The fourth, fully revised edition of this briefing gives expert, concise guidance on how to deliver Very Brief Advice on Smoking (VBA+) to pregnant women who smoke and how to carry out routine carbon monoxide (CO) monitoring with all pregnant women.
Smoking in pregnancy is a significant health problem for the mother and the baby. Many women who smoke will quit by themselves before becoming pregnant and others will stop once their pregnancy is confirmed. However, other pregnant women will need considerable support to stop smoking successfully.
It is important that NCSCT activities are founded on the best possible evidence of need for these activities, the nature of those activities, and the effectiveness of these activities.
Academic links
The research activities of the NCSCT were originally carried out by a team of experts at University College London. This programme of work was led by Professor Susan Michie and Professor Robert West along with a team including Dr Andy McEwen, Dr Emma Beard, Dr Leonie Brose (Institute of Psychiatry) and Fabiana Lorencetto (City University).
Below we list the main findings from NCSCT publications with the citation for these papers.
Advice on service provision
"The English Stop Smoking Services have had an increasing impact in helping smokers to stop in their first 10 years of operation and successfully reached disadvantaged groups. However, performance across local services has varied considerably."
[West R, May S, West M, Croghan E, McEwen A (2013) Performance of English stop smoking services in first 10 years: analysis of service monitoring data. British Medical Journal, 47:f4921.]
"Stop smoking services may enhance success rates with disadvantaged smokers if they promote use of open groups."
[Hiscock R, Murray S, Brose L, McEwen A, Leonardi-Bee J, Bauld L (2013) Behavioural therapy for smoking cessation: the effectiveness of different interventions for disadvantaged and affluent smokers. Addictive Behaviours. In Press.]
"A substantial part of commissioning of Stop Smoking Services in England appears to take place without adequate consultation of evidence-based guidelines or specification of the service to be provided. This may account for at least some of the variation in success rates."
[McDermott M, Thompson H, West R, Kenyon J, McEwen A (In Press) Translating evidence-based guidelines into practice: A survey of practices of commissioners and managers of the English Stop Smoking Services. BMC Health Services Research]
"Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT."
[Brose L, West R, McDermott M, Fidler J, Croghan E, McEwen A (2011) What makes for an effective stop-smoking service? Thorax. 66(10), 924-6. Doi:10.1136/thoraxjnl-2011-200251]
"Most NHS Stop-Smoking Services appear to provide relapse prevention interventions for clients despite there being no evidence that these are effective."
[Agboola, S.A., Coleman, T.J., Leonardi-Bee, J.A., McEwen, A. & McNeill, A.D. (2010) Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey. BMC Health Services Research, 10, 214. Doi: 10.1186/1472-6963-10-214]
"Telephoning smokers from GP lists is a cost-effective method of prompting quit attempts using NHS Stop-Smoking Services."
[McEwen, A., Condliffe, L. & Gilbert, A. (2010) Promoting engagement with a Stop Smoking Service via pro-active telephone calls. Patient Education and Counselling, 80: 277-279. Doi: 10.1016/j.pec.2009. 11.009]
Assessment and training
"There are significant deficiencies in training and supervision of Stop-Smoking Practitioners in England, more so for ‘community’ (for whom smoking cessation is a small part of their role) than ‘specialist’ practitioners."
[McDermot M, West R, Brose L, McEwen A (In Press) Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking Services. Addictive Behaviors.]
"Whilst behaviour change techniques associated with effective smoking cessation support in pregnancy can be identified from high quality RCTs, English Stop-Smoking Services appear to use only a proportion of these."
[Lorencatto F, West R, Michie S (In Press) Identifying evidence-based behaviour change techniques to aid smoking cessation in pregnancy. Nicotine & Tobacco Research.]
"A significant minority of Stop-Smoking Practitioners and Stop-Smoking Managers believe that NRT use for smoking reduction can be harmful to health and undermine smoking cessation."
[Beard E, McDermott M, McEwen A, West R (In Press) Beliefs of stop smoking practitioners in England on the use of nicotine replacement therapy for smoking reduction. Nicotine and Tobacco Research. Doi: 10.1093/ntr/ntr260]
"It is possible to identify specific knowledge and skills required for delivery of effective behavioural support for smoking cessation. This approach can form the basis for development of assessment and training of stop smoking specialists."
[Michie S, Churchill S, West R (2011) Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Annals of Behavioral Medicine, 41(1), 59-70. DOI 10.1007/s12160-010-9235-z]
"It is possible to code reliably group-specific behaviour change techniques for smoking cessation. Fourteen such techniques are present in guideline documents of which two appear to be associated with higher short-term self-reported quit rates when included in treatment manuals of English Stop-Smoking Services."
[West R, Evans A, Michie S (2010) Behaviour change techniques used in group-based behavioural support by the English Stop-Smoking Services and preliminary assessment of association with short-term quit outcomes. Nicotine & Tobacco Research, 12(7), 742-747. Doi: 10.1093/ntr/ntq074]
"It is possible to develop a reliable taxonomy of behaviour change techniques used in behavioural support for smoking cessation which can provide a starting point for investigating the association between intervention content and outcome and can form a basis for determining competences required to undertake the role of stop smoking specialist."
[Michie S, Hyder N, Walia A, West R (2011) Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation. Addictive Behaviors, 36 (4), 315-319. Doi: 10.1016/j.addbeh.2010.11.016]
Online knowledge training course
"Knowledge required to deliver effective stop smoking intervention is improved substantially after using the NCSCT online training programme. Practitioners with all levels of prior knowledge benefit."
[Brose, L.S., West, R., Michie, S., Kenyon, J. & McEwen, A. (In Press). Effectiveness of an Online Knowledge Training and Assessment Program for Stop Smoking Practitioners. Nicotine and Tobacco Research, Online first 16 Jan 2012, doi: 10.1093/ntr/ntr286]
"The 30-minute online training on VBA appears to have produced positive changes in GP's self-reported knowledge, self-efficacy and clinical practice in addressing tobacco use with patients."
Papadakis, S, McEwen A, Walsh K. E-Learning on very brief advice on smoking (VBA): Changes to knowledge, self-efficacy and clinical practice of general practitioners. Smoking in Britain, 2019;7(9).
Two-day skills training course
"The two-day skills training course leads to a substantial increase in participants’ ratings of their confidence and skills."
[Brose, L.S., Michie, S., West, R. & McEwen, A. (Under review) Evaluation of face-to-face courses in behavioural support for Stop-Smoking Practitioners. Journal of Smoking Cessation]
Online training course for GPs in delivery of very brief advice on smoking
"Offer of help with stopping by a GP appears to be more effective than advice to stop in promoting smoking cessation."
[Aveyard, P., Begh, R., Parsons, A. and West, R. (2012), Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. doi: 10.1111/j.1360-0443.2011.03770.x]
It is important that NCSCT research evaluating our training and assessments programme, and into the delivery of behavioural support, is published in peer-reviewed academic and clinical journals. This ensures that we can be confident that what we do is based upon evidence.
The following is a list of our publications to date:
We have come across a number of questions that people often ask us and we hope that these questions and answers are helpful. Otherwise, please feel free to call us on 01305 755 828, or send an email to enquiries@ncsct.co.uk
What is the NCSCT?
The National Centre for Smoking Cessation and Training (NCSCT) aims to support stop smoking services and practitioners, plus other health and social care professionals, to provide high quality stop smoking interventions based on the most up-to-date evidence available. The NCSCT works towards this aim in partnership with the field through the provision of online and face-to-face (virtual) training courses and modules, and a website containing the latest resources and guidance.
What is the significance of the NCSCT Training Standard - Learning Outcomes for Training Stop Smoking Practitioners?
The NCSCT Training Standard superseded the HDA standard as the official benchmark of quality training for stop smoking service personnel in April 2010. It is based on the key competences (knowledge and skills) required to deliver effective smoking cessation interventions and was fully updated in 2018.
What training does the NCSCT provide?
NCSCT online training and assessment programmes are free of charge and are available to all from our website. They are based on the competences identified in the NCSCT Training Standard and include the following elements:
Written in partnership with Public Health England (now the Office for Health Improvement and Disparities) and MD Diagnostics, this briefing provides guidance on delivering VBA+ in dental settings. The briefing covers:
For people with mental illness who smoke, stopping smoking will have the greatest impact on their health than any other behaviour change.
This briefing is aimed at those who work in a mental health setting and gives expert, concise guidance on how to deliver Very Brief Advice (VBA+) to patients who smoke.
People who have a serious mental illness are at greater risk of a range of medical conditions compared to the general population. The high rates of smoking in this population exacerbate these health inequalities. The greatest impact on the health of people with mental illness who smoke will come from the routine provision of smoking cessation support.
These resources are designed to complement our online training module: NCSCT Swap-to-Stop training module.
The Swap-to-Stop briefing below summarises the Swap-to-Stop scheme with case studies from organisations who have implemented it.
Swap-to-Stop: a memory jogger (see below) lays out the main components of Very Brief Advice on Smoking (VBA+) as it relates to the scheme, with typical questions from clients and suggested answers.
Below are links to additional resources to support the delivery of the Swap-to-Stop scheme:
Ambulance Clinicians already routinely ask about smoking status as part of taking a history, but they also have an opportunity to discuss stopping smoking with non-emergency 999 patients.
We've worked with colleagues in the Ambulance Service to produce this guidance for Ambulance Clinicians on delivering Very Brief Advice on Smoking (VBA+).
The original VBA model focussed on referral to local Stop Smoking Services. Some areas no longer offer a Stop Smoking Service to all people who smoke and there is now a wider set of options for stop smoking support. The updated VBA+ model reflects the fact that patients interested in stopping smoking should be referred to the best locally available support.
In some areas this will remain the local Stop Smoking Service, in others this will include trained colleagues in pharmacy, primary care, mental health, maternity and acute care settings.
Importantly, the principles and merits of VBA+ remain the same: promote quit attempts and link people to evidence-based stop smoking support.
As with any clinical skill it is important to ensure this training is refreshed periodically. All those who have previously completed the NCSCT VBA modules can now retake the online VBA+ courses and receive a new certificate of competence as a refresher.
A short training film modelling how to deliver Very Brief Advice (VBA) to smokers and giving the evidence for this lifesaving intervention.
It trains healthcare professionals in the ease and effectiveness of implementing VBA on Smoking: Ask, Advise and Act.
Taken from the NCSCT online module, this film can be used as a stand-alone resource for local training courses.
For ordering details contact enquiries@ncsct.co.uk
Product code VBADVD
This engaging short film has been developed for GPs and other healthcare professionals to help increase the quality and frequency of Very Brief Advice (VBA) given to patients who smoke.
Designed for use as part of the NCSCT online module, this film can also be used as a stand-alone resource for local training courses.
For ordering details contact enquiries@ncsct.co.uk
Product code 30DVD
In this powerful film smokers talk about the impact of working with their families to help create smokefree environments for their children. It can be used as part of the NCSCT online training module or as a stand-alone resource for local training courses.
For ordering details contact enquiries@ncsct.co.uk
Product code SHSDVD
These resources are designed to complement our National Smoke-Free Pregnancy Incentive Scheme (NSPIS) online training module: Click here for the training module
In 2024 the Department of Health and Social Care launched the National Smoke-Free Pregnancy Incentive Scheme (NSPIS). The NSPIS briefing below summarises the NSPIS scheme with case studies from organisations who have implemented stop smoking pregnancy incentive schemes.
NSPIS: a memory jogger lays out the main components of incorporating discussion about the NSPIS into Very Brief Advice on Smoking (VBA) and stop smoking interventions with pregnant women.
