Tobacco use, including smoking and smokeless forms, can lead to dependency due to nicotine, an addictive substance. This dependency is a significant public health concern, linked to numerous preventable diseases and mental health conditions. In England in 2023, 11.6% of adults smoked, contributing to one in six deaths annually. Reducing or quitting tobacco use can significantly lower health risks, but quitting remains challenging without support.

In 2024, Southampton City Council commissioned Healthy Dialogues to undertake a Tobacco Dependency Needs Assessment for the city. The aim of the assessment was to better understand the unmet needs of people who smoke in Southampton, and to identify barriers and enablers to quitting. The findings will inform local strategies to enhance support for tobacco dependency and improve public health outcomes.

The objectives of the needs assessment were:

To provide a clear overview of tobacco use and dependency in Southampton.

To identify barriers and enablers to quitting smoking among the local population.

To highlight gaps in services and suggest areas for improvement.

To provide evidence-based recommendations for local strategies and interventions.

To conduct this needs assessment, Healthy Dialogues drew on a variety of data sources, including local, regional, and national datasets, to understand the local picture of tobacco dependency. We engaged with a wide range of stakeholders, including people with lived experience, health and social care professionals, and community organisations. Engagement activities included stakeholder interviews, focus groups, and a community survey promoted through council newsletters, local organisations, and social media. Targeted engagement was also carried out with groups at higher risk of tobacco dependency, such as people with mental health conditions, people from ethnic minority communities, neurodiverse individuals, pregnant people, and people experiencing homelessness.

Findings were mapped to the COM-B model, a behaviour change framework that explains how capability, opportunity, and motivation influence behaviour. Additionally, evidence from recent literature on effective approaches to tobacco dependency cessation was reviewed and mapped to the Theoretical Domains Framework, guiding practical recommendations for local action.

• Many professionals felt positively about the support available in Southampton, particularly the training provided and responsiveness of local stop smoking services, but highlighted a need for better communication and more accessible service options, such as drop-in services and support outside of working hours.
• Stress and enjoyment were the most common reasons for smoking among survey respondents, while addiction, stress, and lack of support were key barriers to quitting. Respondents emphasised the importance of regular, non-judgemental support, mental health understanding, and personalised advice.
• People from seldom heard groups often smoke as a coping mechanism, with barriers to quitting including stigma, language barriers, cultural norms, and lack of tailored support. Services need to be culturally sensitive, trauma-informed, and flexible to meet diverse needs.

The insights and recommendations from this needs assessment will support Southampton City Council in shaping local tobacco control strategies, aiming to reduce smoking prevalence and address health inequalities across the city.