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Breaking Free from Smoking: A Novel Digital Smoking Cessation Intervention for Offenders in UK Prisons

Published online by Cambridge University Press:  16 March 2018

Stephanie Dugdale*
Department of Research, Breaking Free Group, Manchester, UK
Jonathan Ward
Department of Research, Breaking Free Group, Manchester, UK
Sarah Elison-Davies
Department of Research, Breaking Free Group, Manchester, UK
Glyn Davies
Department of Research, Breaking Free Group, Manchester, UK
Emma Brown
School of Health Sciences, University of East Anglia, Norwich, UK
Address for correspondence: Stephanie Dugdale, Breaking Free Group, 274 Deansgate, Manchester, UK, M3 4JB. Email:


Introduction: The level of smoking cessation support across UK prisons is variable, with most offering pharmacological support, such as nicotine replacement therapy. However, with a complete smoking ban in prisons in England now imminent, additional standardised behavioural support is necessary to help offenders go smoke-free.

Aims: This study used the Behaviour Change Wheel to aim to develop the content of an online smoking cessation intervention for offenders, with consideration of their capability, motivation and opportunity for behaviour change.

Methods: This was an intervention development study. The Behaviour Change Wheel was used to map cognitive, behavioural, physiological and social targets for the intervention, onto appropriate intervention techniques for inclusion in the smoking cessation programme for offenders.

Results: Psychological capability, social opportunity and reflective and automatic motivation were identified through deductive thematic analysis as areas of change required to achieve smoking cessation. A total of 27 behavioural change techniques were chosen for this smoking cessation intervention and were mapped onto the Lifestyle Balance Model which provided the theoretical basis on which the components of the programme are conceptualised. This included strategies around increasing motivation to quit, anticipating smoking triggers, modifying smoking-related thoughts, regulating emotions, managing cravings, replacing smoking and rewarding nicotine abstinence and adopting a healthier lifestyle.

Conclusions: Through the utilisation of the Behaviour Change Wheel, the development process of this digital smoking cessation intervention was achieved. Further research is planned to evaluate the clinical effectiveness of this intervention and to explore how the programme is implemented in practice within prison settings.

Original Articles
Copyright © The Author(s) 2018 

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Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PloS One, 5 (10), e13196.Google Scholar
Aveyard, P., & West, R. (2007). Managing smoking cessation. British Medical Journal, 335 (7609), 3741.Google Scholar
Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (2011). Cognitive therapy of substance abuse. New York, NY: Guilford Press.Google Scholar
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York, NY: Guilford Press.Google Scholar
Borrelli, B., Sepinwall, D., Ernst, D., Bellg, A. J., Czajkowski, S., Breger, R. et al. (2005). A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology, 73 (5), 852.Google Scholar
Bowen, S., Witkiewitz, K., Chawla, N., & Grow, J. (2011). Integrating mindfulness meditation and cognitive behavioral traditions for the long-term treatment of addictive behaviors. JCOM, 18 (10), 473479.Google Scholar
Butler, T., Richmond, R., Belcher, J., Wilhelm, K., & Wodak, A. (2007). Should smoking be banned in prisons? Tobacco Control, 16 (5), 291293.Google Scholar
Carroll, K. M. (2013). Treatment Integrity and dissemination: Rethinking fidelity via the stage model. Clinical Psychology: Science and Practice, 20 (1), 99106.Google Scholar
Carroll, K. M., & Rounsaville, B. J. (2010). Computer-assisted therapy in psychiatry: Be brave—it's a new world. Current Psychiatry Reports, 12 (5), 426432.Google Scholar
Civljak, M., Sheikh, A., Stead, L. F., & Car, J. (2010). Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, 9 (CD007078).Google Scholar
Clarke, J. G., Stein, L. A. R., Martin, R. A., Martin, S. A., Parker, D., Lopes, C. E. et al. (2013). Forced smoking abstinence: Not enough for smoking cessation. JAMA Internal Medicine, 173 (9), 789794.Google Scholar
Condon, L., Hek, G., & Harris, F. (2008). Choosing health in prison: Prisoners' views on making healthy choices in English prisons. Health Education Journal, 67 (3), 155166.Google Scholar
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new medical research council guidance. BMJ, 337, a1655.Google Scholar
Cropsey, K. L., Linker, J. A., & Waite, D. E. (2008). An analysis of racial and sex differences for smoking among adolescents in a juvenile correctional center. Drug and Alcohol Dependence, 92 (1), 156163.Google Scholar
Davies, G., Elison, S., Ward, J., & Laudet, A. (2015). The role of lifestyle in perpetuating substance dependence: A new explanatory model, the lifestyle balance model. Substance Abuse, Treatment, Prevention and Policy, 10 (2).Google Scholar
Dugdale, S., Ward, J., Hernen, J., Elison, S., Davies, G., & Donkor, D. (2016). Using the behavior change technique Taxonomy v1 to conceptualize the clinical content of breaking free online: A computer-assisted therapy program for substance use disorders. Substance Abuse Treatment, Prevention, and Policy, 11 (26).Google Scholar
Dugdale, S., Semper, H., Povey, R., Elison-Davies, S., Ward, J., & Davies, G. (in preparation). “If he's not had a cigarette that day, the first thing he's gonna do is lamp you !”: Offenders' perceptions of the upcoming prison smoking ban in England.Google Scholar
Eadie, D., MacAskill, S., McKell, J., & Baybutt, M. (2012). Barriers and facilitators to a criminal justice tobacco control coordinator: An innovative approach to supporting smoking cessation among offenders. Addiction, 107 (S2), 2638.Google Scholar
Elison, S., Humphreys, L., Ward, J., & Davies, G. (2014a). A pilot outcomes evaluation for computer assisted therapy for substance misuse - an evaluation of breaking free online. Journal of Substance Use, 19 (4), 313318.Google Scholar
Elison, S., Ward, J., Davies, G., Lidbetter, N., Dagley, M., & Hulme, D. (2014b). An outcomes study of eTherapy for dual diagnosis using breaking free online. Advances in Dual Diagnosis, 7 (2), 5262.Google Scholar
Elison, S., Weston, S., Davies, G., Dugdale, S., & Ward, J. (2016). Findings from mixed-methods feasibility and effectiveness evaluations of the “Breaking Free Online” treatment and recovery programme for substance misuse in prisons. Drugs: Education, Prevention and Policy, 23 (2), 176185.Google Scholar
Elison, S., Weston, S., Dugdale, S., Ward, J., & Davies, G. (2016). A qualitative exploration of U.K. Prisoners’ experiences of substance misuse and mental health difficulties, and the breaking free health and justice interventions. Journal of Drug Issues, 46 (3), 198215.Google Scholar
Fulton, E. A., Brown, K. E., Kwah, K. L., & Wild, S. (2016). StopApp: Using the behaviour change wheel to develop an app to increase uptake and attendance at NHS Stop Smoking Services. In Healthcare, 4 (2), 31.Google Scholar
Gould, G. S. (2014). Exploring the barriers and enablers to smoking cessation in pregnant aboriginal and torres strait Islander women with the behaviour change wheel. Australasian Epidemiologist, 21 (2), 31.Google Scholar
Greenberger, D., & Padesky, C. A. (1995). Mind over mood: Change how you feel by changing the way you think. New York, NY: The Guilford Press.Google Scholar
Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D. et al. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ, 348, g1687.Google Scholar
Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. New York, NY: Hyperion.Google Scholar
Kauffman, R. M., Ferketich, A. K., Murray, D. M., Bellair, P. E., & Wewers, M. E. (2011). Tobacco use by male prisoners under an indoor smoking ban. Nicotine & Tobacco Research, 13 (6), 449456.Google Scholar
Landridge, D. (2007). Phenomenological psychology: Theory, research and method. Essex, UK: Pearson Education Limited.Google Scholar
Lincoln, T., Tuthill, R. W., Roberts, C. A., Kennedy, S., Hammett, T. M., Langmore-Avila, E. et al. (2009). Resumption of smoking after release from a tobacco-free correctional facility. Journal of Correctional Health Care, 15 (3), 190196.Google Scholar
MacAskill, S., & Hayton, P. (2006). Stop smoking support in HM Prisons: The impact of nicotine replacement therapy. Executive summary and best practice checklist. Stirling, UK: Institute for Social Marketing: University of Stirling & The Open University.Google Scholar
Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York, NY: Guilford Press.Google Scholar
Marlatt, G., Bowen, S., Chawla, N., & Witkiewitz, K. (2010). Mindfulness-based relapse prevention for substance abusers: Therapist training and therapeutic relationships. In Hick, S., & Bien, T. (Eds.), Mindfulness and the therapeutic relationship (pp. 107121). New York, NY: The Guilford Press.Google Scholar
McCleary, N., Duncan, E. M., Stewart, F., & Francis, J. J. (2013). Active ingredients are reported more often for pharmacologic than non-pharmacologic interventions: An illustrative review of reporting practices in titles and abstracts. Trials, 14 (1), 146.Google Scholar
Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. Surrey, UK: Silverback Publishing.Google Scholar
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W. et al. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46 (1), 8195.Google Scholar
Michie, S., van Stralen, M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6 (1), 42.Google Scholar
National Health Service. (2014). Statistics of NHS stop smoking services, England - April 2013 to March 2014. London, UK: Author.Google Scholar
NVivo 10. (2012). NVivo qualitative data analysis software; QSR International Pty, Limited. Version 10, 2012.Google Scholar
Olmstead, T. A., Ostrow, C. D., & Carroll, K. M. (2010). Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction. Drug and Alcohol Dependence, 110 (3), 200207.Google Scholar
Perepletchikova, F., & Kazdin, A. E. (2005). Treatment integrity and therapeutic change: Issues and research recommendations. Clinical psychology: Science and practice, 12 (4), 365383.Google Scholar
Pezzino, G., Remington, P. L., Anderson, H., Lantz, P. M., & Peterson, D. E. (1992). Impact of a smoke-free policy on prisoners in Wisconsin, United States. Tobacco Control, 1 (3), 180184.Google Scholar
Public Health England. (2015). Reducing smoking in prisons: Management of tobacco use and nicotine withdrawal. London, UK: Author.Google Scholar
Richmond, R., Butler, T., Wilhelm, K., Wodak, A., Cunningham, M., & Anderson, I. (2009). Tobacco in prisons: A focus group study. Tobacco Control, 18 (3), 176182.Google Scholar
Stead, L. F., Koilpillai, P., Fanshawe, T. R., & Lancaster, T. (2016). Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 3 (CD008286).Google Scholar
West, R., & Stapleton, J. (2008). Clinical and public health significance of treatments to aid smoking cessation. European Respiratory Review, 17 (110), 199204.Google Scholar
Williams, C., & Chellingsworth, M. (2010). CBT: A clinician's guide to using the five areas approach. London, UK: Hodder Arnold.Google Scholar
Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8 (3), 172179.Google Scholar
World Health Organization. (2015). Global health observatory (GHO) data: Prevalence of tobacco smoking. Retrieved from Scholar
World Health Organization. (2016). Tobacco [Factsheet]. Retrieved from Scholar