Behavioural therapy for smoking cessation: the effectiveness of different intervention types for disadvantaged and affluent smokers

Abstract

Background: Disadvantaged smokers are less likely to be successful when trying to stop smoking than more affluent smokers. In the UK, NHS Stop Smoking Services (SSS) provide a range of pharmacotherapy and behavioural support, delivered by advisors with a range of backgrounds. Whether the types of support provided and who provides it influence differences in quit rates amongst low SES smokers compared with high SES smokers has not previously been examined.

Methods: 202,084 records of smokers in England who attended a NHS Stop Smoking Service between July 2010 and June 2011 were acquired. Smokers were followed-up by services at four weeks post quit date. Multilevel logistic regression models of CO validated quits were employed. Disadvantage was explored through the National Statistics Socio-Economic Classification (NS-SEC) and by eligibility for free prescriptions, an indicator of low income amongst adults aged between 19 and 59 in England.

Results: Affluent smokers were more likely to quit than disadvantaged smokers (OR 1.38 (1.35 to 1.42) for clients who paid for prescriptions compared to those eligible for free prescriptions). 80% of service clients received one-to-one counselling but open group forms of behavioural therapy were more successful (main effect OR 1.26 (1.12 to 1.41)) except amongst some of the most disadvantaged clients (long-term unemployed and prisoners). Closed groups were little deployed and they were not significantly more successful than one-to-one behavioural therapy after controls. Who delivered treatment did make a difference for some clients, with all but the most affluent less likely to be successful if they had been treated by a nurse compared with other types of advisers, including smoking cessation specialists (main effect OR 0.73 (0.65 to 0.83)).

Conclusion: This study provides further evidence that disadvantaged smokers find quitting more difficult even when they have attended a smoking cessation programme. The findings suggest that open groups should be promoted, although they may not be as effective as other forms of behavioural therapy for the long-term unemployed or prisoners. Further research is required to explore why most groups of smokers who attended services staffed by nurses were less likely to quit than those who received treatment from other types of advisors.

Keywords: Closed groups; GP; General Practitioner (family doctor); HCA; Health Care Assistant: undertakes routine care tasks such as: temperature and pulse rate, maintaining standards of hygiene, helping with patient mobility and emotional support, under the supervision of qualified nurses (NHS Scotland, 2010); Health disparities; IMD; Index of Multiple Deprivation (England); NCSCT; NHS; NRT; NS-SEC; National Centre for Smoking Cessation & Training; National Health Service (UK); National Statistics Socio-Economic Classification (UK) (in this analysis ‘retired’ were merged with ‘caring for home’ and ‘full time students’ were merged with ‘unclassified’ to differentiate socio-economic status from age); Nicotine Replacement Therapy; Open groups; PCT; Primary Care Trust (English health administration areas — there are ~150 PCTs serving a population of 56million people); SES; SSS; Smoking cessation; Socio-economic status; Specialist; Stop Smoking Services.