Institute of Epidemiology & Health Care


Study Background

Start 2 Quit

While figures show a reduction in smoking prevalence in the UK population, down to 22% in 2008, there is no room for complacency. Smoking remains a major cause of ill health and mortality.

The NHS Stop Smoking Services (SSS) offers intensive advice and support to smokers motivated to quit, in group or one-to-one sessions. However, in spite of a desire to quit, only a tiny proportion make use of this free service. A wide range of factors prevent smokers from seeking help and many smokers have insufficient knowledge of the services available. While health professionals are guided to give brief advice and refer smokers to the services, the percentage of smokers receiving such advice is small. Smokers are generally also left to follow-up their referral and contact the service themselves to make the appointment.

Previous research

Evidence suggests that if smokers are proactively and personally invited to use the services, the resultant use will be higher than standard referral by health professionals, or open advertising. In addition the development of tailored self-help materials, intended to meet the needs of one specific person, offer a way of further personalising communications to patients and have the potential to engage with and recruit a larger proportion of the smoking population.

Lichtenstein [1] evaluated an intensive and standardised referral protocol, employing a more proactive method of recruitment and referral by inviting smokers to an intervention with a strong referral message to the service and offering information about what attendance at the service would involve. This intervention included an assessment, measurement of CO level with an interpretation, a 10 minute video of group program featuring former successful group members, a voucher fee waiver, and immediate scheduling of the patient for the group. With this intervention, 11.3% of patients attended the first session of the cessation programme, compared with 0.006% of the control group who received brief advice only.

More recently, Murray and colleagues used a proactive recruitment method to contact large numbers of smokers to ascertain interest in engaging with support [2, 3]. Selected practices identified all patients who were recorded as current smokers or who had no status recorded, and proactively informed them about the services by letter, giving them the option of being contacted by an advisor. Practices were randomized to an intervention group, where smokers indicating that they would like to speak to an adviser were contacted within 8 weeks by a researcher trained as an advisor and offered advice and an appointment, or to a control group, where smokers received no further contact. Murray reported a 7.7% increase in smokers using the smoking cessation services in the intervention group over the control group, and an increase of 1.8% in validated abstinence at the 6-month follow-up in those smokers requesting contact, over the control group (2.2% v 4%).

Extending and expanding on evidence

Our trial will extend and expand this previous work, by combining proactive recruitment methods with the use of a computer program to tailor information to be personally relevant, so as to engage a greater proportion of the smoking population. We will also provide these smokers with a no commitment introductory session designed to inform them about the SSS and what it offers.

Thus, the intervention will employ a two pronged approach that consists of computer tailoring technology to invite and encourage people to attend, and taster sessions to allow smokers to find out more about the service before committing to and signing up for a six week course.

Research question

This study will assess whether smokers who are sent brief personal tailored risk information letters and an invitation to attend a 'Come and Try it' taster session designed to inform them about NHS SSS are more likely to attend such services, compared to smokers who receive a generic letter advertising SSS.


1 Lichtenstein E and Hollis J. Patient referral to a smoking cessation program: who follows through? J Fam Pract, 1992; 34:739-744

2 Murray RL, Coleman T, Antoniak M, Dergus A, Britton J and Lewis S. The potential to improve ascertainment and intervention to reduce smoking in Primary Care: a cross sectional survey. BMC Health Services Research, 2008, 8:6

3 Murray RL, Coleman T, Antoniak M et al. The effect of proactively identifying smokers and offering smoking cessation support in primary care populations: a cluster-randomized trial. Addiction, 2008; 103:998-1006