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Background

Tobacco smoking has been a major public health problem; its prevalence has been increasing daily globally. In UK smoking rates have  been increasing over the years despite the government policies and initiatives like the implementation of plain packaging legislation with key objective of reducing smoking and other relevant government legislations,  have yielded lower impact, (Tobacco ACT,.2011). According to ASH organization UK (2017), smoking among the adults 1 in 5 adults are smokers of this 19% of men and 15 % are women. Approximately there are 9.1 million smokers in UK. Although smoking rates have been halved since 1974 at the rates of 51 % for men and 41 % for women, prevalence is still significant among the young people. Prevalence of the young aged 25-34 was found to be 24 years and it is lower in the age group of above 60.  Surveys have shown that  a good proportion of smokers would like to initiate change to stop smoking but are not able to do so, it is estimate that 30%-40% attempt to quit smoking every year. Among the young people, two thirds of them start smoking before age 14 years, of this between one third and one half are likely to take up smoking to adulthood, (Jamrozik, 2005). Government initiatives have bored fewer benefits in that huge amounts  of resources have been put on mass media campaigns but smaller effect has been felt among the younger generation. This review will analyse literature to determine effective interventions which are more effective in preventive the increasing prevalence of smoking among the young people in UK.

The search of literature was conducted based on the research problem under study , it was done using the online based databases namely Medline, and Google scholar. The inclusion criteria for studies was based on the year of publication in this cases not more than 10 years old and the studies conducted followed randomised control design only. Exclusion criteria was those articles that were following different methodological approach and nor focusing on smoking intervention programs.

The search terms for the review will be ; ‘‘randomised control studies’’ AND ‘‘smoking prevalence’’ OR ‘‘smoking interventions studies’’ AND ‘’smoking programs for the young’’. Further study criteria were studies done in English and those involving humans The data quality of the articles will be based on the validity of answering the hypothesis proposed in the introductory section with an aimed of getting the right type of data needed for evaluation of effective intervention. The comprehensive literature review was guided by the Cochrane. The search yielded 17 articles of which 10 articles were selected which met the review criteria in terms of the content ii had.

Methodology

Basic characteristics of the studies found..

Authors, year, study design

Stopped smoking (n)

Continued smoking (n)

RR (95% CIs)

%/ RR)

M-H weight

Campbell et al, 2008, RCT

9

6

-

60%

47.3

An Lawrence et al, 2008, RCT

105

152

P<0.001

41%

Ybarra et al, 2013

39

62

OR 3.33 CI 1.48, 7.45

Campbell et al, 2008

87566

3561

1.01

OR 0.75

Jayakrishnanaet al, 2009

50% both samples

50%

1.85

Eades  et al., 2012

Similar

Similar

P=0.212

0.93

Marley et al., 2013

6

49

P=0.131

Powell et al., 2016

Similar outcomes

Similar Outcomes

Burford, 2012

22

58

P=0.005

Pechmann et al, 2016

26

14

P=0.17

OR 2.67

 
Table 2

Summary of studies reporting smoking interventions which have been undertaken 

Source

Type of study

Study population

Sample Size

Intervention

Comparator

Length of follow-up

Quit Intention

Key findings

Comments

Whittaker  et al, 2008

RCT

The indigenous population of New Zealand

180

Multimedia mobile based intervention

Observation learning

4 weeks

Intending to quit

Mobile based intervention is feasible for smoking cessation

Sample don’t representative of adult population in New Zealnd.

An Lawrence et al, 2008,

RCT

College smokers at the University of Minnesota

500

Cessation messages and peer email support

None

30 weeks

Providing personalized smoking cessation messages increased 30-day abstinence by 41 % compared to control 23 %

Sample representative of population

Ybarra et al, 2013

Randomised Controlled Trial

Members of public responding - Youth

164

Text messaging–based smoking cessation program

Improving sleep and physical activity

30 days

SMS USA program affected smoking cessation rates at 4 weeks postquit identified profiles of users for whom the program may be particularly beneficial also will be important.

Recruitment limited

Campbell et al, 2008

Prospective Cohort

Students aged 12–13 years in 59 schools in England and Wales.

10,730

Effectiveness of a peer-led intervention that aimed to prevent smoking uptake in secondary schools.

Training activity

2 years

Mixed intentions

The ASSIST intervention could lead to a reduction in adolescent smoking prevalence of public-health importance

Adequate representation of population

Jayakrishnanaet al, 2009

RCT

Smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala

Effectiveness of a cessation intervention in rural Kerala state, India

Mix of activities

12 months

Smoke cessation intention

Various approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.

Adaptable study and applicable to be utilised

Marley et al., 2013

RCT

Australian Aboriginal and Torres Strait Islander peoples

163

Efficacy of a locally-tailored, intensive, multidimensional smoking cessation program

Type of care applied

12 months

Intentions evident

Cultural based interventions if successful implemented can initiate smoke cessation

Justifiable and applicable approach to many community set ups

Eades  et al., 2012

RCT

303

Determining the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres

Intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy

Powell et al., 2016

RCT

Eligible smokers from two English regions entered into the trial and given access to their allocated website

Feasibility of a randomized trial assessing the effects of a novel, experience-based website as a smoking cessation intervention

None

2 weeks

Online sharing of information was a feasible tool in the sharing experiences smoking patients

Had slower rate of recruiting  samples

Pechmann et al, 2016

RCT

Participant who used Facebook daily, texted weekly, and had mobile phones with unlimited texting.

160

novel Twitter-delivered intervention for smoking cessation for online based social sites

None

7 days

Sustained quit sustenance

weet2 Quit was engaging and doubled sustained abstinence. Its low cost and scalability makes it viable as a global cessation treatment

Applicable technology for smoke cessation  and a cost effective approach

Burford, 2012

RCT

Young smokers, aged 18 – 30 years who randomly entered the pharmacy

digital ageing intervention to promote smoking cessation among young adult smokers within a community pharmacy setting

Quit attempts

6 month follow-up

Positive attempts to quit

Providing a link between the intervention on personalised level is an effective tool to imitate motivation to persuade to quit.

Multi sectoail approach is an effective tool

 Based from the literature review, the best intervention to counteract the influence of smoking among the youth is by the use of community based interventions for promoting cessation of smoking as advocated in Jaykrishnan  study of 2013. In this random control study, different approaches was utilised in achieving the outcome. Approaches which are applicable are the use of facial interviews and telephone counselling and providing the young youth in UK with pamphlets with education content on smoking. It is with evidence of the study that 41.3 % and 13.6% in the control group had reduced smoking in the period of 12 months. At a confidence level of 95% with P- Value of 1.05 and odds ratio of 3.25, the intervention can be applied to the general population and achieve significant results.

The intervention selected is that it demands for heavy supply and of human resource who are dedicated in following up the subjects and guiding them throughout the process of change. The close contact of the patients with the health care practitioners is essential and an important parameter in initiating change among the young smokers in UK.. the role of public health officers will be crucial in enrolling this intervention. 

References 

An, L. C., Klatt, C., Perry, C. L., Lein, E. B., Hennrikus, D. J., Pallonen, U. E., ... & Ehlinger, E. P. (2008). The RealU online cessation intervention for college smokers: a randomized controlled trial. Preventive medicine, 47(2), 194-199.

Ash Fact Sheet. Accessed online 20/05/2017.https://ash.org.uk/category/information-and-resources/fact-sheets/

Burford, O. J. (2012). Delivering a personalised smoking cessation intervention by community pharmacists in Western Australia: a randomised controlled trial (Doctoral dissertation).

Campbell, R., Starkey, F., Holliday, J., Audrey, S., Bloor, M., Parry-Langdon, N., ... & Moore, L. (2008). An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. The Lancet, 371(9624), 1595-1602.

Eades, S. J., Sanson-Fisher, R. W., Wenitong, M., Panaretto, K., D'Este, C., Gilligan, C., & Stewart, J. (2012). An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial. Medical Journal of Australia, 197(1), 42.

Jamrozik, K. (2005). Estimate of deaths attributable to passive smoking among UK adults: database analysis. bmj, 330(7495), 812.

Jayakrishnan, R., Uutela, A., Mathew, A., Auvinen, A., Mathew, P. S., & Sebastian, P. (2013). Smoking cessation intervention in rural Kerala, India: findings of a randomised controlled trial. Asian Pacific Journal of Cancer Prevention, 14(11), 6797-6802.

Marley, J. V., Atkinson, D., Kitaura, T., Nelson, C., Gray, D., Metcalf, S., & Maguire, G. P. (2014). The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting. BMC public health, 14(1), 32.

Pechmann, C., Delucchi, K., Lakon, C. M., & Prochaska, J. J. (2016). Randomised controlled trial evaluation of Tweet2Quit: a social network quit-smoking intervention. Tobacco control, tobaccocontrol-2015.

Powell, J., Newhouse, N., Martin, A., Jawad, S., Yu, L. M., Davoudianfar, M., ... & Ziebland, S. (2016). A novel experience-based internet intervention for smoking cessation: feasibility randomised controlled trial. BMC Public Health, 16(1), 1156.

Tobacco Plain Packaging Act 2011, No. 148, 2011, An Act to discourage the use of tobacco products, and for related purposes.

Whittaker, R., Maddison, R., McRobbie, H., Bullen, C., Denny, S., Dorey, E., ... & Rodgers, A. (2008). A multimedia mobile phone–based youth smoking cessation intervention: findings from content development and piloting studies. Journal of Medical Internet Research, 10(5), e49.

 Ybarra, M. L., Holtrop, J. S., Prescott, T. L., Rahbar, M. H., & Strong, D. (2013). Pilot RCT results of stop my smoking USA: a text messaging–based smoking cessation program for young adults. nicotine & tobacco research, 15(8), 1388-1399.

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