The COVID-19 pandemic provided a stark reminder that societies will struggle to address global challenges unless they are able to change behaviour at scale. The widely adopted ‘nudge’ approach epitomizes an individualistic, deficit model of human cognition and motivation that leverages or overcomes people’s weaknesses and biases to get them to do things they would otherwise not. By contrast, we argue that tackling the challenges facing humanity requires a collective, capacity-building approach – one that boosts the competences, opportunities, and motivations of individuals to act together.

Introduction. Activities promoting research reproducibility and transparency are crucial for generating trustworthy evidence. Evaluation of smoking interventions is one area where vested interests may motivate reduced reproducibility and transparency. Aims. Assess markers of transparency and reproducibility in smoking behaviour change intervention evaluation reports. Methods. One hundred evaluation reports of smoking behaviour change intervention randomised controlled trials published in 2018-2019 were identified. Reproducibility markers of pre-registration; protocol sharing; data, material, and analysis script sharing; replication of a previous study; and open access publication were coded in identified reports. Transparency markers of funding and conflict of interest declarations were also coded. Coding was performed by two researchers, with inter-rater reliability calculated using Krippendorff’s alpha. Results. Seventy-one percent of reports were open access, and 73% were pre-registered. However, there are only 13% provided accessible materials, 7% accessible data, and 1% accessible analysis scripts. No reports were replication studies. Ninety-four percent of reports provided a funding source statement, and eighty-eight percent of reports provided a conflict of interest statement. Conclusions. Open data, materials, analysis, and replications are rare in smoking behaviour change interventions, whereas funding source and conflict of interest declarations are common. Future smoking research should be more reproducible to enable knowledge accumulation. This study was pre-registered: https://osf.io/yqj5p.

Understanding and changing eating behaviours are central to the work of Nutrition Society members working in both research and applied settings. The present paper describes a recently published resource to guide the design of interventions to change behaviour, The Behaviour Change Wheel: A Guide to Designing Interventions (BCW Guide). This is a practical guide to intervention design that brings together recently-developed theory-based tools in behavioural science into a coherent step-by-step design process. It is based on the BCW, a synthesis of nineteen frameworks of behaviour change found in the research literature. The BCW has at its core a model of behaviour known as ‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’. The model recognises that behaviour is part of an interacting system involving all these components. The BCW identifies different intervention options that can be applied to changing each of the components and policies that can be adopted to deliver those intervention options. The book shows how the BCW links to theory-based frameworks to understand behaviour such as the Theoretical Domains Framework and the recently developed Behaviour Change Technique Taxonomy v1 for specifying intervention content. In essence, it shows how to link what is understood about a given behaviour to types of intervention likely to be effective and then translate this into a locally relevant intervention. In addition, the present paper sets out some principles of intervention design.

Background: Internet-based interventions can help smokers to quit compared with brief written materials or no intervention. However, they are not widely used, particularly by more disadvantaged smokers, and there is significant variation in their effectiveness. A new smoking cessation website (‘StopAdvisor’) has been systematically developed on the basis of PRIME theory, empirical evidence, web-design expertise and user-testing with socio-economically disadvantaged smokers. This paper reports the protocol of a randomised controlled trial to evaluate the efficacy of StopAdvisor and determine whether it translates across the social spectrum.

Methods: The trial has two arms with participants randomised to the offer of the interactive ‘StopAdvisor’ website (intervention condition) or a non-interactive, static website (control condition). Participants are adults from the UK, who smoke every day and are willing to make a serious quit attempt within a month of enrolment. At least 4260 participants will be recruited with a minimum of 2130 in each of two socio-economic sub-groups. The intervention comprises a structured quit plan and a variety of theory- and evidence-based behaviour change techniques for smoking cessation. Tailored support is offered in the form of a series of tunnelled sessions and a variety of interactive menus for use up to a month before, and then for one month after quitting (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The control is a static website that presents brief and standard advice on smoking cessation. Assessments are at baseline and 2-, 4- and 7-months post-enrolment. The primary outcome measure will be Russell Standard 6-months sustained abstinence, defined as self-reported continuous abstinence verified by saliva cotinine or anabasine at 7-month follow-up. Secondary outcome measures will include 7-day point-prevalence abstinence at 7-month follow-up, self-reported abstinence at 2- and 4-month follow-ups, satisfaction ratings of the website and quantitative indices of website interaction. All analyses will be by intention to treat and the main analysis will compare the two conditions on the primary outcome measure using a logistic regression model, adjusted for baseline characteristics. The efficacy of the intervention across the social spectrum will be assessed by a logistic regression focusing on the interaction between condition and socio-economic disadvantage.

Trial registration: ISRCTN99820519.

Aims: To review population surveys to assess (a) prevalence of the use of NRT for smoking reduction (SR) and temporary abstinence (TA) and (b) how far this is associated with attempts to stop smoking, smoking cessation and reduction in cigarette consumption.

Methods: An electronic search was undertaken of EMBASE, MEDLINE, Web of Science and PsycINFO. Articles were selected if they (1) assessed whether smokers had used or were currently using NRT for SR and/or TA; (2) involved smokers who had not taken part in a harm reduction programme; and (3) assessed prevalence and/or association of SR and/or TA with reductions in cigarette consumption and/or attempts to stop smoking and/or with smoking cessation. Twelve studies met the inclusion criteria and results were extracted independently by two researchers.

Results: Data were available from five countries (US, UK, Canada, Switzerland and Australia). Between 1% and 23% of smokers reported having ever used NRT for smoking reduction and between 2% and 14% during periods of temporary abstinence. Use of NRT for SR and/or TA was associated with little or no reduction in cigarette consumption. There was some evidence that it was positively associated with attempts to stop smoking and smoking cessation.

Conclusion: In smoking populations use of NRT to aid SR and in situations where smoking is not permitted appears to be having little effect on achieving a reduction in cigarette consumption but does not undermine cessation and may promote it.

The ‘Txt2Stop’ SMS messaging programme has been found to double smokers’ chances of stopping. It is important to characterise the content of this information in terms of specific behaviour change techniques (BCTs) for the purpose of future development. This study aimed to (i) extend a proven system for coding BCTs to text messaging and (ii) characterise Txt2Stop using this system. A taxonomy previously used to specify BCTs in face-to-face behavioural support for smoking cessation was adapted for the Txt2Stop messages and inter-rater reliability for the adapted system assessed. The system was then applied to all the messages in the Txt2Stop programme to determine its profile in terms of BCTs used. The text message taxonomy comprised 34 BCTs. Inter-rater reliability was moderate, reaching a ceiling of 61% for the core program messages with all discrepancies readily resolved. Of 899 texts delivering BCTs, 218 aimed to maintain motivation to remain abstinent, 870 to enhance self-regulatory capacity or skills, 39 to promote use of adjuvant behaviours such as using stop-smoking medication, 552 to maintain engagement with the intervention and 24 were general communication techniques. The content of Txt2Stop focuses on helping smokers with self-regulation and maintaining engagement with the intervention. The intervention focuses to a lesser extent on boosting motivation to remain abstinent; little attention is given to promoting effective use of adjuvant behaviours such as use of nicotine replacement therapy. As new interventions of this kind are developed it will be possible to compare their effectiveness and relate this to standardised descriptions of their content using this system.

Introduction: In English National Health Service (NHS) Stop Smoking Services, stop smoking practitioners provide behavioural support and medication to support smokers wanting to quit. There is a need to develop an evidence base for the training of such practitioners. This study evaluated a national face-to-face skills training course in behavioural support for practitioners. Methods: Data were gathered from 169 trainees attending the NHS Centre for Smoking Cessation and Training (NCSCT) courses between October 2010 and August 2011. They provided confidence in competence ratings for 16 core competences before, immediately following and 3 months after training. At 3-month follow-up, they also described what they believed were the most important learning outcomes. Trainees also provided course evaluations in the form of ratings (n = 386, courses not yet followed up included). Results: Confidence ratings increased overall by 40% immediately after the course and the higher level of confidence was maintained at 3-month follow-up; 92% agreed or strongly agreed that the course was very useful and very interesting; 90% that it was very enjoyable; 88% that it improved their skills and 87% that they would recommend it. The learning outcomes rated as most important reflected the relevant behaviour change techniques. Conclusion: The NCSCT skills training course appears to result in a substantial improvement in confidence in ability to deliver smoking cessation support and trainees evaluate it highly. The next step is to assess improvements in observed practice and success rates.

Guidelines recommend that general practitioners (GPs) should advise all smoking patients to quit and provide additional stop-smoking interventions as appropriate. This study aimed to improve our understanding of how this recommendation can be achieved. General practitioners (N = 26) from London completed a questionnaire about their stop-smoking interventions and psychological factors that might affect these. Thirty-one per cent of the patients recognised as smokers by GPs did not receive an intervention and two-thirds of these were judged to be inappropriate for receipt of an intervention. Psychological factors that predicted behaviour were perceptions that doing this was ‘normative’, making an effort to make it happen, and feeling that the behaviour was easy to enact. Strategies to improve guideline implementation may be more effective if they addressed the above psychological factors.

Peer interaction problems are often difficult to ameliorate in a clinical setting. In this study, four boys, whose many problems included difficulties with peer relationships, were given social skills training in a group over ten sessions. The main aim was to improve cooperative play, effective communication and conflict resolution skills by using a general problem-solving framework combining behavioural and cognitive techniques. The formal measures failed to show change, which may be due in part to inadequacies in the measures. Reports from therapists, teachers and parents suggested that there was considerable change within sessions, some improvement at school but very little at home.