What makes for an effective stop-smoking service?

Abstract

Background The English network of stop-smoking services (SSSs) is among the best-value life-preserving clinical intervention in the UK NHS and is internationally renowned. However, success varies considerably across services, making it important to examine the factors that influence their effectiveness. Methods Data from 126 890 treatment episodes in 24 SSSs in 2009e10 were used to assess the association between intervention characteristics and success rates, adjusting for key smoker characteristics. Treatment characteristics examined were setting (eg, primary care, specialist clinics, pharmacy), type of support (eg, group, one-to-one) and medication (eg, varenicline, single nicotine replacement therapy (NRT), combination of two or more forms of NRT). The main outcome measure was abstinence from smoking 4 weeks after the target quit date, verified by carbon monoxide concentration in expired air. Results There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99). Conclusions Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options.

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

“…There was no evidence of differential effects by gender as found in previous studies [16,17]. As in previous findings on effectiveness [31] and efficacy [32], pharmacotherapy use in this clinic mostly predicted higher abstinence than no medication. This included the antidepressant bupropion for which a recent Cochrane review found only weak evidence of efficacy in smokers with past depression and no clear evidence in smokers with current depression [33].…”

Personalised information for improving the uptake of smoking cessation programs

“…Smokers frequently attempt quitting several times unsuccessfully before achieving long-term abstinence (9,10). Smokers who seek support in quitting are much more likely to quit than those who try to quit alone, and the most effective aid for achieving smoking cessation is medication (e.g., nicotine replacement therapy, or varenicline) coupled with tailored behavioral support from specialist stop smoking services, like the National Health Service Stop Smoking Services (NHS SSS) in the UK (11)(12)(13).…”

Development of StopAdvisor

“…On the basis of these associations, other direct evidence on the effectiveness of particular techniques (e.g. [24,25]), and PRIME theory, a core set of BCTs was selected by the study team and linked together in a variety of ways consistent with their use in the evidence-based and successful NHS Stop Smoking Services. This approach is based on an expert Stop Smoking Advisor being both a ready source of information that smokers trying to stop may want or need, and a guide to help the smoker through the process of stopping, using a structured quit plan.…”