Smoking cessation among people with mental health problems

The APMS data will be used to conduct a quantitative study with the overall aim of identifying how the frequency and success of quit attempts can be enhanced among smokers with a range of mental health problems (MHPs). This study comprises part of a project entitled “Improving smoking cessation in smokers with mental health problems” funded by a CRUK/BUPA Foundation Cancer Prevention Fellowship (C52999/A19748). The funders do not have any influence on the results of the research.

This study is motivated by the observation that one third of smokers have MHPs, that smoking prevalence among people with MHPs is far higher than in the population as a whole, and the fact that NICE now recommends that all secondary care settings become smoke-free while providing interventions to support patients. A significant proportion of those requiring support may also be affected by MHPs. This study will be the first time that mental health status and detailed smoking and cessation information will be analysed using data from a representative survey. The study will be purely quantitative in nature and will attempt to incorporate advanced quantitative methods where appropriate.

The study will comprise two phases. First, a preliminary analysis will be carried out to determine smoking prevalence by mental health status (both lifetime and recent diagnosis). The association of level of nicotine dependence and odds of making quit attempts with mental health status (and other sociodemographic variables) using data from the Adult Psychiatric Morbidity Survey will then be investigated. Data from two waves (2007 and 2014) will be used to determine whether there has been change over time. The data for 2007 have already been obtained from the UK Data Service. The entire 2014 dataset is required due to the exploratory nature of this analysis. Its findings will inform the modelling approach in the subsequent phase as it will specify important MHPs and identify relevant covariates and interventions for analysis.

In the second phase, multivariate analyses will be used to address the following research questions as set out in the terms of the fellowship plan presented to CRUK/BUPA Foundation:

1. Do smokers with MHPs make quit attempts as frequently as those without MHPs?

2. What are the most frequent triggers for quit attempts in this population? Does this differ from the general population?

3. Does the use of generally more effective intervention options (prescription medication, behavioural support) differ in smokers with and without MHPs?

4. Does success of quit attempts with different interventions / support used vary with mental health status?

Data are already anonymised. KCL are aware of the potential element of risk that individuals could be re-identified, however. To preclude this, all published results will be at the aggregate level and will only be used to draw population-level inferences. The data will not be linked as there are no identifiers to link on.

Papers may be published that reference the findings from the APMS 2014 survey and compare these with 2007 data.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

In order to protect patient confidentiality in publications resulting from analysis of APMS data users must:

•guarantee that any outputs made available to anyone other than those with whom this agreement is made, will meet required standards, including the guarantee, methods and standards contained in the Code of Practice for Official Statistics and the ONS Statistical Disclosure Control for tables produced from surveys;

•apply methods and standards specified in the Microdata Handling and Security Guide to Good Practice for disclosure control for statistical outputs.

It is anticipated the results will be submitted to peer-reviewed journals as one or more research papers. Although Addiction and Nicotine & Tobacco Research may be suitable options it has not been determined yet where papers would be submitted. These articles are expected to be written in mid-to-late 2018 and published in 2018 or 2019.

It is hoped that the aggregate-level findings of the research using APMS 2014 data will deliver relevant findings for policy and clinical practice at the population level. This will be the first time that mental health status and detailed smoking and cessation information will be available within a representative survey. Thus, the study outputs will provide novel and unique information related to cessation among smokers and recent ex-smokers with MHPs living in the community to identify specific issues and areas for action.

The Addiction Department’s research informs tobacco policy and NICE appraisals, and it is hoped that the findings may inform future policy debates and research on, and implementation of, tobacco cessation interventions. As such the results will be disseminated among the Department's research and funding partners. First, the results and final publications will be shared with Cancer Research UK (the project funder) and Public Health England to potentially inform future research funding priorities and public health policies at the national level. Second, Department research staff participate in the Mental Health and Smoking Partnership and will disseminate the results of the proposed research among its members. The Mental Health and Smoking Partnership brings together groups committed to reducing rates of smoking; particularly among people with a mental health condition. These Royal Colleges, professional bodies, voluntary sector organisations, academics and service users. The Partnership examines implementation of current policies, reviews their progress and issues policy statements on topical issues to influence the policy discourse and highlight areas for future action.

The study’s results may point to gaps in access for groups with specific MHPs due to differences in treatment-seeking behaviours and signpost future work on improving implementation of interventions for specific groups for whom particular interventions may be more or less effective. The findings will be published/disseminated in 2018 or 2019.

Yielded Benefits is not a requirement for new applications.