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expert reaction to draft guideline to tackle the health burden of smoking, as published by NICE

A comprehensive draft guideline to tackle the health burden of smoking has been has been developed by the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE).


Dr Sarah Jackson, Principal Research Fellow, UCL Tobacco and Alcohol Research Group, said:

“E-cigarettes are currently the most popular aid used by smokers trying to quit, and among the most effective. We know from surveys of health professionals that e-cigarettes are frequently brought up in conversations with patients who smoke. But health professionals are often unsure of the evidence on the safety or effectiveness of these devices for quitting smoking, so can be reluctant to recommend them. The new draft guideline provides clear, evidence-based guidance to healthcare staff; this will enable them to have informed discussions with patients in order to select the most suitable option to support their quit attempt.”


Dr Jamie Hartmann-Boyce, Senior Research Fellow in Health Behaviours, University of Oxford, said:

“This new draft guideline from NICE and Public Health England is very welcome. Quitting smoking is the single best thing people who smoke can do for their health. Most people who smoke want to quit, but many find it difficult to do so. Fortunately, evidence shows there are a number of tools available that help people quit. Smoking is a leading cause of health inequalities and evidence-based support to quit smoking needs to be available to all.

“A growing body of evidence suggests that e-cigarettes are considerably less harmful than smoking – though not risk-free – and can help people quit smoking. NICE and Public Health England continue to lead the way in promoting the use of nicotine-containing e-cigarettes as a harm reduction tool based on the best available evidence.

“As highlighted by the new guidance, evidence shows that using two forms of nicotine replacement therapy at once – a patch and a short-acting form like gum or lozenges – is more effective than just using one kind. For the best chances of successfully quitting, people should also be offered behavioural support to quit. There is lots of evidence supporting the use of behavioural counselling for quitting smoking.

“Evidence supports providing vouchers to help pregnant people quit smoking, and it is great to see this in the new draft guidance. Studies of this type of programme show that people remained smoke-free even after the vouchers or other types of rewards finished. Evidence shows these programmes also work outside of pregnancy. It would be positive to see them used across a range of contexts.”


Prof John Britton, Emeritus Professor of Epidemiology at the University of Nottingham, and a member of the advisory committee for this guideline, said:

“This guidance, although phrased in the cautious language that NICE is obliged to use, is a clear endorsement of the vital role that electronic cigarettes can play in helping millions of NHS patients free themselves from the scourge of addiction to tobacco smoking. I am pleased to see this guidance give the green light to NHS organisations and health workers across the country to adopt vaping into their armoury of support for patients who smoke.”


Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“As usual, this is a good evidence-based guideline. Regarding e-cigarettes, it notes that the spate of lung injuries in the US in 2019 that some UK media reported as linked to e-cigarette use was caused by contaminated marijuana products and is not relevant to e-cigarettes used by smokers in the UK; and that our MHRA monitoring identified no major health concerns. E-cigarettes are recommended among other approaches to help smokers quit.”



Declared interests

None received.

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