What makes for an effective stop-smoking service?
- Leonie S Brose1,
- Robert West2,
- Máirtín S McDermott1,
- Jennifer A Fidler2,
- Emma Croghan3,
- Andy McEwen2
- 1NHS Centre for Smoking Cessation and Training (NCSCT), University College London, London, UK
- 2Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- 3Department of Health, London, UK
- Correspondence to Dr Leonie S Brose, NHS Centre for Smoking Cessation and Training (NCSCT), University College London, 1–19 Torrington Place, London WC1E 7HB, UK;
Contributors LSB cleaned and analysed the data, drafted and revised the paper. RW provided the idea for the study, initiated the collaboration with the data provider North51, secured funding for this study, led the design, contributed to the data analysis and revised the draft paper. He is guarantor for this study. MSMcD contributed to the design and data analysis, drafted and revised the paper. JAF contributed to the design and data analysis and revised the draft paper. EC helped to devise the study, secured the data and commented on a draft of the paper. AMcE secured funding for this study and revised the draft paper. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of the article.
- Received 8 February 2011
- Accepted 31 May 2011
- Published Online First 27 June 2011
Background The English network of stop-smoking services (SSSs) is among the best-value life-preserving clinical intervention in the UK NHS and is internationally renowned. However, success varies considerably across services, making it important to examine the factors that influence their effectiveness.
Methods Data from 126 890 treatment episodes in 24 SSSs in 2009–10 were used to assess the association between intervention characteristics and success rates, adjusting for key smoker characteristics. Treatment characteristics examined were setting (eg, primary care, specialist clinics, pharmacy), type of support (eg, group, one-to-one) and medication (eg, varenicline, single nicotine replacement therapy (NRT), combination of two or more forms of NRT). The main outcome measure was abstinence from smoking 4 weeks after the target quit date, verified by carbon monoxide concentration in expired air.
Results There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99).
Conclusions Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options.
- Smoking cessation
- preventive health services
- treatment outcome
- nicotine/*therapeutic use
Funding The study was funded by Cancer Research UK (grant number CR-UK C1417/A7972) and the Department of Health (DOH T336/BSS/M award number 49945).
Competing interests RW undertakes research and consultancy for companies that develop and manufacture smoking cessation medications (Pfizer, J&J, McNeil, GSK, Nabi, Novartis and Sanofi-Aventis). He also has a share of a patent for a novel nicotine delivery device and is a trustee of QUIT, a charity that provides stop smoking support. EC receives royalties from a book on smoking cessation. AMcE receives a personal income from Cancer Research UK via University College London. He has received travel funding, honoraria and consultancy payments from manufacturers of smoking cessation products (Pfizer, J&J, McNeil, GSK, Nabi, Novartis and Sanofi-Aventis). He also receives payment for providing training to smoking cessation specialists, receives royalties from books on smoking cessation and has a share in a patent of a nicotine delivery device.
Ethics approval Joint UCL, UCLH and Royal Free Biomedical research Unit.
Provenance and peer review Not commissioned; externally peer reviewed.