Table 2

Study characteristic

Study (country)Study designSampleInterventionMeasure of smoking abstinenceSummary of findingsQuality appraisal
Bade et al (2016)
(Germany)28
Randomised controlled trial4052 participants from the German lung cancer screening intervention trial.
1535 (62%) male, 950 (38%) female.
1737 (70%) aged 50–59 years, 748 (30%) 60–69 years old.
1823 (73%) ‘low’ in education and 1594 (65%) ‘low’ in vocational training.
Low-dose multislice CT screening and smoking cessation counselling delivered by a psychologist in a radiology department. 20-minute counselling followed by at least one telephone call.Self-report at 12 and 24 monthsProportion of current smokers decreased among screenees (3.4%, p<0.0001), controls (4.5%, p<0.0001), and entire cohort (4.0%, p<0.0001). The magnitude of decrease in smoking rate was larger in SSC participants (screenees 9.6%, p<0.0001; controls 10.4%, p<0.0001) compared with non-SSC participants (screenees 0.8%, p=0.30; controls 1.6%, p=0.03).High
Bauld et al (2009)
(UK)29
Observational study1785 pharmacy service users.
762 (56%) in the Starting Fresh (SF) group and 311 (76%) in the Smoking Concerns (SC) group were aged 41 years or older.
796 (58%) from SF were in the lowest deprivation quintile, 187 (46%) from SC were in the lowest quintile.
Behavioural support delivered by a trained adviser in a group-based community setting (SC) up to 12 weeks or individually in a pharmacy setting (SF) up to 12 weeks, with access to nicotine replacement therapy.Biochemical validation at 1 month146 (36%) quit rate in SC versus 255 (19%) in SF (OR=1.98; 95% CI 1.90 to 3.08). SC and SF deprived smokers had lower cessation rates (OR=0.677; p=0.015). Cessation rate for pharmacy clients increased sharply with age from 13.4% for age 16–40% to 30.7% for age 61 and over (p<0.001). The increase for group-based clients (SC) was statistically insignificant (p<0.25). Determination to quit was not statistically significant: p=0.072 (SF) and p=0.092 (SC).Medium
Celestin et al (2016)
(USA)30
Retrospective cohort study8549 tobacco users in Louisiana’s public hospital facility.
1531 (68%) in the intervention group were aged 45 years and over.
1196 (57%) were from the lowest ‘financial class’.
Standard care plus group behavioural counselling in a hospital classroom. 4 1hour sessions, once a week within a 1month period.Self-report at 12 monthsIntervention participants had greater odds of sustained abstinence than non-attendees (AOR=1.52; 95% CI 1.21 to 1.90).
Higher 12-month quit rate in patients over age 60 (22%) compared with 18–30 years old (11%) (AOR 2.36; 95% CI 1.58 to 3.52). There was a statistically significant effect of COPD status on quit rate (from UOR 1.01 CI 0.86 to 1.19, to aOR 0.75 CI 0.63 to 0.90).
Low
Copeland et al (2005)
(UK)31
Observational cohort study101 patients from a disadvantaged area of Edinburgh. Mean age for males was 47 years and for females was 44 years.General practitioner consultation and subsequent prescription of nicotine replacement therapy.Self-report at 3 monthsPost intervention 35 (35%) smoked the same, 46 (45%) were smoking less and 20 (20%) had stopped smoking.
Older participants were more likely to have stopped or to be smoking less (p<0.00).
Low
Lasser et al (2017)
(USA)32
Prospective, randomised trial352 participants randomised (177 intervention, 175 control).
197 (56%) aged 51–74.
193 (55%) with a household yearly income <US$20 000.
Patient navigation and financial incentive (intervention) versus enhanced traditional care (control). Intervention received 4 hours of support over 6 months. Delivered by patient navigators over the phone or in-person.Biochemical validation at 12 months21 (12%) intervention participants quit smoking compared with four (2%) control participants (OR=5.8, 95% CI 1.9 to 17.1, p<0.00).
In the intervention arm (n=177), participants aged 51–74 had higher quit rates compared with those aged 21–50 (19(19.8%) vs 2(2.0%); p<0.00). Household yearly income of <US$20 000 had higher quit rates compared with >US$20 000 (15(15.5%) vs 4(8%); p=0.00).
Medium
Neumann et al (2013)
(Denmark)33
Observational prospective cohort study20 588 disadvantaged patients (low level of education and receiving unemployment benefits).
15 244 (74%) aged 40 years or over.
6-week manualised Gold Standard Programme in hospitals and primary care facilities (eg, pharmacies). Delivered in five meetings over 6 weeks by a certified staff member. Both group and individual counselling was offered.Self-reported continuous abstinence at 6 months34% of responders reported 6 months of continuous abstinence.
Continuous abstinence was significantly lower in those with less education (30%) versus more education (35%) (p<0.00).
For participants with a lower educational level, individual counselling was a predictor of success in smoking cessation (OR=1.31, 95% CI 1.05 to 1.63).
Medium
Ormston et al (2015)
(UK)37
Mixed-methods, quasi-experimental study2042 smokers living in deprived areas of Dundee. 70 (54%) aged 45 years and over. 119 (92%) from the two most deprived areas.Financial incentive and behavioural support based on Scottish national guidelines, with pharmacotherapy (Quit4u Scheme) delivered in group (practice nurses) and one-to-one settings (community pharmacists) for up to 12 weeks.Biochemical validation at 1, 3 and 12 monthsIntervention was responsible for 36% of all quit attempts in the three most deprived areas. 12-month quit rate (9.3%) was significantly higher than other Scottish stop smoking services (6.5%) (relative difference 1.443, 95% CI 1.132 to 1.839, p=0.00).Medium
Park et al (2015)
(USA)34
Matched case control study3336 National Lung Screening Trial participants.
Aged 55–74 years old.
No report of deprivation at baseline. Subgroup analysis performed for education.
SCI delivered by a primary care clinician using the 5As.Self-report at 12 monthsAssist was associated with a 40% increase in quitting (OR=1.40, 95% CI 1.21 to 1.63). Arrange was associated with a 46% increase in quitting (OR=1.46, 95% CI 1.19 to 1.79). Higher educational level was significantly associated with quitting after delivery of each of the 5As (ORs=1.14 to 1.26 for college degree or higher versus high school education). Lower nicotine dependence (OR=0.94, 95% CI 0.91 to 0.98), and higher quit motivation (OR=1.28, 95% CI 1.21 to 1.35) were significantly associated with quitting after delivery of each of the 5AsMedium
Sheffer et al (2013)
(USA)35
Observational study7267 participants in telephone treatment: 30% aged >50 years, 35% aged 36–49 years.
In-person participants: 38% aged >50 years, 38% aged 36–49 years.
No report of deprivation at baseline. Subgroup analysis performed for deprivation.
Behavioural counselling- manual driven sessions delivered weekly in-person (healthcare settings) or over the telephone, with free nicotine patches for 6 weeks. Delivered by a healthcare provider trained in brief evidence-based tobacco dependence interventions.Self-report at 3 and 6 monthsAbstinence rates were higher for in-person counselling (37.7%) versus telephone counselling (30.8%) (p<0.00). No significant difference at 3 months (p=0.73) and 6 months (p=0.27) between in-person (28.2%; 27.2%) and telephone (28.7%; 28.7%). The highest socioeconomic (SES) group was more likely to be abstinent with telephone treatment (SES3: p=0.03; OR=1.45; 95% CI 1.04 to 2.01). No significant differences between the in-person and telephone for the two lower SES groups (SES1: OR=1.02, 95% CI 0.88 to 1.18, p=0.82; SES2: OR=0.91, 95% CI 0.72 to 1.15, p=0.41).Low
Sheikhattari et al (2016)
(USA)36
Randomised controlled trial409 (52%) were aged 48 years and over.
Recruited in targeted communities where more than 40% of the households earn less than US$25 000. 531 (72%) were unemployed.
Peer-led community-based intervention over three phases. Phase 1 (n=404)—the American Cancer
Society’s 4-week Fresh Start smoking cessation curriculum expanded to 12 weeks at health centres and delivered by a doctor, nurse or social worker. Phase 2 (n=398) and Phase 3 (n=163)—tailored group counselling in community venues, delivered by trained peer motivators.
Self-report and biochemical validation at 3 and 6 monthsDelivery of services in community settings was a predictor of quitting (OR=2.6, 95% CI 1.7 to 4.2). Smoking cessation increased from 38 (9.4%) in Phase 1 to 84 (21.1%) in Phase 2, and 49 (30.1%) in Phase 3. Phases 2 and 3 were associated with higher odds compared with Phase 1, with adjusted ORs of 2.1 (95% CI 1.3 to 3.5) and 3.7 (95% CI 2.1 to 6.3) respectively. Older age (>48 years versus <48 years) was associated with higher quit rate (13.3% vs 19.1%, p=0.028).High
Stewart et al (2010)
(Canada)38
Pilot evaluation of a before and after study44 women, aged 25–69, living on low income in urban areas of Western Canada.
23 (52%) aged 40 years or older.
18 (39%) participants unemployed, 26 (62%) on welfare/income support.
Facilitated group support supplemented with one-to-one support from a mentor. Once a week, duration of 12 weeks minimum. Groups facilitated by professionals and former smokers with the option of one-to-one from peers in community centres.Self-report at 3 monthsThe mean number of cigarettes smoked daily decreased from pre to post-test (p=0.00). Among women completing all data collection (n=22), the mean number of cigarettes consumed daily decreased from 0.95 preintervention to 0.32 immediately after the intervention, then increased to 0.64 at 3 months postintervention. Four women reported sustained cessation.Low
  • AOR, Adjusted odds ratio; 5As, ask, advise, assess, assist and arrange follow-up; CI, Confidence interval; COPD, Chronic obstructive pulmonary disease; OR, Odds ratio; UOR, Unadjusted odds ratio.