Behavioural support for smoking cessation

Using stop smoking services is three times as effective as making an unassisted quit attempt

Variable short-term quit rates amongst stop smoking services, plus evidence from two studies, has led to a review of the claim that: "Smokers are up to four times more likely to succeed with the English stop smoking services than if they try to quit unaided."

The best evidence now shows that using stop smoking services is THREE TIMES as effective as making an unassisted quit attempt.

This briefing provides the basis for this new, revised claim.

This briefing answers the question we are often asked about whether assessing abstinence at 12 weeks gives us a better idea of the number of clients of Stop Smoking Services who will become permanent ex-smokers compared with measuring abstinence at 4 weeks.

Written by leading academics and clinicians this briefing represents the most comprehensive and current summary of the available evidence.

Stopping smoking is possibly the single most important step a person can take to improve their well-being, whatever their age.

The long time horizon of benefits generally associated with smoking cessation means that more acute gains from stopping smoking may be motivating, especially for younger smokers.

This briefing summarises evidence relating to short-term positive consequences of smoking cessation, covering quick gains within the first year of stopping smoking related to physical and mental health, financial benefits, as well as psychosocial, behavioural and cosmetic improvements.

The 'Not-a-Puff' rule is associated with better outcomes than gradual cessation, in both supported and unsupported quit attempts.

The 'Not-a-Puff' rule involves assisting smokers to stop smoking abruptly, commit to not smoking any further cigarettes after the quit date and also to promise to not taking even a single puff on a cigarette from that day forwards.

This briefing provides the rationale and the theoretical and empirical evidence behind this clinical intervention.

Poor bone health has a devastating impact in the UK in terms of disease morbidity and mortality, as well as financial and social costs.

Smoking is a risk factor for poor bone health as it affects the metabolism of hormones, body weight, vitamin D levels, calcium absorption, and blood circulation. It also increases oxidative stress, thus disrupting healthy bone resorption and formation, leading to osteoporosis.

Consequently, smokers have a 25% increase in fracture risk and are nearly twice as likely to experience hip fractures. Smoking also delays bone healing following operations to repair fractures.

However, stopping smoking has been shown to partially reverse the risk of suffering fractures, and smoking cessation is recommended for the prevention and treatment of osteoporosis.

Smoking reduction, cutting down the cigarettes smoked per day, is common in the UK.

However, the amount that smokers cut down by is relatively small and there is little evidence to suggest that reducing cigarette consumption in itself has a positive effect on smoking-related outcomes.

Whilst unaided smoking reduction has not been reliably shown to increase quit attempts or smoking cessation rates, there is good evidence that the provision of NRT to smokers who cut down their cigarette consumption results in longer, substantial decreases in cigarette consumption and improves their chances to stop smoking completely.

It is well established that the social environment influences smoking initiation and maintenance, and cessation as well.

Observational studies investigating the natural progression towards smoking cessation show that social support is clearly associated with abstinence. Positive social support generally increases the likelihood of successfully stopping smoking, and negative social support undermines it.

Weight gain is a common consequence of stopping smoking but many experts in smoking cessation play this down and often the advice given to clients about possible weight gain and weight management strategies are inaccurate.

The aim of this briefing is to summarise the evidence for practitioners, making clear where there are uncertainties.

It is based on Medline searches, examination of systematic reviews, a Cochrane review on preventing weight gain on smoking cessation, and clinical experience.