Early exposure in life combined with addictive nature presents tough challenge Addictive nature The fact that you smoke, you want it so much that, I had a chest infection and was on steroids, I couldn’t smoke, but I still did it, it doesn’t matter what happens to you, you still smoke. (F, North West Wales) • 12-13 common age to begin smoking • Parents smokers • Peer influence • Availability Engrained behaviour 10p and you would have a cigarette and a match. . . . It was like fitting in with the boys and then it grew from there and my Mum and Dad smoked. (M, South East Wales)

11. Social, emotional factors continue to influence habit • Calms the nerves • Less stressed • Socialising routine • With alcohol Enjoyment Something to look forward to after a long day at work. (M, North West Wales) • Relationship changes • Losing a family member • Shift patterns Life events, changes I started when I was about twelve and then I got pregnant, my husband hated it so I gave up but everybody around me smoked, my Mum, my Dad, my brother, but it never bothered me, ever; and then I started smoking when I had my daughter. Never smoked when I was pregnant and then we split up and I started straight away. (F, South East Wales)

12. Resistance to idea of quitting • Never crossed mind – smoked everyday since school • Don’t feel ready to • Feel picked on by Government Not interested Neither of us [partner] has tried giving up, so in my opinion if I want to give up I’ll try but at the moment I don’t so there’s no point just trying. (M, North West Wales) My mother-in-law is dead against me smoking – she has bought me these electronic cigarettes but you don’t want to give up until you’re ready to give up. It’s a personal choice. (M, South East Wales)

13. Health issues play key role in wanting to quit Chest infections, respiratory issues Pregnancy Health Influence of others Social impact of smoking Cost Playing golf – getting out of breath going up the hill and the cost. Part of it, health is another part. I like to walk a lot. I gave up smoking for three years and I noticed in six months how fit I was compared to when I was smoking. (M, North West Wales)

14. Wanting to quit: influence of in-home and social circles fairly common factors given 14 Banned smoking at work, provided support group for employees Recommendation ‘Shamed’ by friend’s effort Guilt Influence of children, partner Quitting together Partner pregnant

15. Wanting to quit: influence of in-home and social circles fairly common factors given They had a counsellor in the factory and we used to go to the counsellor once a week so I thought, right, they’re doing all that to help me, I’m going to try my best to do it. (F, South East Wales) I feel like an embarrassment then because [a friend] was making the effort [to quit] . . . (M, South East Wales) M: My wife was a big help – I would never smoke in the house. F: But you still stunk of it. M: It was the fact that I had to go outside [to smoke] and stuff and we went to the doctors . . . (M, South East Wales) [Participant’s daughter]: I told [my Mum] if you smoke, it’s OK for me to smoke. It’s bad for you. (F, North West Wales)

16. Support to help quit smoking

17. In general, participants do not feel there are issues with amount of support available Motivation, willpower, strategies deemed more problematic • High awareness of risks of smoking • Nicotine replacement therapy (sometimes free) most widely mentioned • Mixed experiences . . . • Making progress with ‘electric fag’ • Champix (initially) effective • Example of useful advice from GP Positive • Unprepared for unpleasant experiences, side effects (e.g. ‘frightening dreams’) Negative

18. Mixed experiences with nicotine replacement therapy You can go to the doctor to get nicotine patches and things like that. There are adverts on the telly. There is plenty of support out there for people who really want to stop. (M, North West Wales) Advice as well was pretty good and he [GP] was suggesting that one of the things to do is break the routine because when I went down, he said he would give me the patches but he also said to break the routine up as well a bit to help and it did work and it was very helpful. (M, South East Wales) I had the patches and did it for six months but I was crawling up the walls. What they tell you more often after a fortnight you feel better, it goes. Load of rubbish. . . . I’m just afraid to go through that experience again. (F, South East Wales)

19. Qualitative participants tend to have heard of Stop Smoking Wales but familiarity limited • Sources of awareness: GP (a card); family member; TV? • Some assume involves group discussions but some uncertain • Service tends to sound useful with notion of group support– but how does this work with shifts for example? • Website contains useful headings e.g. • ‘How to cope with cravings’, ‘Handling stress’ – important to be aware of • ‘How much is smoking costing you?’ looks useful • Named case studies occasionally thought to make it more human If everyone helped each other to stop smoking that would help. To meet every week and see how it goes and so on. (M, North West Wales) It’s basically telling you one day at a time and stay positive and it will get easier and you can do it – you need to know these kind of things. It can be difficult sometimes. (M, South East Wales)

20. Isolated usage examples of Stop Smoking Wales with mixed results • No one else turned up • Did not think convenor had experience of quitting • Deciding not to consider based on word of mouth concerning effectiveness • Reassuring to talk with others • Able to compare experiences, side effects – ‘I’m not on my own’ • Provision of NRT helpful financially I didn’t find people to talk about it. It was just me and the guy. . . . That’s really awkward, and the person hadn’t smoked. . . . I reckon if there were more smoking people, they could understand each other, they could support each other. (M, South East Wales) It was informative because it was a few of us, people were saying what they were experiencing, so I thought I’m not on my own having these weird dreams. (F, South East Wales)

21. Brief description of Smokers Helpline Wales did not particularly appeal to qualitative participants • Assumed to be some kind of support by phone • Doesn’t sound very engaging – webpage not very attractive • Possible confusion with Stop Smoking Wales • Not always clear what purpose of service is • Occasionally – useful to have information pack; option to speak with someone immediately about quitting • But doubts that phone based support can achieve something so difficult It would be a very good idea – I didn’t realise it was something that sends you an information pack. (M, South East Wales) I think more of a group like this [discussion] would be useful. I wouldn’t phone. (M, North West Wales)

22. Preferred approach to support with quitting smoking

23. Face-to-face approach generally preferred No nagging Aspirational outcomes Incentive / reward scheme Family, friends Small responsibilities Attend with friends Social element Locally based Community focus Assess individual needs Word of mouth No transport Tailored approach Health professional Convenor with experience From within community Professional knowledge / advice re side effects Credible Face-to-face

24. Face-to-face approach generally preferred At the end of the day in the community, if we had someone in the community [to lead a group]. (M, South East Wales) It’s easier for you to take notice [face-to-face]. I’d never phone. I’d have no confidence and I’d be ashamed. (F, North West Wales) Rather than just do the meeting for the hour then go; refreshments – give someone a responsibility each week like bring a jar of coffee in or a bag of sugar etc. and then encourage it to be once you’ve talked about it to socialise after because people will then start interacting after and then they will talk about perhaps one to one what they might not feel doing in a big group. (M, South East Wales) Then every week you’ll get a text message saying “You have put in £29.00 etc. and you have x amount of days left until Christmas’ and that’s a visual thing and then the closer you get to Christmas you can see how much money you’ve put in and that’s half of their toys sorted. (M, South East Wales)

25. Diolch Thank you 29 January 2013