Understanding the influences on quit motivation and smoking cessation in older smokers from deprived backgrounds

There is little evidence regarding the optimal smoking cessation intervention for older smokers from deprived backgrounds. An increased understanding of behavioural influences on quit motivation and smoking cessation is needed to adapt smoking cessation interventions for this population. Older smokers from deprived backgrounds are seldom-heard and have an increased risk of a number of health conditions, including lung cancer. These individuals are eligible for targeted lung cancer screening yet are least likely to take part and for whom lung screening could offer a teachable moment for smoking cessation. Research was undertaken to identify factors influencing quit motivation and smoking cessation in the target population. PRIME was the main theory selected for use in the PhD. Findings from a systematic review demonstrated that there were limited data to identify the optimal form of behavioural smoking cessation intervention for the target population. However, intense multimodal behavioural counselling using incentives and peer facilitators, delivered in a community setting and tailored to individual needs indicated a positive impact on smoking outcomes. A crosssectional population based survey showed that interventions are needed to increase self-efficacy for quitting, dispel risk-minimising beliefs and target elements of previous quit attempts that were associated with motivation to stop smoking. Qualitative interviews with smokers who declined smoking cessation support at the time of a lung cancer screening demonstrated that the wider determinants of smoking, including a lack of social support, pre-existing health conditions and intense social isolation, impact an individual’s quit motivation. Findings were used to develop a set of recommendations for adapting an existing smoking cessation intervention for the target population using the ADAPT guidance. Intensive behavioural support that incorporates referral to local health and wellbeing support could be implemented as a strategy to reduce the impact of the wider determinants of smoking in the target population and warrants further feasibility and pilot testing