Guidance

Recommendations on promoting quitting

Recommendations on promoting quitting

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

This guideline should be read alongside NICE's guidelines on patient experience in adult NHS services and babies, children and young people's experience of healthcare, which have guidance on giving information to people and discussing their views and preferences.

In this guideline, we use the following terms for age groups:

  • children: aged 5 to 11

  • young people: aged 12 to 17

  • young adults: aged 18 to 24

  • adults: aged 18 and over.

At the time of publication (November 2021), no nicotine-containing e-cigarettes were licensed as a medicine for stopping smoking by the Medicines and Healthcare products Regulatory Agency (MHRA) and commercially available in the UK market. All nicotine-containing e‑cigarettes in the UK that are not licensed as a medicine by the MHRA are regulated by the Tobacco and Related Products Regulations (2016), and cannot be marketed by the manufacturer for use for stopping smoking.

These recommendations promote options to help people stop smoking or using smokeless tobacco or, if they do not want or are not ready to stop in one go, to reduce their harm.

1.8 Using medicinally licensed nicotine-containing products

Raising awareness

These recommendations are for people working in public health, and others with tobacco control and providing advice about harm reduction as part of their remit.

1.8.1

Raise public awareness of the harm caused by smoking and secondhand smoke. Make it clear that smoking causes a range of diseases and conditions including cancer, chronic obstructive pulmonary disease and cardiovascular disease. [2013]

1.8.2

Provide information on how people who smoke can reduce the risk of illness and death (to themselves and others) by using 1 or more medicinally licensed nicotine-containing products. Explain that they could be used as a partial or complete substitute for tobacco, either temporarily or in the long term. [2013]

1.8.3

Provide the following information about nicotine:

  • smoking is highly addictive mainly because it delivers nicotine very quickly to the brain and this makes stopping smoking difficult

  • most smoking-related health problems are caused by other components in tobacco smoke, not by the nicotine

  • nicotine levels in medicinally licensed nicotine-containing products are much lower than in tobacco, and the way these products deliver nicotine makes them less addictive than smoking. [2013, amended 2021]

1.8.4

Provide the following information about the effectiveness and safety of medicinally licensed nicotine-containing products:

  • any risks from using medicinally licensed nicotine-containing products are much lower than those of smoking; nicotine replacement therapy (NRT) products have been demonstrated in trials to be safe to use for at least 5 years

  • lifetime use of medicinally licensed nicotine-containing products is likely to be considerably less harmful than smoking. [2013]

1.8.5

Provide information on using medicinally licensed nicotine-containing products, including:

  • what forms they take

  • how to use them effectively when trying to stop or cut down smoking

  • long-term use to reduce the risk of relapsing

  • where to get them

  • the cost compared with smoking. [2013]

For recommendations on what information to provide about nicotine-containing e‑cigarettes, see the section on advice on nicotine-containing e-cigarettes.

Point-of-sale promotion

These recommendations are for manufacturers and retailers of medicinally licensed nicotine-containing products, including tobacco retailers.

1.9 Promoting stop-smoking support

Developers of communications strategies

1.9.1

Coordinate communications strategies to support the delivery of stop-smoking support, telephone quitlines, school-based interventions, tobacco control policy changes and any other activities designed to help people to stop smoking. [2018]

1.9.2

Develop and deliver communications strategies about stopping smoking in partnership with the NHS, national, regional and local government and non-governmental organisations. The strategies should:

  • Use the best available evidence of effectiveness, such as Cochrane reviews.

  • Be developed and evaluated using audience research.

  • Use 'why to' and 'how to' stop messages that are non-judgemental, empathetic and respectful. For example, use testimonials from people who smoke or used to smoke.

  • Involve community pharmacies in local campaigns and maintain links with other professional groups such as dentists, fire services and voluntary groups.

  • Ensure campaigns are sufficiently extensive and sustained to have a reasonable chance of success.

  • Think about targeting and tailoring campaigns towards groups that epidemiological data identify as having higher than average or stagnant rates of smoking, to address inequalities. [2018, amended 2021]

Schools

1.9.3

Make information on local stop-smoking support easily available to staff and students. Include details on the type of help available and when, where and how to access the services. [2010]

Employers

1.9.4

Make information on local stop-smoking support easily available at work. Include details on the type of help available and when, where and how to access the services. Publicise these interventions. [2007]

1.9.5

Be responsive to individual needs and preferences of employees. If feasible, and if there is sufficient demand, provide on-site stop-smoking support. [2007]

1.9.6

Allow staff to attend stop-smoking support during working hours without loss of pay. [2007]

1.9.7

Negotiate a smokefree workplace policy with employees or their representatives. This should:

  • State whether or not smoking breaks may be taken during working hours and, if so, where, how often and for how long.

  • Include a stop-smoking policy developed in collaboration with staff and their representatives.

  • Direct people who wish to stop smoking to local stop-smoking support. [2018]

Employees and their representatives

1.9.8

Encourage employers to provide advice, guidance and support to help employees who want to stop smoking. [2007]

1.10 Promoting support for people to stop using smokeless tobacco

These recommendations are for public sector, voluntary and community organisations, health and social care professionals and faith groups. They are particularly relevant to South Asian communities in areas of identified need.

1.10.1

Work in partnership with existing community initiatives to raise awareness of local smokeless tobacco cessation services and how to access them. Ensure any material used to raise awareness of the services:

  • Uses the names that the smokeless tobacco products are known by locally, as well as the term 'smokeless tobacco'.

  • Gives information about the health risks associated with smokeless tobacco and the availability of services to help people quit.

  • Challenges the perceived benefits – and the relative priority that users may place on these benefits (compared with the health risks). For example, some people think smokeless tobacco is an appropriate way to ease indigestion or relieve dental pain, or help freshen the breath.

  • Addresses the needs of people whose first language is not English (by providing translations).

  • Addresses a range of communication needs by providing material in alternative formats, for example pictures, large print, Braille, audio and video.

  • Includes information for specific South Asian subgroups (for example, older Bangladeshi women) who are known to have high rates of smokeless tobacco use.

  • Discusses the concept of addiction in a way that is sensitive to culture and religion (for example, it may be better to refer to users as having developed a 'habit', rather than being 'addicted').

  • Does not stigmatise users of smokeless tobacco products within their own community, or in the eyes of the general community. [2012]

1.10.2

Use existing local South Asian information networks (including culturally specific TV and radio channels), and traditional sources of health advice within South Asian communities to provide information on smokeless tobacco. [2012]

1.10.3

Use venues and events that members of local South Asian communities frequent to publicise, provide or consult on cessation services with them. (Examples include educational establishments and premises where prayer groups or cultural events are held.) [2012]

1.10.4

Raise awareness among those who work with children and young people about smokeless tobacco use. This includes:

  • providing teachers with information on the harm that smokeless tobacco causes and that also challenges the perceived benefits – and the priority that users may place on these perceived benefits

  • encouraging teachers to discuss with their students the reasons why people use smokeless tobacco; this could take place as part of drug education, or within any other relevant part of the curriculum. [2012]