Assessing the impact of smoking cessation services on reducing health inequalities in England: observational study
- 1Social and Policy Sciences, University of Bath, UK
- 2School for Health, University of Bath, UK
- 3RUHBC, University of Edinburgh, UK
- Professor Ken Judge, School for Health, University of Bath, Bath BA2 7AY, UK;
- Received 4 May 2007
- Accepted 15 August 2007
Objective: NHS stop smoking services are expected to play a key part in achieving the infant mortality and life expectancy health inequality targets in England by reducing smoking prevalence in deprived areas. This paper assesses the extent to which services have made a contribution to reducing inequalities in smoking between 2003–4 and 2005–6.
Methods: Synthetic estimates of baseline smoking prevalence data were compared with national monitoring data about the numbers of smokers in receipt of services and the proportion who self report quitting at four weeks. The social distribution of service recipients and quitters was compared with estimates of smoking prevalence to assess impact on inequalities. Comparisons were made between officially designated disadvantaged areas (the Spearhead Group) and others.
Results: Short-term cessation rates were lower in disadvantaged areas (52.6%) than elsewhere (57.9%) (p<0.001), but the proportion of smokers being treated was higher (16.7% compared with 13.4%) (p<0.001). The net effect was that a higher proportion of smokers in the most disadvantaged areas reported success (8.8%) than in more advantaged areas (7.8%) (p<0.001). Using the evidence-based assumption that three-quarters of short-term quitters will relapse within one year, the absolute and relative rate gaps in smoking prevalence between Spearhead areas and others are estimated to fall by small but statistically significant amounts from 5.2 and 1.215 (CIs: 1.216 to 1.213) to 5.0 and 1.212 (CIs: 1.213 to 1.210) between 2003–4 and 2005–6.
Conclusion: NHS stop smoking services have probably made a modest contribution to reducing inequalities in smoking prevalence. To achieve government targets, however, requires both the development of more innovative cessation interventions for the most addicted smokers and action to ensure that other aspects of tobacco control policy make a larger contribution to inequality goals.
Funding: This study was funded by the European Union Commission as part of the Eurothine project coordinated by Erasmus MC, Rotterdam. The EU had no direct involvement in the study design, collection, analysis or interpretation of data and no role in writing this article.
Conflict of interest: none.
Contributors: The study was designed by LB, KJ and SP, and this group also formed the writing committee. KJ coordinated the study and is the principal guarantor of this paper.
- absolute rate gaps
- cumulative outcome
- health action zones
- Index of Multiple Deprivation
- nicotine replacement therapy
- relative rate ratios