Does poor health and wellbeing
affect smoking cessation?
Rosemary Hiscock, Fiona Dobbie, Linda Bauld
UKNSCC
12th-13th June 2014, London
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
BACKGROUND
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
Objective
Conditions for a good life
Subjective
internal – need to talk to /observe person
Dimensions of wellbeing
Physical health
Socioeconomic status
Objective
Conditions for a good life
Subjective
internal – need to talk to/observe person
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 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?
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

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

Unclear whether tobacco control measures aimed at
smoking reduction improve wellbeing (satisfaction)


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


(Beard et al 2014, Gruber & Mulleinathan 2002, Odermatt &
Stutzer 2012, Bordeur 2013)
(Shahab & West 2009, 2012)
Psychological distress associated with failing to quit

(Lawrence et al 2011)
METHODOLOGY
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





Any medical condition
Heart, blood & circulation
Respiratory & lungs
Mental illness
Other condition
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
RESULTS
Mental conditions vs wellbeing
Wellbeing B
Mental condition OR
Level 2 GP
practice/
pharmacy
One to one
Drop in
Group
Level 2 GP
practice/
pharmacy
One to one
Drop in
Group
Models controlling for location and time of year
Histogram of Wellbeing
Skew = -.326
Mean* wellbeing 53 (52 to 54)
Not quit
Quit
51 (50 to 53)
55 (54 to 57)
Clients who in 52 weeks
time would be:
53 (51 to 54)
59 (56 to 62)
Client who in 4 weeks
time would be:
Mean* weighted for age, gender, SES, behavioural support and takes into account cluster by location
Regression modelling of 52 week quit
Stage
Design
Controls added to model
Behavioural support type, Location, Time of year
+Demog
Age, gender, Ethnicity
+SES
N indicators disadvantage
+Dependence on tobacco
Took varenicline @ 1st session
+Champix
Smoked within 5 mins of waking or >30 cigs per day
+Support
Support for quit attempt from spouse/ partner
Half or more of friends and family don’t smoke
+ health or wellbeing
One health or wellbeing variable tested
Medical conditions predict 52 week quit?
Odds ratios
Controls
Design
+Demog
+SES
+Depend
+Champix
+Support
No medical
condition
1.17
(0.91 to 1.50)
1.34
(1.03 to 1.75)
1.27
(0.97 to 1.65)
1.23
(0.94 to 1.61)
1.20
(0.92 to 1.56)
1.17
(0.90 to 1.53)
No heart,
blood,
circulation
1.10
(0.79 to 1.53)
1.39
(0.98 to 1.99)
1.32
(0.93 to 1.89)
1.31
(0.92 to 1.88)
1.28
(0.89 to 1.84)
1.24
(0.86 to 1.78)
No
respiratory
No mental
health
No other
medical
condition
1.19
(0.87 to 1.63)
1.23
(0.89 to 1.68)
1.32
(0.96 to 1.82)
1.27
(0.92 to 1.76)
1.22
(0.89 to 1.69)
1.20
(0.87 to 1.66)
1.69
(1.15 to 2.50)
1.66
(1.12 to 2.45)
1.53
(1.03 to 2.27)
1.45
(0.97 to 2.15)
1.33
(0.89 to 1.98)
1.34
(0.90 to 2.00)
1.24
(0.87 to 1.77)
1.20
(0.83 to 1.73)
1.21
(0.84 to 1.74)
1.20
(0.83 to 1.72)
1.16
(0.80 to 1.68)
1.12
(0.78 to 1.63)
Wellbeing predict 52 week quit? (odds ratios)
Controls
Design
+Demog
+SES
+Depend
+Champix
+Support
Continuous
Case (good vs concerning)
1.011 (1.0051 to 1.017)
1.26 (0.98 to 1.62)
1.011 (1.0047 to 1.017)
1.29 (1.00 to 1.66)
1.011 (1.0049 to 1.017)
1.22 (0.95 to 1.58)
1.010 (1.0035 to 1.016)
1.17 (0.91 to 1.51)
1.008 (1.0023 to 1.015)
1.14 (0.88 to 1.47)
1.007 (1.0013 to 1.014)
1.10 (0.85 to 1.43)
Wellbeing categorised & 52 week quit
Odds ratio of CO validated
quitting at 52 weeks
4
3.5
3
2.5
2
1.5
1
0.5
0
0 to 20
21 to 40
41 to 60
61 to 80
WHO_5 wellbeing score
81 to 100
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
0
50
Number points increased:
100
DISCUSSION
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)

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




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



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





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
Thank you
r.hiscock@bath.ac.uk