Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates.
Design Observational prospective cohort study.
Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database.
Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits.
Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff.
Main outcome measures 6 months of continuous abstinence, response rate: 80%.
Results Continuous abstinence of the 16 377 responders was 34% (of all 20 588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable ‘format’ stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63).
Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.
- smoking cessation intervention
- health disparities
- health inequalities
- nationwide database
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