title: 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)).
  
  
  CONCLUSIONS
  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.
authors: Department for Health, University of Bath, BA2 7AY, UK. r.hiscock@bath.ac.uk
authors: Rosemary
authors: R
authors: Hiscock
authors: Susan
authors: S
authors: Murray
authors: Leonie S
authors: LS
authors: Brose
authors: Andy
authors: A
authors: McEwen
authors: Jo Leonardi
authors: JL
authors: Bee
authors: Fiona
authors: F
authors: Dobbie
authors: Linda
authors: L
authors: Bauld
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D004739:England; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D012923:Social Class; D016896:Treatment Outcome; D055815:Young Adult
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
references: Nicotine Tob Res. 2011 Feb;13(2):135-45
references: 21196451
references: Fam Pract. 2010 Jun;27(3):303-11
references: 20237109
references: Presse Med. 1998 Dec 19;27(40):2179-84
references: 9922797
references: Br J Cancer Suppl. 1996 Sep;29:S78-80
references: 8782805
references: Prev Med. 2004 Nov;39(5):919-26
references: 15475024
references: J Public Health (Oxf). 2004 Mar;26(1):13-8
references: 15044567
references: Nicotine Tob Res. 2012 Jun;14(6):703-10
references: 22193573
references: Nicotine Tob Res. 2010 Jul;12(7):742-7
references: 20478957
references: Addiction. 2009 Feb;104(2):308-16
references: 19149828
references: N Z Med J. 2000 Oct 27;113(1120):433-5
references: 11194762
references: Addiction. 2005 Apr;100 Suppl 2:36-45
references: 15755261
references: Lancet. 2006 Jul 29;368(9533):367-70
references: 16876664
references: Addiction. 1994 Nov;89(11):1371-6
references: 7841845
references: Ann Behav Med. 2011 Feb;41(1):59-70
references: 20936389
references: Int J Drug Policy. 2009 May;20(3):230-6
references: 19110409
references: Addict Behav. 1995 Nov-Dec;20(6):765-72
references: 8820529
references: Addiction. 2005 Mar;100(3):299-303
references: 15733243
references: Br J Gen Pract. 2008 Feb;58(547):118-24
references: 18307856
references: Cochrane Database Syst Rev. 2000;(2):CD000251
references: 10796706
references: MMWR Morb Mortal Wkly Rep. 2009 Nov 13;58(44):1227-32
references: 19910909
references: Prev Med. 2001 Mar;32(3):218-23
references: 11277678
references: Addiction. 2005 Apr;100 Suppl 2:70-83
references: 15844290
references: N Engl J Med. 2008 Jun 5;358(23):2468-81
references: 18525043
references: Addiction. 2005 Apr;100 Suppl 2:59-69
references: 15755262
references: Prev Med. 1986 Nov;15(6):606-13
references: 3797392
references: Health Serv Res. 2008 Dec;43(6):2183-200
references: 18671752
references: Am J Public Health. 2004 Nov;94(11):1965-71
references: 15514238
references: Rev Mal Respir. 2007 Feb;24(2):171-82
references: 17347604
references: J Public Health (Oxf). 2011 Mar;33(1):39-47
references: 21178184
references: Gen Hosp Psychiatry. 2001 May-Jun;23(3):138-44
references: 11427246
references: J Subst Abuse Treat. 2011 Jan;40(1):3-17
references: 20832971
references: Br J Addict. 1989 Jun;84(6):591-8
references: 2752191
references: J Multidiscip Healthc. 2010 Aug 19;3:143-53
references: 21197363
references: Ann N Y Acad Sci. 2012 Feb;1248:107-23
references: 22092035
references: Addiction. 2009 Aug;104(8):1403-10
references: 19549267
references: Nicotine Tob Res. 2010 Oct;12 Suppl:S20-33
references: 20889477
references: Ann Appl Stat. 2011 Jun;5(2A):605-627
references: 21857889
references: Thorax. 2011 Oct;66(10):924-6
references: 21709164