A Case Study of Stoptober: an English Mass Media Smoking Cessation Campaign
Stoptober is a national smoking cessation campaign that was first launched across England in late 2012. The campaign has two key objectives. The first is to use traditional and new mass media messaging to trigger a national movement in which smokers stop smoking at the same time. The second is to advertise and provide a wide range of support including digital tools to help smokers achieve the goal of being smoke-free throughout the month of October while broadcasting the positive message that any smoker would be five times more likely to succeed permanently upon realising the stated goal.
The campaign draws heavily on several key ideas from behavioural and psychological science. One is social contagion theory that suggests national messaging can amplify a campaign by normalising behaviour and turning it into a movement [i.e., a mass quit attempt, . This idea is supported by network analysis of population data that shows interconnected groups of people tend to stop smoking in concert. Another key psychological influence is to base the movement around a SMART (Specific, Measurable, Attainable, Realistic and Time-sensitive) goal. SMART goals aim to help people achieve a difficult behavioural goal by encouraging them to begin with a realistic intermediary goal, which is objective, well-specified and bound to a particular target date. Stoptober sets people the goal of being smoke-free for 28 days starting on October 1st. The call to action is reinforced by the positive messages that smokers achieving this goal are at least five times more likely than at the start to become permanent ex-smokers as a result of having recovered from the worst of the cravings and withdrawal symptoms.
The final key psychological insight comes from PRIME theory. PRIME theory is a comprehensive theory of motivation that argues the motivational system is inherently unstable and requires constant balancing input to maintain a constant pattern of behaviour. In the case of cigarette addiction, cessation is most likely to be successful if a range of support is provided that targets the whole motivational system rather than just some elements of it. Stoptober provides and advertises a wide variety of support to help smokers achieve a smoke-free month including a postal support pack, an accompanying website offering brief advice on smoking cessation, peer support via facilitatory Facebook and Twitter accounts, a motivational text-messaging programme and an app that provides ongoing encouragement and self-monitoring tools.
The first campaign which ran during the autumn of 2012 has now been evaluated by an independent national surveillance programme called the Smoking Toolkit Study . The study has used nationally representative household surveys to assess the incidence of key smoking cessation activity every month in England since 2007. The evaluation of Stoptober included data on quit attempts collected from over 30,000 past-year smokers. Logistic regression models demonstrated that relative to other months in the year, more people tried to quit in October in 2012 as compared with 2007-11. Specifically, in 2012 there was an significant increase in quitting of approximately 50% during October compared with other months of the same year (9.6% vs. 6.6%), whereas in 2007-11 the rate in October was non-significantly less than in other months of the same period (6.4% vs. 7.5%). On the basis of these data, Stoptober is estimated to have generated an additional 350,000 quit attempts and saved 10,400 discounted life years at less than £420 per discounted life year in the most common age group.
Stoptober clearly provided excellent value for money as a life-saving public health intervention. For example, the UK national guidance is that medical interventions are cost-effective if they cost less than £20,000-£30,000 per discounted life year gained. The implication of this evaluation is that designing a national public health campaign with a clear behavioural target (making a serious quit attempt) using key psychological principles can yield a substantial return in terms of behaviour change and public health impact.
The Stoptober campaign has now run for a second time in 2013, and is likely to become a permanent campaign contingent upon its continued effectiveness. Clearly, previous effectiveness is somewhat indicative of the future but unfortunately it is not always this straightforward: campaigns can benefit from novelty or be found to suffer from ‘burnout’. In order to establish whether Stoptober remains a success, an ongoing assessment of its effectiveness is important.
– by Jamie Brown, 31 January, 2014
This article is adapted from the upcoming publication: Brown, J., Kotz, D., Michie, S., Stapleton, J., Walmsley, M., & West, R. How effective and cost-effective was the national mass media smoking cessation campaign ‘Stoptober’? Drug and Alcohol Dependence.
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