Stoptober, the UK's annual quit-smoking campaign, has begun. Smokers across the nation are encouraged to throw away their cigarettes in an attempt to quit smoking for 28 days during the month of October.
The campaign rests on the evidence that if you stop smoking for 28 days you are five times more likely to stop for good (West and Stapleton 2008). In this article, we explore how successful the smoking cessation campaign has been in helping people to quit smoking.
A unique smoking cessation campaign
Stoptober as a campaign is different from other smoking cessation campaigns that have been trialled. The messaging of most quit-smoking programmes is harm-focused. This is because studies have shown that highlighting the harm associated with smoking is more effective at generating quitting behaviour than interventions focusing on anti-industry or how-to-quit themes.
Rather than focusing on the perils of smoking, Stoptober adopted a more positive approach to messaging. It involved reframing the usual call to action from 'quit now' to 'join the 28-day quitting challenge'. It also aimed at creating a social movement around quitting smoking for 28 days. The campaign was underpinned by three psychological principles:
- Make it social: Inspired by social contagion theory, the campaign has sought to make quitting a collective mass behaviour, thereby hoping to normalise it and make it a social movement. The use of social networks means that people feel socially supported by fellow quitters as they embark on their quitting journey together.
- Set SMART goals: Quitting smoking is often understood as a very difficult thing to do, but, using SMART goals - specific, measurable, attainable, realistic and time-sensitive - smokers are able to feel more confident about a challenge that may otherwise seem insurmountable.
- Use motivational theory to change behaviour: With the help of a variety of tools such as a community, social media profile logos, apps, personal quit plans, the support package is designed to decrease the motivation to smoke and create new desires to quit smoking.
The effectiveness of Stoptober
Public Health England claim that since the launch of Stoptober in 2012, there have been 2 million quit attempts in England. That's a conveniently round number, but how many of these quit attempts are actually as a result of the campaign?
Having looked at the published reports on Stoptober campaigns over the years, this is what emerges:
The first Stoptober campaign in 2012 increased the odds of making a quit attempt in October by 80%, resulting in 350,000 quit attempts (Brown et al. 2014). Over the next five years, a similar trend was seen - quit attempts were more prevalent in October than in other months (Kuipers et al. 2020). In the five years previous to the first Stoptober campaign in 2012 (2007-2011), the number of quit attempts in October was similar to other months, thus showing that the increase in quit attempts in the month of October in 2012-2017 can be attributed to the Stoptober campaign (Kuipers et al. 2020).
An evaluation of the 2018 Stoptober campaign showed that the campaign generated quit attempts among 19% of all smokers and recent ex-smokers. This was broadly in line with the previous year where the figure was 16% (Public Health England 2019). However only 8% of smokers were still not smoking after four weeks. This was similar to previous years (Public Health England 2019).
The report also found that half of the failed quit attempts ended in relapse during the first two weeks (Public Health England 2019), making this a critical period for enhanced motivational messaging.
In stop-smoking services, experts agree that the provision of support tools (such as the Personal Quit Plan introduced in Stoptober 2018) is important for short term abstinence and quit success rates (Brose et al. 2011; West et al. 2010; Dobbie et al. 2015). But even though 55% of smokers appreciated this fact, 41% of smokers were still more likely to use willpower alone to make a quit attempt (PHE 2019). There needs to a be a greater understanding as to why this group of people do not engage with the various support tools provided by the campaign.
The results are certainly positive if we only look at the effectiveness of the campaign in increasing quit attempts. In fact, following the positive evaluation of the first Stoptober campaign in 2012, versions of the campaign have been adopted in other countries, such as New Zealand, the Netherlands and France. But it is still difficult to say whether Stoptober has resulted in long-lasting behaviour change.
A qualitative study of the Stoptober campaign in the Netherlands found that many expressed a need for continued support after the campaign. This could be in the form of a prolonged Stoptober campaign or continued support by Stoptober participants through online and offline groups or by linking up with regular smoking cessation services after the campaign ends and encouraging the use of follow up services (Troelstra et al. 2019). According to the same study, many felt that the campaign messaging did not adapt to the changing needs of the participant during their quitting journey.
In conclusion, we can say that Stoptober campaigns over the years have resulted in greater awareness and desire to quit as well as increased quit attempts. The positive messaging and the behaviour change principles underlying the campaign are perhaps the reasons for its success. The jury is still out on whether Stoptober campaigns have resulted in longer lasting behaviour change, however. Perhaps a more prolonged, nuanced, interactive and responsive service that is personalised to an individual's quitting journey and changing needs, underpinned by behaviour change principles, might reduce the relapse rates and effect more long-lasting behaviour change.
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Brose LS et al. (2011) What makes for an effective stop-smoking service? Thorax. 66(10):924–926.
Brown J et al. (2014) How effective and cost-effective was the national mass media smoking cessation campaign 'Stoptober'? Drug Alcohol Depend. 135(100): 52–58. doi: 10.1016/j.drugalcdep.2013.11.003
Dobbie F et al. (2015). Evaluating long-term outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technol Assess. 19(95):1–156.
Kuipers MAG et al. (2020) Impact of the "Stoptober" Smoking Cessation Campaign in England From 2012 to 2017: A Quasiexperimental Repeat Cross-Sectional Study. Nicotine & Tobacco Research; 22(9): 1453–1459, https://doi.org/10.1093/ntr/ntz108
Public Health England (2019) Stoptober 2018: Campaign evaluation. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/835518/Stoptober_2018_evaluation.pdf
Troelstra SA et al. (2019) "Like you are fooling yourself": how the "Stoptober" temporary abstinence campaign supports Dutch smokers attempting to quit. BMC Public Health; 19(522). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6833-y
West R et al. (2010). Behavior change techniques used by the English Stop Smoking Services and their associations with short-term quit outcomes. Nicotine Tob Res. 12(7):742–747."