Targeted, high quality SSS are a key component of cost-effective tobacco control strategies at local and national level, and essential to the reduction of health inequalities. Research shows that people who access evidence-based SSS are four times as likely to quit as if they tried to go it alone. 14

Recommendations on delivery of SSS from NICE include the following. 1516

  • SSS should target, and be accessible to, relevant minority ethnic and socially disadvantaged communities in the local population.
  • Performance (i.e. quit rate) targets need to be realistic for both the number of people using the service and the proportion who successfully quit smoking, and should reflect the demographics of the local population.
  • Services should aim to treat at least 5% of the estimated local population of people who smoke or use tobacco in any form each year, and aim for a success rate of at least 35% of service users having quit at four weeks (validated by carbon monoxide monitoring) – four week quitters are much more likely to remain smoke-free.
  • The most effective intervention involves a combination of behavioural support from a trained stop smoking practitioner plus licensed pharmacotherapy (such as Champix or nicotine replacement therapy, or NRT).
  • Success should be validated by a CO monitor reading of less than 10 ppm at the four week point. This does not imply that treatment should stop at four weeks.

In order to maximise referrals to SSS, formalised systems should be in place to enable the monitoring of referral sources, and to help identify areas where referral rates could be improved. 17

Specific guidance is also available on provision of SSS in acute, maternity and mental health settings. 18  As mentioned previously, people with SMI are much more likely to smoke than the general population; they are more likely than average to anticipate difficulty in quitting and less likely to succeed.  However, there is good evidence of the effectiveness and safety of SSS strategies specifically designed for people with SMI. 19

For those people who are not ready, willing or able to stop in one step, harm reduction interventions can support them in moving closer to becoming smoke-free. 20

In addition to the abundance of NICE guidance available on delivery of local SSS, various resources are available for providers and commissioners of SSS on the National Centre for Smoking Cessation and Training (NCSCT) website. 21

Over recent years, electronic cigarettes (EC) have become a very popular stop smoking aid in the UK and many people have found them helpful for quitting. Long term health effects are still not known, but a recent review of the latest evidence highlighted the fact that use of EC is much less harmful than smoking tobacco. 22 In April 2016, the Royal College of Physicians Tobacco Advisory Group published a report which recommended that EC should continue to be supported by government and promoted as a tobacco harm reduction strategy. 23

Recent guidance has been published on use of EC within SSS, use of EC in public places and workplaces and use of EC in pregnancy. 242526

References

  1. “Smoking Toolkit Study,” [Online]. Available: www.smokinginengland.info. [Accessed 2 November 2016].
  2. NICE, “Stop Smoking Services (PH 10),” 2008 February. [Online]. Available: https://www.nice.org.uk/guidance/ph10. [Accessed 2 November 2016].
  3. NICE, “Smoking: supporting people to stop (QS43),” Agust 2013. [Online]. Available: https://www.nice.org.uk/guidance/qs43. [Accessed 2 November 2016].
  4. NCSCT/PHE, “Local SSS Service and delivery guidance,” 2014. [Online]. Available: http://www.ncsct.co.uk/publication_service_and_delivery_guidance_2014.php. [Accessed 2 November 2016].
  5. NICE, “Smoking: acute, maternity and mental health services (PH48),” 2013. [Online]. Available: https://www.nice.org.uk/guidance/PH48. [Accessed 2 November 2016].
  6. ASH, “Smoking and mental health. ASH briefing,,” March 2016. [Online]. Available: http://ash.org.uk/information-and-resources/fact-sheets/smoking-and-mental-health/. [Accessed 2 November 2016].
  7. NICE, “Smoking harm reduction (PH45),” June 2013. [Online]. Available: https://www.nice.org.uk/guidance/ph45. [Accessed 2 November 2016].
  8. NCSCT, “National Centre for Smoking Cessation and Training,” [Online]. Available: http://www.ncsct.co.uk/pub_training-resources.php. [Accessed 2 November 2016].
  9. A. McNeill, L. S. Brose, R. Calder, S. C. Hitchman, P. Hajek and H. McRobbie, “E-cigarettes: an evidence update. A report commissioned by Public Health England.,” PHE, London, 2015.
  10. Tobacco Advisory Group, Royal College of Physicians, “Nicotine without smoke: tobacco harm reduction,” RCP, https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0, 2016.
  11. NCSCT/PHE, “NCSCT and PHE Electronic cigarettes: A briefing for stop smoking services,” 2016. [Online]. Available: http://www.ncsct.co.uk/publication_electronic_cigarette_briefing.php. [Accessed 2 November 2016].
  12. PHE, “Use of e-cigarettes in public places and workplaces,” 2016. [Online]. Available: https://www.gov.uk/government/publications/use-of-e-cigarettes-in-public-places-and-workplaces. [Accessed 2 November 2016].
  13. Smoking in Pregnancy Challenge Group , “Use of electronic cigarettes in pregnancy,” 2016. [Online]. Available: http://www.smokefreeaction.org.uk/SIP/files/eCigSIP.pdf. [Accessed 2 November 2016].
  14. “Smoking Toolkit Study,” [Online]. Available: www.smokinginengland.info. [Accessed 2 November 2016].
  15. NICE, “Stop Smoking Services (PH 10),” 2008 February. [Online]. Available: https://www.nice.org.uk/guidance/ph10. [Accessed 2 November 2016].
  16. NICE, “Smoking: supporting people to stop (QS43),” Agust 2013. [Online]. Available: https://www.nice.org.uk/guidance/qs43. [Accessed 2 November 2016].
  17. NCSCT/PHE, “Local SSS Service and delivery guidance,” 2014. [Online]. Available: http://www.ncsct.co.uk/publication_service_and_delivery_guidance_2014.php. [Accessed 2 November 2016].
  18. NICE, “Smoking: acute, maternity and mental health services (PH48),” 2013. [Online]. Available: https://www.nice.org.uk/guidance/PH48. [Accessed 2 November 2016].
  19. ASH, “Smoking and mental health. ASH briefing,,” March 2016. [Online]. Available: http://ash.org.uk/information-and-resources/fact-sheets/smoking-and-mental-health/. [Accessed 2 November 2016].
  20. NICE, “Smoking harm reduction (PH45),” June 2013. [Online]. Available: https://www.nice.org.uk/guidance/ph45. [Accessed 2 November 2016].
  21. NCSCT, “National Centre for Smoking Cessation and Training,” [Online]. Available: http://www.ncsct.co.uk/pub_training-resources.php. [Accessed 2 November 2016].
  22. A. McNeill, L. S. Brose, R. Calder, S. C. Hitchman, P. Hajek and H. McRobbie, “E-cigarettes: an evidence update. A report commissioned by Public Health England.,” PHE, London, 2015.
  23. Tobacco Advisory Group, Royal College of Physicians, “Nicotine without smoke: tobacco harm reduction,” RCP, https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0, 2016.
  24. NCSCT/PHE, “NCSCT and PHE Electronic cigarettes: A briefing for stop smoking services,” 2016. [Online]. Available: http://www.ncsct.co.uk/publication_electronic_cigarette_briefing.php. [Accessed 2 November 2016].
  25. PHE, “Use of e-cigarettes in public places and workplaces,” 2016. [Online]. Available: https://www.gov.uk/government/publications/use-of-e-cigarettes-in-public-places-and-workplaces. [Accessed 2 November 2016].
  26. Smoking in Pregnancy Challenge Group , “Use of electronic cigarettes in pregnancy,” 2016. [Online]. Available: http://www.smokefreeaction.org.uk/SIP/files/eCigSIP.pdf. [Accessed 2 November 2016].