Brief opportunistic Smoking cessation Advice for financially Vulnerable Individuals accessiNG financial Support (SAVINGS): a randomised controlled trial

Research question Does providing very brief opportunistic advice to quit smoking within financial guidance services, including the provision of an e-cigarette and referral to behavioural support, result in more people quitting smoking than if no smoking cessation support is provided? Background Smoking prevalence increases with increasing socioeconomic deprivation, exacerbating health inequalities. Brief opportunistic advice for quitting smoking is acceptable and effective in clinical settings. It could provide a quick, cost-effective way to reach vulnerable populations if delivered within financial guidance settings, such as social housing, debt advice, or other social service settings, in turn alleviating disparities and reducing financial strain. A recent scoping review and service evaluation demonstrate the acceptability and feasibility of this approach. Aims and objectives Aim: to evaluate the impact of very brief, opportunistic, smoking cessation advice compared to usual care, provided by financial guidance services to adults receiving support for financial difficulties who smoke tobacco. Objectives: 1) to conduct a randomised controlled trial (RCT), with an internal pilot; 2) to estimate the intervention’s cost-effectiveness relative to usual care; 3) to conduct a process evaluation to understand factors, e.g., quit attempts; intervention acceptability, influencing intervention effects. Methods A two-arm RCT, recruiting 1,538 people who smoke daily, accessing a service to provide assistance with their financial difficulties. The intervention arm (N=769) will receive very brief advice on quitting smoking as part of their usual appointment, including information on the financial benefits of quitting, the best ways to quit and support available. They will be sent an e-cigarette starter kit (e-cigarette and e-liquid), advised of different forms of behavioural support available (local services; a mobile phone app; national quit line and web resources) and directed to the one most suited to them. The comparator arm (N=769) will receive usual care for this setting in the UK (i.e. no advice/resource on quitting smoking). We will assess the number of participants who have quit smoking (biochemically verified) at 12 weeks and 9 months follow-up. We will assess the economic impact of the intervention from a public sector perspective and conduct a process evaluation. For the latter we will record and analyse intervention delivery and interview participants and service providers about their experiences in the study. Timelines for delivery Initial set-up will take 6 months, followed by 25 months of recruitment, 9 months to complete follow-up, and 8 months to allow for delayed follow-ups, data management, analysis and write-up (4 years total). Anticipated impact and dissemination We will share findings with participants, financial guidance providers, the public, policy makers and researchers. We will use innovative methods, such as podcasts, videos and infographics, as well as conference presentations, attending meetings and webinars, peer reviewed papers, and press engagement. We will design outputs with public representatives and other relevant stakeholders. Dissemination will be aided by the National Centre for Smoking Cessation and Training (NCSCT) and Action on Smoking and Health (ASH), through their established networks. NCSCT will develop and implement a training programme for financial guidance settings based on study findings.