title: Promoting smoking cessation in Pakistani and Bangladeshi men in the UK: pilot cluster randomised controlled trial of trained community outreach workers.
abstract: BACKGROUND
  Smoking prevalence is high among Pakistani and Bangladeshi men in the UK, but there are few tailored smoking cessation programmes for Pakistani and Bangladeshi communities. The aim of this study was to pilot a cluster randomised controlled trial comparing the effectiveness of Pakistani and Bangladeshi smoking cessation outreach workers with standard care to improve access to and the success of English smoking cessation services.
  
  
  METHODS
  A pilot cluster randomised controlled trial was conducted in Birmingham, UK. Geographical lower layer super output areas were used to identify natural communities where more than 10% of the population were of Pakistani and Bangladeshi origin. 16 agglomerations of super output areas were randomised to normal care controls vs. outreach intervention. The number of people setting quit dates using NHS services, validated abstinence from smoking at four weeks, and stated abstinence at three and six months were assessed. The impact of the intervention on choice and adherence to treatments, attendance at clinic appointments and patient satisfaction were also assessed.
  
  
  RESULTS
  We were able to randomise geographical areas and deliver the outreach worker-based services. More Pakistani and Bangladeshi men made quit attempts with NHS services in intervention areas compared with control areas, rate ratio (RR) 1.32 (95%CI: 1.03-1.69). There was a small increase in the number of 4-week abstinent smokers in intervention areas (RR 1.30, 95%CI: 0.82-2.06). The proportion of service users attending weekly appointments was lower in intervention areas than control areas. No difference was found between intervention and control areas in choice and adherence to treatments or patient satisfaction with the service. The total cost of the intervention was £124,000; an estimated cost per quality-adjusted life year (QALY) gained of £8,500.
  
  
  CONCLUSIONS
  The intervention proved feasible and acceptable. Outreach workers expanded reach of smoking cessation services in diverse locations of relevance to Pakistani and Bangladeshi communities. The outreach worker model has the potential to increase community cessation rates and could prove cost-effective, but needs evaluating definitively in a larger, appropriately powered, randomised controlled trial. These future trials of outreach interventions need to be of sufficient duration to allow embedding of new models of service delivery.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN82127540.
authors.affiliation: UK Centre for Tobacco Control Studies, Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Rachna A
authors.initials: RA
authors.lastname: Begh
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
authors.forename: Penney
authors.initials: P
authors.lastname: Upton
authors.forename: Raj S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: Martin
authors.initials: M
authors.lastname: White
authors.forename: Amanda
authors.initials: A
authors.lastname: Amos
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: Raman
authors.initials: R
authors.lastname: Bedi
authors.forename: Pelham
authors.initials: P
authors.lastname: Barton
authors.forename: Monica
authors.initials: M
authors.lastname: Fletcher
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.forename: Qaim
authors.initials: Q
authors.lastname: Zaidi
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D001459:Bangladesh / Q000208:ethnology; D016000:Cluster Analysis; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D010349:Patient Compliance; D017060:Patient Satisfaction; D010865:Pilot Projects; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics / Q000208:ethnology*; D016540:Smoking Cessation / Q000191:economics / Q000208:ethnology*; D000074606:Smoking Prevention; D013222:State Medicine; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult