A community approach to kicking the habit

Funded by NHS Nottingham City, the initiative is harnessing the power of local community champions to challenge the general acceptance of smoking in Nottingham's Aspley ward and to encourage more people to quit.

Nottingham has the 3rd highest rate of smoking in England and more than half the people who live in Aspley smoke -- 53 per cent, compared to the national average of 21 per cent. Smoking is a key reason why people living in Aspley die, on average, 10 years younger than people in wealthier parts of the city.

The researchers, led by Professor Ann McNeill, of the UK Centre for Tobacco Control Studies at the University, set out to discover why so many people in Aspley smoke and what effect social challenges, including high unemployment and low incomes were having on the community's smoking rates.

By getting a fuller understanding of the issues contributing to the problem, they are hoping to develop more of a community-led approach to tobacco control in the ward and to foster a positive environment in which young people do not start to smoke and people who do want to give up are offered all the support they need.

The study is focusing on three estates within the ward -- Aspley, Bells Lane and Broxtowe. During the initial phase of the project, researchers conducted 100 street interviews and held a series of focus groups with smokers, ex-smokers and non-smokers of all ages to explore attitudes towards smoking

Among the consistent themes they uncovered were:

• Smoking was very much the social norm. It was strongly associated with unemployment, boredom and stress and was often seen as a shared activity, creating a sense of belonging and identity with the rest of the community.
• There was a general lack of health awareness in relation to healthy eating, alcohol and smoking, but considerable sympathy on the part of residents for the plight of people who were seen as both disadvantaged and addicted to tobacco.
• There was an acceptance of the dangers of passive smoking, especially to children, but government warnings on the dangers of smoking were viewed by some with suspicion and hostility.
• Children in smoking families had little to counteract the strong pressure to smoke and it was generally believed that there needed to be more education about the dangers of smoking and that this should start in primary school.
• Cigarettes are still regarded by many smokers, as a 'little luxury' that disadvantaged people could enjoy and this view is often shared by non smokers. Whilst stopping smoking is an aspiration among most smokers, it was often 'put on hold' until the time or mental state was perceived to be right.
• There was a need for stop smoking services such as New Leaf to be seen to have a more flexible approach and be more accessible to these communities.
• Resentment existed over the presence of illicit supplies of cheap tobacco from local 'fag houses' and even, in one case, an ice cream van, but there was a general acceptance that this would be difficult to tackle during the tough economic climate.
• There was a need to challenge some of the negative messages circulating by 'word of mouth' by disseminating positive messages regarding healthy lifestyles and smoking.

Professor McNeill said: "Another theme which we identified was the strong sense of community within each of the separate estates that could be used to promote our anti-smoking initiatives. We felt that we would have more success by presenting our project positively and allowing problems to be addressed at a local level. People in the Aspley ward want to be able to feel a sense of pride in the communities in which they live." Professor McNeill said: "Another theme which we identified was the strong sense of community within each of the separate estates that could be used to promote our anti-smoking initiatives. We felt that we would have more success by presenting our project positively and allowing problems to be addressed at a local level. People in the Aspley ward want to be able to feel a sense of pride in the communities in which they live."

Marilyn Antoniak, a research fellow working on the project, commented: "We aim to galvanise the local communities to adopt a tobacco control agenda in an effort to denormalise smoking in the area. Together with local community members, we will be profiling positive messages to smokers to encourage them to make use of the support available locally to help them to reduce and stop smoking."

The study also sought the views of local stop smoking service providers and the network of community health professionals, such as health trainers and Change Makers, based within each estate.

Local retailers were asked for their views regarding stocking nicotine replacement therapies (NRT) and problems with underage youngsters attempting to buy cigarettes illegally or by harassing other customers to buy them on their behalf.

The two-year project is an example of innovative 'action research', where researchers address issues and solve social problems in tandem with the local community.

As a result, the team will be enlisting the help of local community 'champions' in order to raise awareness of the issue; in some cases these will be ex-smokers or smokers who are trying to give up. By offering cessation training to the existing network of community organisations such as local action groups it is hoped that they will become involved in the wider smoking cessation programme.

Drop-in information and advice sessions will be held at community centres on each of the estates and a mobile trailer providing information and support on stopping smoking will also be located in the area.

The project will be targeting the local schools offering them educational materials on the dangers of smoking and feeding into the existing DARE programme to get the message across. In this way it is hoped that informed youngsters will step up the pressure on parents who smoke.

Many of the shopkeepers in the area have also agreed to do their bit by displaying New Leaf smoking cessation leaflets and posters within their shops.

Dr Jeanelle de Gruchy, Deputy Director of Public Health at NHS Nottingham City, said: "This kind of research is crucial to understanding why smoking is so high in certain communities and why they aren't following the national trend of reducing smoking levels. Once we know that, we can more effectively target our resources to support community actions to provide an environment which prevents young people starting to smoke and supports people wanting to quit. NHS Nottingham City is committed to reducing health inequalities -- and reducing the rate of people smoking in Aspley would be a significant step towards this."