Smoking Cessation Interventions
NICE guidance (NG92) on stop smoking interventions and services recommends that at every opportunity, health professionals should ask people if they smoke and advise them to stop smoking in a way that best suits their preferences.1 (Health professionals in Scotland should refer to the SIGN 149 guideline).2
There are a number of interventions to help people stop smoking. Different cessation tools, including prescribed medication, nicotine replacement therapy (NRT) and e-cigarettes, will work better for different individuals, but we know that quit attempts are more likely to be successful with behavioural support.
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Stop Smoking Services
Evidence shows that Stop Smoking Services are the most effective way to quit and are one of the most cost-effective interventions in the NHS.3 Where they are available, Stop Smoking Services should be considered the first-choice route for a smoker who is ready to quit, as they are over three times as likely to quit using a Stop Smoking Service compared to going cold turkey. In some areas, Stop Smoking Services are now offered as part of an Integrated Lifestyle Service, and in others they are still a standalone service. Unfortunately, in areas where services are no longer provided, (which is in part due to Local Authority budget cuts in England), your support is even more valuable. You can direct your patients to www.nhs.uk/smokefree for a personalised quitting plan and further advice (or Wales - www.helpmequit.wales, Scotland - www.nhsinform.scot/healthy-living/stopping-smoking, Northern Ireland - www.stopsmokingni.info/ways-quit/whats-quit-kit).
Offering advice and prescription medication
To help people quit, NICE recommend offering advice on nicotine-containing products on general sale to smokers and prescribing medication such as varenicline or bupropion. When prescribed by a healthcare professional, NRT can significantly reduce withdrawal symptoms and cravings and prescription medications are also shown to improve the success of quit attempts. When bought over the counter, NRT does not appear to be any more effective at helping smokers quit compared to going cold turkey, which might be due to the amount people use not delivering enough nicotine to satisfy their cravings.
Research so far shows that e-cigarettes are far less harmful than smoking 4, 5 and can be an appropriate quitting aid for some people who smoke, including those who have tried and failed to quit previously using other methods. There is ever-growing evidence that e-cigarettes are an effective cessation tool.6, 7, 8, 9, 10, 11 A recent study showed that those using e-cigarettes were 95% more likely to quit than those not using e-cigarettes.12 However, being a new technology, the long-term impact of e-cigarette use is not yet known. It is important to note that e-cigarettes are not risk free and should not be recommended for use by people who don't smoke. Some toxic chemicals (such as NNALs, acetaldehydes and formaldehyde) have been found in some products, but usually at much lower levels than in tobacco. The evidence suggests their safety profile is far more comparable to that of other NRT products than tobacco.13, 14
The RCGP (2017 position statement on e-cigarettes) and NICE recommend that e-cigarettes should be discussed as an option for smoking cessation. Patients using e-cigarettes should be advised that they need to switch completely rather than becoming ‘dual users’ – using e-cigarettes and smoking. For people using an e-cigarette who want to use other nicotine-containing products at the same time, it is safe to do so.
Non-smokers and young people should avoid using e-cigarettes. It has been argued that e-cigarettes could act as a gateway to taking up smoking cigarettes. So far, the evidence in the UK does not support this.15 Youth smoking rates continue to decline and regular use of e-cigarettes by young people who have never smoked in Great Britain is very low at between 0 and 1%.16
This hub has been sponsored and written by Cancer Research UK.
- NICE, Clinical guideline 92: Stop smoking interventions and services. 2018.
- Health Improvement Scotland. SIGN Guideline 149: Risk estimation and the prevention of cardiovascular disease, 2017. Available at: www.sign.ac.uk/assets/sign149.pdf. Accessed December 2019.
- NCSCT. Effectiveness and cost-effectiveness of programmes to help smokers to stop and prevent smoking uptake at local level. 2015
- Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health. 2014.
- Shahab L et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. 2017.
- Hartmann-Boyce J et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. 2016.
- Liu, X. et al. Efficiency and adverse events of electronic cigarettes: A systematic review and meta-analysis, Medicine, 97(19). 2018.
- Beard E. et al. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ. 2016.
- Statistics on NHS Stop Smoking Services: England, April 2016 to March 2017, 2017.
- Brown, J. et al. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014.
- Hajek P. et al. A randomised trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of medicine. 2019.
- Jackson SE. et al. Moderators of real-world effectiveness of smoking cessation aids: a population study. Addiction. 2019.
- Williams M et al. Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol. PLoS ONE 8(3). 2013.
- Goniewicz et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control. 2013.
- Bauld L., MacKintosh A.M., Eastwood B. et al. Young People's Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017. Int J Environ Res Public Health. 2017.
- Action on smoking and health. Use of e-cigarettes among young people in Great Britain. 2019.