UCL: Smoking Toolkit study

The Smoking Toolkit study is a survey conducted since November 2006 for University College London that explores smoking behaviour, particularly in relation to attempts to quit smoking. The study consists of monthly face-to-face omnibus surveys of smokers in England and postal follow up surveys with smokers who agree to being recontacted. As part of the postal follow up, half of respondents are asked to return a saliva sample, which provides a biomeasure of recent nicotine intake. For more information about the study, see http://smokinginengland.info/

A large number of academic papers have been published based on data from the Smoking Toolkit Study. These articles are written by academics at University College London, and TNS-BMRB does not take responsibility for the content of them. Subscription to the relevant journal is usually necessary to view the full articles, but the abstracts can be viewed using the below links.

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Sociodemographic differences in triggers to quit smoking: findings from a national survey, 2008, Tobacco Control
http://tobaccocontrol.bmj.com/content/17/6/410.abstract

‘‘A concern about future health problems’’ (28.5%) was the most commonly cited trigger followed by ‘‘health problems I had at the time’’ (18%) and then ‘‘a decision that smoking was too expensive’’ (12.2%). The most common external trigger was advice from a health professional (5.6%). Future health concern was more common in smokers with higher socioeconomic status (SES), whereas cost and current health problems were more often cited by lower SES smokers. Younger smokers were more likely to report their quit attempt being triggered by a TV advertisement while older smokers were more likely to cite advice from a health professional. Concern about future health problems was cited less often by 16 to 24 year olds and those aged 65+ than those aged 25 to 64 years.

Do ex-smokers report feeling happier following cessation? Evidence from a cross-sectional survey, 2009, Nicotine & Tobacco Research
http://ntr.oxfordjournals.org/content/11/5/553.abstract?sid=fd8169ae-274b-4730-9625-71a21a8e2a92

The large majority of ex-smokers (69.3%) reported feeling happier now than when they were smokers, and only a very small minority (3.3%) reported feeling less happy. In multiple regression analysis, controlling for all other variables, we found that greater happiness following cessation was associated with being younger and having quit more than a year but responses were not related to other sociodemographic factors, prior cigarette consumption, or previous enjoyment of smoking. Irrespective of these associations, in every given category of respondents, the majority of ex-smokers reported being happier having quit smoking.

Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding, 2009, Tobacco Control
http://tobaccocontrol.bmj.com/content/18/1/43.abstract

There was a large difference in success rates of quit attempts: 20.4% in social grade AB versus 11.4% in social grade E of those who made attempts were still not smoking by the time of the survey. However, there was no difference across social grades in the rate of attempts to stop (42.7% in social grade AB to 41.3% in E), use of medications to aid cessation (46.7% of those making quit attempts in AB to 50.9% in E) or use of NHS Stop Smoking Services (7.0% of those making quit attempts in AB to 4.8% in E).

Factors associated with the use of aids to cessation in English smokers, 2009
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2009.02639.x/abstract

More than half of smokers trying to quit (51.2%) had used any kind of pharmacological or behavioural treatment; 48.4% had used some form of medication but only 6.2% had used the NHS-SSS (the most effective treatment option) despite it being free of charge. The use of some form of smoking cessation treatment was higher in female than in male smokers and increased with age and cigarettes smoked per day. There was no association with social grade. Smokers who planned their quit attempt were more likely to have used all types of smoking cessation treatments, except for telephone support.

Self-perceived smoking motives and their correlates in a general population sample, 2009, Nicotine & Tobacco Research
http://ntr.oxfordjournals.org/content/11/10/1182.abstract?sid=4ca31d42-af91-4450-9587-54a28e6722b3

Enjoyment and stress relief were the most commonly reported motives (51% and 47%, respectively). Women reported stress relief and weight control more often than men, whereas men were more likely to report enjoyment and liking being a smoker. Older smokers reported enjoying smoking and liking being a smoker more than younger smokers but were less likely to report socializing and stress relief as important motives. Not having made a quit attempt in the last year was associated with enjoying smoking and liking being a smoker. Higher dependence was associated with a greater number of reported motives. While smoking for stress relief is common, perceptions of enjoyment of smoking and positive smoker identity may be the key motives that inhibit attempts at cessation.

Changes in smoking prevalence in 16–17-year-old versus older adults following a rise in legal age of sale: findings from an English population study, 2010, Addiction
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03039.x/abstract

The prevalence change following the legislation among those aged 16 and 17 was 7.1 percentage points (denominator = 1136) compared with 2.4 percentage points (denominator = 52 186) for older adults. There was no difference within older age categories. This provides some support to the view that raising the age of sale can, at least in some circumstances, reduce smoking prevalence in younger age groups.

Failure to report attempts to quit smoking, 2010, Addictive Behaviors
http://www.sciencedirect.com/science/article/pii/S0306460310001693

There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates.

Public support in England for a total ban on the sale of tobacco products, 2010, Tobacco Control http://tobaccocontrol.bmj.com/content/19/2/143.abstract

A substantial proportion of the total sample (44.5%) would support a move towards a complete ban. While never smokers and ex-smokers were more likely to support this idea, even among current smokers, a third would favour moving towards a sales ban of tobacco products. Adjusting for other background characteristics, younger, female participants, those living in London and those from lower socioeconomic groups were most likely to support a ban. Among smokers, a higher cigarette consumption, smoking enjoyment and contentment with being a smoker were associated with opposition to a ban, while feeling uncomfortable being a smoker, wanting to be a non-smoker and being worried about future health consequences of smoking were associated with support for a ban. It is conceivable that as smoking prevalence falls further and smoking becomes more socially unacceptable, support might grow to a point where such a policy could become feasible.

Public support in England for raising the price of cigarettes to fund tobacco control activities, 2010, Tobacco Control
http://tobaccocontrol.bmj.com/content/19/4/331.abstract

6216 participants (71%), including half (47%) of current cigarette smokers, indicated that they would support a 20p price increase if funds were dedicated to tobacco control activities. Levels of support among smokers were similar across the social gradient and gender. Younger smokers were more likely to support the increase. Smokers who smoked 0-10 cigarettes per day were more supportive of the increase than heavier smokers. The absence of a social gradient among smokers concurs with other research showing that more disadvantaged smokers are as engaged with tobacco control objectives as more affluent smokers.

Quit attempts in response to smoke-free legislation in England, 2010, Tobacco Control
http://tobaccocontrol.bmj.com/content/19/2/160.abstract

A greater percentage of smokers reported making a quit attempt in July and August 2007 (8.6%) compared with July and August 2008 (5.7%); there was no significant difference in the number of quit attempts made at other times in 2007 compared with 2008. In the 5 months following the introduction of the legislation 19% of smokers making a quit attempt reported that they had done so in response to the legislation. There were no significant differences in these quit attempts with regard to gender, social grade or cigarette consumption; there was however a significant linear trend with increasing age. The prevalence of respondents planning to quit before the ban came into force decreased over time, while those who planned to quit when the ban came into force increased as the ban drew closer. England’s smoke-free legislation was associated with a significant temporary increase in the percentage of smokers attempting to stop, equivalent to over 300 000 additional smokers trying to quit. As a prompt to quitting the ban appears to have been equally effective across all social grades.

Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components, 2010 http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03226.x/abstract

In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but Strength of Urges To Smoke (SUTS) had the strongest association (better than FTND or HSI). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure. A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short-term quit success in English smokers and as such may be a useful measure of cigarette addiction.

The role of desire, duty and intention in predicting attempts to quit smoking, 2010
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03317.x/full

More smokers believed they ought to quit smoking than wanted to or intended to soon (38.9%, 29.4% and 23.5% respectively). Desire and intention were independent predictors of quit attempts at both follow-ups, whereas combining them did not add predictive value and duty was not a predictor. While the predictive value of desire or intention alone disappeared when accompanied by duty, their combination was robust against its negative effect.

Enjoyment of smoking and urges to smoke as predictors of attempts and success of attempts to stop smoking: A longitudinal study, 2011, Drug and Alcohol Dependence
http://www.sciencedirect.com/science/article/pii/S0376871610003613

Only enjoyment of smoking predicted whether a quit attempt was made and only strength of urges to smoke predicted whether a quit attempt was successful. This pattern of results remained when controlling for sociodemographic factors and method of support used. Interventions to promote cessation need to address both in order to maximise the rate of quit attempts and their chances of success.

Use of nicotine replacement therapy for smoking reduction and during enforced temporary abstinence: a national survey of English smokers, 2011
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03215.x/abstract

Of the participants, 56% were attempting smoking reduction (SR), 14% were using NRT for SR and 14% were using NRT for temporary abstinence (TA). Use of NRT for SR and TA were highly correlated. The nicotine patch was the most commonly used form of NRT. The use of NRT for SR, compared with unassisted SR, was more common among older smokers, while the use of NRT for TA was more common among women. Cigarette consumption was higher in those using NRT for SR than those attempting SR without NRT. The use of NRT for SR and TA was associated positively with past quit attempts. Nicotine replacement therapy use for smoking reduction and temporary abstinence is common in England. The use of NRT for SR and TA does not appear to be associated with lower cigarette consumption relative to SR or TA without NRT, but is associated with a higher rate of past quit attempts.

Variation in saliva cotinine as a function of self-reported attempts to reduce cigarette consumption, 2011, Psychopharmacology http://www.springerlink.com/content/m02700t0644q3555/

The ‘test–retest’ measure of cotinine stability was 0.76, and the simple correlation was 0.73. Smokers not using NRT who reported cutting down on one occasion but not the other showed a small reduction in cigarette consumption at the time they were cutting down (1.1 cig per day) but no significant difference in saliva cotinine concentrations (mean reduction=13.4 ng/ml). Saliva cotinine concentrations show moderate-to-high stability within subjects over a 3-month period. Smokers’ reports of attempting to cut down their smoking are associated with small daily cigarette consumption decreases but no detectable change in nicotine intake.

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