title: Targeting smokers in priority groups: the influence of government targets and policy statements.
abstract: BACKGROUND
  Cessation services were instructed to make special attempts to attract smokers from three 'priority groups': those who were young, pregnant and economically disadvantaged. Progress with attracting priority groups was not assessed formally, but services were set monitored targets to encourage throughput of smokers. Initial research suggests that services have been successful in attracting smokers who live in disadvantaged areas. This paper investigates how smoking cessation services responded to targets and instructions to attract priority groups and discusses the relative impact these on service development.
  
  
  OBJECTIVE
  To describe how monitored throughput targets influenced the development of smoking cessation services, including attracting priority groups. To describe the range of priority groups that smoking cessation services targeted, methods used and reported progress with this.
  
  
  METHODS
  Postal surveys of English smoking cessation coordinators conducted in April 2001 and April 2002. Seventy-eight qualitative, semistructured interviews with cessation service staff in two former English health regions conducted in autumn 2001 and 1 year later.
  
  
  RESULTS
  A total of 69.3% of coordinators responded to the first survey (79% to the second survey). In the first survey 91% reported targeting priority groups (100% in the second survey). The proportions (second survey in brackets) who reported targeting the different priority groups were: pregnant women 86% (99%), economically disadvantaged 79% (100%) and young smokers 20% (75%). Interviews showed that coordinators gave the greatest priority to reaching monitored targets as they came under pressure to achieve these. Service staff were generally unclear about how to attract priority groups and developing strategies for this was hindered by the need to meet throughput targets. Locating services in poor areas was thought to attract economically disadvantaged smokers and specialist staff were being appointed to work with pregnant smokers, but otherwise there was little evidence of active strategies for attracting priority groups being applied in practice.
  
  
  CONCLUSIONS
  Monitored targets for smoker throughput ensured that services quickly began to treat smokers, but this rapid implementation diverted service staff from devising methods for attracting priority group smokers. Coordinators found reaching priority groups challenging and, particularly in the case of young smokers, would have appreciated clear instructions for this aspect of service implementation. Those implementing services in other countries should consider whether similar targets would be helpful to stimulate service development within their health systems.
authors.affiliation: Department of General Practice and Primary Health Care, University of Leicester, Leicester, UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Pound
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.forename: Catherine
authors.initials: C
authors.lastname: Adams
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
authors.forename: Janet
authors.initials: J
authors.lastname: Ferguson
mesh_terms: D004739:England; D006306:Health Surveys; D006801:Humans; D009937:Organizational Objectives; D010353:Patient Education as Topic; D011314:Preventive Health Services / Q000458:organization & administration*; D011640:Public Policy; D016540:Smoking Cessation / Q000379:methods*; D013222:State Medicine / Q000458:organization & administration