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Marketing the NSD stop smoking challenge to ‘Hard to Reach’ groups Part 1

Introduction
Smoking is the main reason why inequalities in health are widening between the general population and disadvantaged groups. Only one in 4 of the adult UK population smokes. But smoking rates are as high as 8 out of 10 amongst the certain groups including the poorest, Asian men, prisoners, mental health service users, homeless people, drug and alcohol addicted and the gay community. These groups are often described as ‘Hard to Reach’ but the tobacco industry seems to be able to get to them!

So it is a ‘Great Challenge’ for No Smoking Day Challenge local organisers whose job it is to reach those groups where smoking is at its highest levels and offer help to smokers to stop smoking.

Here are some suggestions for reaching disadvantaged groups with the Great No Smoking Day Challenge including some good practice case studies. :

Types of activities for promoting the Great No Smoking Day Challenge to hard-to-reach groups
There are many ways of reaching smokers with the Great No Smoking Day Challenge but these are the most popular.

Stalls are the most popular activity for No Smoking Day and there is a guide to running a NSD stall on the NSD website. Events such as Health Fairs, fun days, sporting and community events.

Services to help smokers to stop - one to one, drop in, groups, telephone and text support, self-help groups.

Written information and stop smoking advice such as books and leaflets.

Media stories and publicity to inspire and assist smokers to stop.

Reaching disadvantaged groups and increasing their access to stop smoking help
People in disadvantaged groups often don’t want to have to visit their GP or go through lots of bureaucratic hoops to get help to stop smoking. Here are some tips to increase the number of disadvantaged groups to take up the Challenge.

Set up services and activities in the target community and make it easy to access.

Improve access to medications with vouchers in place of prescriptions.

Involve the target community in planning and running the activity.

Do market research by seeking the views of your target groups.

Keep paperwork to a minimum

Have written information in plain English and have resources for those with only basic literacy.

Make your event or services friendly and welcoming and make sure you make this a feature in your publicity.

If necessary get testimonials from local people confirming that the stop smoking advice is helpful and friendly.

Find out what time of day is best for your target group – after dropping off children, during lunchtime, evenings or weekends.

It helps if smokers can identify with the advisors. Train successful quitters as group leaders particularly in your target groups and target areas.

Train community tobacco control activists to publicise and promote No Smoking Day and all stop smoking support available and to campaign on other tobacco issues such as smuggled tobacco and youth access.

Continue improving and modifying your services based on market research.

CASE STUDY
Supermarket and shopping centre stalls
In an attempt to reach the poorest smokers, a stop smoking advisor set up stalls in the entrance of a local supermarket and in the local shopping centre in the target areas with nothing more than a CO monitor, some leaflets and a mobile phone to arrange appointments. Between 25 and 50 smokers a day were recruited. The limiting factor was only having one person!

CASE STUDY
Mosque Stop Smoking Drop-in
Every Friday in the community centre attached to a Mosque, health workers set up a drop in stop smoking advice stall. Invitations to ‘drop-in’ for a cup of tea and biscuits were handed out to men as they entered the Mosque for Friday prayers. The sessions Friday attracted about 25 men in each week, not all to stop smoking.

CASE STUDY
GPs in training
Many smokers are embarrassed or resistant to visiting their own GP to ask about stopping smoking. However many smokers are more influenced by a doctor’s advice that other people. Various projects have used GPs in training to attend No Smoking Day events.
- One used 5 public health trainees to answer the special phone lines set up at a radio station to talk to callers.
- Another ran a Give it Up Give it a Go event in a community centre. Four GPs from other parts of town volunteered take part and see smokers. The queue went out into the street! People wanted a doctor’s advice but ‘anonymously’. They were told that if any signs of illness were spotted they would have to inform the person’s own GP and 4 people with undiagnosed COPD were identified and their GPs informed.
- A third project was an Asian Heart Health project which invited Asian GPs in training to come to the weekly stop smoking drop in. The attendance of the doctors was advertised on the Asian radio programme and numbers went up from 3 visitors a week to 23!

Encourage more people to make a quit attempt
The more people who try to quit will result in more people eventually quitting. Do everything possible to encourage smokers who want to quit to give it a go! With any of the groups where smoking is at high levels, it is harder to get even small numbers to quit. But there are many smokers wanting to quit in all these groups. Research shows that people try to quit but have less success in staying stopped. The challenge is to find ways of encouraging more smokers who want to quit to try to stop and finding ways to support them to stay stopped. It is also about setting lower expectations of success. Rejoice in the smaller numbers of successes and use these for encouraging others.

Counter the myth that you need buckets of willpower to quit. Willpower grows with every day that you stay off cigarettes!

Challenge the view that having tried and failed is the end of the road. The average number of quit attempts is 14!

Encourage people to expect relapse as part of the process and use it as a learning. experience.

Encourage smokers to have another go and to build on their skills.

Make sure people know they can come back to the service and that there is not a limit to the number of attempts.

Make sure people who have tried before are welcomed and given the same help as anyone else.

Offer incentives and support to stop. Give awards to everyone who stops for the one week of the challenge.

Quit & Win and similar challenges offer smokers a sense of belonging to a group and an incentive.

On stalls in disadvantaged areas make sure that anyone wanting to quit is recruited and given a time and place to meet with an advisor.

Have incentives and encouragement for smokers who have quit to recruit other smokers in their group or community.

Encourage family challenges to sign up whole families to stop together.

Invite smokers to ring a helpline and send them a quit pack and follow up support by text or phone.

Invite back 4 week quitters who have not quit and give them extra support and encouragement to try again.

Use 4 week, 6 month or 12 months follow up to invite back to service if relapsed.

Encourage ex-smokers to call the helplines in between one to ones or groups. Include Pregnancy and Asian language helplines if relevant.

Text messages of support in between times.

Maintain support for as long as people need it. If you have a fixed 6 weeks this may not give enough support for some people.

CASE STUDY
Gathering sporting heroes views about smoking
One community group made a list of all their sporting heroes – local and national. They wrote to each one asking if they smoke and what they felt about smoking. They then set up a display of the replies and photos.

CASE STUDY
Unable to fly to Spain
A group of ‘at risk’ young people were discussing reasons to be smokefree. They were asked to think about the freedom of being smokefree. A young man said his dad had not had a family holiday for 10 years because he cannot smoke on a plane. This made more impact than the reasons offered by the teacher!

Find different venues and locations for Great NSD Challenges
You need to be set up wherever you can reach your target audience to sign up to take the Great NSD Challenge. In any setting you will need to obtain permission to set up a stall from the person in charge. Write down a list of all the potential places where you could reach your target group or groups. Here are some suggestions:

Pubs and working men’s clubs

Canteens in workplaces

Rooms in schools and nursery settings

Health settings such as baby clinics

Day centres such as mental health centres

Leisure, sport and community centres

Shopping centres and supermarkets particularly in target areas

Markets, car boot sales, jumble sales

Charity shops

Bingo halls

Betting shops

Job centres

Benefit offices

Neighbours in a street or a block of flats

Homeless day centres

Mental Health day centres

Asian community centres

Football matches

Gay clubs

Childcare centres

Social service centres

Children’s centres and Sure Starts

Family support groups

Parent and toddlers groups

Hospital entrances and Outpatients waiting areas

Toy superstores and shops

Large pharmacies

Children’s sports days or children’s playgrounds

Places of religious worship – churches, temples, mosques

Family events

Health buses visiting the community

CASE STUDY
Quit and Get Fit
A local YMCA gym in a poor area of the city set up Quit & Get Fit groups for women only with a crèche for younger children. Women received 45 minutes of stop smoking group and 1 hour aerobics. Some women who did not stop smoking stayed in the group for the aerobics and with the intention of stopping sometime. 30% women were stopped a year later.

CASE STUDY
Shop to Stop
A PCT took over a short lease on a shop in a run down area of town and set up a stop smoking advice and drop in centre as part of a health information shop.

CASE STUDY
Bingo drop-in
Health workers set up a No Smoking Day stall in the entrance of a Bingo Hall. It was such a success that they regularly ran a drop in advice centre at the Bingo Hall.

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