Evaluation of smoking cessation services in disadvantaged areas of the Netherlands

Background: A socioeconomic gradient exists in both smoking prevalence and cessation; individuals of low socioeconomic status (SES) smoke more and successfully quit less frequently than their high SES peers. Smoking cessation behavioural therapy (SCBT) with/without pharmacotherapy, offered free in deprived areas in the UK, has been shown to be effective. The Dutch government’s reimbursement of this combined therapy in 2011 allowed a pilot study evaluating this offering in Dutch disadvantaged areas. This thesis investigates the effect, recruitment channels and attendance of SCBT (part 1). It also considers the effect of social norm on inequalities in utilisation of smoking cessation pharmacotherapy before/during/after reimbursement (part 2). Methods: For Part 1, data was collected from four disadvantaged areas in the Netherlands using interviewer-led repeated surveys, dossier research and in-depth interviews. For Part 2, national databases of repeated cross-sectional surveys were used. Data analysis used SPSS or MAXQDA software. Results: Part 1 - All SCBT types surpassed the background quit-rate. Rolling group and individual face-to-face counselling had most quitters. Most participants heard about and were referred to SCBT through the GP. Frequent attenders named more self-determined motivations for attendance than infrequent attenders. Part 2 -A more accepting injunctive norm toward smoking may partially underlie the lack of uptake of subsidised pharmacotherapy in low SES groups. Conclusion: All forms of SCBT offered were effective, recruitment occurred mainly through the GP and frequent attenders had more self-determined motivations. More accepting injunctive norms toward smoking amongst low SES groups may contribute to low uptake of subsidised pharmacotherapy