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Smoking and tobacco
Research
What are older smokers’ attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study
  1. Hannah Jordan1,
  2. Mira Hidajat2,
  3. Nick Payne1,
  4. Jean Adams3,
  5. Martin White3,
  6. Yoav Ben-Shlomo2
  1. 1 Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
  2. 2 School of Social and Community Medicine, University of Bristol, Bristol, UK
  3. 3 MRC Epidemiology Unit & CEDAR, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
  1. Correspondence to Dr Hannah Jordan; h.c.jordan{at}sheffield.ac.uk

Abstract

Objectives To investigate whether age is associated with access to smoking cessation services.

Design Data from the Smoking Toolkit Study 2006–2015, a repeated multiwave cross-sectional household survey (n=181 157).

Setting England.

Participants Past-year smokers who participated in any of the 102 waves stratified into age groups.

Outcome measures Amount smoked and nicotine dependency, self-reported quit attempts and use of smoking cessation interventions. Self-report of whether the general practitioner (GP) raised the topic of smoking and made referrals for pharmacological support (prescription of nicotine replacement therapies (NRTs)) or other support (counselling or support groups).

Results Older smokers (75+ years) were less likely to report that they were attempting to quit smoking or seek help from a GP, despite being less nicotine-dependent. GPs raised smoking as a topic equally across all age groups, but smokers aged 70+ were more likely not to be referred for NRT or other support (ORs relative to 16–54 years; 70–74 years 1.27, 95% CI 1.03 to 1.55; 75–79 years 1.87, 95% CI 1.43 to 2.44; 80+ years 3.16, 95% CI 2.20 to 4.55; p value for trend <0.001).

Conclusions Our findings suggest that there are potential missed opportunities in facilitating smoking cessation in older smokers. In this large population-based study, older smokers appeared less interested in quitting and were less likely to be offered support, despite being less addicted to nicotine than younger smokers. It is unclear whether this constitutes inequitable access to services or reflects informed choices by older smokers and their GPs. Future research is needed to understand why older smokers and GPs do not pursue smoking cessation. Service provision should consider how best to reduce these variations, and a stronger effectiveness evidence base is required to support commissioning for this older population so that, where appropriate, older smokers are not missing out on smoking cessation therapies and the health benefits of cessation at older ages.

  • public health
  • smoking cessation
  • inequalities
  • aging
  • primary care

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-018150

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    Footnotes

    • Contributors The study was initially conceived and designed by YB-S, HJ and MH, with contributions from all authors. Data analysis was carried out by MH and YB-S. All authors contributed to drafting and critically revising the paper. All authors have approved the final version and are equally accountable for the work.

    • Funding The Smoking Toolkit Study is currently primarily funded by Cancer Research UK (C1417/A14135; C36048/A11654; C44576/A19501), and has previously also been funded by Pfizer, GlaxoSmithKline and the Department of Health. MW and JA are funded by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. This work was undertaken as part of the Ageing Well Programme, funded by the NIHR School for Public Health Research (SPHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval Ethical approval was granted to the STS, and the anonymised study data were used under licence.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data that support these findings are available from the Smoking Toolkit Study. Restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are however available from the authors on reasonable request and with the permission of Robert West at robertwest100@googlemail.com.