Understanding White British smokers: Qualitative Research
43% of Hackney’s White British population smoke, higher than the London average of 21% and the Borough of Hackney average of 32% (but lower than the 68% found among the Turkish and Kurdish community). A further 5% have quit in the last six months.
Smoking did not vary much by age group or gender. Packeted cigarettes were smoked by the majority and one in five smokers were heavy smokers (smoke 20+ a day). Two thirds smoked indoors.
Attitudes towards smoking showed that the vast majority believed cigarette smoke is harmful to children, a majority smoked to reduce stress and give them something to do while a minority felt that smoking was part of their identity, helped them perform better at work, or improved social cohesion – giving them social confidence or acceptance from family and friends.
Who are the prime targets?
Almost one third had made a previous quit attempt and 33% REALLY wanted to stop smoking (defined as serious quitters). Over half of those who had made a previous quit attempt still REALLY wanted to stop smoking. Findings indicate that serious quitters are more likely to be aged 25-54, with little difference by gender, presence of children or working status.
What messages need to be communicated?
Awareness and consideration of the NHS Stop Smoking Service was strong (and stronger than awareness or consideration of talking to a GP). The NHS Stop Smoking Service was the prime support service respondents were aware of (46% spontaneous and 79% after prompting) and that they would consider (27%), although previous usage was low (8%).
The belief is that there is help available to quit smoking and that help is easy to find, and there was recognition that giving up smoking on your own is hard, but still, over half of respondents agreed that if they choose to they can give up on their own and don’t need help. Furthermore, going it alone, cutting down and NRT were the most frequently mentioned methods of quitting. Therefore, campaign messaging perhaps needs to reinforce the benefits of getting help when trying to quit (along with continued awareness building) to provide a reason to use the Services.
Persuasive messages too need to focus on the key motivations for quitting (which were improved health and financial reasons) and overcome the perceived barriers (fear of becoming stressed, the difficulty of stopping, smoking being something to do or part of their identity, just enjoying smoking or preferring to cut down).
Many believed that the methods and products available to stop people smoking are expensive, so there would be potential to communicate the fact that these are available on prescription, and that, for those receiving benefits, these prescriptions are free (since two fifths of those on benefits were unaware of their entitlement to free prescriptions for NRT).
How can they be most effectively communicated to?
Of the media measured, Metro, the Evening Standard and the Hackney Gazette were the most widely read, with Facebook and Google the most frequently used websites.
Doctors’ surgeries and pharmacies were the places respondents would most expect and most like to find a local Stop Smoking Service, so messages communicated in these locations might also be persuasive.
What type of Service should be provided?
There was a preference for stop smoking advice from a medical professional or specialist stop smoking service. The greatest preference was for one to one support (40%) rather than group support (23%) though many had no preference (36%).
Overall, there was a preference for services allowing cutting down before setting a quit date (36%) rather than stopping straight away (28%) though, again, many had no preference (27%). Results suggest that offering the Cut Down to Quit option might increase usage of local Stop Smoking Services in Hackney from 42% to 47%.
The preferred opening hours for support services were weekdays, both 9 to 5 and evenings, as well as Saturday daytimes and Sunday mornings. A GP surgery would be an obvious location for services as services are most expected to be here, and there is a preference for services at GP surgeries.
Communicating to segments
Previous research carried out for City and Hackney PCT among City workers and among the Turkish and Kurdish community in Hackney had identified four smoker segments where attitudes to quitting differed. This segmentation theory was also applied to the White British community using a combination of questions about how serious their intent to quit was and if they had made a quit attempt in the past. These four smoker segments were:
Revolving Rounders: Have tried to quit, still want to quit
Desirers: Not tried to quit, but want to quit
The Lost: Never quit and don’t want to
Disappointed: Tried to quit and now don’t want to
By definition, Revolving Rounders and Desirers are the warmest targets – these make up 54% of Hackney’s White British smoker population.
Specific objectives of the research were to:
• Size and profile the White British smoking population in Hackney
• Establish smoking habits: what they smoke and when
• Understand attitudes to smoking and attitudes to quitting
• Measure awareness, knowledge and perceptions of ways to quit
• Understand preferred quit methods
• Identify existing and potential barriers to quitting
• Measure awareness and use of NHS City and Hackney or other smoking cessation services among White British smokers
• Identify gaps in smoking cessation services and any additional services or improvements to services needed
• Understand media consumption habits
• Identify and quantify any targetable segments of the White British smoking community for effective marketing communications.
NHS City and Hackney’s smoking cessation service has a target of 2,000 four week quitters a year. Hackney is an ethnically diverse borough, and several research studies have been undertaken among different BME groups to understand their smoking behaviours and attitudes, leading to the commissioning of a range of services for BME communities including a Turkish-speaking smoking cessation service and a broader BME smoking cessation service. However, the White British community, which makes up just under half (48.45%) of Hackney’s population, had not been specifically addressed as an ethnic group, and there was, therefore, a need to consult with them.
Research was required to provide an understanding of smoking habits and attitudes to quitting smoking among White British smokers in Hackney, in order to identify motivations and barriers to quitting and to using services. Those wanting to quit (54%) were identified as the main target for communications about quitting.
A preliminary stage of research was conducted to establish the smoker profile. A representative sample of White British adults aged 16+ was interviewed face-to-face using a very short questionnaire that recorded gender, age, social grade and smoking behaviour.
For the main stage, face-to-face in-street interviews were conducted throughout the Borough of Hackney.
230 preliminary stage interviews, 547 main stage interviews
Sept - Oct 2010