Longer term outcomes & Stop smoking services

Study TeamStop Smoking Service Sites Linda Bauld Fiona Dobbie Rosemary Hiscock Jo Leonardi – Bee Andy McEwen Paul Aveyard Tim Coleman Carol Anne Greenan Leonie Brose Maureen Kennedy Hayden McRobbie Susan Murray Richard Purves Lion Shahab Sarah Simms Advisory group chair: Ann McNeill Bristol County Durham and Darlington Hull and East Riding Leicestershire County and Rutland Oldham Northamptonshire North East and North Lincolnshire Rotherham South East Essex

Acknowledgements This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 09/161/101) and will be published in full in Health Technology Assessment. This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 09/161/101) and will be published in full in Health Technology Assessment. The views and opinions expressed are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. The views and opinions expressed are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. Thanks to the UK Centre for Tobacco and Alcohol Studies, North51, National Centre for Smoking Cessation and Training, participating Stop Smoking Services, PCRN/CLRN, TNS- BMRB. Thanks to the UK Centre for Tobacco and Alcohol Studies, North51, National Centre for Smoking Cessation and Training, participating Stop Smoking Services, PCRN/CLRN, TNS- BMRB.

Outline Background to the study – Evaluating Longer-term Outcomes from NHS Stop Smoking Services (ELONS) Overall results: 4 and 52 week quit rates 4 and 52 weeks quit rates by key variables ELONS compared with previous studies Impact

Aim and objectives The study aimed to: The study aimed to: explore the factors that determine longer term abstinence from smoking following intervention by NHS stop smoking services. Objectives were to: examine the effectiveness of NHS stop smoking services by PCT and intervention type using routine data explore the reach of services by identifying what proportion of the local population set a quit date with services using routine data describe the factors that determine longer term abstinence from smoking or relapse to smoking examine the relationship between client characteristics, adherence to treatment, intervention type received, and longer term abstinence

Study design Observational study Observational study Part 1 - Secondary analysis of routine data collected by SSSs using the North51 database – completed Spring 2012 Part 1 - Secondary analysis of routine data collected by SSSs using the North51 database – completed Spring 2012 Part 2 - Prospective study of clients from 9 Stop Smoking Services in England examining different types of behavioural support: Part 2 - Prospective study of clients from 9 Stop Smoking Services in England examining different types of behavioural support: closed groups closed groups rolling groups rolling groups one to one drop-in one to one drop-in one to one sessions with a specialist advisor one to one sessions with a specialist advisor one to one sessions with a sessional advisor (i.e. practice nurse or pharmacist) one to one sessions with a sessional advisor (i.e. practice nurse or pharmacist)

Prospective study Baseline Stop Smoking Advisors collected additional monitoring data and saliva samples (at or around the time a quit date was set ) 4 weeks post quit date via N51 QuitManager database Self reported abstinence and CO measurement Client satisfaction survey Record of pharmacotherapy taken and session attendance 52 weeks post quit date via TNS-BMRB Self reported abstinence and CO measurement (CO measurements taken during a home visit for those who report they have quit) Collection of saliva samples

Prospective study analysis Final achieved sample was 3075 Final achieved sample was 3075 Weights created to improve the representativeness of the data (for the nine study sites) Weights created to improve the representativeness of the data (for the nine study sites) 2 stages of analysis: 2 stages of analysis: Bivariate descriptive analysis Bivariate descriptive analysis Multivariate logistic regression Multivariate logistic regression

CO validated quit rates (n=3057) RawWeighted* 4 weeks44%41% (35% to 48%) 52 weeks9%8% (7% to 9%) * Weighted for behavioural support, location, age, gender, SES.

Weighted means Multivariate regression Not quit Quit Odds ratio (95% CI) Age (p<.05) 43 years47 years1.011 (1.002 to 1.020) WHO_5 Wellbeing ( p<.05) 53/100 59/ ( to 1.013) Gender N% quit Female (6.0 to 8.5)1.0 Male (6.8 to 10.2)1.2 (0.9 to 1.5) SES More affluent (8.4 to 12.7)1.4 (1.1 to 1.9) More disadvantaged (5.0 to 7.7)1.0 Participant characteristics

Smoking-related characteristics N% quit Multivariate OR (95% CI) Dependence other (7.7 to 12.4)1.5 (1.1 to 1.9) highly dependent (2.9 to 8.2)1.0 Determination to quit other (4.3 to 8.0)NS very/extremely determined (6.7 to 9.5) Support for quit attempt from spouse/partner other (4.5 to 8.5)1.0 support from spouse/partner (7.4 to 11.3)1.4 (1.0 to 1.8) Friends and family other (2.6 to 4.4)1.0 half or fewer smoke (7.5 to 10.9)2.0 (1.4 to 2.9)

Service and timing N% quit Multivariate OR (95% CI) Behavioural support group specialist (10.5 to 13.8)3.4 (1.7 to 6.7) drop in specialist (5.1 to 11.0)1.7 (0.9 to 3.5) one to one specialist (7.6 to 13.7)2.3 (1.2 to 4.6) GP practice or pharmacy (2.8 to 9.3)1.0 other or unknown 21.7 Not available2.3 (0.5 to 11.6) Quit date other months (5.2 to 9.4)1.2 (0.8 to 1.7) Summer- July, Aug (4.4 to 8.9)1.0 back to school- Sept, Oct (6.4 to 11.7)1.2 (0.9 to 1.6) New Year- Jan, Feb (5.1 to 29.6)1.7 (1.0 to 2.9) Medication in week 1 Varenicline not recorded (4.9 to 7.7)1.0 took varenicline (7.2 to 13.8)1.7 (1.3 to 2.3)

Comparison with previous studies

Comparison with monitoring: UK

Impact 724,247 quit attempts with services in England 724,247 quit attempts with services in England April 2012 to March 2013 April 2012 to March ,872 quit at 4 weeks (265,140 CO validated) 373,872 quit at 4 weeks (265,140 CO validated) 55,767 estimated quit at 12 months from ELONS data 55,767 estimated quit at 12 months from ELONS data 879,458 quit attempts with services across the UK 879,458 quit attempts with services across the UK April 2012 to March 2013 April 2012 to March ,718 estimated quit at 12 months if we assume similar outcomes to ELONS 67,718 estimated quit at 12 months if we assume similar outcomes to ELONS

Impact Best estimates suggest that the lifetime risk of relapse to smoking after one year is 35% Best estimates suggest that the lifetime risk of relapse to smoking after one year is 35% On this basis if we use the ELONS results, around 44,000 adults in England who used the services in 2012/2013 stopped smoking for good. On this basis if we use the ELONS results, around 44,000 adults in England who used the services in 2012/2013 stopped smoking for good. This means many premature deaths from smoking-related diseases were prevented. This means many premature deaths from smoking-related diseases were prevented.

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