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Does poor health and wellbeing affect
smoking cessation?
Rosemary Hiscock, Fiona Dobbie, Linda Bauld
UKNSCC12th-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 & wellbeingHealth: ‘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 moodBuilds up overtime i.e. resilience
Dimensions of wellbeing
Objective SubjectiveConditions for a good life internal – need to talk to /observe person
Dimensions of wellbeing
Objective SubjectiveConditions for a good life internal – need to talk to/observe person
Physical health
Socioeconomic status
Dimensions of wellbeing
Objective SubjectiveConditions for a good life internal – need to talk to/observe person
Hedonic
Eudemonic
Emotions e.g are you content?
Interests e.g. are you bored?
Physical health
Socioeconomic status
Dimensions of wellbeing
Objective SubjectiveConditions for a good life internal – need to talk to/observe person
Hedonic
Eudemonic
Emotions e.g are you content?
Interests e.g. are you bored?
Physical health
Socioeconomic status
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
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)
Wellbeing and smoking
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
Mental condition OR
Gro
up
Dro
p in
On
e to
...
Level ...
Wellbeing B
Gro
up
Dro
p in
On
e to
on
e
Leve
l 2 G
...Models controlling for location and time of year
Histogram of Wellbeing
Skew = -.326
Mean* wellbeing 53 (52 to 54)
Not quit Quit
Client who in 4 weeks time would be:
51 (50 to 53)
55 (54 to 57)
Clients who in 52 weeks time would be:
53 (51 to 54)
59 (56 to 62)
Mean* weighted for age, gender, SES, behavioural support and takes into account cluster by location
Regression modelling of 52 week quit
Stage Controls added to modelDesign 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/ partnerHalf 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 No medical condition
No heart, blood, circulation
No respiratory
No mental health
No other medical condition
Design 1.17 (0.91 to
1.50)
1.10 (0.79 to
1.53)
1.19 (0.87 to
1.63)
1.69 (1.15 to
2.50)
1.24 (0.87 to
1.77)+Demog 1.34
(1.03 to 1.75)
1.39 (0.98 to
1.99)
1.23 (0.89 to
1.68)
1.66 (1.12 to
2.45)
1.20 (0.83 to
1.73)+SES 1.27
(0.97 to 1.65)
1.32 (0.93 to
1.89)
1.32 (0.96 to
1.82)
1.53 (1.03 to
2.27)
1.21 (0.84 to
1.74)+Depend
1.23 (0.94 to
1.61)
1.31 (0.92 to
1.88)
1.27 (0.92 to
1.76)
1.45 (0.97 to
2.15)
1.20 (0.83 to
1.72)+Champix
1.20 (0.92 to
1.56)
1.28 (0.89 to
1.84)
1.22 (0.89 to
1.69)
1.33 (0.89 to
1.98)
1.16 (0.80 to
1.68)+Support
1.17 (0.90 to
1.53)
1.24 (0.86 to
1.78)
1.20 (0.87 to
1.66)
1.34 (0.90 to
2.00)
1.12 (0.78 to
1.63)
Wellbeing predict 52 week quit? (odds ratios)
Controls Continuous Case (good vs concerning)
Design 1.011 (1.0051 to 1.017) 1.26 (0.98 to 1.62)
+Demog 1.011 (1.0047 to 1.017) 1.29 (1.00 to 1.66)
+SES 1.011 (1.0049 to 1.017) 1.22 (0.95 to 1.58)
+Depend 1.010 (1.0035 to 1.016) 1.17 (0.91 to 1.51)
+Champix 1.008 (1.0023 to 1.015) 1.14 (0.88 to 1.47)
+Support 1.007 (1.0013 to 1.014) 1.10 (0.85 to 1.43)
Wellbeing categorised & 52 week quit
0 to 20 21 to 40 41 to 60 61 to 80 81 to 100
0
0.5
1
1.5
2
2.5
WHO_5 wellbeing score
Od
ds
rati
o o
f C
O v
al-
idate
d q
uit
tin
g a
t 5
2
week
s
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 50 100
Number points increased:
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 [email protected]
