Does the level of expenditure on stop smoking services influence the likelihood of quitting smoking among smokers in England? A cross-sectional ecological study

To determine whether level of expenditure on stop smoking services (SSSs) in England was associated with the likelihood of quitting smoking among smokers. This was a repeat cross-sectional ecological study using Statistics on NHS Stop Smoking Services in England data for 2016/17 to 2018/19, the Annual Population Survey-based estimates of smoking prevalence for the period, the 2019 English Index of Multiple Deprivation scores for upper tier local authorities, and local authority land areas for 2019. The association between the likelihood of quitting smoking after 4 weeks of setting a quit date with SSSs and variables of interest was evaluated using multivariate logistic regression analyses. Local authorities spent an average of £12.29 per resident smoker over the study period. Spending levels and quit rates declined between 2016/17 and 2018/19 from £13.00 to £11.50 per smoker and from 2427 per 100,000 smokers (95% confidence interval: 2414–2440) to 2145 per 100,000 smokers (95% confidence interval: 2132–2158) respectively. Increasing expenditure was positively associated with the likelihood of quitting (adjusted OR: 1.05; 95% CI 1.04–1.05, for an increase of £1.00 per smoker). The likelihood of achieving a 4-week quit declined over the study period and smokers in high smoker density areas and most deprived areas were most likely to quit. The results suggested that level of expenditure per smoker and the concentration of smokers in an area could influence the likelihood of achieving 4-week quits. Increasing funding for local authority SSSs in England will contribute to the goal of England becoming ‘smoke-free’ by 2030. More research is however needed on effective approaches to delivering SSSs in an era of dwindling resources.