Research
Nudging towards Smoking Cessation
Dr Kevin Luk Tzu-tsun | Project Lead of 15th “Quit to Win” Campaign
Hong Kong has been making strides in reducing smoking prevalence but getting the remaining smokers to stop has become increasingly challenging. Those who continue to smoke despite stringent tobacco control policies tend to lack the motivation to quit or seek cessation support. To reach these “hardcore” smokers, a proactive collaborative approach that integrates expertise and resources across disciplines is crucial.
The School of Nursing has responded to that need by partnering with the Hong Kong Council on Smoking and Health (COSH) to launch the “Quit to Win” Smoke-free Community Campaign, which is now in its 15th iteration. This territory-wide initiative features multilevel cross-sectoral collaborations and aims to incentivise smokers in the community to take the first step towards quitting.
The campaign has also been conducting research on the most effective methods for encouraging smoking cessation. A full-scale randomised controlled trial (ClinicalTrials.gov, NCT06451081) recently evaluated a new kind of intervention that draws from behavioural economics.
Behavioural Economics x Public Health
The basis of the trial is to compare “opt-out” versus “opt-in” approaches when it comes to referring smokers to local cessation services. These services are free and effective, but underused. Participants in the “opt-in” group are informed that they will be referred to a service of their choice if they explicitly request it, while those in the “opt-out” group are automatically referred to a service unless they actively decline.
At the heart of this strategy is the concept of “nudges”, which are subtle prompts or cues that can encourage the desired behaviour without restricting choices. The “opt-out” approach leverages the behavioural economic principle of default bias, where individuals tend to stick with the default option presented to them, even when better alternatives are available. By making referral to cessation services the default choice, we nudge the smokers to utilise these services and improve their cessation outcomes.
Collaborative Efforts to Promote Cessation
The use of the nudge approach in the “Quit to Win” campaign has been further strengthened by involving multiple stakeholders from multiple sectors — including all 18 District Councils and over 60 non-profit organisations and local companies — who provide a backbone network of support for smoking cessation. These organisations facilitate community outreach and publicise smoke-free messages to the public, thereby creating an inviting environment for smoking cessation.
Partnerships were also formed with major cessation service providers to offer smokers a diversity of choice. The partners include all seven clusters of the Hospital Authority, providing over 70 service points across the territory, and several community health services. This variety is crucial in reducing barriers to accessing cessation services, like time and location constraints.
Nurturing Future Interdisciplinary Collaborations
The campaign also has an educational aspect that involves trained students from different universities — not just HKU — conducting fieldwork. These students come from diverse academic backgrounds, including nursing, dentistry, social sciences, and STEM disciplines. From June to October 2024, they collectively recruited and delivered the nudge interventions to over 1,300 smokers across Hong Kong. The students’ participation not only fostered their sense of community involvement and responsibility, but also cultivated an interdisciplinary mindset towards tackling public health challenges.
Conclusion
The 15th “Quit to Win” campaign exemplifies the power of cross-sectoral collaboration on multiple levels, from partnership between academia and various governmental and non-governmental organisations at the institutional level, to the integration of behavioural economics insights into public health approaches. As we move forward, the lessons learned from this campaign will be invaluable in shaping future initiatives that leverage interdisciplinary approaches, ultimately contributing to a healthier, smoke-free Hong Kong.
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