Tobacco: preventing uptake, promoting quitting and treating dependence

Allen Carr's in-person group seminar

A session lasting between 4.5 and 6 hours with elements of cognitive behavioural therapy and a brief relaxation exercise. Participants are encouraged to carry on smoking as normal until they attend the session and to smoke as normal during scheduled smoking breaks (around every 45 to 60 minutes) until a final ritual cigarette at the end. After the session, regular texts remind participants that they can contact the provider if they have further questions. The price includes up to 2 shorter (around 3.5 hours) follow-up sessions if wanted.

Behavioural support

Scheduled meetings (face to face or virtual) between someone who smokes and a counsellor trained to provide stop-smoking support. Behavioural support can be provided either individually or in a group. Discussions may include information, practical advice about goal setting, self-monitoring and dealing with the barriers to stopping smoking as well as encouragement. The support also includes anticipating and dealing with the challenges of stopping (see NICE's guideline on behaviour change: general approaches and the National Centre for Smoking Cessation and Training [NCSCT] Training Standard). Support is typically offered weekly for at least the first 4 weeks of a quit attempt (that is, for 4 weeks after the quit date) or 4 weeks after discharge from hospital (where a quit attempt may have started before discharge), and normally given with stop-smoking pharmacotherapies. Behavioural support does not include Allen Carr's Easyway in-person group seminar.

Cessation

Stopping the use of tobacco, smoked or smokeless. This includes stopping use of tobacco and moving on to pharmacotherapies (including nicotine replacement therapy) or nicotine-containing e‑cigarettes.

Closed institutions

Environments where people are detained or stay for a long time and where smoking is not permitted. These include secure mental health units, immigration removal centres and custodial sites, as well as places like long-stay mental health units and military establishments.

Compensatory smoking

Inhaling more deeply or smoking more of each cigarette to compensate for smoking fewer cigarettes.

E-cigarettes

Also called electronic cigarettes or vaping devices. A product that can be used for the inhalation of vapour through a mouthpiece. E‑cigarettes can be disposable or refillable by means of a refill container and a tank, or can be rechargeable with single-use cartridges. Products may be used to consume nicotine or used without nicotine (see nicotine-containing e-cigarettes).

Products that contain or could contain nicotine in the form of e‑liquid are covered under the European Union's 2014 Tobacco Products Directive and need to be notified to the Medicines and Healthcare products Regulatory Agency (MHRA). Other devices such as disposable e‑cigarettes that do not contain nicotine, and 0% nicotine e‑liquids, are regulated under the General Product Safety Regulations (2005; definition informed by the MHRA's e-cigarettes regulations for consumer products). E‑cigarettes are not currently (November 2021) licensed medicines but are regulated by the Tobacco and Related Products Regulations (2016).

Harm reduction

Measures to reduce the illnesses and deaths caused by smoking tobacco among people who smoke and those around them. Some measures or products may reduce harm more than others. People who smoke and currently do not want, or are not ready, to stop in one go can reduce their harm by smoking less and abstaining from smoking temporarily. The benefits of harm reduction itself are uncertain, but it may mean people are more likely to stop smoking altogether in the future.

Medicinally licensed nicotine-containing products

Nicotine-containing products that have been given marketing authorisation by the MHRA. At the time of publication (November 2021), nicotine replacement therapy products were the only type of medicinally licensed nicotine-containing product on the market. If any nicotine-containing e‑cigarette were licensed by the MHRA and made commercially available, it would be included in this definition.

Nicotine-containing products

Products that contain nicotine but do not contain tobacco and so deliver nicotine without the harmful toxins found in tobacco. This currently includes nicotine replacement therapy, which has been medicinally licensed for smoking cessation by the MHRA (see nicotine replacement therapy), and nicotine-containing e-cigarettes. Currently there are no licensed nicotine-containing e‑cigarettes on the market. Nicotine-containing e‑cigarettes on general sale are regulated under the Tobacco and Related Products Regulations (2016) by the MHRA. For further details, see the MHRA website.

Nicotine-containing e-cigarettes

Nicotine-containing e‑cigarettes are vaping devices filled with nicotine-containing e‑liquid. These devices must be notified to the MHRA and must meet the requirements of the European Union (2014) Tobacco Products Directive (definition informed by the MHRA's e-cigarettes regulations for consumer products).

Nicotine replacement therapy

Products medicinally licensed for use as a stop smoking aid and for harm reduction, as outlined in the BNF. They include transdermal patches, gum, inhalation cartridges, sublingual tablets, lozenges, mouth spray and nasal spray.

Pharmacotherapies

This covers medication licensed for smoking cessation such as varenicline or bupropion, as well as nicotine replacement therapy. In August 2022, varenicline was unavailable in the UK. See the MHRA alert on varenicline.

Safety

This refers to the incidence of minor and major side effects associated with nicotine-containing products.

Schools

'Schools' is used to refer to:

Secondary care

All publicly funded secondary and tertiary care facilities, including buildings, grounds and vehicles. It covers drug and alcohol services in secondary care; emergency care; inpatient, residential and long-term care for severe mental illness in hospitals, psychiatric and specialist units and secure hospitals; and planned specialist medical care or surgery. It also includes maternity care in hospitals, maternity units, outpatient clinics and in the community.

Self-help materials

Any manual or structured programme, in written or digital format, that someone can use to try to stop smoking or reduce the amount they smoke. These can be used without the help of healthcare professionals, stop-smoking advisers or group support. They can be aimed at anyone who smokes, particular populations (for example, certain ages or ethnic groups), or may be tailored to individual need.

Smokefree

Air that is free of tobacco smoke. E‑cigarettes are not covered by smokefree legislation.

Smokeless tobacco

Any product containing tobacco that is placed in the mouth or nose and not burned and which is typically used in England by people of South Asian family origin. It does not include products that are sucked, like 'snus' or similar oral snuff products (as defined in the European Union 2014 Tobacco Products Directive).

The types used vary across the country but they can be divided into 3 main categories, based on their ingredients (Stanfill et al. 2010):

South Asian family origin

People with ancestral links to countries in southern Asia, including Bangladesh, India, Nepal, Pakistan or Sri Lanka.

Specialist tobacco cessation services

Evidence-based services that offer support to help people stop smoking or using smokeless tobacco. In England, these are generally referred to as 'stop-smoking support or services' or 'smoking cessation services' because they normally focus on people who smoke tobacco. But a service might brand itself as a generic tobacco cessation or tobacco dependence service, to emphasise a focus on more than 1 form of tobacco.

Stop in one go

The standard approach in most stop-smoking support. The person makes a commitment to stop smoking on or before a particular date (the quit date). This may or may not involve the use of pharmacotherapies or nicotine-containing e‑cigarettes before the quit date and for some time afterwards, depending on the person's needs.

Stop-smoking support

Interventions and support to stop smoking, regardless of how services are commissioned or set up.

Telephone quitlines

These provide proactive or reactive advice, encouragement, counselling and support by phone to anyone who smokes who wants to quit, or who has recently quit.

Temporary abstinence

Stopping smoking with or without medication for a particular event or series of events, in a particular location, for specific time periods (for example, while at work, during long-haul flights or during a hospital stay), or for the foreseeable future. (The latter might include, for example, abstinence while serving a prison sentence or while detained in a secure mental health unit.)

Under-served groups

Groups who may be less likely to benefit from an intervention because they have specific needs that the intervention does not address, or because they may face additional challenges in engaging with the intervention.