By Gayatri Koshy, Head of mHealth (Updated October 2022)
The UK’s annual quit-smoking campaign Stoptober has begun. Smokers are again being encouraged to throw away their cigarettes and quit smoking for 28 days during October.
The core evidence behind the campaign is that if you stop smoking for 28 days you are five times more likely to stop for good (West and Stapleton 2008). But what impact has it really had since its launch in 2012? We explore just how successful Stoptober has been in helping UK smokers quit for good.
Unique smoking cessation campaign
Stoptober is uniquely different to other stop smoking campaigns in terms of its messaging.
Most others use harm-focused messaging. They have this approach because studies show that highlighting risks is more effective at motivating smokers to stop, compared with interventions that emphasise the unfair practices of the tobacco industry or simply provide how to quit advice, without motivational advice (Durkin et al. 2012).
Instead, Stoptober has a more positive approach. It reframes the usual call to action from ‘quit now’ to ‘join the 28-day quitting challenge’. It also creates a social movement around quitting smoking for these 28 days.
The campaign is underpinned by three psychological principles:
- Make it social: Inspired by social contagion theory, the campaign makes quitting a collective mass behaviour, normalising it so it’s a social movement. The use of social networks means that people feel socially supported by fellow quitters as they embark on their collective quitting journey.
- Set SMART goals: Quitting smoking is tough, but Stoptober uses SMART goals – specific, measurable, attainable, realistic and time-sensitive – so smokers feel more confident about an otherwise insurmountable challenge.
- Use motivational theory to change behaviour: With tools such as an online community, campaign logos users can upload to their social profiles, apps and personal quit plans, Stoptober’s support package is designed to decrease the motivation to smoke and create new desires to quit.
The effectiveness of Stoptober: what the evidence says
The UK Health Security Agency (previously Public Health England) claims that since the launch of Stoptober in 2012, there have been over two million quit attempts in England alone. But how many of these quit attempts are a result of the campaign?
This is what emerges from published reports on successive Stoptober campaigns since its launch:
The first Stoptober campaign 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 before the first Stoptober campaign (2007-2011), the number of quit attempts in October was similar to other months. This shows that the increase in quit attempts in October between 2012-2017 can be attributed to the Stoptober campaign (Kuipers et al. 2020).
Stoptober was brought under the banner of the Better Health campaign.
It generated quit attempts in 12.3% of all smokers (Public Health England 2021). However, only 4% of smokers were still not smoking after four weeks, compared to 5% in 2019. Younger smokers were more likely to be motivated to quit but older smokers were more likely to sustain their quit attempt (PHE 2021).
In 2020, there was a greater proportion of people attempting to quit but starting to smoke again: 63% of quitters restarted, compared with 53% of quitters in 2019. Smokers report that the relapse was driven by stress (35%) (Public Health England 2021). This finding is not surprising given the context of the Covid-19 pandemic. Experts agree that providing support tools in stop-smoking services (such as the Personal Quit Plan, introduced in 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 67% of smokers appreciated the value of Stoptober tools, use and awareness of these tools declined in 2020 compared to 2019. For example, 30% of quit attempts were made without Stoptober-related support compared to 10% in 2019. And 39% acknowledged Stoptober offered support, down from 45% in 2019 (PHE 2021). This low engagement needs to be unpicked and better understood.
Analysing Stoptober’s success
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 launched 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 quitters expressed a need for continued support after the campaign (Troelstra et al. 2019). This could be through a prolonged Stoptober campaign, continued support in online and offline groups, or by linking up with regular smoking cessation services and encouraging the use of follow-up services. According to the same study, many felt that the campaign messaging did not adapt to participants’ changing needs on their respective quitting journeys.
In conclusion, we can say that successive Stoptober campaigns 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 the secret to its success.
But the jury’s out on whether Stoptober campaigns have resulted in longer lasting behaviour change. The campaign needs to better understand the motivational drivers of sustained smoking cessation. What’s needed is a more prolonged, nuanced, interactive and responsive service to reduce relapse rates and effect more enduring change. One that is personalised to an individual’s quitting journey and to their evolving needs and motivations.
Gayatri is the Head of mHealth at Thrive. With a Master of Public Health (MPH) degree, she has extensive experience working in global health projects as well as national level programmes such as India’s National AIDS Control Programme.
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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.
Durkin S et al. (2012) Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob. Control. 2012;21:127–138.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.”