Effectiveness of the Gold Standard Programme Compared with Other Smoking Cessation Interventions in Denmark

Strengths and Limitations of this Study

• This study was based on a large cohort of smokers from all regions and settings in Denmark. 46 287 smokers were included in the study, and the follow-up rate was high (74%).

• The study was based on routinely collected health data with high completeness and precision, and the implications were considered minimal, as the research question was in line with the purposes of the database.

• Confounding effects were carefully considered and adjusted for, but we cannot exclude the possibility of residual confounding from other potential confounders, such as genetic predispositions, comorbidities, competing addictions and lifestyle factors not considered due to a lack of information.

• A limitation is that the results were based on self-reporting since patients are likely to overestimate their success. We assumed that overestimations were evenly distributed and that the groups were thus comparable in spite of potentially slightly overestimated quit rates.

• Owing to varying cultural traditions, smoking habits and socioeconomic conditions, generalisations should be considered carefully.

Abstract

Objectives: We compared the effectiveness of the Gold Standard Programme (a comprehensive smoking cessation intervention commonly used in Denmark) with other face-to-face smoking cessation programmes in Denmark after implementation in real life, and we identified factors associated with successful quitting.

Design: Prospective cohort study.

Setting: A total of 423 smoking cessation clinics from different settings reported data from 2001 to 2013.

Participants: In total, 82,515 patients were registered. Smokers ≥15 years old and attending a programme with planned follow-up were included. Smokers who did not want further contact, who intentionally were not followed up or who lacked information about the intervention they received were excluded. A total of 46,287 smokers were included.

Interventions: Various real-life smoking cessation interventions were identified and compared: The Gold Standard Programme, Come & Quit, crash courses, health promotion counselling (brief intervention) and other interventions.

Main outcome: Self-reported continuous abstinence for 6 months.

Results: Overall, 33% (11,184) were continuously abstinent after 6 months; this value was 24% when non-respondents were considered smokers. The follow-up rate was 74%. Women were less likely to remain abstinent, OR 0.83 (CI 0.79 to 0.87). Short interventions were more effective among men. After adjusting for confounders, the Gold Standard Programme was the only intervention with significant results across sex, increasing the odds of abstinence by 69% for men and 31% for women. In particular, compliance, and to a lesser degree, mild smoking, older age and not being disadvantaged were associated with positive outcomes for both sexes. Compliance increased the odds of abstinence more than 3.5-fold.

Conclusions: Over time, Danish smoking cessation interventions have been effective in real life. Compliance is the main predictor of successful quitting. Interestingly, short programmes seem to have relatively strong effects among men, but the absolute numbers are very small. Only the comprehensive Gold Standard Programme works across sexes.