Impact of specialist and primary care stop smoking support on socio‐economic inequalities in cessation in the United Kingdom: a systematic review and national equity analysis

Smith, Chery; Hill, Sarah; Amos, Amanda

doi:10.1111/add.14760

Cited by 19 publications

(18 citation statements)

References 36 publications

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“…To help reduce inequalities, campaigns should be developed and targeted to be particularly effective for smokers with mental health problems. Stop smoking services used to be available across England and the services were able to help reduce inequalities [42]; however, services have been reduced considerably in recent years [43]. Evidence-based support in the form of medication and behavioural support provided by trained practitioners needs to be available for all those who need them [44].…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews indicate that, with the exception of stop smoking services that can compensate for lower quit rates in disadvantaged populations through increased reach, individual-level behavioural and pharmacological smoking cessation interventions often do not reduce socio-economic inequalities in smoking [42,47]. Evidence on interventions that help reduce inequalities related to mental health is sparse as is evidence on the effectiveness of e-cigarettes for smoking cessation or reduction among smokers with mental health problems.…”

Section: Discussionmentioning

confidence: 99%

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Mental health and smoking cessation—a population survey in England

Brose

Brown

McNeill

2020

BMC Med

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Background: To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. Methods: Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. Results: Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/ behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/ behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). Conclusions: Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mental health and smoking cessation—a population survey in England

Brose

Brown

McNeill

2020

BMC Med

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“…They found that NHS stop smoking services in the UK achieve equitable effects, and services which speci cally targeted low-SES smokers achieved a higher uptake among low-SES smokers, which may attenuate the inequality gradient that exists for smoking cessation (14). This was supported in a more recent systematic review that focused solely on the UK which found that low-SES smokers were more likely to receive GP brief intervention or referral, but low-SES smokers were less successful at smoking abstinence (29). However, both reviews use a much broader de nition of SES compared to this study and the other two previously discussed systematic reviews (65,66) by including education level and occupation within the description of SES.…”

Section: Comparison To Existing Literaturementioning

confidence: 93%

“…Few data from existing systematic reviews of the impact of smoking cessation interventions on health inequalities come from randomised controlled trials [RCTs] (5/30 studies in Smith et al, (29) and 6/29 studies in Brown et al, (30)). We focus on RCTs as a source of high-quality evidence to assess if there are inequalities in outcomes of smoking cessation interventions delivered in primary care.…”

Section: Introductionmentioning

confidence: 99%

Examining inequality in trials of smoking cessation interventions delivered in primary care: critique and reanalysis of Cochrane reviews

Birch

Dambha‐Miller

Griffin

et al. 2020

Preprint

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Background Tobacco smoking is a major cause of chronic disease and premature mortality. Its effects are socially patterned. Observational studies show that low socioeconomic status [SES] is associated with higher smoking prevalence and lower cessation rates. Interventions in primary care may improve or exacerbate health inequalities depending on socioeconomic patterning of access and uptake. Data on the impact of trials of smoking cessation interventions delivered in primary care on health inequalities by SES have not been synthesised. Aims To examine the impact of smoking cessation interventions delivered in primary care on inequalities in health by socioeconomic status. Methods We searched the Cochrane database of systematic reviews from inception until June 2019. We included reviews of trials of smoking cessation interventions delivered in primary care and published in English. Findings We identified eight Cochrane reviews (413 studies). Eighty five studies included an intervention delivered in primary care. Interventions were: behavioural, (very) brief advice, and pharmacological (including nicotine replacement therapy). Full texts were accessed for 70 studies; 17 reported an SES measure. Two studies targeted low-SES groups. There was heterogeneity in SES measures used across the studies, which included household income, occupational level and social class. Three studies analysed SES as a predictor of effectiveness of the smoking cessation intervention; none found effectiveness differed by SES. Implications This summary and critique of Cochrane reviews demonstrates that trials of smoking cessation interventions delivered in primary care are not designed to allow analysis of effects by measures of SES. Studies rarely reported SES of participants at baseline and hardly ever as a predictor of smoking cessation. Our work highlights the need for routine reporting of SES amongst trials and greater consensus in included measures. Consistent reporting of a core set of SES indicators will enable testing of similarities between trial groups and differential effects by SES.

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“…One argument frequently put forward against individual-level interventions is that they are inequitable, with greater success among those of more advantaged socio-economic status (SES) [2]. This review by Smith et al [3] provides useful counter-evidence by highlighting the role that smoking cessation support delivered at the individual-level can play alongside population-level interventions to achieve a range of equity-positive outcomes in disadvantaged groups, namely increased access to and provision of services. An ambitious public health agenda should not place individual and population-based approaches in false competition [4], but should promote a comprehensive agenda and action at multiple levels of the system.…”

mentioning

confidence: 99%