Trinity College Dublin: Success for pilot ‘no smoking programme’ for women in socio-economic disadvantaged areas

Trinity report highlights success of smoking cessation pilot programme for women living in socio-economic disadvantaged areas, on national No Smoking Day

The ‘We Can Quit’ (WCQ) is a community-based outreach stop smoking programme specifically designed for women living in socio-economic disadvantaged areas in Ireland (Dublin and Cork).



Lung cancer is now the most common cause of cancer death for women in Ireland, having surpassed breast cancer rates. Tobacco use directly causes lung cancer. The health consequences of smoking tobacco impact women more in low socio-economic status groups where they are more likely to smoke to cope with negative emotions and stressful situations. Socio Economic Disadvantage (SED) contributes to higher tobacco use among adult women which affects subsequent generations through role-modelling or by exposure to second-hand smoke.

Researchers from the Discipline of Public Health and Primary Care, School of Medicine at Trinity College undertook a pilot programme in response to the need to find more effective ways to engage SED women smokers in smoking cessation services and to improve health equity. Their findings are published in the journal of Nicotine and Tobacco Research:


The World Health Organization Framework Convention on Tobacco Control has recommended the need for gender based approaches to tobacco control policies in the light of increasing lung cancer rates especially in SED women.

What is We Can Quit (WCQ)?
We Can Quit (WCQ) is a community-based stop smoking programme specifically designed for women living in socio-economic disadvantaged communities in Ireland. It was developed initially by the Irish Cancer Society (ICS) in collaboration with the National Women’s Council of Ireland, the Institute of Public Health and the Health Service Executive (HSE). Uniquely, the programme is delivered by trained local lay women (Community Facilitators).

The key components of the WCQ programme were:

Group-based support once a week for 12 weeks, delivered by Community Facilitators (CFs): lay trained women living/working in target areas.
Access to Nicotine Replacement Therapy (NRT) – a medically approved way of taking a low level of nicotine by means other than tobacco free of charge for all participants who wish to take it.
Individual one-to-one text support between sessions.
What answers were researchers looking for?
If it was feasible to recruit eight community districts (four matched pairs) to a stop smoking trial.
One district (24-25 women) in each matched pair would be randomly assigned to the WCQ programme and one (24-25 women) to a one-on-one smoking cessation service with a Smoking Cessation Officer provided by the Health Service Executive (HSE).
If there were 2/3 participants remaining at the end of the follow up
If the process of being involved in a trial was acceptable to the women and the CFs and what their views were of the WCQ programme.
Participant Profiles
The average age of the women was 48 years.
Almost half were not in paid employment and had only primary/no formal education.
Two-thirds were medical cardholders (Researchers aimed to achieve a minimum of 50% target).
Women smoked on average 18 cigarettes a day.
Most were very or extremely determined to quit.
Many women smoked for over 25 years.
KEY FINDINGS
It was possible though challenging to recruit SED women to a smoking cessation pilot trial delivered in their local community setting through the combined effort of community, voluntary and statutory stakeholders.

Approximately half of the recruited women provided follow-up data at 12 weeks and/or 6 months.
Low literacy was identified as a key barrier to retention at follow-up: “I don’t write very well. So, what we were doing was [XX] would help us with the filling out so you don’t feel embarrassed… it is embarrassing when they’re asking us to fill in stuff which I can’t do…” [Programme participant A].
Women recalled positive reinforcement, peer learning (from others and from the facilitators) and the motivation derived from group support as really helpful strategies: “… it’s encouragement and listening to their stories and to be able to say I can take that on board, and you end up saying ‘I can do that as well.” [Programme participant B].
Women highlighted the support from the community pharmacist for their quit attempt.
Removing cost as a barrier for using NRT was welcome.


Dr Catherine Hayes, Associate Professor in Public Health/Specialist in Public Health Medicine, Trinity and senior author on the study, said:



We Can Quit is an effective way to engage heavily dependent women smokers who experience multiple stresses through disadvantage, by delivery of an outreach programme in their own communities in a way that is meaningful for them and that directly addresses their needs.



Having a community-based structure in place will facilitate future assessment of cost-effectiveness in terms of smoking cessation and expansion and integration of the programme into the HSE which is currently in progress. Removing cost as a barrier to using NRT for those who attend smoking cessation programmes is an important issue for government policy.