Evaluation of London-wide Ramadan Campaign

Evaluation of London-wide Ramadan Campaign

Ann TaketMehul KotechaRuth Belling

Faculty of HealthSouth Bank University

June 2003

Evaluation of London-wide Ramadan Campaign

Ann TaketMehul KotechaRuth Belling

Faculty of HealthSouth Bank University

June 2003

Faculty of Health,Erlang HouseSouth Bank University103, Borough RoadLondon SE1 0AAUK

Tel : +44(0)20 7815 8097Email: [email protected]

© South Bank University

Ramadan Campaign Evaluation DRAFT June 2003

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Acknowledgements

Funding from the Department of Health to support the evaluation is gratefullyacknowledged.

This evaluation would not have been possible without the efforts of:� Salman Khaled, Abdi Barud, Mohammed N Barbuiyan and Siman Yilmaz who

carried out the interviews in the mosque surveys and the telephone follow-upsurvey;

� Sharmin Shajahan who recruited the interviewers and co-ordinated their trainingand allocation to the different mosques.

Our grateful thanks go out to all of them.

Finally we would like to thank the respondents to the two surveys for their time.Without their participation, this report would certainly not have been possible


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Abbreviations

DoH Department of HealthHAZ Health Action ZonesNRT Nicotine replacement therapyPCT Primary Care TrustSAfH Social Action For Health


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CONTENTSPage

ACKNOWLEDGEMENTS................................................................................................. IABBREVIATIONS .........................................................................................................IIINDEX TO TABLES AND FIGURES .................................................................................V

EXECUTIVE SUMMARY .....................................................................................VIITHE EVALUATION STUDY ......................................................................................... VIIMAIN FINDINGS........................................................................................................ VIICONCLUSIONS AND IMPLICATIONS .......................................................................... VIII

1. INTRODUCTION...................................................................................................1

2. THE LONDON-WIDE RAMADAN CAMPAIGN, SEPTEMBER 2002 TODECEMBER 2002 .......................................................................................................2

2.1 BACKGROUND.......................................................................................................22.2 THE RAMADAN CAMPAIGN, SEPTEMBER 2002 TO DECEMBER 2002.....................2

Aims for the Ramadan Campaign ..........................................................................3Objectives for the Ramadan Campaign .................................................................3

3. THE EVALUATION DESIGN...............................................................................43.1 BASELINE DATA COLLECTED BY CAMPAIGN WORKERS..........................................43.2 THE MOSQUE SAMPLE SURVEY ..............................................................................5

The questionnaire...................................................................................................5The sample of mosques ..........................................................................................6Data management and analysis .............................................................................6Characteristics of the sample.................................................................................7

3.3 SMOKERS FOLLOW-UP SURVEY .............................................................................8The sample obtained ..............................................................................................8Data management and analysis .............................................................................8Characteristics of the sample.................................................................................8

4. THE IMPACT OF THE CAMPAIGN ...............................................................104.1 ATTITUDES TO SMOKING CESSATION DURING RAMADAN....................................104.2 KNOWLEDGE ABOUT TOBACCO CESSATION AND AWARENESS OF CAMPAIGN ANDITS SPECIFIC COMPONENTS ........................................................................................12

4.2.1 Knowledge about sources of help for tobacco cessation ............................124.2.2 General awareness of tobacco cessation messages during Ramadan andthe campaign........................................................................................................154.2.3 Awareness of calendars ..............................................................................184.2.4 Views about calendars ................................................................................204.2.5 Awareness of radio advice ..........................................................................214.2.6 Knowledge about smoking cessation phone help-lines...............................23

4.3 CHANGES IN SMOKING BEHAVIOUR.....................................................................244.3.1 Smoking history of the mosque sample .......................................................244.3.2 Outcomes of smokers’ attempts to give up..................................................25


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4.3.3 Sources of help for giving up smoking........................................................26

5. IMPACT OF THE COMMUNITY OUTREACH WORKERS.......................275.1 VIEWS ABOUT GIVING UP SMOKING.....................................................................275.2 CHANGES IN SMOKING BEHAVIOUR.....................................................................275.3 EXTENT OF FOLLOW-UP BY LOCAL STOP SMOKING SERVICE................................285.4 SERVICE USE AND SMOKING STATUS AT FOLLOW-UP...........................................28

6. CONCLUSIONS AND IMPLICATIONS ...........................................................30

REFERENCES...........................................................................................................32

APPENDIX 1 – QUESTIONNAIRE USED IN THE MOSQUE SURVEY .........33

APPENDIX 2 – QUESTIONNAIRE USED FOR THE FOLLOW UP SURVEYTO SMOKERS...........................................................................................................35


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Index to Tables and Figures

TABLE 2.1: KEY PARTNERS FOR THE RAMADAN CAMPAIGN ...........................................3TABLE 2.2: PROGRAMME FOR COMMUNITY BASED ACTIVITIES IN THE RAMADAN

CAMPAIGN ..............................................................................................................3TABLE 3.1: CHARACTERISTICS OF THE BASELINE SAMPLES.............................................4TABLE 3.2: PRE-RAMADAN BASELINE SAMPLE: DISTRIBUTION OF RESPONDENTS BY

AREA.......................................................................................................................5TABLE 3.3: THE MOSQUES INCLUDED IN THE SURVEY.....................................................6TABLE 3.3: NUMBER OF RESPONDENTS BY AREA AND LANGUAGE GROUP.......................7TABLE 3.4: DISTRIBUTION OF RESPONDENTS BY AGE (NUMBERS AND PERCENTAGE) OF

MOSQUER SURVEY IN COMPARISON TO PERCENTAGE DISTRIBUTION OF LONDONPOPULATION BY AGE ...............................................................................................8

TABLE 3.5: DISTRIBUTION OF RESPONDENTS BY AGE (NUMBERS AND PERCENTAGE) FORSMOKERS FOLLOW-UP SURVEY................................................................................9

TABLE 4.1: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, COMPARISON OFPRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN.......................10

TABLE 4.2: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, MEASURED ATTHREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP ....................................11

TABLE 4.3: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, MEASURED ATTHREE MONTHS AFTER RAMADAN, BY AREA.........................................................11

TABLE 4.4: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION,COMPARISON OF PRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN..............................................................................................................................12

TABLE 4.5: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION THREEMONTHS AFTER RAMADAN, BY LANGUAGE GROUP ...............................................12

TABLE 4.6: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION THREEMONTHS AFTER RAMADAN, BY AREA....................................................................13

TABLE 4.7: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION,COMPARISON OF PRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN,BY AREA................................................................................................................14

FIGURE 4.1: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION,COMPARISON OF PRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN,BY AREA................................................................................................................15

TABLE 4.8: RECOLLECTION OF MESSAGES ABOUT TOBACCO CESSATION DURINGRAMADAN, MEASURED AT THREE MONTHS AFTER RAMADAN, OVERALL AND BYAREA.....................................................................................................................16

TABLE 4.9: RECOLLECTION OF MESSAGES ABOUT TOBACCO CESSATION DURINGRAMADAN, MEASURED AT THREE MONTHS AFTER RAMADAN, BY LANGUAGEGROUP...................................................................................................................16

TABLE 4.10: SOURCE OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, OVERALL AND BY AREA ..........17

TABLE 4.11: SOURCE OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP .............17

TABLE 4.12: RECOLLECTION OF RAMADAN CALENDARS, MEASURED AT THREE MONTHSAFTER RAMADAN, OVERALL AND BY AREA...........................................................18

TABLE 4.13: RECOLLECTION OF RAMADAN CALENDARS, MEASURED AT THREE MONTHS


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AFTER RAMADAN, BY LANGUAGE GROUP..............................................................19TABLE 4.14: RECOLLECTION OF PLACE WHERE RAMADAN CALENDARS SEEN, MEASURED

AT THREE MONTHS AFTER RAMADAN....................................................................19TABLE 4.15: RECOLLECTION OF PLACE WHERE RAMADAN CALENDARS SEEN, MEASURED

AT THREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP ...............................20TABLE 4.16: VIEWS ON USEFULNESS OF RAMADAN CALENDARS, MEASURED AT THREE

MONTHS AFTER RAMADAN, OVERALL AND BY AREA, FOR THOSE WHO REPORTEDSEEING THE CALENDARS........................................................................................21

TABLE 4.17: VIEWS ON USEFULNESS OF RAMADAN CALENDARS, MEASURED AT THREEMONTHS AFTER RAMADAN, BY LANGUAGE GROUP, FOR THOSE WHO REPORTEDSEEING THE CALENDARS........................................................................................21

TABLE 4.18: RECOLLECTION OF HEARING RADIO ADVICE DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, OVERALL AND BY AREA ..........22

TABLE 4.19: RECOLLECTION OF HEARING RADIO ADVICE DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP .............23

TABLE 4.20: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASUREDTHREE MONTHS AFTER RAMADAN, ALL AREAS .....................................................23

TABLE 4.21: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASUREDTHREE MONTHS AFTER RAMADAN, BY AREA.........................................................24

TABLE 4.22: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASUREDTHREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP ....................................24

TABLE 4.23: SMOKING HISTORY OF THE MOSQUE SAMPLE............................................25TABLE 4.24: ATTEMPTS TO GIVE UP SMOKING FOR THE MOSQUE SAMPLE, BY TIME OF

LAST ATTEMPT ......................................................................................................25TABLE 4.25: OUTCOMES OF SMOKERS’ ATTEMPTS TO GIVE UP, BY TIME OF LAST

ATTEMPT...............................................................................................................25TABLE 4.26: SOURCES OF HELP FOR GIVING UP SMOKING .............................................26TABLE 5.1: VIEWS AND INTENTIONS OF SMOKERS AT THE BEGINNING OF RAMADAN,

SMOKERS FOLLOW-UP SURVEY..............................................................................27TABLE 5.2: CHANGES IN SMOKING BEHAVIOUR BY THREE MONTHS AFTER THE END OF

RAMADAN, SMOKERS FOLLOW-UP SURVEY...........................................................28TABLE 5.3: EXTENT OF FOLLOW-UP BY LOCAL STOP SMOKING SERVICE, BY LANGUAGE

GROUP, SMOKERS FOLLOW-UP SURVEY .................................................................28TABLE 5.4: SERVICE USE BY SMOKING STATUS AT END OF FOLLOW-UP PERIOD, SMOKERS

FOLLOW-UP SURVEY..............................................................................................29


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Executive summary

The London-wide Ramadan Campaign was a programme of tobacco cessationactivities aimed at Muslim communities in London carried out over the periodSeptember 2002 to December 2002. It was funded by the Department of Health.

The evaluation studyThe evaluation was designed to examine the impact of the Campaign in the mediumterm, defined as three months after the end of Ramadan. It is based on three distinctsources of data:1. A survey of 1051 people carried out in a sample of 21 mosques during March

2003, i.e. 3 months after the end of Ramadan.2. A follow-up survey, carried out by telephone, of smokers with whom the

community outreach workers had contact, (28 people were followed up), carriedout over the period March to May 2003.

3. Baseline data collected by campaign workers, on 203 people before the start ofRamadan, and 132 at the end of Ramadan.

Main findingsThe acceptability of the Ramadan Campaign, as measured by the level of agreementwith the statement that Ramadan is a good time to give up smoking, is high. Thelevel 3 months after the end of Ramadan was higher than the pre-Ramadan level, thisincrease was statistically significant. [Section 4.1]

Reported knowledge about where to obtain help with tobacco cessation increasedfrom 27% pre Ramadan to 58% measured 3 months after Ramadan, this increase isstatistically significant. [Section 4.2.1]

Three months after the end of Ramadan:� There were statistically significant differences between areas and between

language groups in the level of knowledge about where to obtain help withtobacco cessation. [Section 4.2.1]

� The vast majority of those who reported they knew where to access helpsuggested some non-specialised part of the health services (90%), only 13%overall mentioned specialised smoking/tobacco cessation services. The samegeneral pattern was reported in most of the different areas, and for most of thedifferent language groups. [Section 4.2.1]

� 74% of the mosque survey sample recalled some information seeing orhearing some information about tobacco cessation over Ramadan. Differencesbetween areas and between language groups are statistically significant.[Section 4.2.2]

� The most frequently mentioned source of information about tobacco cessationover Ramadan was the radio or TV, mentioned by 52% of the entire sample.The second most frequent category was composed of sources that could belinked directly to the activities of the Ramadan Campaign; this was mentionedby 35% of the entire sample. The percentage of respondents who mentioned a


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source that could be directly linked to the Ramadan Campaign varied fromarea to area, it was highest in Camden and Islington, at 83%, followed byTower Hamlets, at 73%, and fell to zero in Barking and Havering, Brent andHarrow, and Hackney (Table 4.10). [Section 4.2.2]

� In response to a specific question on whether they had seen the Campaigncalendars, 58% of the overall sample report seeing them. There arestatistically significant differences between areas and between languagegroups. Recall of calendars is highest in the areas in which the Campaignworked most intensively. The location of the calendars most frequentlyreported was the mosque. [Section 4.2.3]

� Respondents reported that calendars contained useful information abouttobacco cessation overall, for each language group, and for each area(excluding those areas where numbers of respondents seeing the calendar werevery small). [Section 4.2.4]

� In response to a specific question on whether they had heard advice on theradio about tobacco cessation over Ramadan, 65% of the overall sample reportthat they did. Differences between areas and between language groups wereboth statistically significant. Recall of radio advice is highest in the areas inwhich the Campaign worked most intensively. [Section 4.2.5]

� In response to specific questions about phone lines, a relatively highproportion, 71%, of respondents reported that they knew where to get thenumber of at least one of the help-lines. The NHS line was the most wellknown. The percentage of respondents who know how to get the number of atleast one help-line varies considerably by area, from 36% in Westminster to92% in Camden and Islington, and by language group, from 43% in theTurkish group to 84% in the Bengali group. [Section 4.2.6]

� The success rate for smokers trying to give up whose last attempt was sincethe beginning of Ramadan, at 61%, is significantly greater than that for thosewhose last attempt was more than 6 months ago, 23%. This is likely to reflectthe impact of the Ramadan Campaign, since success in giving up smoking wasalso linked in the sample to having help, and this was more often reported forthe group trying to give up since the beginning of Ramadan. [Section 4.3]

� For the sample of smokers followed up at three points in time, 62% of thosewho had given up during Ramadan succeeded maintaining this until the3month follow up (a very similar percentage to that obtained for the mosquesample survey). [Section 5.2]

� One of the tasks undertaken by the outreach workers was to pass on contactdetails to local services so that people could be followed up. Overall 29% ofinformants in the smokers’ follow-up survey reported that they had beencontacted by their local service, while 13% were not sure. The results werestrikingly different for the two language groups, none of the Hindi/Urduspeakers reported being contacted by their local stop smoking service.[Section 5.3]

Conclusions and implications

The evaluation reported here provides considerable evidence of the effectiveness of


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the London-wide Ramadan Campaign, in terms of impact on attitudes, knowledge andsmoking behaviour, as is demonstrated in the main findings listed above. For many ofthe results, statistically significant differences between areas and between languagegroups were obtained, and seem related to the relative intensity of Campaign activitiesin the different areas. This reinforces the likelihood that the changes observed inattitudes, knowledge and smoking behaviour are due to Campaign activities. The 3-month quit rates reported for those who stopped smoking since the beginning ofRamadan compare very well to national statistics on quit rates.

Details of the sources and locations of information recalled by the different groups(both by area and by language group) can be used in planning the implementation offuture tobacco cessation activities during Ramadan.

One area of the Ramadan Campaign where implementation fell short of plans, was thecontacting of smokers by local stop smoking services. For any future RamadanCampaign, this aspect is one where implementation could be improved.


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1. Introduction

This report describes the results of the evaluation of the London-wide Ramadan Campaigncarried out by South Bank University. The London-wide Ramadan Campaign was carriedout over the period September 2002 to December 2002, and was funded by the Department ofHealth. The evaluation was designed to examine the impact of the Campaign in the mediumterm, defined as at least three months after the end of Ramadan.

The report is set out in five major sections:

� Section 2 describes the background to the London-wide Ramadan Campaign, its aimsand objectives and the programme of work undertaken during the Campaign.

� Section 3 describes the evaluation design, and details the baseline data set and the twosets of data collected three months after the end of Ramadan.

� Section 4 describes the findings from the mosque sample survey, comparing these tobaseline data where possible.

� Section 5 describes the findings from the follow-up survey of a sample of smokersthat the community outreach workers had worked with.

� Section 6 presents overall conclusions and implications.


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2. The London-wide Ramadan Campaign, September 2002 toDecember 2002

This section outlines the work of the London-wide Ramadan Campaign, based ondescriptions taken from the funding proposal for the Campaign, and other reports by theCampaign.

2.1 Background

The Ramadan Campaign is an already established campaign in Muslim communities ongiving up tobacco use. The Ramadan Campaign was originally developed by Tower HamletsHealth Strategy Group in the 1980s and has subsequently been taken up by national (HealthEducation Authority), regional and local agencies.

The month of Ramadan seeks to encourage Muslims amongst other aspects to purifythemselves physically and spiritually and use this month to give up bad habits. The Qurancarries many messages of avoiding use of harmful substances. Due to communication andother barriers it is difficult for many Muslim groups to access health services and mainstreamtobacco cessation support. The Ramadan Campaign has and will encourage individuals toaccess help and support in a familiar and religiously acceptable environment. A timetable inRamadan for starting and breaking the fast is used by Muslims to guide them for the timingsof abstaining from food from sunrise to sunset. The use of this calendar to publicise languagespecific smoking cessation help-lines provides a useful avenue to extend the tobaccocessation campaign into Muslim communities.

The London Ramadan Campaign has demonstrated an increase in the number of free help-line phone calls during the campaign period. In 1998-99 there was a 66% increase, whichresulted in a raised level of calls throughout the year.

The South Asian & Muslim Tobacco Cessation Network was launched in July 2002 and isco-ordinated by Social Action for Health1. The Ramadan workshop that marked theinauguration of the network generated a great deal of interest in a Ramadan Campaign. At theNetwork’s steering group meeting it was agreed that SAFH would lead the Campaign as ithas a wide range of contacts in the Muslim communities where tobacco use is a concern. Asuccessful bid was made to the Department of Health to fund a London-wide RamadanCampaign over the period September 2002 to December 2002.

2.2 The Ramadan Campaign, September 2002 to December 2002

The programme of work for the Ramadan Campaign commenced in September 2002 andlasted for a period of 12 weeks. Activities were carried out across London, in 49 mosquesacross 21 PCT areas. Key partners are shown in Table 1. A co-ordinator was in post for 12weeks and community outreach workers undertook 8 weeks of community outreachactivities, the programme for these eight weeks is shown in Table 2. Social Action for Health

1 Social Action for Health is an East London based registered charity that works across London withcommunities to address issues that affect their health and wellbeing. Before 2000 the organisation was known asthe Tower Hamlets Health Strategy Group.


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(SAfH) was responsible for overall management and co-ordination of the Campaign.

Aims for the Ramadan Campaign� To encourage London’s Muslim communities to use Ramadan as an opportunity to give

up tobacco� To provide information, training and support for dissemination of tobacco cessation

messages� To ensure co-operative working between agencies in different sectors

Objectives for the Ramadan Campaign� To train Imams (religious leaders in mosques) and community support workers who will

raise awareness in the community of harmful effects of smoking, tobacco chewing andpassive smoking

� The community support outreach workers to refer tobacco users to local cessationservices and encourage them to contact language specific help-lines

� The community support outreach workers to target appropriate venues such as mosques(and retailers like Halal meat shops) across London

� To raise awareness of NRT in reducing withdrawal symptoms, and increasing rates ofsuccess

TABLE 2.1: KEY PARTNERS FOR THE RAMADAN CAMPAIGN

� Social Action for Health – Campaign lead� Camden and Islington PCT� Smoke Free London: funding� British Heart Foundation� Croydon PCT� City & Hackney� Ealing, Hammersmith & Harrow PCT� Newham PCT� Merton, Sutton & Wandsworth (MSW) Health Authority� Tower Hamlets Primary Care Trust (PCT)� Redbridge & Waltham Forest PCT� Enfield & Haringey PCT� Greenwich, Bromley PCT� DoH South Asian Media campaign

Source: Ramadan Campaign proposal

TABLE 2.2: PROGRAMME FOR COMMUNITY BASED ACTIVITIES IN THE RAMADAN CAMPAIGNWeek 1 Introduction and gathering pre-Ramadan baseline awareness informationWeek 1: Distribution of calendars & awareness raisingWeek 3-6: Provide information, continuous awareness raising and referring to local

tobacco cessation services & encouraging people to contact the languagespecific help-lines

Week 7 Gather post-Ramadan awareness informationWeek 8 Compare pre and post Ramadan information & feedback from the community

outreach workers & debriefing.Source: Ramadan Campaign proposal


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3. The evaluation design

The evaluation described here focuses on the impact of the Campaign in the medium term,defined as at least 3 months after the end of Ramadan. It is based on three distinct sources ofdata:1. Baseline data collected by campaign workers, on 203 people before the start of Ramadan,

and 132 at the end of Ramadan.2. A survey of 1051 people carried out in a sample of 21 mosques during March 2003, i.e. 3

months after the end of Ramadan.3. A follow-up survey, carried out by telephone, of smokers with whom the community

outreach workers had contact, (28 people were followed up), carried out over the periodMarch to May 2003, i.e. at least 3 months after the end of Ramadan.

These are described in more detail below in sections 3.1 to 3.3 respectively.The evaluation of Campaign outputs and the views of the community outreach workers arethe subject of separate reports.

3.1 Baseline data collected by campaign workers

During the Ramadan Campaign, simple pre- and post- Ramadan questionnaires wereadministered by the campaign workers to a sample of individuals that they worked with. Thisdata was provided to the evaluation team entered into two Excel spreadsheets. Owing tonecessary limitations on the way this data was collected and on the size of the sample onwhich data was collected, only limited baseline information is available from these data sets.

For the pre-Ramadan sample, data was collected on smoking status, intentions about givingup smoking, knowledge about sources of help, and attitude to giving up over Ramadan. Forthe post-Ramadan sample, data was collected on smoking status, knowledge about sources ofhelp, contact with community outreach worker, contact with phone lines, awareness of posterand awareness of radio advice. For both samples demographic information on age group,gender and ethnicity was also recorded, however ethnicity was not coded and entered into thespreadsheet in a consistent enough fashion for analysis by ethnicity to be reliable orcomparable with the data on language group collected in the two surveys carried out threemonths after the end of Ramadan2. Basic characteristics of the two baseline samples of dataare shown in Table 3.1, and the distribution of respondents by area for the pre-Ramadanbaseline in shown in Table 3.2.

TABLE 3.1: CHARACTERISTICS OF THE BASELINE SAMPLESPre-Ramadan baseline End of Ramadan baseline

Total number in sample 203 132

Number (%) of respondents aged:18-29 72 (36%) 31 (24%)30-39 49 (24%) 33 (25%)40-49 33 (16%) 28 (21%)50-59 25 (12%) 20 (15%)60-69 20 (10%) 17 (13%)70+ 3 (1%) 2 (2%)

Age unknown 1 1

2 Within the time available for the evaluation, there was not sufficient time to request the original data collectionforms and to investigate whether it would have been possible to re-code them consistently.


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Table 3.1 shows that the baseline samples are both younger in average age than the mosquesample (Table 3.5) and the smokers’ follow-up survey (Table 3.6).

TABLE 3.2: PRE-RAMADAN BASELINE SAMPLE: DISTRIBUTION OF RESPONDENTS BY AREAArea Number of respondentsBarking, Havering 2Brent, Harrow 9Camden, Islington 33Croydon 7Ealing, Hounslow, Hammersmith 34Hackney 4Lambeth, Southwark, Lewisham 15Merton, Sutton, Wandsworth 0Newham 12Redbridge, Waltham Forest 7Tower Hamlets 61Westminster 19

As indicated above the two baseline samples were obtained from the Campaign’s outreachworkers. Assuming that workers were equally likely to ask each individual with whom theyhad contact, and that response rates were not likely to vary between the different areas, thenthe size of the samples obtained in each area can be taken to give a very rough indication ofthe intensity of the outreach workers’ efforts in the different areas. I.e. most effort wasexpended in Tower Hamlets, followed by Camden and Islington and Ealing, Hammersmithand Hounslow, followed by Westminster, Lambeth, Southwark and Lewisham, Newham,Brent and Harrow, Croydon, Redbridge and Waltham Forest, and least of all in the remainingthree areas (Barking and Havering, Hackney, Merton Sutton and Wandsworth). This can beused to divide the areas into three groups according to the intensity of the Campaign workers’effort allocated to each area:� High intensity: Tower Hamlets, Camden and Islington and Ealing, Hammersmith and

Hounslow;� Medium intensity: Westminster, Lambeth, Southwark and Lewisham, Newham, Brent

and Harrow, Croydon, Redbridge and Waltham Forest;� Low intensity: Barking and Havering, Hackney, Merton Sutton and Wandsworth.

3.2 The mosque sample survey

A questionnaire survey was carried out in a sample of mosques across London during March2003, 3 months after the end of Ramadan. The aim was to interview a convenience sample of50 people in each mosque. Trained bi-lingual interviewers administered the questionnaire.Languages included were Arabic, Bengali, English Hindi/Urdu, Somali, and Turkish. Theoriginal plan of the evaluation envisaged that both male and female interviewers would beavailable, so that interviewers would be matched to respondents by language and gender. Inthe event, only male interviewers were available, and for this reason with 1 exception, therespondents were all male.

The questionnaireThe questionnaire used is shown in Appendix 1. It contains 12 questions coveringknowledge of resources to support tobacco cessation, awareness of the Ramadan Campaign


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and associated activities, and smoking behaviour.

The questions were deliberately ordered to ask general questions about knowledge andcampaign awareness first, before asking about specific aspects of the Ramadan Campaign’swork and awareness of specific resources to support tobacco cessation (phone lines).

The questionnaire was deliberately designed to be short and easy to administer. For thisreason the information obtained on smoking behaviour was necessarily limited, and there wasno attempt to obtain a complete smoking history. The emphasis was put on current smokingstatus, whether the person had ever smoked, and the timing of the last occasion on whichindividuals had tried to give up smoking in relation to Ramadan.

The sample of mosquesIn order to achieve reasonable sample sizes for analysis by the different areas within London,and by the different language groups, the largest mosques were selected. The mosques atwhich the survey was carried out were selected by the Ramadan Campaign co-ordinator.Table 3.3 shows the mosques at included in the survey by area.

TABLE 3.3: THE MOSQUES INCLUDED IN THE SURVEYArea (see note 1) MosquesBarking and Havering � Al Madina MosqueBrent and Harrow � Harrow Central Mosque

� Central Mosque of BrentCamden and Islington � Shajalal Jame Masjid (Euston Mosque)

� Somers Town Islamic Cultural & Education Centre� Muslim World League

Croydon � Croydon MosqueEaling, Hounslow, andHammersmith

� Jamia Mashid Islamic Centre� Hounslow Jamia Masjid & Islamic Centre

Hackney � Sulymaniye MosqueLambeth, Southwark andLewisham

� Brixton Mosque� South East London Bait-ul-Aziz (Masjid and

Madrasha Trust) Islamic Cultural CentreMerton, Sutton, and Wandsworth � Tooting Islamic CentreNewham � Minhaj-Ul-Quran

� Quwwat-ul-Islam SocietyRedbridge and Waltham Forest � Ilford Essex Islamic Centre

� Mashid & Madrassah Al-TawheedTower Hamlets � East London Mosque

� Ishatul-Islam mosque� Al-Huda mosque

Westminster � Central London Mosque (Regent’s Park)Notes:1. Most of the areas correspond to the old Health Authority boundaries and are combinations of

PCTs, there are some areas that correspond to single PCTs such as Tower Hamlets,Hackney and Newham

Data management and analysisCompleted questionnaires were checked for consistency and entered into SPPS version 10 foranalysis. Answers to open questions were categorised and coded before entry.

A limited number of problems were identified with the completeness of information provided


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on some questionnaires, this has affected the numbers available for some parts of theanalysis.

The bulk of the analysis is based on descriptive statistics. A limited amount of inferentialanalysis was carried out using non-parametric statistical tests to explore differences by agegroup, area and language group, and changes over time. Where statistical tests were carriedout a significance level of 0.01 was used.

By request, this report focuses on analysing the results by area and language groups, as, in themain, these characteristics were how the effort in the Campaign was targeted. It should benoted however, that there were significant differences in the age distribution of the mosquesample for different areas and for different language groups. However, when the areas aregrouped into the 3 groups defined by level of intensity of effort expended by Campaignworkers described above, there is no significant difference in the age distribution of the 3groups thus formed.

Characteristics of the sample1051 completed questionnaires were returned for analysis, from 1050 men and one woman.Table 3.3 shows the numbers of respondents by area and language group. As would beexpected, the distribution of responses by language group is very different from area to area.For three areas, the responses are dominated by members of single language group: Turkishin Hackney, Hindi/Urdu in Barking and Havering, Arabic in Westminster.

TABLE 3.3: NUMBER OF RESPONDENTS BY AREA AND LANGUAGE GROUPNumber of respondents by language group:

AreaTotal number of

respondents Arabic Bengali Hindi/Urdu Somali Turkish Other

Barking, Havering 47 0 7 32 6 0 2

Brent, Harrow 102 5 14 54 5 6 17

Camden, Islington 150 11 79 35 21 1 3

Croydon 50 3 24 12 6 3 2

Ealing, Hounslow,Hammersmith

91 0 8 32 43 1 5

Hackney 53 1 2 0 4 40 6

Lambeth, Southwark,Lewisham

99 6 37 38 13 2 3

Merton, Sutton,Wandsworth

59 1 16 30 6 1 5

Newham 100 1 14 67 4 1 10

Redbridge, WalthamForest

100 8 15 44 9 5 7

Tower Hamlets 150 1 85 6 58 0 0

Westminster 50 49 0 0 0 0 0

Total 1051 86 301 350 175 60 60Note: language was not specified in 19 cases

The distribution of the overall sample by age is shown in Table 3.4, which also shows forcrude comparison purposes the age distribution of the male population of London obtainedfrom 2001 census data. As this table shows that sample contained a good spread across the


8

different age groups.

TABLE 3.4: DISTRIBUTION OF RESPONDENTS BY AGE (NUMBERS AND PERCENTAGE) OFMOSQUER SURVEY IN COMPARISON TO PERCENTAGE DISTRIBUTION OF LONDONPOPULATION BY AGE

Age group Number of respondentsin age group

% of respondents inage group

% of London male population inage group, 2001

18-29 171 16% 26%30-39 262 25% 25%40-49 276 26% 18%50-59 201 19% 14%60-69 104 10% 10%70+ 37 4% 8%Total 1051

3.3 Smokers follow-up survey

During the Ramadan Campaign, simple pre- and post- Ramadan questionnaires wereadministered by the outreach workers to a sample of individuals that they worked with. Afinal questionnaire was administered by phone, to all those who could be contacted during theperiod March to May 2003, i.e. at least 3 months after the end of Ramadan. The finalquestionnaire used is shown in Appendix 2. It covers smoking status, motivation to give up,knowledge to access help, and views on whether Ramadan is a good time to give up tobaccouse.

The sample obtained28 individuals who had been in contact with the outreach workers during Ramadancompleted a questionnaire, administered by phone in the relevant community language, 3months after the end of Ramadan. The questionnaire was deliberately designed to permitcomparisons:1. with data obtained pre-Ramadan and immediately after the end of Ramadan through

questionnaires administered by the outreach workers2. with data obtained from the impact questionnaire administered in mosques 3 months after

the end of Ramadan.

Data management and analysisCompleted questionnaires were checked for consistency and entered into SPPS version 10for analysis. Data for each individual was identified from the data sets collected by outreachworkers before and at the end of Ramadan. Some problems were identified with missinginformation, particularly for the pre and end of Ramadan data sets; this has affected thenumbers available for some parts of the analysis. In particular for 3 individuals, no preRamadan data could be identified. The analysis is based on descriptive statistics, sincenumbers are too small to permit meaningful statistical testing.

Characteristics of the sampleResponses were obtained from 22 Bengali speakers and 6 Hindi/Urdu speakers, all weremale. The average age of the Bengali speakers was 48, while that of the Hindi/Urdu speakerswas 40. Four of these men did not smoke, 2 had never smoked and the other two had givenup before the start of Ramadan. The age distribution of respondents who were smokers is


9

shown in Table 3.5.

TABLE 3.5: DISTRIBUTION OF RESPONDENTS BY AGE (NUMBERS AND PERCENTAGE) FORSMOKERS FOLLOW-UP SURVEY

Age group Number of respondentsin age group

% of respondents inage group

18-29 3 13%30-39 5 21%40-49 7 29%50-59 4 17%60-69 5 21%70+ 0 0%Total 24

Respondents were drawn from five different areas: Barking and Havering, Camden andIslington, Croydon, Newham and Tower Hamlets.

The original intention was that all of the smokers to whom the outreach workers hadadministered questionnaires before and at the end of Ramadan would be followed up at the 3-month point. Limitations on the interviewing resources available meant that the three-monthfollow-up had to be restricted to those for whom a telephone number was available, thisrestricted the numbers that could be contacted.


10

4. The impact of the campaign

This section explores the findings from the mosque sample survey, comparing these tobaseline data where possible. It is organised in three main sections.

Section 4.1 is on attitudes to tobacco cessation during Ramadan.

Section 4.2 explores knowledge about sources of help for tobacco cessation, and discussesawareness of the Campaign and its specific components. This covers awareness of tobaccocessation messages during Ramadan, and awareness of calendars, radio advice andknowledge about the specific smoking cessation phone help-lines.

Section 4.3 explores changes in smoking behaviour, presenting the smoking history of themosque sample and the outcomes of smokers’ attempts to give up. The use of differentsources of help for giving up smoking is also explored.

As noted in section 3 above, by request, this report focuses on analysing the results by areaand language groups, as, in the main, these characteristics were how the effort in theCampaign was targeted.

4.1 Attitudes to smoking cessation during Ramadan

Respondents were asked about whether they considered that Ramadan was a good time togive up smoking. Table 4.1 shows the results for the mosque survey as a whole, and presentscomparative figures for the pre Ramadan baseline data. Table 4.2 shows results for themosque survey by language group and Table 4.3 by area. Attitudes to smoking cessationduring Ramadan did not vary significantly between the different age groups.

TABLE 4.1: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, COMPARISON OF PRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN

Is Ramadan a good time to giveup smoking?

All areas No YesTotal

Number of respondents 17 1033 1050Mosque survey (note 1) % of respondents 2% 98%Number of respondents 10 191 201Pre Ramadan baseline

(note 2) % of respondents 5% 95%Notes:1. N= 1050 (1 missing case)2. N = 201 (11 missing cases)

As Table 4.1 shows the level of agreement that Ramadan is a good time to give up smoking isvery high pre-Ramadan, indicating the acceptability of smoking cessation activities inRamadan amongst the Muslim community, the figure rises slightly by 3 months postRamadan, and this increase is statistically significant3.

As Table 4.2 shows, only one language group, Turkish, displays a slightly slower level of

3 At 0.01 level using chi-squared test with Yates correction. Note that significant differences in attitudes tosmoking cessation during Ramadan were not found by age group within either sample.


11

agreement, with only 85% of individuals agreeing that Ramadan is a good time to give upsmoking. In line with this feature, as Table 4.3 shows, it is the area where a significantTurkish population was interviewed (Hackney) that the level of agreement that Ramadan is agood time to give up smoking is lower, at 77%. Values for all other areas are 98% or higher.

TABLE 4.2: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, MEASURED AT THREEMONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Is Ramadan a good time to giveup smoking?Language group

No YesTotal

Number of respondents 3 83 86Arabic % within language group 3% 97%Number of respondents 1 300 301Bengali % within language group 0.3% 99.7%Number of respondents 0 350 350Hindi/Urdu % within language group 0% 100%Number of respondents 2 173 175Somali % within language group 1% 99%Number of respondents 9 50 59Turkish % within language group 15% 85%Number of respondents 1 59 60Other % within language group 2% 98%

N= 1031 (20 missing cases)

TABLE 4.3: ATTITUDES TO SMOKING CESSATION DURING RAMADAN, MEASURED AT THREEMONTHS AFTER RAMADAN, BY AREA

Is Ramadan a good time to give upsmoking?Area No Yes

Total

Number of respondents 0 47 47Barking, Havering % within Area 0% 100%Number of respondents 1 101 102Brent, Harrow % within Area 1% 99%Number of respondents 1 149 150Camden, Islington % within Area 1% 99%Number of respondents 0 100 100Croydon % within Area 0% 100%Number of respondents 0 91 91Ealing, Hounslow,

Hammersmith % within Area 0% 100%Number of respondents 12 40 52Hackney % within Area 23% 77%Number of respondents 0 99 99Lambeth, Southwark,

Lewisham % within Area 0% 100%Number of respondents 1 58 59Merton, Sutton,

Wandsworth % within Area 2% 98%Number of respondents 0 100 100Newham % within Area 0% 100%Number of respondents 2 98 100Redbridge, Waltham

Forest % within Area 2% 98%Number of respondents 0 150 150Tower Hamlets % within Area 0% 100%Number of respondents 0 50 50Westminster % within Area 0% 100%

N = 1050 (1 missing case)


12

4.2 Knowledge about tobacco cessation and awareness of campaign and itsspecific components

4.2.1 Knowledge about sources of help for tobacco cessationRespondents were asked whether they would know where to direct a friend who wanted helpto give up smoking or chewing tobacco. Table 4.4 shows the results for the mosque surveyas a whole, and presents comparative figures for the pre Ramadan baseline data. Table 4.5shows results for the mosque survey by language group and Table 4.6 by area.

TABLE 4.4: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION, COMPARISON OFPRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN

Know where to refer a friend forhelp with tobacco cessation?

All areas No YesTotal

Number of respondents 443 607 1050Mosque survey (note 1) % of respondents 42% 58%Number of respondents 139 53 193Pre Ramadan baseline

(note 2 and 3) % of respondents 73% 27%Notes:1. N= 1050 (1 missing case)2. N = 193 (19 missing cases)3. ‘No’ includes 1 respondent who reported ‘not sure’

As Table 4.4 shows the percentage of respondents who report knowing where to obtain helpincreased from 27% pre Ramadan to 58% measured 3 months after Ramadan, this differenceis a statistically significant increase4. This provides one important measure of the impact ofthe Ramadan Campaign.

TABLE 4.5: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION THREE MONTHSAFTER RAMADAN, BY LANGUAGE GROUP

Know where to refer a friend forhelp with tobacco cessation?Language group No Yes

Total

Number of respondents 34 52 86Arabic % within language group 40% 60%Number of respondents 74 226 300Bengali % within language group 25% 75%Number of respondents 165 185 350Hindi/Urdu % within language group 47% 53%Number of respondents 88 87 175Somali % within language group 50% 50%Number of respondents 37 23 60Turkish % within language group 62% 38%Number of respondents 37 23 60Other % within language group 62% 38%


As Table 4.5 shows, the extent of knowledge about source of help for tobacco cessation, threemonths after the end of Ramadan varied considerably by language group. The highest levelsof knowledge about sources of help are reported from the Bengali group, followed by theArabic group. The lowest levels are reported by the Turkish group, although this is stillhigher that the overall level for the pre Ramadan baseline. Differences between the levels of

4 At 0.01 level using chi-squared test with Yates’ correction. Note that significant differences in knowledgeabout sources of help for tobacco cessation were not found by age group within the baseline sample.


13

knowledge of sources of help for the different language groups were statistically significant.Figures are not available for pre-Ramadan levels of knowledge by language group.

As Table 4.6 shows, differences in the levels of knowledge of sources of help varyconsiderably from area to area. The highest levels are found in Camden and Islington, TowerHamlets, and Lambeth Southwark and Lewisham. In one area, Barking and Havering, thepercentage reporting knowledge of where to obtain help was lower than the overall level forthe pre Ramadan baseline. Newham was the area with the second lowest percentagereporting knowledge of where to obtain help, the figure of 28% was only just 1% higher thanthe pre-Ramadan baseline. Differences between the levels of knowledge of sources of helpfor the different areas were statistically significant.

TABLE 4.6: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION THREE MONTHSAFTER RAMADAN, BY AREA

Know where to refer a friend for helpwith tobacco cessation?Area

No YesTotal





Forest % within Area 41% 59%Number of respondents 52 98 150Tower Hamlets % within Area 35% 65%Number of respondents 23 27 50Westminster % within Area 46% 54%

N= 1050 (1 missing case)

For six of the areas, the numbers of informants in the pre-Ramadan baseline data weresufficient5 to calculate baseline figures for the area, the results are shown in Table 4.7. As thetable shows, in each of these five areas, the level of reported knowledge of sources of help fortobaccos cessation was higher 3 months post Ramadan and before Ramadan. Figure 4.1summarises the changes. Pre-Ramadan samples are large enough to carry out statisticaltesting on the change in knowledge of sources of help for only three of these areas, Camdenand Islington, Ealing Hammersmith and Hounslow, and Tower Hamlets. In each case theincrease in knowledge is statistically significant.

Unfortunately the numbers of informants in the pre-Ramadan baseline data in the other 6

5 Sufficient was defined as 10 or more informants in an area.


14

areas were too low to calculate a baseline figure for these areas. For this reason it cannot besaid with certainty that knowledge increased in these areas, however, on the basis that Table4.4 and Figure 4.1 show increases for all areas, regardless of starting level of knowledge, itappears likely that this is the case.

TABLE 4.7: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION, COMPARISON OFPRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN, BY AREA

Know where to refer a friend forhelp with tobacco cessation?

No YesTotal

Camden and IslingtonNumber of respondents 17 133 150Mosque survey % of respondents 11% 89%Number of respondents 16 15 31Pre Ramadan baseline % of respondents 53% 47%

Ealing, Hounslow, HammersmithNumber of respondents 36 55 91Mosque survey % of respondents 40% 60%Number of respondents 26 6 32Pre Ramadan baseline % of respondents 81% 19%

Lambeth, Southwark, LewishamNumber of respondents 36 63 99Mosque survey % of respondents 36% 64%Number of respondents 14 1 15Pre Ramadan baseline % of respondents 93% 7%

NewhamNumber of respondents 71 28 99Mosque survey % of respondents 72% 28%Number of respondents 11 1 12Pre Ramadan baseline % of respondents 92% 8%

Tower HamletsNumber of respondents 52 98 150Mosque survey % of respondents 35% 65%Number of respondents 39 22 61Pre Ramadan baseline % of respondents 64% 16%

WestminsterNumber of respondents 23 27 50Mosque survey % of respondents 46% 54%Number of respondents 19 0 19Pre Ramadan baseline

(note 1) % of respondents 100% 0%Note: 1. ‘No’ includes 1 respondent who reported ‘not sure’

Informants were also asked where they would send a friend who wanted help. Responseswere categorised into:

� Specialised smoking/tobacco cessation services, e.g. quit lines� Other health services (not specialised smoking/tobacco cessation)� Friends� Family� Other community facilities

Multiple answers were coded. The vast majority of those who reported they knew where toaccess help suggested some non-specialised part of the health services (90%), only 13%overall mentioned specialised smoking/tobacco cessation services. The same general patternwas reported in most of the different areas, and for most of the different language groups.There were some exceptions. In Tower Hamlets, 66% mentioned non-specialised healthservices, and 44% mentioned specialised services (12% mentioned both). In four areas,(Camden and Islington, Croydon, Redbridge and Waltham Forest, Westminster) and onelanguage group (Arabic), none of the respondents mentioned specialised services.


15

FIGURE 4.1: KNOWLEDGE ABOUT SOURCES OF HELP FOR TOBACCO CESSATION, COMPARISON OFPRE-RAMADAN BASELINE WITH THREE MONTHS AFTER RAMADAN, BY AREA

0%

20%

40%

60%

80%

100%

Camde

n and

Isling

ton

Ealing,

Houns

low, H

ammers

mith

Lambe

th, Sou

thwark

, Lew

isham

Newha

m

Tower

Hamlet

s

Westm

inster

Area

% k

now

ing

whe

re to

get

toba

cco

cess

atio

n he

lp

Pre Ramadan baseline3 months after end of Ramadan

4.2.2 General awareness of tobacco cessation messages during Ramadan and thecampaignRespondents were asked an unprompted, open question about whether they has seen or heardany information about giving up tobacco use over Ramadan. If they replied ‘yes’ they wereasked where and what they had seen. This question was asked before any specific questionsabout particular Ramadan Campaign activities. Responses on source of information werecategorised and grouped as follows:

� Radio/TV� Ramadan Campaign (including sources such as calendars, community workers etc)� Health services� Mosque� Other

Multiple sources were given in some cases. Table 4.8 presents information on whetherrespondents saw/heard information by area and overall, and Table 4.9 presents the results bylanguage group. Table 4.10 presents information about source by area and overall and Table4.11 by language group.

As Table 4.8 shows, there are considerable differences in the percentage of respondentsrecalling seeing or hearing information about tobacco cessation over Ramadan by area, thedifferences are statistically significant. Overall, 74% of the mosque survey sample recalledsome information. In five areas (Camden and Islington, Croydon, Redbridge and WalthamForest, Tower Hamlets, Westminster), the percentage recalling information is very high(between 90% and 100%). In a second group of four areas (Brent and Harrow, Ealing,Hounslow and Hammersmith, Lambeth Southwark and Lewisham, Merton, Sutton andWandsworth) the majority of respondents recalled information, percentages between 51%and 73%. For the other three areas (Barking and Havering, Hackney, Newham), the majorityof respondents did not recall any information.


16

TABLE 4.8: RECOLLECTION OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, OVERALL AND BY AREA

Did you see/hear any informationover Ramadan?Area No Yes

Total





Forest % within Area 10% 90%Number of respondents 6 144 150Tower Hamlets % within Area 4% 96%Number of respondents 0 49 49Westminster % within Area 0% 100%Number of respondents 273 776 1049All areas % within Area 26% 74%


There are also significant differences by language group. Two groups had low levels ofrecall, the Turkish group and the mixed category represented by other languages. In all otherlanguage groups, levels of recall were high.

TABLE 4.9: RECOLLECTION OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Did you see/hear any informationover Ramadan?Language group

No YesTotal



Considering the sources of information, over all areas, the most frequently mentioned source


17

was the radio or TV6 (with radio being mentioned more frequently than the TV within thiscategory), 73% of those who saw or heard some information mentioned this source, thisequates to 52% of the entire sample (Table 4.10). The second most frequent category was asource that could be linked directly to the activities of the Ramadan Campaign, this wasmentioned by 49% of those who saw or heard some information, equivalent to 35% of theentire sample (Table 4.10). The percentage of respondents who mentioned a source thatcould be directly linked to the Ramadan Campaign varied from area to area, it was highest inCamden and Islington, at 83%, followed by Tower Hamlets, at 73%, and fell to zero inBarking and Havering, Brent and Harrow, and Hackney (Table 4.10).

TABLE 4.10: SOURCE OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, OVERALL AND BY AREA

Radio/TV Campaign Mosque OtherArea Number of

respondents% within

areaNumber of

respondents% within

areaNumber of

respondents% within

areaNumber of

respondents% within

areaBarking, Havering 22 47% 0 0% 0 0% 0 0%Brent, Harrow 49 48% 0 0% 0 0% 1 1%Camden, Islington 120 80% 124 83% 0 0% 1 1%Croydon 30 60% 17 34% 0 0% 0 0%Ealing, Hounslow,Hammersmith

31 34% 26 29% 1 1% 2 2%

Hackney 0 0% 0 0% 8 15% 1 2%Lambeth, Southwark,Lewisham

64 65% 43 43% 0 0% 0 0%

Merton, Sutton,Wandsworth

38 64% 24 41% 0 0% 2 3%

Newham 42 42% 1 1% 0 0% 2 2%Redbridge, WalthamForest

60 61% 2 2% 22 22% 2 2%

Tower Hamlets 72 48% 110 73% 11 7% 2 1%Westminster 14 29% 21 43% 10 20% 4 8%All areas 542 52% 368 35% 52 5% 17 2%

N=1049 (2 missing cases)Many individuals mentioned more than one source

TABLE 4.11: SOURCE OF MESSAGES ABOUT TOBACCO CESSATION DURING RAMADAN,MEASURED AT THREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Radio/TV Campaign Mosque OtherLanguage group Number of

respondents% within

areaNumber of

respondents% within

areaNumber of

respondents% within

areaNumber of

respondents% within

areaArabic 33 39% 38 45% 9 11% 4 5%Bengali 195 65% 189 63% 5 2% 1 0%Hindi/Urdu 237 68% 52 15% 15 4% 7 2%Somali 46 26% 83 47% 12 7% 4 2%Turkish 7 12% 0 0% 8 13% 1 2%Other 11 18% 4 7% 0 0% 0 0%

N = 1030 (21 missing values)Many individuals mentioned more than one source

Examining the results by language group, Table 4.11, some clear differences emerge. In theArabic and Somali language groups, higher percentages of respondents mentioned sourcesclearly identifiable with the Ramadan Campaign than any other category. For the Turkish

6 It is quite possible that a good proportion of the radio or TV information was stimulated by the RamadanCampaign, although the extent of this cannot be known.


18

language group, the most frequent source mentioned was the mosque, this may well relatedirectly to Ramadan Campaign activities. For the Bengali group, radio/TV and the Campaignwere both mentioned by a high percentage of the respondents. Finally for the Hindi/Urdugroup, the highest percentage of respondents mentioned the radio/TV as their source.

4.2.3 Awareness of calendarsRespondents were asked specifically whether they saw the Ramadan Campaign calendars,and if so where. This question was asked after the general question about seeing or hearingany information about giving up tobacco use over Ramadan. Table 4.12 presents the resultson recollection overall and by area, and Table 4.13 by language group. Table 4.14 shows theresults about where calendars were seen.

As Table 4.12 shows, there are considerable differences in the percentage of respondentsrecalling seeing the Ramadan Campaign calendars by area, the differences are statisticallysignificant. Overall, 58% of the mosque survey sample recalled seeing the calendars. Inthree areas (Camden and Islington, Tower Hamlets, Westminster), the percentage recallingthe calendars is very high (99% or 100%). In a second group of four areas (Croydon,Lambeth Southwark and Lewisham, Merton, Sutton and Wandsworth, Redbridge andWaltham Forest) the majority of respondents recalled the calendars, percentages between51% and 64%; the figure for Ealing, Hounslow and Hammersmith is fairly close at 48%. Forthe other four areas (Brent and Harrow, Barking and Havering, Hackney, Newham), themajority of respondents did not recall any information, less than 20% in each area recall thecalendars. Recall of calendars is highest in the areas in which the Campaign worked mostintensively.

TABLE 4.12: RECOLLECTION OF RAMADAN CALENDARS, MEASURED AT THREE MONTHS AFTERRAMADAN, OVERALL AND BY AREA

Did you see the Ramadan Campaigncalendars?Area

No YesTotal








19

Examining the results by language group, Table 4.13, some clear differences emerge, theseare statistically significant. In the Arabic, Bengali and Somali language groups, higherpercentages of respondents recalled the Ramadan Campaign calendar, for 78% to 84%. Forthe Turkish, Hindi/Urdu and other language groups, the percentages recalled seeing thecalendar were much lower, ranging from 18% to 38%.

TABLE 4.13: RECOLLECTION OF RAMADAN CALENDARS, MEASURED AT THREE MONTHS AFTERRAMADAN, BY LANGUAGE GROUP

Did you see/hear any informationover Ramadan?Language group

No YesTotal



As Table 4.14 shows, the place that was most frequently reported for where calendars wereseen was the mosque, 75% of those who saw calendars had seen them in the mosque. Therewere some differences by area, although the number who saw the calendar are too small(under 20) in four areas (Barking and Havering, Brent and Harrow, Hackney and Newham) topermit meaningful analysis. In six of the areas Camden and Islington, Croydon, Lambeth,Southwark and Lewisham, Merton, Sutton and Wandsworth, Redbridge and WalthamForest), the mosque was the place mentioned by a clear majority of those people who hadseen the calendar (72% to 94%). In Ealing, Hounslow and Hammersmith, the mosque wasthe venue mentioned by 43% of those who had seen the calendar, and the figure forWestminster was 47%. In Westminster, 43% of those who had seen the calendar saw it inrestaurants and shops, almost as many as saw it in mosques.

TABLE 4.14: RECOLLECTION OF PLACE WHERE RAMADAN CALENDARS SEEN, MEASURED ATTHREE MONTHS AFTER RAMADAN

Place Number ofrespondents

reporting venue

% of respondentswho had seen

calendar

Mosque 431 75%

Restaurant or shop 137 24%

Other community venues 115 20%

Other (including workplace and healthsetting) 10 2%

N= 578 (21 missing cases)Multiple places reported by 115 people

There are also some differences by language group, summarised in Table 4.15. Numbers in


20

the Turkish and other groups who had seen the calendars were too small to permit meaningfulanalysis. As this table shows, mosques were relatively more frequent to the Bengali groupand least to the Somalis as a venue in which calendars were seen.

TABLE 4.15: RECOLLECTION OF PLACE WHERE RAMADAN CALENDARS SEEN, MEASURED ATTHREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Place Number ofrespondents inlanguage group

% of respondentsin language group

who had seencalendar

MosqueArabic 42 62%

Bengali 217 94%Hindi/Urdu 94 78%

Somali 69 50%Restaurant or shop

Arabic 22 32%Bengali 42 18%

Hindi/Urdu 29 24%Somali 33 24%

Other community venuesArabic 18 26%

Bengali 24 10%Hindi/Urdu 25 21%

Somali 47 34%Other (including workplace and health setting)

Arabic 0 0%Bengali 2 1%

Hindi/Urdu 2 2%Somali 6 4%

4.2.4 Views about calendarsRespondents who had seen the calendars were asked whether they though they gave usefulinformation about Ramadan and about giving up tobacco use. Results overall and by area areshown in Table 4.16, and by language group in Table 4.17. Overall 65% of those who sawthe calendars thought they contained useful information about both Ramadan and tobaccocessation, 8% thought they contained useful information about tobacco cessation only, and18% about Ramadan only. While there are some differences by area and by language group,in all but one area and all language groups the majority of respondents thought that thecalendars contained useful information about tobacco cessation (the total of the last twocolumns in each table). The one exception is for Brent and Harrow, where the number ofpeople who recollected the calendars is extremely small (5 in total).


21

TABLE 4.16: VIEWS ON USEFULNESS OF RAMADAN CALENDARS, MEASURED AT THREE MONTHSAFTER RAMADAN, OVERALL AND BY AREA, FOR THOSE WHO REPORTED SEEING THECALENDARS

Calendars give useful informationArea AboutRamadan only

About tobaccocessation only About both

Number of respondents 0 0 2Barking, Havering % within Area 0% 0% 40%Number of respondents 2 6Brent, Harrow % within Area 0% 18% 55%Number of respondents 45 0 104Camden, Islington % within Area 30% 0% 70%Number of respondents 4 0 25Croydon % within Area 13% 0% 78%Number of respondents 7 1 33Ealing, Hounslow,

Hammersmith % within Area 16% 2% 75%Number of respondents 1 6 3Hackney % within Area 10% 60% 30%Number of respondents 18 2 36Lambeth, Southwark,

Lewisham % within Area 31% 3% 61%Number of respondents 5 0 25Merton, Sutton,

Wandsworth % within Area 17% 0% 83%Number of respondents 0 2 8Newham % within Area 0% 13% 53%Number of respondents 3 23 19Redbridge, Waltham

Forest % within Area 5% 42% 35%Number of respondents 17 11 109Tower Hamlets % within Area 11% 7% 74%Number of respondents 10 0 24Westminster % within Area 20% 0% 49%Number of respondents 110 47 394All areas % within Area 18% 8% 65%

N= 607

TABLE 4.17: VIEWS ON USEFULNESS OF RAMADAN CALENDARS, MEASURED AT THREE MONTHSAFTER RAMADAN, BY LANGUAGE GROUP, FOR THOSE WHO REPORTED SEEING THECALENDARS

Calendars give useful information:Language group AboutRamadan only

About tobaccocessation only About both

Number of respondents 11 1 44Arabic % within Area 15% 1% 62%Number of respondents 49 3 179Bengali % within Area 21% 1% 76%Number of respondents 11 17 87Hindi/Urdu % within Area 8% 13% 66%Number of respondents 36 16 70Somali % within Area 26% 12% 50%Number of respondents 0 7 4Turkish % within Area 0% 58% 33%Number of respondents 3 2 6Other % within Area 27% 18% 55%

N=600

4.2.5 Awareness of radio adviceAn earlier section has already noted that when asked an unprompted question aboutinformation on tobacco cessation, the most frequent response on source was radio. A laterquestion asked specifically about whether respondents heard radio advice about tobaccocessation during Ramadan. The results by area and overall are shown in Table 4.18 and bylanguage group in Table 4.19.


22

TABLE 4.18: RECOLLECTION OF HEARING RADIO ADVICE DURING RAMADAN, MEASURED ATTHREE MONTHS AFTER RAMADAN, OVERALL AND BY AREA

Did you hear any radio adviceover Ramadan?Area

No YesTotal







As would be expected, the levels of recollection on specific questioning about the radio werehigher than those obtained on the open question7. In every area except Brent and Harrow,more than 50% of respondents recollected hearing radio advice over Ramadan, in Brent andHarrow only 19% recollected hearing advice. For three of the language groups, Bengali,Hindi/Urdu and Somali, more 50% of respondents recollected hearing radio advice, figuresfor the first two of these groups were particularly high at 83% and 72% respectively, seeTable 4.19. For the other three language groups, less that 50% of respondents recollected anyradio advice, although note that for the Arabic group, the figure, at 49%, is close to this level.Differences between areas and between language groups were both statistically significant.

7 Please note that the tables given in this report for the open question (Tables 4.10 and 4.11) combine TV andradio in one category.


23

TABLE 4.19: RECOLLECTION OF HEARING RADIO ADVICE DURING RAMADAN, MEASURED ATTHREE MONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Did you hear any radio adviceover Ramadan?Language group

No YesTotal

Number of respondents 42 41 83Arabic % within Area 51% 49%Number of respondents 51 249 300Bengali % within Area 17% 83%Number of respondents 99 249 348Hindi/Urdu % within Area 28% 72%Number of respondents 76 96 172Somali % within Area 44% 56%Number of respondents 39 20 59Turkish % within Area 66% 34%Number of respondents 50 10 60Other % within Area 83% 17%

N=1022 (29 missing cases)

4.2.6 Knowledge about smoking cessation phone help-linesSpecific questions were asked about three phone lines, some overall results are tabulated inTable 4.20, some results by area in Table 4.21 and by language group in Table 4.22.

TABLE 4.20: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASURED THREEMONTHS AFTER RAMADAN, ALL AREAS

Knows where to getnumber

Does not know where toget number

Uncertain

Number ofrespondents

% ofrespondents


% ofrespondents


% ofrespondents

N

NHS line 720 69% 253 24% 72 7% 1045Local line 334 33% 533 52% 149 15% 1016Asian Quit line 227 35% 357 55% 63 10% 650 (note 1)At least one line 742 71% 1049

Note1. Bengali and Hindi/Urdu respondents only

As Table 4.20 shows, a relatively high proportion, 71%, of respondents reported that theyknew where to get the number of at least one of the help-lines. The NHS line was the mostwell known. The percentage of respondents who know how to get the number of at least onehelp-line varies considerably by area, from 36% in Westminster to 92% in Camden andIslington, and by language group, from 43% in the Turkish group to 84% in the Bengaligroup.


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TABLE 4.21: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASURED THREEMONTHS AFTER RAMADAN, BY AREA

Knows where to get number of atleast one line

Area Number ofrespondents

% ofrespondents

N

Barking, Havering 27 57% 47Brent, Harrow 61 60% 102Camden, Islington 138 92% 150Croydon 32 64% 50Ealing, Hounslow, Hammersmith 75 83% 90Hackney 21 40% 53Lambeth, Southwark, Lewisham 76 77% 99Merton, Sutton, Wandsworth 50 85% 59Newham 71 71% 100Redbridge, Waltham Forest 66 67% 99Tower Hamlets 107 71% 150Westminster 18 36% 50

TABLE 4.22: KNOWLEDGE ABOUT SMOKING CESSATION PHONE HELP-LINES MEASURED THREEMONTHS AFTER RAMADAN, BY LANGUAGE GROUP

Knows where to get number of at leastone line

Language Group Number ofrespondents

% of respondents N

Arabic 44 51% 86Bengali 252 84% 301Hindi/Urdu 272 78% 349Somali 99 57% 174Turkish 26 43% 60Other 35 58% 60

4.3 Changes in smoking behaviour

Respondents where asked a number of questions about smoking behaviour: whether they hadever smoked; their current smoking status; whether they had ever tried to give up (and if so,whether this was before the beginning of Ramadan, or since the beginning of Ramadan);whether they had any help to give up smoking, and if so what. Table 4.23 presents thesmoking history of the mosque sample as a whole. Table 4.24 examines the extent to whichsmokers tried to give up, comparing two periods, before the start of Ramadan, and since thebeginning of Ramadan. Table 4.25 then focuses on the outcomes of attempts to give upsmoking, and compares the quitting success rate for two groups: those whose date of lasttrying to give up was more than 6 months ago (i.e. who last tried to give up before the start ofRamadan); and those whose date of last trying to give up was since the start of Ramadan.Sources of help are summarised in Table 4.26.

4.3.1 Smoking history of the mosque sampleThe smoking history of the respondents in the mosque sample is shown in Table 4.23. Forty-four percent of the sample had never smoked, 17% were ex-smokers, and 37% were smokersat the time of the survey.


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TABLE 4.23: SMOKING HISTORY OF THE MOSQUE SAMPLENumber of

respondents% of all

respondentsNever smoked 480 44%Ex smoker 179 17%

� Gave up before the start of Ramadan 49 5%� Gave up since the start of Ramadan 96 9%� Date of giving up unknown 34 3%

Current smoker 385 37%� Last tried to give up before the start of Ramadan 161 15%� Last tried to give up since the start of Ramadan 62 6%� Never tried to give up 160 15%� Not known whether ever tried to give up 2 <0.5%

Has smoked, not known whether given up or not 5 <0.5%N=1049 (2 missing cases)

An analysis of the difference in attempts to stop smoking before the beginning of Ramadancompared to since the beginning of Ramadan is presented in Table 4.24. What is noticeablefrom this Table is how high the percentage of smokers who made their latest attempt to giveup since the beginning of Ramadan, compared to those whose latest attempt was before thebeginning of Ramadan, given the short length of the period since the start of Ramadan incomparison to the period represented by over six months ago. This provides an indication ofimpact of the Ramadan Campaign.

TABLE 4.24: ATTEMPTS TO GIVE UP SMOKING FOR THE MOSQUE SAMPLE, BY TIME OF LASTATTEMPT

Last attempt to give upOver 6 months

agoSince the start of

RamadanNumber of people in sample who have ever smokedduring the period shown

528 479

Number who tried to give up in period shown 210 159% of smokers who tried to give up in period shown 40% 33%

N=528Note: This analysis is based on the assumption that none of the sample

started to smoke for the first time since the beginning of Ramadan.

4.3.2 Outcomes of smokers’ attempts to give upAnalysis of the outcomes of smokers’ attempts to give up smoking, by the timing of their lastattempt, are shown in Table 4.25.

TABLE 4.25: OUTCOMES OF SMOKERS’ ATTEMPTS TO GIVE UP, BY TIME OF LAST ATTEMPTLast attempt to give up

Over 6 monthsago

Since the start ofRamadan

Number of people in sample who have ever smoked 210 158Gave up successfully – number of respondents 49 96

% of those trying 23% 61%Failed to give up– number of respondents 161 62

% of those trying 77% 39%N=368

The success rate for smokers trying to give up whose last attempt was since the beginning of


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Ramadan is significantly greater than that for those whose last attempt to give up was morethan 6 months ago. This is likely to reflect the impact of the Ramadan Campaign, sincesuccess in giving up smoking was also linked in the sample to having help, and this was moreoften reported for the group trying to give up since the beginning of Ramadan.

4.3.3 Sources of help for giving up smokingInformation on the sources of help (in response to an open question) was provided by the 199smokers who reported having help to try and give up, 60 gave 2 sources of help. Theirresponses were categorised into the following broad groups:

� Nicotine replacement products� Specialist smoking cessation services� NHS� Friends and family� Other

The results are presented in Table 4.26, and show that friends and family are the mostfrequent form of help, followed may the category of ‘Other NHS’, mainly doctors.

TABLE 4.26: SOURCES OF HELP FOR GIVING UP SMOKING

Source of helpNumber of

respondents% of all respondentswho reported help

Friends and family 133 67%Nicotine replacement products 37 19%Specialist smoking cessation services 27 14%Other NHS 55 28%Other 7 4%

N=199


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5. Impact of the community outreach workers

This section describes the findings from the follow-up survey of a sample of those smokersthat the community outreach workers had been in contact with. The first subsection describesthe views of the sample respondents about giving up smoking and their intentions at thebeginning of Ramadan. Section 5.2 then examines changes in their smoking behaviour.Section 5.3 looks at respondents recollections of follow-up by the local smoking cessationservice. Finally section 5.4 examines service use and smoking status at 3-month follow-up.

5.1 Views about giving up smoking

Of the 24 individuals who smoked at the beginning of Ramadan, information on their viewsand intentions at the beginning of Ramadan were available for 20, see Table 5.1. Asignificant majority (75%) reported that they wanted to give up smoking, a further 15% werenot sure.

TABLE 5.1: VIEWS AND INTENTIONS OF SMOKERS AT THE BEGINNING OF RAMADAN, SMOKERSFOLLOW-UP SURVEY

Number %Want to give up smoking 15 75%Not sure about giving up smoking 3 15%Do not want to give up smoking 2 10%

Know where to get help to give up tobacco use 8 40%Do not know where to get help to give up tobacco use 12 60%

Think Ramadan is a good time to give up smoking 20 100%

N=20 (views at beginning of Ramadan missing for 4 smokers)

5.2 Changes in smoking behaviour

Table 5.2 summarises the changes in smoking behaviour that took place during Ramadan andin the three months after the end of Ramadan. Forty-one percent of the smokers (10 men)gave up during Ramadan8, and were not smoking at the end of Ramadan, and thirty threepercent of smokers (8 men) were still not smoking three months after the end of Ramadan.Those who succeeded in giving up smoking during Ramadan and maintained this until the3month follow up amounted to 62% of those who had given up during Ramadan. Three mengave up smoking after the end of Ramadan, one of these had reported he did not want to giveup smoking at the beginning of Ramadan, another had reported he was not sure about givingup smoking at the beginning of Ramadan, while the third had wanted to give up.

8 This is higher than the figure obtained for sample comprised by the smokers interviewed at the end ofRamadan by the community outreach workers, 35% of these reported that they were not smoking at the end ofRamadan. This could indicate that it was the more motivated group who were prepared to give their contactdetails for the three-month follow-up, and that this 3-month follow-up group is therefore not representative ofthe whole sample. Note however that in terms of simple intention (as measured by whether wanted to give upsmoking) the three-month follow up sample was very similar to the pre-Ramadan sample.


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TABLE 5.2: CHANGES IN SMOKING BEHAVIOUR BY THREE MONTHS AFTER THE END OFRAMADAN, SMOKERS FOLLOW-UP SURVEY

Whole of smokers follow-up survey sample Number %Did not try to give up smoking at any point 11 46%Gave up during Ramadan and re-started again by the end of

Ramadan0 0%

Gave up during Ramadan and re-started again by 3months afterthe end of Ramadan

2 8%

Gave up during Ramadan, still not smoking at 3 months after theend of Ramadan

8 33%

Gave up after the end of Ramadan, still not smoking at 3 monthsafter the end of Ramadan

3 13%

N=24Sub-sample who attempted to give up smoking during RamadanSucceeded in giving up smoking in Ramadan and maintained

this for at least 3 months8 62%

N=13

None of the men who reported they were not sure or did not want to give up smoking at thebeginning of Ramadan gave up during Ramadan, however as noted above two of these didgive up after the end of Ramadan. Although caution is necessary owing to the small size ofthis sample, this does provide some evidence of an influence of the Ramadan Campaign onindividuals’ intentions as well as on smoking behaviour.

5.3 Extent of follow-up by local stop smoking service

Informants were asked whether they had been contacted by their local stop smoking service,as one of the tasks undertaken by the outreach workers was to pass on contact details to thelocal services so that people could be followed up. Table 5.3 shows the extent of follow-upby local stop smoking service by language group for those who were smokers at thebeginning of Ramadan. Overall 29% of informants reported that they had been contacted bytheir local service, while 13% were not sure. The results were strikingly different for the twolanguage groups, none of the Hindi/Urdu speakers reported being contacted by their localstop smoking service.

TABLE 5.3: EXTENT OF FOLLOW-UP BY LOCAL STOP SMOKING SERVICE, BY LANGUAGE GROUP,SMOKERS FOLLOW-UP SURVEY

Number (%) ofindividuals who were:

Contacted bylocal service

Not contacted bylocal service

Not sure aboutcontact

Total

Bengali speakers 7 (37%) 10 (53%) 2 (11%) 19Hindi/Urdu speakers 0 (0%) 4 (80%) 1 (20%) 5All respondents 7 (29%) 14 (58%) 3 (13%) 24

N=24

5.4 Service use and smoking status at follow-up

Table 5.4 summarises service use by individuals according to smoking status at the 3-monthfollow-up. The sample size is too small for statistical testing. Very few clear patterns


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emerge from this data, perhaps not surprisingly given the small size of the sample. The onething that is noticeable is that the proportion of ex smokers (those who had given up since thebeginning of Ramadan) who reported receiving advice from a community outreach worker ismuch higher than the same proportion for those who were still smoking at the 3-month followup, 9 out of 11, compared to 6 out of 13.

TABLE 5.4: SERVICE USE BY SMOKING STATUS AT END OF FOLLOW-UP PERIOD, SMOKERSFOLLOW-UP SURVEY

Smokers Ex-smokers TotalAdvice from community outreach workerYes 6 9 15No 7 2 9

Total 13 11 24Reported help in giving up smokingYes 8 4 12No 3 4 7

Total 11 8 19Use of Asian Quit line (note 1)Yes 5 1 6No 8 10 18

Total 13 11 24Use of NHS Quit lineYes 10 3 13No 3 8 11

Total 13 11 24Use of local stop smoking lineYes 7 5 12No 6 6 12

Total 13 11 24Reported contact by local stop smoking lineYes 4 3 7Not sure 3 0 3No 6 8 14

Total 13 11 24Note:1. all sample members were Bengali or Hindi/Urdu


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6. Conclusions and implications

The evaluation reported here provides considerable evidence of the effectiveness of theLondon-wide Ramadan Campaign, in terms of impact on attitudes, knowledge and smokingbehaviour. For many of the results, statistically significant differences between areas andbetween language groups were obtained, and seem related to the relative intensity ofCampaign activities in the different areas. This reinforces the likelihood that the changesobserved in attitudes, knowledge and smoking behaviour are due to Campaign activities.

The acceptability of the Ramadan Campaign, as measured by the level of agreement with thestatement that Ramadan is a good time to give up smoking, is high. The level 3 months afterthe end of Ramadan was higher than the pre-Ramadan level, this increase was statisticallysignificant for the mosque sample [Section 4.1].

Reported knowledge about where to obtain help with tobacco cessation increased from 27%pre Ramadan to 58% measured 3 months after Ramadan, this increase is a statisticallysignificant [Section 4.2.1]. The vast majority of those who reported they knew where toaccess help suggested some non-specialised part of the health services (90%), only 13%overall mentioned specialised smoking/tobacco cessation services. The same general patternwas reported in most of the different areas, and for most of the different language groups[Section 4.2.1].

The mosque sample respondents reported considerable awareness of Ramadan Campaignactivities. 74% of the mosque survey sample recalled some information seeing or hearingsome information about tobacco cessation over Ramadan [Section 4.2.2]. When asked togive details about what they had seen or heard, unprompted, 35% of the respondentsmentioned something that could be linked directly to the activities of the Ramadan Campaign[Section 4.2.2].

The success rate for smokers trying to give up whose last attempt was since the beginning ofRamadan, at 61%, is significantly greater than that for those whose last attempt was morethan 6 months ago, 23%. This is likely to reflect the impact of the Ramadan Campaign, sincesuccess in giving up smoking was also linked in the sample to having help, and this was moreoften reported for the group trying to give up since the beginning of Ramadan [Section 4.3].For the sample of smokers followed up at three points in time, 62% of those who had givenup during Ramadan succeeded maintaining this until the 3month follow up [Section 5.2]. It isnoticeable that these two figures from the two different samples are very similar. The figuresobtained look very favourable in comparison to published national statistics. Fox (2003, page4) quotes a figure of 51% of individuals across HAZ smoking cessation schemes who set aquit date for stopping smoking in the period April to December 2002 had successfully givenup and maintained this for 4 weeks according to self-report9. The DoH statistical bulletinprovides more detailed information by area, and gives a lower self-reported 4-week quit ratefor London of 46% (DoH, 2002, page 54)10.

One of the tasks undertaken by the outreach workers was to pass on contact details to localservices so that people could be followed up. Overall 29% of informants in the smokers’ 9 Note that the national comparative figures are for a much shorter quit period, and therefore could be expectedto be higher than those obtained with a three-month quit period.10 Note that this source also gave figures are based on measurement of carbon monoxide validation, whichyielded a lower figure than self-report.


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follow-up survey reported that they had been contacted by their local service, while 13%were not sure. The results were strikingly different for the two language groups, none of theHindi/Urdu speakers reported being contacted by their local stop smoking service [Section5.3]. For any future Ramadan Campaign, this aspect is one where implementation could beimproved.

Details of the sources and locations of information recalled by the different groups (both byarea and by language group) can be used in planning the implementation of future tobaccocessation activities during Ramadan.


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References

Department of Health (2002) Statistics on smoking cessation services in England, April 2001to March 2002. Statistical Bulletin 2002/25, November 2002.

Fox J (2003) Statistical supplement to the Chief Executive’s Report to the NHS. Departmentof Health, May 2003.


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Appendix 1 – questionnaire used in the mosque survey

POST RAMADAN QUESTIONNAIRE

NAME OF MOSQUE NAME OF INTERVIEWER DATE

1. Age range18-2930-3940-4950-5960-6970+

2. Language groupBengaliHindi/UrduSomaliTurkishArabicOther

3. Gender:malefemale

4. If a friend of yours wanted some help to give up smoking/chewing tobacco, wouldyou know where to send them?

Yes, please specify No

5. Have you ever smoked?No, [go to question 8]Yes, If yes, do you smoke now?

Yes No

6. [If yes to question 5] Have you ever tried to give up smoking?No, [go to question 8]Yes, If yes, when was the last time you tried?

since the beginning of Ramadan 1423over 6 months ago

7. [If yes to questions 5 and 6] Did you have any help to try to give up smoking?Yes, please specify No


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8. Do you think Ramadan is a good time to give up smoking?YesNo

9. Did you see or hear any information about giving up tobacco use over Ramadan?Yes, please say where/what

No

10. Did you see the Ramadan Campaign calendars?NoYes, please say where

What did you think was useful about the calendars?[tick all that apply] They give useful information about Ramadan

They give useful information about giving up tobacco use

11. Over Ramadan, did you hear any radio advice about giving up tobacco use?YesNo

12. Do you know where to get the numbers for the following phone lines?Asian Quitline Yes No Don’t knowNHS line Yes No Don’t knowYour local stopSmoking line Yes No Don’t know

Thank you very much


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Appendix 2 – questionnaire used for the follow up survey tosmokers

POST RAMADAN QUESTIONNAIRE – for individuals being followed up

NAME OF interviewee NAME OF INTERVIEWER DATE

2. Age range18-2930-3940-4950-5960-6970+

2. Language groupBengaliHindi/UrduSomaliTurkishArabicOther

3. Gender:malefemale

4. If a friend of yours wanted some help to give up smoking/chewing tobacco, wouldyou know where to send them?

Yes, please specify No

5. Have you ever smoked?No, [go to question 8]Yes, If yes, do you smoke now?

Yes No

6. [If yes to question 5] Have you ever tried to give up smoking?No, [go to question 8]Yes, If yes, when was the last time you tried?

since the beginning of Ramadan 1423over 6 months ago

7. [If yes to questions 5 and 6] Did you have any help to try to give up smoking?Yes, please specify No


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8. Do you think Ramadan is a good time to give up smoking?YesNo

9. Did you see or hear any information about giving up tobacco use over Ramadan?Yes, please say where/what

No

10. Did you see the Ramadan Campaign calendars?NoYes, please say where

What did you think was useful about the calendars?[tick all that apply] They give useful information about Ramadan

They give useful information about giving up tobacco use

11. Over Ramadan, did you hear any radio advice about giving up tobacco use?YesNo

12. Have you received advice from a community outreach worker about how to give uptobacco use?

YesNo

13. Have you contacted any of the following phone lines?Asian Quitline Yes NoNHS line Yes NoYour local stopSmoking line Yes No

14. Have you been contacted by your local stop smoking service?YesNoNot sure

Thank you very much!

Evaluation of London-wide Ramadan Campaign

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