Background: Smoking cessation services cater for the minority of people ready to stop smoking. Yet, it is the larger “not ready” group that carries the greater burden of death and disease and where the greater public health gains can be made. This project aimed to assess the smokefree outcomes for “not ready” people after six months participation in a smoking cessation service designed for people at all levels of smoking cessation readiness.

Method: Smokechange is personalised support to address smoking, especially in pregnancy and where there are young children. Practitioners follow clear protocols, use an eight item tool to asses readiness, then work to build the capacity of participants to consider, plan achieve and maintain smokefree changes. Programme goals are: more people smokefree and more ready to consider it.

Results: For 1125 smoking people with six months participation in Smokechange, 991 (88%) were assessed at enrolment as “not ready” (not ready to stop smoking in the next month). When reassessed after six months, 312 (32%) of this group had been smokefree for more than seven days. This compared to 71 of 134 (53%) in the “ready” group.

Conclusions: While “ready” people had higher smokefree rates, the greater proportion (82%) of people becoming smokefree was from the “not ready” group.

Implications: The combination of inclusive enrolment criteria and appropriate intervention methodologies needs to be considered if smoking cessation services are to contribute to reducing health inequalities as well as supporting “ready” people to become smokefree.