E of computer-tailored S moking C essation A dvice in P rimary car E A Randomised Controlled Trial ffectiveness Hazel Gilbert Department of Primary Care and Population Sciences UCL

Clinical approach Intensive face-to-face Relatively high quit rates Low participation rates Unrepresentative Smoking Cessation Interventions Public health campaigns Large-scale programs Impersonal High reach Low quit rates

Longer term data collected from two PCTs Oct 2001 to March 2003  4 week abstinence 53%  52 week abstinence 15%  consistent with published studies Low participation rates  6% of smokers use the services per year  1% of smokers are helped to stop long-term NHS Smoking Cessation Service

 To increase success rates in clinics  Reach the smokers who do not use clinics Challenges for Primary Care

Self-help Materials  Generic leaflets and manuals  Personalised generic  Targeted materials to particular groups  Individually Tailored Feedback Definition: ‘intended to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment’ (Kreuter et al 1999)

Proactive recruitment  Contact individuals directly offering a service  Higher participation  More demographically representative Escape trial is proactively recruiting smokers by sending questionnaires to a large population group using GP records

participation rates of public health campaigns behavioural intervention principles of the clinical approach provide personal, individually tailored self- help reports for a large population of smokers Tailored feedback + Proactive Recruitment

 Smokers not motivated to quit  Areas of high deprivation where smoking prevalence is higher Primary Care Networks can help us to target these specific population groups and achieve the objectives Targeting specific population groups

 Aimed to recruit 100 MRC GPRF practices, representing high and low socio-economic areas  116 expressed an interest in the study  Ranked practice postcodes from least to most deprived by Carstairs scores  Allocated to deprivation quintiles  Selected proportionally from each quintile Practice Recruitment

Deprivation Quintiles EnglandScotlandWalesAll (-1) (+10) (-12)(-1)23 Total83(-3)9(-1)496(-4)

1)Practices identify current cigarette smokers aged 18 to 65 from records using the computer system 2)Randomly select a sample of 520 3)List screened by GP to exclude patients not appropriate e.g. terminal illness 4)Smokers (n=50,000) sent the Smoking Behaviour Questionnaire together with a covering letter from GP Participant Recruitment Estimate a response rate of 15% from 2 mailings (reminder and duplicate SBQ) to secure 7250 participants

Respondents by Deprivation

Co-investigators Professor Irwin Nazareth Dr Richard Morris Department of Primary Care and Population Sciences, UCL Professor Stephen Sutton Institute of Public Health, University of Cambridge Professor Christine Godfrey Department of Health Sciences, University of York General Practice Research Framework

Respondents by practice

Respondents by readiness to quit

To examine the effect of computer generated individually tailored feedback reports designed to help and encourage smokers to quit, on quit rates and quitting activity, when sent to smokers with varying levels of motivation and reading ability, identified from GP lists Aim

Respondents by newspaper read

Smoking status, cognitive change, adherence to advice, perceptions of the feedback reports, and economic issues assessed by postal questionnaire at a 6-month follow-up The Trial Interventions Participants return the questionnaire to the research team at UCL. Randomly allocated to either: Control Group  Standard booklet  Usual care offered by the practice Intervention Group  Standard booklet  Usual care offered by general practice  Computer-tailored feedback report  Additional assessment and feedback report one month after baseline received

Expected outcomes Simple and inexpensive intervention Low-cost, high-reach approach that can complement and extend the brief advice given by GPs Enable the standardised collection of relevant information by practice nurses or other health professionals, and can be used to structure and reinforce the advice given Could offer an efficient tool to integrate smoking cessation counselling into a busy primary care practice

Why do we need research into smoking cessation? Leading preventable cause of disease and death Smoking is a modifiable behaviour Approximately 25% of the population still smoke

Respondents by region

Respondents by qualifications