Is Stoptober running out of puff?
With smoking among 25-34s rising, does Stoptober actually make a difference?
The government has signalled its intention to raise the minimum age at which smoking is legal by one year, every year. The intention is that no child turning 14 or younger this year will ever be legally allowed to smoke.
It is estimated that about 13% of the adult population of the UK smoke, which equates to around 6.4 million people. Most age groups have experienced a decline in smoking (particularly the 18-25 year group) but the prevalence among those those aged 25-34 went up in 2022. Adults aged 25 to 34 years have the highest proportion of current smokers (16%, around 1.4 million people), compared with any other age group. This is an increase in comparison with the same group in 2021 (16%, around 1.3 million people).
One of the many initiatives targeted at getting smokers to quit is Public Health England's annual Stoptober intiative. First introduced in October 2012, Stoptober is a challenge for smokers to quit for 28 days. Research suggests that if a smoker can make it that far without a cigarette they are five times more likely to quit for good. The campaign has an app that people can download for support and advice, a large social media presence to encourage a sense of mass participation and personal quit plans to help navigate through the 28 days.
So does Stoptober actually work?
The impact of the campaign
What then has been the impact of the campaign?
Public Health England (PHE) has evaluated the campaign in the past but has not published a review since 2020. This most recently evaluation shows that, 12% of smokers made an attempt to quit and one third of these (4% of all smokers) made it through to the 28 day mark.
It is not possible to compare the impact in previous years because PHE changed survey suppliers in 2019 which led to a marked difference in the scores on each metric. It is possible to say, however, that the proportion of smokers making an attempt to quit was more or less the same between 2015 and 2019 (although at a much higher level than 2020's figure). So too was the proportion who made it to 28 days (again at a higher level than 2020).
There is some evidence to suggest that awareness of Stoptober has been diminishing. Looking at Google Trends data we can see that searches for Stoptober have fallen over time. The peak search time is usually the last week in September. The figure below shows that the relative number of searches for Stoptober has declined since September 2018 with searches for 2023 in the peak week down to around one fifth of the 2018 number.
Popularity of searches for Stoptober on Google 2018-2022
Source : Google Trends. Numbers represent search interest relative to the highest point on the chart within the time period (23rd Sept 2018 to 3rd Oct 2023). A value of 100 is the peak popularity for the term. A value of 50 means that the term was half as popular. Searches peak in the last week of September each year.
The 2020 campaign evaluation reported that awareness of the campaign was down on the previous year (40% down from 54%). PHE stated this could partly be due to confusion with the Better Health campaign which also encourages people to quit smoking. There is some evidence to support this : in 2020 the volume of searches for 'Better Health' peaked in August. This seems to be a one off because in 2021 and 2022 searches peaked in January.
The question is does the plateauing of quit attempts, decline in campaign recall and drop in Google searches mean that Stoptober has run out of puff? Does it actually lead to long term behaviour change?
Does Stoptober lead to a long term behaviour change?
Stoptober encourages people to attempt to quit smoking. It is estimated that it has helped over 2.3m smokers make an attempt to quit since its introduction in 2012. That's an impressive figure. But giving up smoking is not a yes/no decision. There are many points in the journey from someone thinking about quitting to actually doing it.
Initiatives like Stoptober have an important role to play in moving people along the path of behaviour change. There are three points in particular where Stoptober has an impact: (i) motivating people who are open to attempting to quit to find out more about the help and support available (ii) providing support, encouragement and advice to those planning to quit so that they make the step to actually attempting it and (iii) encouraging those who have tried to give up in the past (New Year's resolution for example) to try again.
The focus on Stoptober being a mass participation event (and its use of social media to underpin this) is important for people who are contemplating quitting. The feeling of not being alone, combined with its emphasis on the positive benefits of quitting (rather than just on the harm caused by smoking) brings positive encouragement to people open to the idea of quitting. Things like the app, personalised quit plans and making quitting more achievable by doing it for 28 days are important in encouraging people to take action because they provide the tools necessary to move from thinking about it to actually doing something.
The biggest challenge for Stoptober is to help as many people give up for 28 days and beyond. PHE's own research shows that two-thirds don't make it to 28 days and in fact half drop out after two weeks. There will be a number of reasons for this: lack of engagement with the support tools, low confidence to succeed, diminished willpower, motivational messages not cutting through or factors such as stress and personal circumstances. For many the cravings will just be too much - smoking is an addiction after all. How can the two-thirds be better supported in the future?
The government's ambition is for England to be designated smokefree by 2030. This is defined as meaning only 5% of the population smoke. A campaign, with an appropriate level of funding, that encourages and supports people to quit can be a useful part of the making smoking obsolete toolkit.
Whether that campaign is one with a month long focus such as Stoptober or one that is part of a more holistic and ongoing campaign around better health outcomes, is up for debate.
