Impact of specialist and primary care stop smoking support on socio-economic inequalities in cessation in the United Kingdom: a systematic review and national equity initial review completed 22 January 2019; final version accepted 19 July 2019 analysis.

Aim: To assess the impact of UK specialist and primary care-based stop smoking support on socio-economic inequalities in cessation.

Methods: Systematic review and narrative synthesis, with a national equity analysis of stop smoking services (SSS). Ten bibliographic databases were searched for studies of any design, published since 2012, which evaluated specialist or primary care-based stop smoking support by socio-economic status (SES) or within a disadvantaged group. Studies could report on any cessation-related outcome. National Statistics were combined to estimate population-level SSS reach and impact among all smokers by SES. Overall, we included 27 published studies and three collated, national SSS reports for England, Scotland and Northern Ireland (equivalent data for Wales were unavailable).

Results: Primary care providers and SSS in the United Kingdom were particularly effective at engaging and supporting disadvantaged smokers. Low SES groups were more likely to have their smoking status assessed, to receive general practitioner brief cessation advice/SSS referral and to attempt a quit with SSS support. Although disadvantaged SSS clients were less successful in quitting, increased service reach offset these lower quit rates, resulting in higher service impact among smokers from low SES groups. Interventions that offer tailored and targeted support have the potential to improve quit outcomes among disadvantaged smokers.

Conclusions: Equity-orientated stop smoking support can compensate for lower quit rates among disadvantaged smokers through the use of equity-based performance targets, provision of targeted services and the development of tailored interventions.