Smoking cessation outcomes by employment status and education attainment after intensive smoking cessation intervention

Abstract

Introduction Intensive smoking cessation interventions (I-SCIs) are among the most effective approaches to smoking cessation. Although socioeconomic inequalities in smoking are well-established, smoking cessation outcomes among detailed educational and employment subgroups receiving I-SCI remain poorly understood. Therefore, this study aimed to examine smoking cessation outcomes by educational attainment and employment status among participants receiving I-SCI. Methods This nationwide prospective cohort study was conducted in Denmark and included participants aged ≥18 years from the Danish STOPbase who received an I-SCI between January 2006 and June 2023. I-SCI comprised a structured behavioural and educational smoking cessation programme of ≥5-sessions, including pharmaceutical therapy. The primary outcome was continuous cessation from smoking at 6 months, self-reported by structured interviews. Results Among 101,549 participants, 34.1% achieved abstinence at 6-months. Cessation rates showed a clear educational gradient, ranging from 38.5% among participants with long-term education to 28.2% among those with no education or primary school education. After adjustment, participants with no education or primary school education were less likely to achieve smoking cessation (risk ratio (RR), 0.76 [95% confidence interval (CI): 0.70–0.83]). Employment status was also associated with smoking cessation outcomes, although the pattern was less consistent and did not show a clear socioeconomic gradient. Conclusion Higher educational attainment was consistently associated with greater continuous smoking cessation success after I-SCI, whereas associations with employment status were more heterogeneous. Educational attainment showed a clearer socioeconomic gradient in cessation outcomes than employment status, although residual confounding factors and health-selection effects may have influenced the observed associations.