Skip to main content Accessibility help

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

  • Stephanie Dugdale (a1), Jonathan Ward (a1), Sarah Elison-Davies (a1), Glyn Davies (a1) and Emma Brown (a2)...

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.

Corresponding author
Address for correspondence: Stephanie Dugdale, Breaking Free Group, 274 Deansgate, Manchester, UK, M3 4JB. Email:
Hide All
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.
Aveyard, P., & West, R. (2007). Managing smoking cessation. British Medical Journal, 335 (7609), 3741.
Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (2011). Cognitive therapy of substance abuse. New York, NY: Guilford Press.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York, NY: Guilford Press.
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.
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.
Butler, T., Richmond, R., Belcher, J., Wilhelm, K., & Wodak, A. (2007). Should smoking be banned in prisons? Tobacco Control, 16 (5), 291293.
Carroll, K. M. (2013). Treatment Integrity and dissemination: Rethinking fidelity via the stage model. Clinical Psychology: Science and Practice, 20 (1), 99106.
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.
Civljak, M., Sheikh, A., Stead, L. F., & Car, J. (2010). Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, 9 (CD007078).
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.
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.
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.
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.
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).
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. New York, NY: Hyperion.
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.
Landridge, D. (2007). Phenomenological psychology: Theory, research and method. Essex, UK: Pearson Education Limited.
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.
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.
Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York, NY: Guilford Press.
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.
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.
Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. Surrey, UK: Silverback Publishing.
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.
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.
National Health Service. (2014). Statistics of NHS stop smoking services, England - April 2013 to March 2014. London, UK: Author.
NVivo 10. (2012). NVivo qualitative data analysis software; QSR International Pty, Limited. Version 10, 2012.
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.
Perepletchikova, F., & Kazdin, A. E. (2005). Treatment integrity and therapeutic change: Issues and research recommendations. Clinical psychology: Science and practice, 12 (4), 365383.
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.
Public Health England. (2015). Reducing smoking in prisons: Management of tobacco use and nicotine withdrawal. London, UK: Author.
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.
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).
West, R., & Stapleton, J. (2008). Clinical and public health significance of treatments to aid smoking cessation. European Respiratory Review, 17 (110), 199204.
Williams, C., & Chellingsworth, M. (2010). CBT: A clinician's guide to using the five areas approach. London, UK: Hodder Arnold.
Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8 (3), 172179.
World Health Organization. (2015). Global health observatory (GHO) data: Prevalence of tobacco smoking. Retrieved from
World Health Organization. (2016). Tobacco [Factsheet]. Retrieved from
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Smoking Cessation
  • ISSN: -
  • EISSN: 1834-2612
  • URL: /core/journals/journal-of-smoking-cessation
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed