Cigarette smoking constitutes a serious burden to health and economy . Connecting smokers to effective cessation services is a public health priority. The majority of smokers intend to quit smoking and a substantial proportion of smokers make repeated quit attempts . When attempting to quit, relapse is the most probable outcome. Approximately, three-quarters of unaided quitters resume smoking within three months . In a meta-analytic review of unaided smoking cessation, it was concluded that only 7% of unaided quit attempts last longer than 10 months . Several forms of cessation support have been shown effective in increasing the chance of successful smoking cessation . However, only a minority of smokers make use of such programs. In the United States, 37% of smokers who have tried to quit smoking report that they had ever read written material on smoking cessation, 12% had called a quitline, and 9% had attended individual counselling . Similar rates on the use of cessation treatments are reported by Shiffman and colleagues . In the Netherlands, one third of quitters report that they received assistance in quitting and less than 1% of smokers contact the national quitline .
Smoking parents represent an important subpopulation among adult smokers. Forty percent of smokers live with a child younger than 18 years old . Twenty percent of parents are self-reported smokers . Parental smoking is detrimental, not only to the parent, but also the child. A recent meta-analysis concluded that the risk of smoking uptake in adolescence is nearly threefold when both parents smoke . Moreover, smoking parents frequently expose their children to second-hand smoke [11, 12], which is associated with a variety of adverse health outcomes including childhood asthma, respiratory infections, and decreased lung growth in children [13, 14]. Smoking parents may be particularly motivated to quit smoking. Smoker’s primary reasons for wanting to quit are concerns about the health consequences of their smoking . Nearly two-thirds of adult smokers express concern for modelling smoking to children . In a telephone survey, 64% of parent smokers indicated that they would accept telephone cessation support if recommended . Also, parents of children with smoking-related illnesses display a particularly high motivation to quit [16, 17]. Connecting smoking parents to cessation support may yield important health benefits for both parents and children. Parents who quit smoking will not only improve their own health, but will also reduce the risk of physical illness , smoking initiation , and regular smoking  in their children.
Proactive outreach may increase use of cessation support. Proactive outreach is the systematic targeting of all individuals in a defined population of smokers and the attempt to engage smokers with varying levels of motivation. Up to this point, efforts to engage smoking parents have almost exclusively focused on clinical settings [17, 21, 22]. While these efforts are valuable, proactive outreach of health care practices and hospitals may not extend to the general population of smoking parents. Public schools are a highly promising but understudied venue for reaching parents who smoke. Promoting cessation support through schools has the potential to reach a major proportion of smoking parents, thus yielding high potential public health impact. Also, schools are likely to constitute a ‘teachable setting’, that is, smokers may be more likely to make use of cessation support when reminded of their role as parents. To date, no study has evaluated the use of primary schools as a venue to promote smoking cessation among parents.
Previous studies have used varying approaches to increase smoker’s exposure to cessation support (e.g., direct mailings, health care provider outreach, telephone recruitment, or media advertisements). Offering cessation support through mailings has been shown to yield response rates between 2-11% in smokers identified from general practice and health care provider records [23–26]. Recruitment rates tend to be higher for interpersonal recruitment, with recruitment rates ranging between 44-65% [27–29]. While interpersonal recruitment (e.g., telephone recruitment) may constitute an efficient way to recruit smokers into clinical trials, this approach may be less feasible for implementation into the health care system, where few resources for recruitment are available. Though response rates vary considerably between studies and recruitment approaches, previous studies indicate that proactive outreach has considerable potential to connect smokers to cessation support.
Several forms of cessation support have demonstrated efficacy in increasing the chance of successful smoking cessation . Telephone counselling, or quitline support, has been shown effective in increasing smoking cessation rates in a meta-analytic review . Data from the European Smoking Cessation Helplines Evaluation study (ESCHER), which assesses cessation rates after quitline use in several European countries, showed point prevalent abstinence rates between 12% and 28% and prolonged abstinence rates between 4% and 15% at one-year follow-up . Self-help materials (i.e., didactic materials giving information and advice on how to quit smoking) have also demonstrated efficacy in a meta-analytic review, which concluded that non-tailored self-help materials have a small benefit compared to no intervention . Therefore, self-help materials constitute a cost-effective method to support otherwise unaided quit attempts, which can be disseminated easily and has the potential to help a large proportion of smokers.
The aim of the present study was two-fold: First, we sought to evaluate the reach of mailings distributed through primary schools in recruiting smoking parents into cessation support (i.e., school-based promotion of cessation support using mailings). Second, among smoking parents recruited into cessation support through primary schools, we compared use and acceptability of two cessation treatments with high potential public health impact: telephone counselling versus self-help material.