Stopping smoking (evidence-based guidance)
There is evidence that helping smokers to stop smoking can be effective and highly cost-effective.
The essentials are:
- ASK about tobacco smoking at every opportunity
- ADVISE all smokers to stop smoking
- ASSIST all smokers to stop smoking
- ARRANGE follow up
There is evidence that even brief intervention (2-3 minutes) has a worthwhile effectiveness.
Useful features of intervention are to:
- set a date to stop completely
- review previous attempts to stop smoking - and what helped/hindered
- plan ahead - identify potential problems and strategies to cope
- plan how to handle alcohol-drinking situations
- try smoking cessation treatment e.g. nicotine replacement therapy, bupropion
Calculating the number of cigarettes a day (2):
All Wales Medicines Strategy Group. Initial Clinical Management of Adult Smokers in Secondary Care. June 2021.
NICE state (3):
Tell people who smoke that a range of interventions is available to help them stop smoking. Explain how to access them and refer people to stop-smoking support if appropriate Ensure the following are accessible to adults who smoke:
Consider NRT for young people aged 12 and over who are smoking and dependent on tobacco. If this is prescribed, offer it with behavioural support. Do not offer varenicline or bupropion to people under 18 Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it. Discuss with people which options to use to stop smoking, taking into account:
Consider NRT for young people aged 12 and over who are smoking and dependent on tobacco. If this is prescribed, offer it with behavioural support Do not offer varenicline or bupropion to people under 18. Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it. Discuss with people which options to use to stop smoking, taking into account:
Advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:
Advise people (as appropriate for their age) that the options that are less likely to result in them successfully stopping smoking, when combined with behavioural support, are:
For adults, prescribe or provide bupropion, varenicline or NRT before they stop smoking:
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Study evidence shows that among men and women from diverse racial and ethnic groups, quitting smoking was associated with large reductions in the excess mortality associated with continued smoking (4)
- all-cause mortality rate ratio (RR) for current vs never smoking was 2.80 overall
- when comparing those who quit smoking before age 45 years with never-smokers, all-cause mortality RRs were 1.15
A systematic review stated that (5):
- most effective interventions were nicotine e-cigarettes, varenicline and cytisine
- found high-certainty evidence that when compared to control, nicotine e-cigarettes, varenicline and cytisine might lead to an additional eight (95% CrI 4-13), eight (6-10) and seven (4-12) additional quitters per 100, respectively
Reference:
- British Heart Foundation, Factfile 6/99.
- All Wales Medicines Strategy Group. Initial Clinical Management of Adult Smokers in Secondary Care. June 2021.
- NICE (November 2021). Tobacco: preventing uptake, promoting quitting and treating dependence
- Thomson B, Emberson J, Lacey B, et al. Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults. JAMA Netw Open. 2022;5(10):e2231480. doi:10.1001/jamanetworkopen.2022.31480
- Lindson N et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. Cochrane Database of Systematic Reviews 2023, Issue 9. Art. No.: CD015226. DOI: 10.1002/14651858.CD015226.pub2. Accessed 16 September 2023.
Related pages
- Efficacy
- Smoking
- Nicotine replacement therapy
- Bupropion
- Smoking and ischaemic heart disease
- Bupropion and weight gain
- NICE guidance - use of nicotine replacement therapy (NRT) , varenicline and bupropion for smoking cessation
- Varenicline
- Rimonabant
- Carbon monoxide monitoring in smoking cessation
- NICE guidance - smoking cessation in pregnancy
- Smoking (cigarette smoking equivalences to cigar smoking and roll-ups)
- Stopping smoking and weight gain
- Smoking cessation and reduction in risk of head and neck cancers
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