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Neighbourhood deprivation and Stop Smoking Service outcomes

Neighbourhood deprivation and Stop Smoking Service outcomes. Leonie Brose 1 , Volker Behrends 2 1 Addictions, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, KCL 2 Department of Surgery and Cancer, Imperial College. Acknowledgements. Professor Robert West

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Neighbourhood deprivation and Stop Smoking Service outcomes

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  1. Neighbourhood deprivation and Stop Smoking Service outcomes Leonie Brose1, Volker Behrends2 1Addictions, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, KCL 2 Department of Surgery and Cancer, Imperial College

  2. Acknowledgements Professor Robert West Dr Andy McEwen Everyone at the NCSCT who helped with the data provision North51 All service managers who agreed to share data My post is funded by the UK Centre for Tobacco and Alcohol Studies. Funding from the Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (MR/K023195/1).

  3. Social injustice kills • England: Gap in life expectancy 17 years • Other negative effects, unaffordable to ignore Approaches • Universal health care • Address health behaviours • Smoking particular determinant of inequality

  4. Deprivation and smoking • Not less likely to attempt to stop, but attempts less successful e.g. 2, 3 • In stop smoking services (2001-03): ‘Rather than quitting smoking, disadvantaged smokers quit treatment’ 4 1 Office for National Statistics, 2014. 2Kotz et al, 2009. 3 Reid et al, 2010. 4 Hiscock et al, 2011

  5. Questions • To what extent is neighbourhood deprivation associated with • loss to follow-up • success of quit attempts while taking into account other demographic or treatment characteristics? • Can difference in success be explained by loss to follow-up? • Does neighbourhood deprivation add anything above and beyond other indicators of deprivation?

  6. How we measured deprivation • Index of multiple deprivation, IMD • 38 indicators in seven domains • Income • Employment • Health and disability • Education and Training • Barriers to housing & services • Living environment • Crime • Available across England for Lower Super Output Areas • LSOAs: neighbourhoods consisting of about 1500 residents • Other indicators • Occupation (NS-SEC) • Education • IMDs for larger areas, e.g. service

  7. Sample • 555,744 treatment episodes from 2009 to 2012 • Excludes 14% of initial sample: ongoing treatment, telephone support, prisoners, incomplete postcodes • Linked to Index of Multiple Deprivation for neighbourhood (LSOA) using postcode • Split into 10 groups of different levels of deprivation relative to all English LSOAs

  8. Measures – associations? • Deprivation • Index of Multiple Deprivation, 10 groups • Occupation NS-SEC: employed v not employed • Exemption from prescription charges Demographics • Age • Gender • Heaviness of smoking (18%) Outcomes • Loss to 4-week follow-up • Self-reported 4-week success • 4-week CO-validated success rates (lost=no) Intervention • Medication • Type • Setting • First or later attempt with stop smoking service

  9. Medication

  10. Each step from more to less deprivation vs 1-1 vs specialist clinic vs 1st time

  11. Does loss explain differences in success? • Lost usually treated as not successful - Loss to follow-up closely linked to success rates • Only completed episodes (416,436 episodes): • Association success and deprivation only very slightly smaller (OR=1.03, 95% CI: 1.03 to 1.03, p<0.001) • No

  12. Does neighbourhood deprivation add anything to other indicators? • Added individual indicators of deprivation and service-level deprivation to model • All closely related, but • Neighbourhood deprivation remained associated with reduced follow-up and quit success • Unemployment, exemption and service-level deprivation also associated with worse outcomes • Yes

  13. Conclusions • Services continue to support many disadvantaged smokers • Follow-up rates and success rates decrease with deprivation • Some characteristics that are associated with reduced success also associated with deprivation • Additional hurdles to stopping • Do not explain difference in outcomes • Limitations • Data collected prior to 2013 • Repeated recording of the same individual

  14. Some remaining questions • Why? • Background quit rates? • Those returning may need more/different support • What is the full picture on dependence? • What causes difference in medication use across deprivation? • Recording practice pharmacies? Thank you Leonie.brose@kcl.ac.uk

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