Title: Smoking: new approaches to cessation service delivery, prevention of passive smoke exposure in children, and healthcare cost estimation
Funder: Department of Health (England)

Abstract: Aims and Objectives: To assess a new approach to ensure that smokers admitted to hospital receive effective smoking cessation interventions; to develop and assess a new service to bring NHS Stop Smoking Services (SSS) to disadvantaged smokers who do not currently access SSS; to develop and assess a new method of reducing children’s exposure to passive smoke in the home; and to provide comprehensive estimates of the cost of smoking to the NHS at individual level. Background: Smoking is the biggest avoidable cause of death, disability and health inequality in the UK. Ten million UK adults smoke, half of whom will die from smoking unless they quit. About four million children live with a smoker, sustaining substantial morbidity and mortality from passive smoke exposure. Although the health risks of smoking are well known, the excess costs of smoking to the NHS are still poorly defined. Implementation and uptake of NHS SSS is far from comprehensive. Research Plans: We propose to: 1. Use a contemporary cohort of over 1000 people first studied in 1991 to estimate smoking-related health care costs, by age and socioeconomic status, and the cost savings achievable from smoking cessation interventions 2. Evaluate the effectiveness of a systematic smoking cessation service, provided by SSS practitioners with delegated prescribing rights, designed to ensure that all smokers admitted to hospital are offered effective behavioural support and appropriate pharmacotherapy, before and after discharge, to help them stop smoking 3. Develop and assess the impact of a mobile, community-based cessation service as a means of bringing SSS to smokers living in disadvantaged areas 4. Develop and test the use of Nicotine Replacement Therapy (NRT) as a means to support smokers in abstaining from smoking inside the home, and hence reduce passive exposure of children Research Team: The research team comprises a partnership between the core academic group that leads the UK Centre for Tobacco Control Studies (UKCTCS; see www.ukctcs.net for details) in Nottingham, colleagues from NHS Nottingham City who lead the design and delivery of smoking cessation and wider tobacco control initiatives (including the New Leaf NHS SSS), the health economics group led by Christine Godfrey in York (also part of the UKCTCS), and lay representatives of the various target populations studied. Programme management: The programme will be managed by a Steering Committee (SC) of all of the applicants, chaired by the Principal Applicant and meeting monthly to oversee progress in all workstreams Additional SC meetings will be organised whenever need. The workstreams will be integrated as closely as possible to allow sharing of staff and resources according to need. Research Environment: The UKCTCS is an academic research and training network based at Nottingham University with access to skills across the range of disciplines and expertise necessary for the proposed work, and at the centre of a strong research and teaching environment. The group works closely with NHS Nottingham City in the design and delivery of SSS. The research environment has all the necessary resources to deliver the programme. Outputs and impact: The programme will deliver peer-reviewed research publications and related outputs from year 3 onwards, producing economic cost estimates and new models for SSS provision that will be immediately nationally implementable, with potential to save thousands of lives. Patient and public involvement: Three lay people will work with us in developing, implementing and disseminating all aspects of the research. Wayne Sherwood, a co-applicant, recent ex-smoker and member of the British Lung Foundation’s Breathe Easy group (a support group network providing support and information for people in Nottingham living with a lung condition) has commented on the proposal and agreed to continue to work with us for the duration of the project. In addition, two smokers, one from Nottingham and another from Bath who has worked with members of the UKCTCS previously, will also support the work as collaborators. Further involvement will be sought from the UKCTCS smokers’ panel when it is established in October 2009.The Trent Local Children’s Research Network (for workstream 4) has also offered to support the work. Ethics: Ethics approval has been granted for workstream 1; full regulatory approvals will be obtained as necessary for all other work, which will be carried out in full compliance with established guidance on Good Clinical Practice, with oversight by the Nottingham Clinical Trials Unit where appropriate. Resources: Resources are requested primarily for staff (academic and NHS) to carry out the research and deliver the interventions being assessed; for involvement of lay representatives in our programme development; and for core posts to support governance, administration and the statistical and economics analyses.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE;RESPIRATORY;CANCER AND NEOPLASMS;CARDIOVASCULAR