The effectiveness of smoking cessation interventions to reduce the rates of premature death in disadvantaged areas through proactive case finding, retention and access to services

This report outlines findings from a systematic review of the evidence concerning the
effectiveness of smoking cessation interventions that reduce the rates of premature
death in disadvantaged areas through proactive case finding, retention and access to
services. This includes: assessing the evidence on interventions aimed at finding and
then supporting adults living in disadvantaged areas who are at higher than average
risk of premature death; and assessing the evidence on interventions aimed at
providing – and improving access to – services for adults living in disadvantaged
areas, with a higher than average risk of premature death. The review focuses not
just on smokers living in disadvantaged areas but also disadvantaged and manual
groups more broadly, including pregnant women.
Methodology: The review was conducted in four stages: search, screening, critical
appraisal and synthesis. UK evidence was examined first, followed by international
studies. A total of 7,842 titles and abstracts were screened. Full paper copies of 46
UK studies and 44 international studies were obtained. 24 UK studies and 24
international studies were data extracted and quality assessed in the final review.
Results: Limited evidence was identified to address the main research questions
posed by the review. The quality of evidence was mixed and studies often included
poorly specified outcomes.
Finding and supporting adults
Evidence was identified that suggests a number of interventions may be effective in
identifying smokers. Some of these may also be effective in supporting smokers to
quit once they have been reached, although this evidence is more limited. Effective
methods for identifying and/or supporting adults include: the Quality Outcomes
Framework (QOF) element of the 2004 GP contract in the UK, the use of primary
care records to contact smokers and provide access to cessation services, the use of
health equity audit methods to determine whether NHS stop smoking services are
reaching disadvantaged smokers, social marketing approaches, tailoring
interventions to fit the needs of disadvantaged groups, and combining advice or
treatment to stop smoking with other interventions such as cervical screening.
However, a weakness of some of the studies identified was that although they
identified promising approaches to finding and then supporting smokers, not all of
them focussed specifically on disadvantaged groups.
Providing and improving access to services
Disadvantaged smokers face a number of barriers to accessing services including
fear of failure, fear of being judged and lack of knowledge. Pregnant women,
particularly disadvantaged pregnant smokers, also experience a number of barriers
to seeking support to quit. Evidence suggests that there are a number of effective
ways of improving the accessibility of cessation interventions. Training pharmacists
and dental professionals to deliver cessation can make effective treatment available
to larger numbers of smokers. Workplace interventions can also be successful with
manual groups. Some limited evidence also exists that including a drop in or rolling
group element to smoking treatment may improve access and outcomes for some
smokers. Finally, evidence exists that a number of different forms of incentive
schemes, including access to free NRT, can encourage smokers to make a quit
attempt.
Review findings point to the need for further research in a number of areas, in
particular the need to test promising approaches with disadvantaged groups rather
than the wider population.