Elsevier

Addictive Behaviors

Volume 38, Issue 11, November 2013, Pages 2787-2796
Addictive Behaviors

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

https://doi.org/10.1016/j.addbeh.2013.07.010Get rights and content
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Highlights

  • Higher socio-economic status was associated with quitting smoking

  • Open groups were usually the most effective intervention type

  • Open groups were not more effective for prisoners and the unemployed

  • After controls, closed groups were not more effective than one to one support

  • Generally nurse advisors were less successful than other advisor types

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.

Abbreviations

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)
IMD
Index of Multiple Deprivation (England)
NCSCT
National Centre for Smoking Cessation & Training
NHS
National Health Service (UK)
NRT
Nicotine Replacement Therapy
NS-SEC
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)
PCT
Primary Care Trust (English health administration areas — there are ~ 150 PCTs serving a population of 56 million people)
SES
Socio-economic status
SSS
Stop Smoking Services

Keywords

Smoking cessation
Socio-economic status
Health disparities
Open groups
Closed groups
Specialist

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