The Smoke Free North East Office: a model of good practice for England.

Lead Research Organisation: Durham University
Department Name: Anthropology

Abstract

This study takes advantage of a unique opportunity ? the formation of a Smoke Free North East Office (SFNEO) modelled on the California Tobacco Control Office (TCO) that has been trialled successfully in the USA. But how effective is the model when applied in the UK context? This study provides an in-depth description and analysis of the workings and dynamics of the SFNEO, its adaptation to local environments, stakeholders and institutions, and the quality of its interventions. It aims to assess how successful the SFNEO is in its first three years of operation, and its potential for transferability elsewhere, alongwith potential problems and pitfalls. The SFNEO is under development, and its research and evalaution advisory committee (see list of research collaborators) has been instrumental in defining the aims and objectives of the study. A large number of organizations are collaborating in the establishment of the SFNEO and they and their counterparts elsewhere in the UK will be the beneficiaries of the research. Other regions are waiting eagerly to see whether and if so how the SFNEO performs, and the dissemination of the results of this study through the network of the other eight regional tobacco control co-ordinators in England is built into the proposal. A project steering group will oversee the progress and development of the research. This will comprise a balance of members from the SFNEO s research and evaluation advisory and management steering groups, including lay members. Tobacco use remains the single most important preventable cause of illness and death in the UK today and of the English regions, the North East bears the greatest burden. Understanding how effective an intervention the SFNEO represents, and its potential transferability to other regions, could have a major impact on health and healthcare in the UK.

Technical Summary

This proposal is to study the effectiveness of the Smoke Free North East Office (SFNEO), the first regional Tobacco Control Office (TCO) in England. It is modelled on the successful experience of the California TCO. A phased approach using multiple methods (including anthropological, epidemiological and economic) will be used to fully describe the formation and functioning of the TCO and to monitor outcomes. Primary outcomes include changes to public opinion; secondary outcomes include prevalence of smoking. Comparisons will be made with England over the same time period. The results of this study will be used to further publicise the work and operation of the SFNEO in the NE of England, provide a model for other regions considering developing a TCO and evidence on which the development of equivalent bodies can be based, and will inform the development of the SFNEO and increase its efficiency.

Publications

10 25 50
 
Description Centre for Translational Research in Public Health/Association of North East Councils seminar afternoon
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Department of Health working group for the development of the document 'Excellence in Tobacco Control: 10 High Impact Changes to achieve Tobacco Control'
Geographic Reach National 
Policy Influence Type Participation in advisory committee
Impact The 'Excellence in Tobacco Control: 10 High Impact Changes to achieve tobacco control: an evidence-based resource for local alliances' has as its first recommendation 'Work in Partnership'. This draws heavily upon recommendations by Durham University researchers referring to their research papers on tobacco control alliances and collaboration in public health. More specifically, 'Excellence in Tobacco Control' recommends as good practice specific factors underlying successful partnerships based on Durham research findings, viz. 1) "a clear but detailed purpose that enables each of the partners to identify the importance of their and their organisation's contribution", 2) "co-ordination by a 'neutral' officer not seen as entirely within the structure and procedures of any one member organisation" and 3) "dedication of managerial time and attention to developing effective working relationships and a shared sense of mission" (pp. 14-15). This document was distributed to Directors of Public Health in all 152 Primary Care Trust areas of England by the Tobacco Control and Health Inequalities national Support Teams (NSTs). This resulted in the emergence and strengthening of local Tobacco Control Alliances, which was a direct recommendation made in the 'Work in Partnership' impact change to establish such alliances. For instance, building upon this recommendation suggested by the NST, the Great Yarmouth and Waveney Primary Care Trust issued a Tobacco Control Action Plan, which proposed 'multi-agency partnership working' and an annual investment of ?150,000 from 2010/11 to maintain an effective tobacco control initiative. This funding was secured in order to: create a dedicated Tobacco Control Coordinator role; set up a working party of strategic partners to develop a local tobacco control plan; and to form a local alliance, linking with Norfolk and Suffolk county alliances, in order to deliver the plan. Dr Shamsher Diu, Consultant in Public Health for NHS Norfolk & Waveney notes that the NST's recommendation on partnership working allowed the Great Yarmouth and Waveney PCT to have the best Stop Smoking services in the East of England Strategic Health Authority.
 
Description DoH's Tobacco Strategy Consultation
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Local Alliance Toolkit
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The Local Alliance Toolkit was co-designed by Dr Sue Lewis, RA on the NPRI project, with collaborators from Fresh Smoke Free North East. The Toolkit enabled tobacco control partnerships to conduct self-appraisal work and improve practice. It translates findings from Durham University's research into a set of PowerPoint presentations offering tobacco control guidelines and a reflexive self-assessment exercise for Alliances. The exercise encourages partners to listen to and acknowledge differing viewpoints, recognise their own and others' roles, and decide collectively how to improve their functioning. The Toolkit was made freely available to all Alliances through the 'professional area' of Fresh's web-site. In 2008, 13 out of 15 local Tobacco Control Alliances successfully used it. The Toolkit is referred to in a document issued by the Department of Health in 2011 to reflect on the experience and key learning of the Tobacco Control and Health Inequalities National Support Team (NST)'s programme. This document, entitled 'A Comprehensive Guide to Achieving Effective Local Tobacco Control: Evidence, Support and Publications Developed by the Tobacco Control National Support Team', stressed the particular importance of the 'Work in Partnership' impact change informed by Durham University's research, stating that the Local Alliance Toolkit proved to be a valuable resource "to help Alliances assess their functionality as partnerships, to plan for the challenges and priorities ahead, and to reflect on achievements to date" (p.42). The following example illustrates how the value of the Toolkit was assessed by its users: the Hartlepool Tobacco Control Alliance, in the Hartlepool PCT Annual Report 2007-8 states that it "undertook a self-assessment by using the Fresh Alliance Toolkit. This process proved very helpful in assessing current effectiveness, strengths and weaknesses and provided action points for the coming year" (p17). The Business Manager at Fresh, in e-email correspondence, has confirmed that "the Toolkit played a significant role in the overall sustainability of the 12 local alliances across the North East region", and that it "helped tobacco control leads to facilitate local discussions in terms of tobacco remaining the number one public health priority". Moreover, the success of the Toolkit is also evidenced in the fact that it was replicated outside the region. Thus in 2008, Smoke Free North West, another tobacco control programme based on the successful model provided by Fresh, developed its own Tobacco Alliance Toolkit, which, according to the Greater Manchester Directors' of Public Health 'Smoke Free North West Business Case for Investment in Tobacco Control' is "based on the excellent Fresh model" (p4).
 
Description Parliamentary All-Party Parliamentary Group meeting on contraband and counterfeit tobacco
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Talking to MBBS Phase I medical students
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Cancer Research UK grant
Amount £20,363 (GBP)
Organisation Cancer Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2008 
End 07/2008
 
Description NPRI
Amount £166,064 (GBP)
Organisation Medical Research Council (MRC) 
Department National Prevention Research Initiative (NPRI)
Sector Charity/Non Profit
Country United Kingdom
Start 09/2008 
End 08/2010
 
Title participatory action research in public health institutions 
Description Embedded researcher acts in a multi-level, action research capacity, feeding back results of research in an iterative process in order to enhance effectiveness and improve outcomes 
Type Of Material Improvements to research infrastructure 
Year Produced 2009 
Provided To Others? Yes  
Impact Article in the journal 'Ethnography' 
 
Description County Durham and Darlington Primary Care Trust 
Organisation County Durham and Darlington NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution RA on 'Revealing alcohol narratives: a Qualitative study of young people's relationships with alcohol in County Durham and Darlington'
Collaborator Contribution Brought together an active partnership of individuals representing diverse health and social care practitioner organizations and groups through the steering committee
Impact Lewis, S, Russell A, Carro-Ripalda S, Masson K (2011) 'Revealing Alcohol Narratives': A Qualitative Study of Young People's Relationships with Alcohol in County Durham and Darlington. Final Report. Available on open access at: http://www.dur.ac.uk/resources/anthropology/research/marg/FINALREPORT-11NOV11AR.pdf
Start Year 2009
 
Description Don't Get Me Started Project 
Organisation Action on Smoking and Health (ASH)
Department Action on Smoking and Health (ASH Scotland)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Took a representative of ASH Scotland, Greater Glasgow and Clyde Health Board, and six members of W-West on appraisal visit to Uruguay to evaluate the use and potential of 'Respira Uruguay' exhibition at the Espacio Ciencia (Science Centre), Montevideo, for tobacco control in the UK
Collaborator Contribution Contributed to the appraisal and evaluation of the exhibition's potential
Impact ASH Scotland are actively pursuing the possibility of establishing the UK's first exhibition designed to discourage young people from smoking at a science education centre in Scotland, involving input from W-West and academics at Durham University.
Start Year 2011
 
Description Don't Get Me Started Project 
Organisation NHS Greater Glasgow and Clyde (NHSGGC)
Department W-West young persons' tobacco control advocacy group
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Took a representative of ASH Scotland, Greater Glasgow and Clyde Health Board, and six members of W-West on appraisal visit to Uruguay to evaluate the use and potential of 'Respira Uruguay' exhibition at the Espacio Ciencia (Science Centre), Montevideo, for tobacco control in the UK
Collaborator Contribution Contributed to the appraisal and evaluation of the exhibition's potential
Impact ASH Scotland are actively pursuing the possibility of establishing the UK's first exhibition designed to discourage young people from smoking at a science education centre in Scotland, involving input from W-West and academics at Durham University.
Start Year 2011
 
Description FUSE Centre for Translational Research in Public Health 
Organisation UK Clinical Research Collaboration
Department FUSE Centre for Translational Research in Public Health
Country United Kingdom 
Sector Public 
PI Contribution Organised the 8th Quarterly Research Meeting in Newcastle, October 2010
Collaborator Contribution Opportunity for dissemination through quarterly research meetings
Impact Report on QRM - see http://www.fuse.ac.uk/news.php?nid=1036
Start Year 2007
 
Description James Cook University Hospital 
Organisation James Cook University Hospital
Country United Kingdom 
Sector Hospitals 
PI Contribution Contributed to methodology and pilot study
Collaborator Contribution Development of protocol for study into impact of smoking cessation on rheumatoid arthritis.
Impact PMID 21628310 Multi-disciplinary collaboration involving rheumatology, epidemiology and anthropology
Start Year 2009
 
Description North East Improvement and Efficiency Partnership 
Organisation North East Improvement and Efficiency Partnership NIEP
Country United Kingdom 
Sector Public 
PI Contribution Organised first 'From Research to Reality: Delivering Better Outcomes' workshop in November 2009, and produced associated documentation
Collaborator Contribution Engagement with local authority and other stakeholders in tobacco control
Impact Delivered workshop linked to Local Area Agreement Outcome 152 (Stopping Smoking), attended by over 50 non-academic staff.
Start Year 2009
 
Title Local Alliance toolkit 
Description Local Alliance Toolkit enables induction and training of new local alliance members and self-appraisal of local alliance. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2007
Development Status Under active development/distribution
Impact Taken up by the DoH as a model for other public health interventions. 
 
Description Easington workplaces 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Primary Audience Participants in your research and patient groups
Results and Impact Working with employers and employees in Easington, Co. Durham, on workers' attitudes to smoking. Results were fed back to employers in the form of a report.

None
Year(s) Of Engagement Activity 2006,2007
 
Description Focus group with young people in Easington 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact A focus group with young people in Easington was conducted as part of an outreach organisation's education programme.

The discussion was followed up by staff working with young people on the dangers of smoking.
Year(s) Of Engagement Activity 2007
 
Description Peer-led research with 'Investing in Children' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact Briefing of young people who then conducted peer-led research/focus groups in 'adult free zones' on smoking attitudes and behaviour.

Young people's reports fed back directly into the findings of our project
Year(s) Of Engagement Activity 2008
 
Description Presentations at 'Best Practice' forums 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Primary Audience Public/other audiences
Results and Impact Feedback on results of research and organising roundtable discussions and activities related to the organization of Smoke Free North East

Led to the development of the Local Alliance Toolkit
Year(s) Of Engagement Activity 2007,2008
 
Description Project website 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact http://www.dur.ac.uk/anthropology/research/projects/fresh/

Unknown
Year(s) Of Engagement Activity 2006,2007,2008,2009
 
Description Tobacco Control Research and Monitoring Seminar 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Primary Audience Public/other audiences
Results and Impact Presented findings from the study

None
Year(s) Of Engagement Activity 2009