Impact of the NHS stop smoking services on smoking prevalence in England: a simulation modelling evaluation

Abstract

BackgroundThe English National Health Service (NHS) Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England.MethodsA discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001–2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS.ResultsSmoking prevalence was reduced by 10.8% in absolute terms during 2001–2016 in England, and 15.1% of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11% could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.6% in 2001, to as high as 19.3% in 2011, and then reduced to 8.4% in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1%vs11.7%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards.ConclusionsApproximately 15% of the percentage point reduction in smoking prevalence during 2001–2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services.

Reduction in smoking prevalence and e‐cigarettes: an English exception?

“…We also note that the impact of cigarette-oriented policies may have been greater than we estimated in the post-vaping period, precisely because of the impact of e-cigarettes. E-cigarettes are commonly found to be a substitute for cigarettes [3][4][5][6], and thus may have increased the impact of cigarette-oriented policies by providing smokers an alternative.…”

“…(a) the partial tobacco point of sale display ban introduced in April 2012 [2]; and (b) the launch of Stoptober in 2012, a health awareness campaign by Public Health England that is part of the broader One You campaign aimed at helping people to quit smoking. For the 2017 campaign, 16% of smokers reported a quit attempt and 8% were still smoke-free at the end of October [3]; (c) the introduction of standardized packaging of tobacco products in May 2016, the second nation in the world after Australia; (d) the maintenance of a robust tax regime with high duty rates (5% above inflation in 2012 and then after 2% per year) plus in 2016 a 5% tax on hand-rolled tobacco, not to mention the 10% one in 2011) [4]; and (e) a most convenient service for assisting cessation for quitting, the NHS Stop Smoking Services was the first such service in the world, providing free at the point of use treatment [5].Secondly, the hypothetical effect of e-cigarettes from an indirect method of simulation modelling in the English setting can hardly be generalized: according to the World Health Organization (WHO) trends report 2019 concerning tobacco use, the European Region has the highest levels of tobacco-use prevalence (more than 29%) despite high rates of e-cigarette use, as in England, where smoking prevalence is 14% [6]. France is one example of these countries where tobacco control measures are flawed (smoking prevalence was 35% daily 25% in 2018 and is plateauing) despite most experts and the Ministry of Health promoting e-cigarettes as a tool for cessation [7].…”

“…(a) the partial tobacco point of sale display ban introduced in April 2012 [2]; and (b) the launch of Stoptober in 2012, a health awareness campaign by Public Health England that is part of the broader One You campaign aimed at helping people to quit smoking. For the 2017 campaign, 16% of smokers reported a quit attempt and 8% were still smoke-free at the end of October [3]; (c) the introduction of standardized packaging of tobacco products in May 2016, the second nation in the world after Australia; (d) the maintenance of a robust tax regime with high duty rates (5% above inflation in 2012 and then after 2% per year) plus in 2016 a 5% tax on hand-rolled tobacco, not to mention the 10% one in 2011) [4]; and (e) a most convenient service for assisting cessation for quitting, the NHS Stop Smoking Services was the first such service in the world, providing free at the point of use treatment [5].…”