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Does poor health and wellbeing affect smoking cessation? Rosemary Hiscock , Fiona Dobbie , Linda Bauld. UKNSCC 12 th -13 th June 2014, London. Outline . Background Definitions of health and wellbeing Health and wellbeing and smoking Health and wellbeing in the ELONS study Results

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does poor health and wellbeing affect smoking cessation rosemary hiscock fiona dobbie linda bauld

Does poor health and wellbeing affect smoking cessation?Rosemary Hiscock, Fiona Dobbie, Linda Bauld

UKNSCC

12th-13thJune 2014, London

outline
Outline
  • Background
    • Definitions of health and wellbeing
    • Health and wellbeing and smoking
  • Health and wellbeing in the ELONS study
  • Results
    • Wellbeing basic characteristics
    • Regression analysis
      • Do health and wellbeing at baseline predict quitting 1 year later?
      • What predicts wellbeing?
  • Discussion
health wellbeing
Health & wellbeing

Health: ‘a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity’

(WHO 1946)

Wellbeing: ‘positive mental state enhanced and supported by various social, environmental and psychological factors’ (See DEFRA, 2007)

Wellbeing over TIME:

More than just momentary mood

Builds up overtime i.e. resilience

dimensions of wellbeing
Dimensions of wellbeing

Subjective

Objective

internal – need to talk to /observe person

Conditions for a good life

dimensions of wellbeing1
Dimensions of wellbeing

Physical health

Socioeconomic status

Subjective

Objective

internal – need to talk to/observe person

Conditions for a good life

dimensions of wellbeing2
Dimensions of wellbeing

Hedonic

Emotions e.g are you content?

Physical health

Socioeconomic status

Subjective

Objective

Conditions for a good life

internal – need to talk to/observe person

Eudemonic

Interests e.g. are you bored?

dimensions of wellbeing3
Dimensions of wellbeing

Hedonic

Emotions e.g are you content?

Physical health

Socioeconomic status

Subjective

Objective

internal – need to talk to/observe person

Conditions for a good life

Eudemonic

Interests e.g. are you bored?

who 5 wellbeing index
WHO_5 wellbeing Index
  • Over the last two weeks:
    • I have felt cheerful and in good spirits
    • I have felt calm and relaxed
    • I have felt active and vigorous
    • I woke up feeling fresh and rested
    • My daily life has been filled with things that interest me
  • Response scale
    • All of the time=5,
    • Most of the time=4
    • More than half the time=3
    • Less than half the time =2
    • Some of the time=1
    • At no time=0
medical conditions smoking
Medical conditions & smoking

Cancer (90% lung cancers)

Heart disease

Circulatory disease (stroke)

Respiratory disease (COPD, exacerbates athsma)

Infertility and impotence

http://www.nhs.uk/chq/Pages/2344.aspx?CategoryID=53

wellbeing and smoking
Wellbeing and smoking
  • Unclear whether tobacco control measures aimed at smoking reduction improve wellbeing (satisfaction)
    • (Beard et al 2014, Gruber & Mulleinathan 2002, Odermatt & Stutzer 2012, Bordeur 2013)
  • Quitting smoking associated with
    • Increased quality of life & positive affect
    • Decreased stress, depression & anxiety
    • (Metaanalysis: Taylor, McNeill et al 2014)
  • Quitting smoking associated with increased happiness
    • (Shahab & West 2009, 2012)
  • Psychological distress associated with failing to quit
    • (Lawrence et al 2011)
elons study
ELONS study
  • 3057 smokers setting a quit date at one of nine English NHS Stop Smoking Services (SSS)
  • Enhanced monitoring data collected at baseline included WHO_5 Wellbeing Index, medical conditions
  • CO validated abstinence assessed
    • @4 weeks by SSS advisor
    • @12 months by BMRB (market research company)
medical conditions
Medical conditions

Any medical condition

Heart, blood & circulation

Respiratory & lungs

Mental illness

Other condition

wellbeing scale
Wellbeing scale
  • Derived scoring
    • Continuous: Sum the scores for each item and multiply by 4.
    • Case:
      • Concerning level of wellbeing: if score<13 or any item scores 0 to 1
      • Good level of wellbeing
    • Categorised wellbeing score
      • 0 to 20
      • 21 to 40
      • 41 to 60
      • 61 to 80
mental conditions vs wellbeing
Mental conditions vs wellbeing

Mental condition OR

Wellbeing B

Models controlling for location and time of year

mean wellbeing 53 52 to 54
Mean* wellbeing 53 (52 to 54)

Mean* weighted for age, gender, SES, behavioural support and takes into account cluster by location

individual wellbeing items
Individual wellbeing items
  • 4 week quit after controls
    • I have felt calm and relaxed
    • My daily life has been filled with things that interest me
  • 52 week quit after controls
    • I have felt cheerful and in good spirits
predictors of wellbeing
Predictors of wellbeing

0 50 100

Number points increased:

implications
Implications
  • Feelings of wellbeing predict quitting 1 year later
  • Specialist services treat more clients with mental health issues than level 2s
    • However feelings of wellbeing more important than the presence/absence of a medical condition
  • Clients with higher wellbeing access groups
implications 2
Implications (2)
  • Predictors of wellbeing often similar to predictors of quitting
    • Services should perhaps assess clients wellbeing and see if they can improve wellbeing BEFORE client makes a quit attempt e.g.
      • reducing dependence,
      • improving support
      • treatment for mental health issues
caveats
Caveats
  • Differences between advisors and locations suggests different modes of assessment may affect wellbeing
  • Ethnic differences
  • Possible translation issues e.g. ‘vigorous’ ‘some of the time’?
  • Those with extremely high wellbeing not so likely to quit e.g. answered ‘all of the time’
    • Social deception?
    • Unable to deal with challenges?
conclusions
Conclusions

Wellbeing at baseline has long term implications for smoking cessation

Wellbeing an important concept for further study

What can advisors do to enhance or maintain wellbeing in their clients?

acknowledgements
Acknowledgements

Funders: 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 therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.

ELONS Project team: Linda Bauld, Paul Aveyard, Leonie Brose, Tim Coleman, Fiona Dobbie, Carol Anne Greenan, Rosemary Hiscock, Maureen Kennedy, Jo Leonardi-Bee, Andy McEwen, Hayden McRobbie, Susan Murray, Richard Purves, Lion Shahab, Sarah Simm.

UK Centre for Tobacco and Alcohol Studies, North51, National Centre for Smoking Cessation and Training, NHS Stop Smoking Services, PCRN/CLRN, TNS-BMRB

For further information contact: Fiona Dobbie, ELONS Project Manager, School of Management, University of Stirling, Stirling FK9 4LA, Tel: 01786 467369, Email -fiona.dobbie@stir.ac.uk

slide32
Thank you

r.hiscock@bath.ac.uk