1. Longer term outcomes & Stop smoking services
See acknowledgement slide at the end for detail on CIs, project team, disclaimer etc.

2. Stop Smoking Service Sites Bristol County Durham and Darlington
Study Team
Stop 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
Do you want titles added?
Do you want members of the advisory group added also?
If alphabetical should Paul appear above Leonie??

3. 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.
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.
Note I’m not sure this is in line with NIHR guidance see relevant text copied from guidance document below:
4.4. Presentations
Researchers can include the NIHR logotype on presentations about NIHR-funded research projects or awards, but not in the top right-hand corner. The NIHR logotype must be positioned bottom right, accompanied by a funding acknowledgement and disclaimer.
If another NHS organisation logo is used, there are two options:
1. Use the NIHR logotype positioned bottom right on the opening slide, with a relationship statement giving details of the NIHR funding or award, and use the NHS organisation logo on all the other slides.
2. Use the NHS organisation logo on all the slides, but add a funding statement giving details of the NIHR funding or award on the opening slide.
4. The second slide on study design (slide 5 in your version) needs to be in larger font/may require some cutting of words

4. 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

5. Aim and objectives The study aimed to: Objectives were 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

6. Study design Observational study
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:
closed groups
rolling groups
one to one drop-in
one to one sessions with a specialist advisor
one to one sessions with a sessional advisor (i.e. practice nurse or pharmacist)

7. 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
Baseline: Stop Smoking Advisors collected additional monitoring data and saliva samples (at or around the time a quit date was set): Linda I've kept this vague because there were issues around when clients were recruited to ELONS. We briefed that it should be when a quit date is set but this didn’t work for some sites – remember some site were doing strange things with quite dates (ie not setting them or changing them etc) Also the issue with the time it took to obtain consent meant some site recruited clients before the set a quit date

8. Prospective study analysis
Final achieved sample was 3075
Weights created to improve the representativeness of the data (for the nine study sites)
2 stages of analysis:
Bivariate descriptive analysis
Multivariate logistic regression
Weights were created because we achieved around 5% of the eligible number of clients who could have participated from the 9 SSS who recruited to ELONS. This level of non response means the raw data is not representative. To create the weights we used the N51 data on all clients (from the 9 sites who recruited for ELONS only) over the study recruitment period March March 2013
Data presented today will be weighed data unless otherwise specified
2 stages of analysis:
Bivariate descriptive analysis - descriptive frequencies, crosstabs and chi square tests to explore the data and generate ideas for further multivariate analysis
Multivariate logistic regression – to explore the relationship between quit attempt outcomes and the wide range of client and service characteristics that we collected (e.g. behavioural support, socio economic status, gender, age, level of support from family, friends)

9. CO validated quit rates (n=3057)
Raw
Weighted*
4 weeks
44%
41% (35% to 48%)
52 weeks 9%
8% (7% to 9%) *
Weighted for behavioural support, location, age, gender, SES.

10. Participant characteristics Multivariate regression
Weighted means
Multivariate regression
Not quit
Quit
Odds ratio (95% CI)
Age (p<.05)
 43 years
47 years
1.011 (1.002 to 1.020)
WHO_5 Wellbeing (p<.05)
53/100
59/100
1.007 ( to 1.013)
Gender N %
% quit
Female
1710
55.9
7.2 (6.0 to 8.5)
1.0
Male
1347
44.1
8.4 (6.8 to 10.2)
1.2 (0.9 to 1.5)
SES
More affluent
1123
36.7
10.3 (8.4 to 12.7)
1.4 (1.1 to 1.9)
More disadvantaged
1934
63.3
6.2 (5.0 to 7.7)

11. Smoking-related characteristicsN %
% quit
Multivariate OR
(95% CI)
Dependence
other
1681
55.0
9.8 (7.7 to 12.4)
1.5 (1.1 to 1.9)
highly dependent
1376
45.0
4.9 (2.9 to 8.2)
1.0
Determination to quit
328
10.7
5.9 (4.3 to 8.0) NS
very/extremely determined
2729
89.3
8.0 (6.7 to 9.5)
Support for quit attempt from spouse/partner 
1507
49.3
6.2 (4.5 to 8.5)
support from spouse/partner
1550
50.7
9.2 (7.4 to 11.3)
1.4 (1.0 to 1.8)
Friends and family
771
25.2
3.4 (2.6 to 4.4)
half or fewer smoke
2286
74.8
9.1 (7.5 to 10.9)
2.0 (1.4 to 2.9)

12. Service and timing N % % quit Multivariate OR (95% CI)N %
% quit
Multivariate OR (95% CI)
Behavioural support
group specialist
652
21.3
12.1 (10.5 to 13.8)
3.4 (1.7 to 6.7)
drop in specialist
887
29.0
7.6 (5.1 to 11.0)
1.7 (0.9 to 3.5)
one to one specialist
1131
37.0
10.2 (7.6 to 13.7)
2.3 (1.2 to 4.6)
GP practice or pharmacy
366
12.0
5.1 (2.8 to 9.3)
1.0
other or unknown 21 .7
Not available
2.3 (0.5 to 11.6)
Quit date
other months
767
25.1
7.0 (5.2 to 9.4)
1.2 (0.8 to 1.7)
Summer- July, Aug
970
31.7
6.3 (4.4 to 8.9)
back to school- Sept, Oct
1128
36.9
8.7 (6.4 to 11.7)
1.2 (0.9 to 1.6)
New Year- Jan, Feb
192
6.3
13.1 (5.1 to 29.6)
1.7 (1.0 to 2.9)
Medication in week 1
Varenicline not recorded
1661
54.3
6.2 (4.9 to 7.7)
took varenicline
1396
45.7
10.0 (7.2 to 13.8)
1.7 (1.3 to 2.3)

13. Comparison with previous studies

14. Comparison with monitoring: UK
Survival/relapse curves
Data collated from published data April March (except 2012 data from Scotland and 2011/12 data for NI 52 week follow up)
Only self report data is collected by the devolved services rather than CO validated
No published data for England on 52 weeks – hence need for ELONS

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

16. Impact
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, then smoking cessation services in the UK prevented just over 44,000 premature deaths from smoking in the UK in 2012/2013.
That’s more than the entire population of towns such as Dover and Bury St Edmunds.

17. Thank you 17