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A Stop Smoking in Schools Trial: A process evaluation of the implementation of ASSIST in Scotland

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In 2014 the Institute for Social Marketing and a team of collaborators were appointed to conduct a process evaluation of ASSIST (A Stop Smoking in Schools Trial). ASSIST is a peer-led, school-based smoking prevention programme that encourages the dissemination of non-smoking norms by training students aged 12-14 to work as peer supporters. ASSIST was previously evaluated via a large cluster randomised trial of 59 schools in South Wales and Avon, England. Results from this trial showed that ASSIST was effective and cost effective at reducing smoking prevalence in young people (Campbell et al 2008), (Hollingworth et al 2012). This led to the wider roll out of ASSIST in parts of England and Wales and more recently in Scotland.

The overall aim of the study was to evaluate the process of implementing ASSIST in Scotland.

Three different delivery models were piloted in three NHS boards. This did not impact on fidelity or acceptability which was rated highly. Partnership working, from the onset, was viewed as being key to successful delivery and securing school participation. Feedback was overwhelmingly positive regarding the wider benefits of taking part in ASSIST for peer supporters (i.e. personal and communication skills) but also for the school and communities. There was less certainty regarding the extent of message diffusion and the impact this may have an adolescence smoking prevalence. Student survey results showed no significant change in self-reported smoking prevalence between baseline (1.6%) and follow-up (1.8%) and conversation recall with a peer supporter was low at 9%.

However, it is important that the current context (where regular smoking prevalence is 2% overall in 13 year olds in Scotland (SALSUS, 2015 is taken into account. Opportunities to have informal conversations about smoking with peers may now be limited due to the ongoing decline in adolescent smoking since ASSIST was first developed. In addition, the data collection mode was a self-complete survey, so there is a possibility that by follow-up (12 weeks after baseline) young people may simply not remember conversation(s) with a peer supporter or may not have known that they had spoken with a peer supporter.

Overall, this study has demonstrated that it is feasible and acceptable to deliver the ASSIST programme in Scottish schools, although questions remain about the extent of message diffusion. Further consideration is required to assess whether delivery of ASSIST still offers a suitable return on investment and what role it may play in schools in areas of deprivation where smoking rates are higher. Now may be the time to consider whether, 13 years on from the original Randomised Control Trial, an implementation trial of ASSIST is warranted to determine if it is still effective and cost effective.

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Fiona Dobbie
24 March 2017

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The importance of talking about Smoking in the context of Cancer

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Professor Mary Wells

Our recent research highlights the importance of understanding the multiple factors which influence continued smoking in people affected by cancer.  It also shows that engaging patients and families in discussion about smoking within the context of a cancer diagnosis is acceptable, but that an individualised and integrated approach to smoking cessation across the whole cancer journey is needed.

Research evidence illustrates the value of cessation for patients’ treatment outcomes, survival and future health.  Last month we held two public engagement sessions in Dundee as part of the NMAHP Research Unit’s CSO-funded ‘Cancer & Smoking Cessation Study’.  Over the past 18 months this has been exploring key factors likely to increase uptake of smoking cessation services among families, within the context of a recent cancer diagnosis.  Researchers Tricia Aitchison and Fiona Harris have conducted more than 65 in-depth interviews with patients, relatives and health professionals in Tayside and Forth Valley.

The ‘Talking about smoking and cancer: Help us design better services’ sessions brought together a range of people.  Participants included consultant oncologists, cancer nurse specialists, radiographers, smoking cessation advisors, charity representatives and health promotion staff – as well as a small number of patients and family members who had taken part in interviews for the study.  An advert had also been placed in the local Courier newspaper to invite members of the public to attend.

The aim of the public engagement sessions was not only to present key findings from the study but also to provide opportunity for participants to suggest, discuss and evaluate ideas for future interventions.  Three short, 10-minute presentations on study findings were followed by small group discussions facilitated by members of the study Steering Group.

The presentations were:

  • Talking About Smoking: What patients, family members and health professionals bring to conversations about smoking in the context of cancer;
  • Moving from talking about smoking to doing something about it: What happens next? and
  • What opportunities are there for intervention and what might these look like?

They certainly seemed to stimulate lots of talking and interaction within the groups!

Our study findings highlight that potential opportunities for talking to patients and families about smoking may often be missed by healthcare professionals.  There was consensus among the participants at our event that barriers to discussing and addressing smoking need to be overcome so that patients are given effective cessation advice and support throughout their care journey.

Professor Mary Wells, University of Stirling, School of Health Sciences
4 February 2015