Can smoking cessation services be better targeted to tackle health inequalities? Evidence from a cross-sectional study

Abstract

Objective To investigate how smoking cessation services could be more effectively targeted to tackle socioeconomic inequalities in health. Design Secondary analysis of data from a household interview survey undertaken for Middlesbrough Council in north east England using the technique of Qualitative Comparative Analysis. Setting Home-based interviews in Middlesbrough. Method Qualitative Comparative Analysis of data for 2882 respondents aged 16 years or over. Smoking prevalence was calculated for different combinations of respondents' characteristics: worklessness, income, education, neighbourhood liveability and neighbourliness. Results Smoking prevalence ranged from 74.5 per cent to 10.3 per cent across 19 combinations of the selected characteristics. Almost all combinations with smoking rates higher than 50 per cent included worklessness. One other combination exceeded 50 per cent and included respondents reporting all of the following: unhelpful neighbours, no further education, low liveability and low income. The combinations with the lowest smoking prevalences had only one or two of these characteristics present and the very lowest prevalence of 10.3 per cent was associated with all being absent. If unhelpful neighbours were present in any combination smoking rates were moderately high (32.4 per cent or higher). Conclusions The analysis points to important features of the context of smokers' lives. By improving these conditions, appreciable reductions in smoking prevalence are likely. These reductions might be even greater if interventions to improve neighbourhoods and job opportunities are combined with the timely provision of smoking cessation services. Targeting these transitions could be a more effective strategy than simply targeting all deprived neighbourhoods.