Recommendation

1. Reducing smoking among women living on low income must be addressed within the wider context of strategies that tackle poverty, disadvantage and health.

1.2. Any work which seeks to support a particular group to address their smoking behaviour must acknowledge the impact and influence of their family, peer network and the culture in which they live.

1.3. There is a need to target services in areas and for groups where smoking prevalence is highest.

1.4. There is a need to develop cessation services that involve families members in providing support to smokers.

1.5. Health improvement programmes developed by health boards should include a community development approach in their local strategies to tackle smoking.

1.6. Any strategy for tobacco control should involve multi-disciplinary partnership working and

should be supported at senior management level and appropriately resourced.

1.7. In developing this strategy the views of practitioners and potential service users should be taken into account.

1.8. The strategy should incorporate community based services and support which range from providing specific cessation support to addressing smoking within a broader framework of women's health issues. Nicotine Replacement Therapy as one form of this support should be available on prescription to those who need it and for as long as they need it.

9. The project provided some learning about the development of sustainable community based tobacco related work. However, there is a need to identify what elements (e.g. structures, training for staff, funding) are needed to sustain work in the longer term.

2. FUNDING

2.1. Long term and dedicated core funding is needed to ensure the development of co-ordinated and sustainable community based initiatives that support the reduction of smoking among those on low income.

2.2. The funding of community based work must reflect the real costs of the work and must include finance to support and maintain participants` involvement (such as childcare costs, sitter costs, translation costs, transport costs).

4. Organisations responsible for the distribution and management of small grants should be responsive and flexible to take account of the financial situation and potential cash flow problems of community based and small voluntary sector groups and organisations.

3. METHODS OF WORKING

3.1. Work seeking to tackle tobacco use must be responsive to the needs and life circumstances of the communities and individuals involved.

3.2. There is a need to develop a range of support services, integrating direct and indirect approaches to tackling tobacco use.

3.3. The approaches used should be non-blaming and acknowledge that the participants may have to overcome significant barriers before addressingtheir smoking e.g. low self confidence, previous experience of cessation support, living in a smoking culture, transport and child care difficulties.

3.4. Culturally sensitive and user friendly materials that recognise the role tobacco plays in people’s lives should be developed.

4. TRAINING AND SUPPORT OF STAFF

4.1. There is a need to develop national training standards and opportunities for staff to acquire professional skills in tobacco based work at community level.

4.2. There is a need to develop training opportunities which provide community groups with the skills to prepare a funding proposal. This training should include writing work plans, setting realistic aims, objectives and timescales and preparing budgets.

4.3. There is a need to train community workers on how to develop and implement appropriate evaluation strategies for tobacco work.

4.4. There is a need to develop smoking cessation guidelines for non health professionals working at community level.

4.5. There is a need to develop a network for community workers which provides access to information and contacts relevant to tobacco based work.

4.6. Personnel support must therefore be an integral part of any small grant scheme and this must be flexible and reflect the nature of the work and the experience and skills of those involved. It is unrealistic to distribute small grants funding to community groups without providing ongoing advice and guidance to support the development of work.

4.7. There is a need to monitor and encourage a greater understanding and working relationships between health service staff and those groups and organisations working at community level.

5. EVALUATION

1. Further evaluation should be carried out on the effectiveness of community based work in addressing smoking reduction among low income groups.

5.2. An evaluation strategy should be developed for community based tobacco related work in Scotland reflecting the values and approaches of community work and community development.

5.3. Any evaluation of community based tobacco related work should focus on both process and outcome data.

5.4. Any evaluation of small grant work requires to be consistent with the time and resources invested in the work.

6. RESEARCH

6.1. There is a need for more research into the role and training requirements of community workers in delivering smoking cessation interventions.

2. Research into social disadvantage and smoking should be undertaken at regular intervals to determine smoking prevalence and to assess the impact of cessation services.
3. Further research into the role and contribution of men and other family members as support for women trying to change their smoking behaviour is required.

6.4. There is need for further research which focuses on the media strategies used by the tobacco industry to target those living on low income.