The UCL Tobacco and Alcohol Research Group (UTARG) Output
Health Behaviour Research Centre
Institute of Epidemiology and Health Care, University College London, 1-19 Torrington
Place, London WC1E 6BT
Updated 17th November 2015 by Robert West (robertwest100@gmail.com)
The UTARG undertakes clinical trials of smoking cessation and alcohol reduction interventions, national and
international surveys of smoking and alcohol use patterns, analysis of large clinical data sets, field studies of
behavioural support for smoking cessation in practice, and experimental and interview studies aimed at
identifying novel intervention components. The four largest components of the programme are: 1)
development and evaluation of digital smoking cessation and alcohol reduction aids, 2) the ‘Smoking Toolkit
Study’ consisting of monthly national surveys of smoking and smoking cessation patterns in England, 3) the
‘Alcohol Toolkit Study’ which does a similar thing for alcohol use, and 4) identifying and promoting best
practice in the national network of Stop-Smoking Services. The alcohol research was added in late 2013.
This document shows the output of the Tobacco Research Group led by Professor Robert West since the
beginning of the Cancer Research UK programme in April 2007, renewed in April 2012.
Entries are listed in reverse date order. The most significant publications since 2011 are in bold.
Primary research and systematic reviews in refereed journals
Citations
Key findings
* denotes articles arising from the Smoking Toolkit Study
^ denotes studies arising from synergy with the National
Centre for Smoking Cessation and Training
1. Ebbert J, Hughes J, West R, Rennard S,
Russ C, McRae T, Treadow J, Ching-Ray Y,
Dutro M, Park P, (2015) Effect of
Varenicline on Smoking Cessation Through
Smoking Reduction: A Randomized Clinical
Trial. Journal of the American Medical
Association. 313(7):687-94. doi:
10.1001/jama.2015.280.
2. Kotz D, Simpson C, Viechtbauer W, van
Schayck O, West R, Sheikh A, (2015)
Cardiovascular and neuropsychiatric safety
of varenicline and bupropion compared with
nicotine replacement therapy for smoking
cessation: study protocol of a retrospective
cohort study using the QResearch® general
practice database. BMJ Open, 4(8):e005281.
doi: 10.1136/bmjopen-2014-005281.
3. Ussher M, Lewis S, Aveyard P, Manyonda I,
West R, Lewis B, Marcus B, Riaz M, Taylor
A, Daley A, Coleman T, (2015) A
randomised controlled trial of physical
activity for smoking cessation in pregnancy.
British Medical Journal, 14, 350:h2145. doi:
10.1136/bmj.h2145.
4. Beard E, Brown J, McNeill A, Michie S,
West R, (2015) Has growth in electronic
cigarette use by smokers been responsible
UTARG Output
Varenicline substantially improves smoking
cessation rates when used by smokers not willing to
stop in the next month but willing to reduce
consumption with a view to quitting within the next
3 months.
Varenicline does not appear to be associated with
an increased risk of recorded cases of
cardiovascular events, self-harm or depression
requiring treatment compared with nicotine
replacement therapy.
Adding a physical activity intervention to
behavioural smoking cessation support for
pregnant women did not increase cessation rates at
end-of-pregnancy. During pregnancy, physical
activity is not recommended for smoking cessation
but remains indicated for general health benefits
The shapes of the trajectories since 2011 suggest
that electronic cigarettes are probably not
responsible for the decline in use of licensed
Page 1
5.
6.
7.
8.
for the decline in use of licensed nicotine
products? Findings from repeated cross
sectional surveys. Thorax, 70(10):974-8. doi:
10.1136/thoraxjnl-2015-206801.*
Shahab L, Gilchrist G, Hagger-Johnson G,
Shankar A, West E, West R, (2015)
Reciprocal associations between smoking
cessation and depression in older smokers:
findings from the English Longitudinal
Study of Ageing (ELSA). British Journal of
Psychiatry, 207(3):243-9. doi:
10.1192/bjp.bp.114.153494.
West R, Raw M, McNeill A, Stead L,
Aveyard P, Britton J, Stapleton J,
McRobbie H, Pokhrel S, Lester-George A,
Borland R, (2015) Healthcare interventions
to promote and assist tobacco cessation: a
review of efficacy, effectiveness and
affordability for use in national guideline
development. Addiction, 110(9):1388-403.
doi: 10.1111/add.12998.
Brown J, West R Angus C, Beard E,
Brennan A, Drummond C, Hickman M,
Holmes J, Kaner E, Michie S, (2015)
Comparison of brief interventions in
primary care on smoking and excessive
alcohol consumption in England: a
population survey. British Journal of
General Practice.*
Ussher M, Kakar G, Hajek P, West R (2015)
Dependence and motivation to stop smoking as
predictors of success of a quit attempt among
smokers seeking help to quit. Addictive
Behaviors, 53, 175-180. doi:
10.1016/j.addbeh.2015.10.020.
9. Brown J, Michie S, Walmsley M, West R,
(2015). An online documentary film to
motivate quit attempts among smokers in the
general population (4Weeks2Freedom): A
randomised controlled trial. Nicotine &
Tobacco Research, pii: ntv161. [Epub ahead of
print]
10. Simon R, West R, (2015) Models of addiction
and types of interventions. International
Journal of Alcohol and Drug Research, 4(1),
13-20.
doi:http://dx.doi.org/10.7895/ijadr.v4i1.198
11. Gilbody S, Peckham E, Man M, Mitchell N, Li
J, Becque T, Hewitt C, Knowles S, Bradshaw
UTARG Output
nicotine products. Electronic cigarettes appear to
have increased the total market for use of nontobacco nicotine-containing products.
In older smokers, depression appears to act as an
important barrier to quitting while quitting has no
long-term impact on depression.
Brief advice from a healthcare worker, telephone
helplines, automated text messaging, printed selfhelp materials, cytisine and nortriptyline are
globally affordable healthcare interventions to
promote and assist smoking cessation. Evidence on
smokeless tobacco cessation suggests that face-toface behavioural support and varenicline can
promote cessation.
Whereas approximately half of smokers in England
visiting their GP in the past year report having
received advice on cessation, less than 10% of those
who drink excessively report having received advice
on their alcohol consumption.
Cigarette dependence, measured by the FTCD, or by
its HSI or non-HSI components, predicts both shortterm and medium-term outcomes of attempts to stop
smoking in treatment-seeking smokers, whereas
strength of motivation to stop predicts neither. Both
the HSI and non-HSI components may be considered
as briefer alternatives to the full FTCD.
The online documentary film (4Weeks2Freedom)
designed to boost motivation and self-efficacy and to
promote ex-smoker identity does not appear to prompt
quit attempts among smokers.
While substance- and non-substance-related addictions
differ in a number of respects, they share key
elements: a repeated powerful motivation to engage in
a particular behaviour, acquired through enacting the
behaviour, despite the experience or risk of significant
harm. Nine different types of intervention to combat
addiction found in the literature involve attempts to
change one or more of three factors that interact to
underpin behaviour: capability, opportunity, and
motivation (the “COM-B” model). The models of
addiction reviewed may serve as a basis for such
interventions
It is feasible to recruit people with severe mental
illness into an RCT to assess the benefits of a bespoke
Page 2
12.
13.
14.
15.
16.
17.
T, Planner C, Parrott S, Michie S, Shepherd C,
(2015) Bespoke smoking cessation for people
with severe mental ill health (SCIMITAR): a
pilot randomised controlled trial. Lancet
Psychiatry, 19(25):1-148, v-vi. doi:
10.3310/hta19250.
Brose L, McEwen A, Michie S, West R, Chew
X, Lorencatto F, (2015) Treatment manual use
and training with successful provision of stop
smoking support. Behaviour Research &
Therapy, 71:34-9. doi:
10.1016/j.brat.2015.05.013.
Nelson V, Goniewicz M, Beard E, Brown J,
Sheals K, West R, Shahab L, (2015)
Comparison of the characteristics of long-term
users of electronic cigarettes versus nicotine
replacement therapy: a cross-sectional survey
of English ex-smokers and current smokers.
Drug and Alcohol Dependence.
doi:10.1016/j.drugalcdep.2015.05.005.
Beadman M, Das R, Freeman T, Scragg P,
West R, Kamboj S, (2015) A comparison of
emotion regulation strategies in response to
craving cognitions: effects on smoking
behaviour, craving and affect in dependent
smokers. Behaviour Research and Therapy,
69:29-39. doi: 10.1016/j.brat.2015.03.013.
Brose LS, Hitchman SC, Brown J, West R,
McNeill A, (2015) Is the use of electronic
cigarettes while smoking associated
with smoking cessation attempts, cessation and
reduced cigarette consumption? A survey with
a 1-year follow-up. Addiction, 110(7):1160-8.
doi: 10.1111/add.12917 .
Hitchman S, Brose L, Brown J, Robson
D, McNeill A, (2015) Associations Between ECigarette Type, Frequency of Use, and
Quitting Smoking: Findings From a
Longitudinal Online Panel Survey in Great
Britain. Nicotine & Tobacco Research,
17(10):1187-94. doi: 10.1093/ntr/ntv078.
Garnett C, Crane D, West R, Brown J, Michie
S, (2015) Identification of behaviour change
techniques and engagement strategies to design
a smartphone app to reduce alcohol
consumption using a formal consensus method.
Journal of Medical Internet Research,3(2):e73)
doi:10.2196/mhealth.3895.
18. Thompson TP, Aveyard P, Ayres R, Taylor
RS, Warren FC, Campbell JL, Byng R, Ussher
M, Michie S, West R, Green C, Greaves CJ, &
Taylor AH, (2015). Lessons learned from
recruiting socioeconomically disadvantaged
smokers into a pilot randomised controlled trial
to explore the role of Exercise Assisted
Reduction then Stop (EARS) smoking. Trials,
UTARG Output
smoking cessation programme. Such a programme
may improve 12-month abstinence rates compared
with referral to standard stop-smoking services.
Access to, and use of, treatment manuals among
practitioners in the English stop-smoking services is
associated with higher success rates.
Compared with people who use NRT for at least 6
months, those who use EC over that time period
appear to have a stronger smoker identity and like their
products more. Among long-term users who have
stopped smoking, EC are perceived as more helpful
than NRT, appear more effective in controlling
withdrawal symptoms and continued use may be more
likely.
Reappraisal appears to be better at achieving reduction
in cigarette cravings than attempted suppression.
Daily use of e-cigarettes while smoking appears to be
associated with subsequent increases in rates of
attempting to stop smoking and reducing smoking, but
not with smoking cessation. Non-daily use of ecigarettes while smoking does not appear to be
associated with cessation attempts, cessation or
reduced smoking.
Whether e-cigarette use is associated with quitting
depends on type and frequency of use. Compared with
respondents not using e-cigarettes, daily tank users
were more likely, and non-daily cigalike users were
less likely, to have quit. Tanks were more likely to be
used by older respondents and respondents with lower
education.
The behaviour change techniques with greatest
potential to include in a smartphone app to reduce
alcohol consumption were judged by experts to be
self-monitoring, goal-setting, action planning, and
feedback in relation to goals. The strategies most
likely to engage users were ease of use, design,
tailoring of design and information, and unique
smartphone features.
Mailed invitations, and follow-up, from health
professionals was an effective method of recruiting
disadvantaged smokers into a trial of an exercise
intervention to aid smoking reduction. Recruitment via
community outreach approaches was largely
ineffective.
Page 3
16(1):1. doi:10.1186/1745-6215-16-1.
19. Thompson TP, Greaves CJ, Ayres R, Aveyard
P, Warren FC, Byng R, Campbell JL, Taylor
RS, Ussher M, Michie S, West R, Green C, &
Taylor AH, (2015). An exploratory analysis of
the smoking and physical activity outcomes
from a pilot randomised controlled trial of an
exercise assisted reduction to stop (EARS)
smoking intervention in disadvantaged groups
with various imputation methods. Nicotine &
Tobacco Research. pii: ntv099. [Epub ahead of
print]
20. Crane D, Garnett C, Brown J, West R, Michie
S, (2015) Behaviour change techniques in
popular alcohol reduction apps. Journal of
Medical Internet Research, 17(5):e118. doi:
10.2196/jmir.4060.
21. Tombor I, Shahab L, Brown J, Notley C, West
R, (2015) Does non-smoker identity following
quitting predict long-term abstinence?
Evidence from a population survey in England.
Addictive Behaviors, 45, 99-103. doi:
10.1016/j.addbeh.2015.01.026.
22. Ubhi HK, Michie S, Kotz D, Wong WC, West
R, (2015). A mobile app to aid smoking
cessation: Preliminary evaluation of
SmokeFree28. Journal of Medical Internet
Research, (17)1:e17. doi: 10.2196/jmir.3479.
23. Ferguson S, Brown J, Frandsen M, West R,
(2015) Associations between use of
pharmacological aids in a smoking cessation
attempt and subsequent quitting activity: a
population study. Addiction, 110(3):513-8. doi:
10.1111/add.12795.*
24. Beard, E., Bruguera, C, McNeill, A., Brown, J.,
& West, R, (2015). Association of amount and
duration of NRT use in smokers with cigarette
consumption and motivation to stop smoking: a
national survey of smokers in England..
Addictive Behaviors, 40C, 33-38. doi:
10.1016/j.addbeh.2014.08.008.*
25. Brown J, West R, (2014) Smoking
prevalence in England is below 20% for the
first time in 80 years. British Medical
Journal, 348, g1378 doi:
10.1136/bmj.g1378.*
26. Brown J, Michie S, Geraghty A, Yardley L,
Gardner B, Shahab L, Stapleton J, West R,
(2014) Internet-based intervention for
smoking cessation (StopAdvisor) in people
with low and high socioeconomic status: a
randomised controlled trial. Lancet
UTARG Output
A smoking reduction intervention for economically
disadvantaged smokers which was structured around a
programme of physical activity appears to be more
effective than usual care in achieving reduction and
may promote cessation. The effect does not appear to
be mediated by an increase in physical activity.
Only a minority of alcohol-related apps promote health
while the majority implicitly or explicitly promote the
use of alcohol. Alcohol-related apps that promote
health contain few behaviour change techniques
(BCTs) and none refer to theory. The mention of
evidence is more prevalence in more popular apps, but
popularity and user ratings are only weakly associated
with the BCT content
The majority of people who quit smoking recently
consider themselves as non-smokers. Younger people
and those who have been abstinent for longer are more
likely to take on a non-smoker identity. Ex-smokers
who make this mental transition following a quit
attempt appear more likely to remain abstinent in the
medium term than those who still think of themselves
as smokers.
The recorded 28-day abstinence rates from the mobile
app, SF28, suggest that it may help some smokers to
stop smoking. Further evaluation by means of a
randomized trial appears to be warranted.
Smokers who have tried to quit in the past year are
more likely to try to quit again in the next 6 months
regardless of whether they used a pharmacological aid,
and they are more likely to use the same method again
as they used previously.
Amount of nicotine replacement therapy used for
smoking reduction and duration of use are positively
associated with motivation to stop smoking and
negatively associated with daily cigarette
consumption.
Smoking prevalence continues to decline in
England and latest figures put it at significantly
below 20% in 2013 for the first time in at least 80
years.
The interactive internet-based smoking cessation
intervention, StopAdvisor, is more effective than an
information-only website in smokers with lower,
but not higher, socioeconomic status. User testing
of the website was done exclusively in smokers with
lower socioeconomic status and seems to have been
Page 4
Respiratory Medicine, 12, 997-1006.
doi.org/10.1016/S2213-2600(14)70195-X.
27. Pujades-Rodriguez M, George J, Shah A,
Rapsomaniki E, Denaxas S, West R, Smeeth
L, Timmis A, Hemingway H, (2014)
Heterogeneous associations between
smoking and a wide range of initial
presentations of cardiovascular disease in 1
937 360 people: lifetime risks and
implications for risk prediction.
International Journal of Epidemiology.
44(1):129-41. doi: 10.1093/ije/dyu218.
28. Brose L, West R, Michie S, McEwen A,
(2014) Changes in success rates of smoking
cessation treatment associated with take up
of a national evidence-based training
programme. Preventive Medicine, 69C, 1-4.
doi: 10.1016/j.ypmed.2014.08.021. ^
29. Brown J, Beard E, Kotz D, Michie S, West
R, (2014) Real-world effectiveness of ecigarettes when used to aid smoking
cessation: a cross-sectional population study.
Addiction, 109, 1531-40. doi:
10.1111/add.12623.*
30. Brown J, West R, Beard E, Michie S,
Shahab L, McNeill A, (2014) Prevalence and
characteristics of electronic cigarette users
in Great Britain: findings from a general
population survey. Addictive Behaviors, 39,
1120-1125. doi:
10.1016/j.addbeh.2014.03.009.
31. Kotz D, Brown D, West R, (2014)
Effectiveness of varenicline versus nicotine
replacement therapy for smoking cessation
with minimal professional support: evidence
from an English population study.
Psychopharmacology, 231, 37-42. doi:
10.1007/s00213-013-3202-x.*
32. Hsueh K, Hsueh S, Chou M, Pan, L, Tu M,
McEwen A, West R, (2014) Varenicline
versus Transdermal Nicotine Patch: A 3year Follow-up in a Smoking Cessation
Clinic in Taiwan. Psychopharmacology, 231,
2819-23. doi: 10.1007/s00213-014-3482-9.
33. Garnett C, Crane D, West R, Michie S, Brown
J, Winstock, (2014) Normative misperceptions
about alcohol use in the general population of
drinkers: a cross-sectional survey. Addictive
Behaviors, 47, 63-6. doi:
10.1093/alcalc/agr125.
34. Shahab L, Beard E, Brown J, West R, (2014)
Prevalence of NRT use and associated nicotine
intake in smokers, recent ex-smokers and
UTARG Output
successful in producing an effective website for that
group.
There is substantial heterogeneity in associations
between smoking and different CVD presentations
suggests different underlying mechanisms.
English stop smoking services that have greater
uptake of a national evidence-based training
programme have shown greater improvements in
success rates
Among smokers who have attempted to stop
without professional support, those who use ecigarettes are more likely to report continued
abstinence than those who used a licensed NRT
product bought over-the-counter or not aid to
cessation. The difference persists after adjusting for
a range of smoker characteristics such as nicotine
dependence.
There is a near universal awareness of e-cigarettes
and their use appears to be common among
smokers in Great Britain although a quarter of all
smokers are unsure as to whether e-cigarettes are
less harmful than cigarettes. E-lites – a brand that
delivers a low dose of nicotine – is the most
popular. E-cigarette users appear to have higher
socio-economic status, to smoke more cigarettes per
day and to have attempted to quit in the past year.
Varenicline use with minimal professional support
in the general population of smokers appears more
effective than NRT Rx in achieving short-term
abstinence. However, this effect may disappear in
the long term.
Varenicline appears to yield higher abstinence rate
out to 3 years than nicotine transdermal patch in a
smokers clinic where smokers can choose their
medication option.
Underestimating one’s own alcohol consumption
relative to other drinkers is common in Australia,
Canada, the UK and US, with a substantial minority of
harmful drinkers believing their consumption to be at
or below average.
Use of nicotine replacement therapy while smoking
does not appear to increase overall nicotine intake, and
ex-smokers using NRT longer-term have a lower
Page 5
longer-term ex-smokers. Plos One, 9, e113045.
doi: 10.1371/journal.pone.0113045.
eCollection 2014.*
35. Kotz D, Brown J, West R, (2014) Prospective
cohort study of the effectiveness of smoking
cessation treatments used in the "real world".
Mayo Clinic Proceedings, 89, 1360-7. doi:
10.1016/j.mayocp.2014.07.004.*
36. Herbec A, Beard E, Brown J, Gardner B,
Tombor I, West R, (2014) The needs and
preferences of pregnant smokers regarding
tailored Internet-based Smoking Cessation
Interventions: a qualitative interview study.
BMC Public Health, 14, 1070. doi:
10.1186/1471-2458-14-1070.
37. Smit E, Hoving C, Schellerman-Offermans K,
West R, de Vries H, (2014) Predictors of
successful and unsuccessful quit attempts
among smokers motivated to quit. Addictive
Behaviors, 39, 1318-1324. doi:
10.1016/j.addbeh.2014.04.017.
38. Taylor A, Thompson T, Greaves C, Taylor R,
Green C, Warren F, Kandiyali R, Aveyard P,
Ayres R, Byng R, Campbell J, Ussher M,
Michie S, West R, (2014) A pilot randomised
trial to assess the methods and procedures for
evaluating the effectiveness and costeffectiveness of Exercise Assisted Reduction
then Stop (EARS) among disadvantaged
smokers. Health Technology Assessment, 18
(4). doi: 10.3310/hta18040.
39. Raupach T, Brown J, Herbec A, Brose L, West
R, (2014) A systematic review of studies
assessing the association between adherence to
smoking cessation medication and treatment
success. Addiction, 109, 35-43 doi:
10.1111/add.12319.
40. Herbec, A, Brown J, Tombor I, Michie S, West
R, (2014) Pilot randomized controlled trial of
an internet-based smoking cessation
intervention for pregnant smokers
(‘MumsQuit’). Drug and Alcohol Dependence,
140, 130-6. doi:
10.1016/j.drugalcdep.2014.04.010.
41. Raupach T, Falk J, Vangeli E, Schiekirka S,
Rustler C, Grassi M, Pipe A, West R, (2014)
Structured smoking cessation training for
health professionals on cardiology wards: a
prospective study. European Journal of
Preventive Cardiology, 21, 915-922 doi:
10.1177/2047487312462803.
42. Tombor I, Shahab L, Ruiz M, West R, (2014)
Healthcare providers’ views on digital smoking
cessation interventions for pregnant women.
Journal of Smoking Cessation, 1-8. doi:
10.1017/jsc.2014.6.
UTARG Output
nicotine intake than smokers.
The most successful method of stopping cigarette
smoking in England is a combination of specialist
behavioral support and prescription medication.
Pregnant smokers willing to try using a digital
smoking cessation intervention may particularly value
one offering a high degree of targeting of
comprehensive information to them as a group and
tailoring support and advice to their individual needs,
as well as one providing post-relapse support, peer-topeer communication and personal support from
experts.
Strength of intention to quit is important in predicting
quit attempts in Dutch smokers motivated to quit but
not the success of those attempts. Self-efficacy appears
to play an important role in success of quit attempts in
this group.
Offering support for smoking reduction and physical
activity appears to have value in promoting reduction
and cessation in disadvantaged smokers not currently
motivated to quit
There is modest evidence to support the assumption
that lack of adherence to nicotine replacement therapy
regimens undermines effectiveness in clinical studies.
MumsQuit is an engaging and possibly helpful form of
support for pregnant women who seek cessation
support online, and merits further development and
evaluation in a full-scale RCT.
Introduction of a set of standard operating procedures
for smoking cessation advice was effective with
physicians but not nurses. Analysis of the barriers
suggested that motivation rather than capability or
opportunity was the major factor that needed to be
addressed.
From the perspective of healthcare providers (HCPs)
who interact with pregnant smokers, digital
interventions offer a range of potential benefits that
could make them useful for those who do not want
HCP support, or as an adjunct to that support, but there
Page 6
43. Kouimtsidis D, Stahl D, West R, Drummond
C, (2014) Can outcome expectancies be
measured across substances? Development and
validation of a questionnaire for populations in
treatment. Drugs and Alcohol Today. 14 Iss: 4,
pp.172 – 186. doi.org/10.1108/DAT-02-20140007.
44. Silla K, Beard E, Shahab L, (2014)
Characterization of characteristics of long-term
nicotine replacement therapy users: evidence
for a national survey. Nicotine & Tobacco
Research, 16, 1050-5. doi:
10.1093/ntr/ntu019.*
45. Brown,J, Vangeli E, Fidler J, Raupach T, West
R, (2014) Quitting Without Reporting Having
Tried: Findings From a National Survey.
Journal of Smoking Cessation. Available on
CJO 2014 doi:10.1017/jsc.2013.41.*
46. Beard E, Brose L, Brown J, West R, McEwen
A, (2014). How are the English Stop-Smoking
Services responding to growth in use of
electronic cigarettes? Patient Education and
Counselling, 94, 276-281. doi:
10.1016/j.pec.2013.10.022.^
47. Kouimtsidis D, Stahl D, West R, Drummond
C, (2014) How important are Positive and
Negative Outcome Expectancies in the
treatment of Addiction. A narrative review of
the literature. Drugs and Alcohol Today, 14,
137-149. doi: 10.1108/DAT-11-2013-0051
48. Shahab L, Brown J, Gardner B, Smith SG.
(2014) Seeking health-related information and
support online – does it differ as a function of
engagement in risky health behaviours?
Evidence from the Health Information National
Trends Survey. Journal of Medical Internet
Research. doi: 10.2196/jmir.3368.
49. 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. doi:
http://dx.doi.org/10.1136/bmj.f4921. ^
50. Shahab L, Andrews S, West R (2013)
Changes in prevalence of depression and
anxiety following smoking cessation: results
from an international cohort study
(ATTEMPT). Psychological Medicine, 44,
127-41. doi: 10.1017/S0033291713000391.
51. Brose L, West R, Stapleton J (2013)
Comparison of the effectiveness of
varenicline and combination nicotine
replacement therapy for smoking cessation
in clinical practice. Mayo Clinic
UTARG Output
are important limitations that need to be considered.
A new questionnaire that has been developed can
assess outcome expectancies relating to drug use in a
way that allows useful comparisons across substances.
Smokers who have also been using nicotine products
long term, are more motivated to stop smoking than
smokers not using such products.
A substantial minority of people who report having
stopped in the past year may fail to report a
corresponding quit attempt. However, quitting
smoking without considering that one has tried appears
to be rare. Instead, the most common reason for the
discrepancy is inconsistent reporting of
the timing of quit attempt.
Although use of electronic cigarettes by smokers
attending the English Stop Smoking Services is
common, few provisions are in place to record their
use. Practitioners mostly advise that products are not
licensed.
Both positive and negative expectancies in relation to
drug use appear to be predictive of outcomes in
substance use disorder p nicotiatients attending
treatment programmes.
Internet access and use to obtain health-related
information and support is widespread and mostly
independent of engagement in various health-risk
behaviors. However, those with low fruit/vegetable
intake or inadequate sun-protective behaviors may be
more difficult to reach with Internet-based
interventions.
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.
Smoking cessation does not appear to be associated
with an increase in anxiety or depression and may
lead to reduced incidence of depression.
Averaged across current English clinical practice
and populations, varenicline is marginally more
effective than combination nicotine replacement
therapy (NRT) but there is very wide variation
across local services, with varenicline being more
Page 7
Proceedings, 88, 226-33. doi:
10.1016/j.mayocp.2012.11.013. ^
52. Kotz D, Brown D, West R, (2013) Real
world effectiveness of smoking cessation
treatments: a population study. Addiction,
109, 491-9. doi: 10.1111/add.12429.*
53. Brown J, Kotz D, Michie S, Stapleton J,
Walmsley M, West R, (2013) How effective
and cost-effective was the national mass
media smoking cessation campaign
‘Stoptober’? Drug and Alcohol Dependence,
135, 52-8. doi:
10.1016/j.drugalcdep.2013.11.003.*
54. Tombor I, Shahab L, Brown J, West R
(2013) Positive smokier identity as a barrier
to quitting smoking: findings from a
national survey of smokers in England.
Drug and Alcohol Dependence, 133, 740745. doi: 10.1016/j.drugalcdep.2013.09.001.*
55. Stapleton J, West R, Hajek P, Wheeler J,
Vangeli E, Abdi Z, O’Gara C, McRobbie H,
Humphrey K, Ali R, Strang J, Sutherland G
(2013) Randomized trial of NRT, bupropion
and NRT plus bupropion for smoking
cessation. Addiction, 108, 2193-201. doi:
10.1111/add.12304.
effective in some services and combination NRT
being more effective in others.
After adjusting for major confounding variables
such as tobacco dependence, smokers in England
who use a combination of behavioural support and
pharmacotherapy in their quit attempts have
almost three times the odds of success than those
who use neither pharmacotherapy or behavioural
support. Smokers who buy nicotine replacement
therapy over the counter with no behavioural
support have similar odds of success as stopping as
those who stop without any aid.
Designing a national public health campaign with a
clear behavioural target (making a serious quit
attempt) using key psychological principles can
yield substantial behaviour change and public
health impact.
Only a minority of smokers in England have a
positive smoker identity. However, where it is
present it may be an important barrier to quitting
smoking and merits further study.
There appears to be no clinically meaningful
difference overall between bupropion, nicotine
replacement therapy and bupropion plus nicotine
replacement therapy in effectiveness at helping
smokers to stop in the context of an intensive
behavioural support programme although
bupropion may be more effective than NRT for
smokers with a history of depression. Group
support in the English Stop Smoking Services with
NRT or bupropion can be expected to deliver 6
month sustained abstinence rates of approximately
25% when undertaken according to established
principles.
56. Brose L, McEwen A, West R (2013)
RCTs have failed to find a benefit for single form
Association between nicotine replacement
nicotine replacement therapy to aid smoking
therapy use in pregnancy and smoking
cessation in pregnancy. This may be because of
cessation. Drug and Alcohol Dependence,
inadequate dosing. Data from the English Stop
132, 660-4. doi:
Smoking Services suggests that use of a
10.1016/j.drugalcdep.2013.04.017. ^
combination of nicotine patch and a faster acting
form appears to confer a significant benefit where
single form NRT does not.
57. Kralikova E, Kmetova A, Stepankova L,
Smokers in the same behavioural support
Zvolska K, Davis R, West R (2013) Fifty-two programme who use varenicline have a greater
week continuous abstinence rates of smokers probability of achieving long-term abstinence than
being treated with varenicline versus
those using their choice of nicotine replacement
nicotine replacement therapy, Addiction,
therapy options, even after adjusting for potentially
108, 1497-502. doi: 10.1111/add.12219.
confounding smoker characteristics taking after
selection bias has been ruled out.
58. Brown J, Hajek P, McRobbie H, Locker J,
Smokers who temporarily abstain in naturalistic
Gillison F, McEwen A, Beard E, West R
settings experience craving and withdrawal
(2013) Cigarette craving and withdrawal
symptoms that emerge linearly over the first 6
symptoms during temporary abstinence and hours of abstinence. Changes in craving and
UTARG Output
Page 8
the effect of nicotine gum.
Psychopharmacology, 229, 209-18. doi:
10.1007/s00213-013-3100-2.
59. Lorencatto F, West R, Seymour N, Michie S
(2013) Developing a method for specifying
the components of behaviour change
interventions in practice: the example of
smoking cessation. Journal of Consulting
and Clinical Psychology, 81, 528-44. doi:
10.1037/a0032106.^
60. Lorencatto F, West R, Bruguera C, Michie S,
(2013) A method for assessing fidelity of
delivery of telephone-based smoking
ccessation behavioural support in practice.
Journal of Consulting & Clinical Psychology,
8, 40. doi:10.1186/1748-5908-8-40.^
61. Lorencatto F, West R, Christopherson C,
Michie S, (2013) Assessing fidelity of delivery
of smoking cessation behavioural support in
practice. Implementation Science, 8: 40. doi:
10.1186/1748-5908-8-40.
62. Shahab L, Brose L, West R (2013) Novel
delivery systems for nicotine replacement
therapy as an aid to smoking cessation:
rationale and evidence for advantages over
existing systems. CNS Drugs, 27, 1007-19.
doi: 10.1007/s40263-013-0116-4.
63. Kouimstsidis C, Stahl D, West R, Drummond
C (2013) Path analysis of cognitive
behavioural models in substance misuse. What
is the causal relationship between concepts
involved? Journal of Substance Abuse.
doi: 10.3109/14659891.2013.837974.
64. Ussher M, Brown J, Rajamanoharan A, West R
(2013) How do prompts for attempts to quit
smoking relate to method of quitting and quit
success? Annals of Behavioral Medicine, 47,
358-68. doi: 10.1007/s12160-013-9545-z.*
65. Lindson-Hawley N, Begh R, McDermott M,
McEwen A, Lycett D (2013) The importance
of practitioner smoking status: a survey of
NHS Stop Smoking Service practitioners.
Patient Education and Counselling. doi:
10.1016/j.pec.2013.04.021.^
66. 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
UTARG Output
several mood withdrawal symptoms can be
detected within the first three hours. Nicotine gum
may not have an acute effect on the development of
these symptoms.
It is possible to apply a taxonomy to reliably
identify and classify BCTs in smoking cessation
behavioural support delivered in practice, and
train inexperienced coders to do so reliably. This
method can be used to investigate variability in
provision of behavioural support across services,
monitor fidelity of delivery, and identify training
needs.
The content of telephone-delivered behavioural
support can be reliably coded in terms of behaviour
change techniques. This can be used assess fidelity to
treatment manuals and in turn identify training needs.
Observed low fidelity underlines the need to establish
routine procedures for monitoring delivery of
behavioural support.
The extent to which smoking cessation behavioural
support is delivered as specified in treatment manuals
can be reliably assessed using transcripts of audiotaped
sessions. This allows the investigation of the
implementation of evidence-based practice in relation
to smoking cessation, a first step in designing
interventions to improve it. There are grounds for
believing that fidelity in the English Stop-Smoking
Services may be low and that routine monitoring is
warranted
In theory, novel nicotine delivery systems that provide
nicotine more rapidly in adjustable doses and in a form
that is easy to use and with minimal local adverse
reactions would be expected to improve on success
rates of existing products. However, to date evidence
is lacking that such products are more effective.
Across a range of psychoactive substances (alcohol,
stimulant and opioids), urges to use were strongly
associated, and negative expectancies weakly
positively related to positive outcomes of addiction
treatment.
Quit attempts prompted by health professional advice
appear to be more likely to involve gradual reduction
and use of treatments, while those prompted by health
concerns and cost appear more likely to be successful.
Smokers attending stop smoking services believe that
stop smoking advisors are more effective if they are
former smokers.
Stop smoking services may enhance success rates with
disadvantaged smokers if they promote use of open
groups.
Page 9
Behaviours, 38, 2787-96. doi:
10.1016/j.addbeh.2013.07.010.
67. Hughes, L., McIlvar, M, & McEwen, A. (2013)
How to advise and refer inpatients who smoke.
Nursing Times, 109(1/2):14-18.
68. Docherty G, Lewis S, Bauld L, McEwen A,
Coleman T (2013) Does use of ‘non-trial’
cessation support help explain the lack of effect
from offering NRT to quitline callers in a
RCT? Nicotine & Tobacco Research. doi:
10.1136/tobaccocontrol-2013-051107.
69. Crutzen R, Viechtbauer W, Kotz D (2013) No
differential attrition in randomized controlled
trials published in general medical journals: a
meta-analysis. Journal of Clinical
Epidemiology, 66, 948-54. doi:
10.1016/j.jclinepi.2013.03.019.
70. Beard E, Brown J, West R. (2013) Does
smoking reduction make smokers happier?
Evidence from a cross-sectional survey.
Journal of Smoking Cessation, 9, 1-5.
doi: http://dx.doi.org/10.1017/jsc.2013.14.*
71. Langley T, Lewis S, McNeill A, Gilmore A,
Szatkowski L, West R, Sims M (2013)
Characterising tobacco control mass media
campaigns in England. Addiction, 108, 2001-8.
doi: 10.1111/add.12293.
72. Beard E, Shahab L, Curry S, West R (2013)
Association between smoking cessation and
short-term health-care utilisation: results from
an international prospective cohort study
(ATTEMPT) Addiction, 108, 1979-88. doi:
10.1111/add.12281.
73. Ussher M, Beard E, Abikoye G, Hajek P, West
R (2013) Urge to smoke over 52 weeks of
abstinence. Psychopharmacology, 226, 83-89.
doi: 10.1007/s00213-013-3202-x.
74. Kotz, D, Willemsen M, Brown J, West R
(2013) Light smokers are less likely to receive
advice to quit from their GP than moderate to
heavy smokers: a comparison of national
survey data from the Netherlands and England.
European Journal of General Practice, 19, 99105. doi: 10.3109/13814788.2013.766792.*
75. Krampe H, Strobel L, Beard E, Anders S, West
R, Raupach T (2013) German medical
students’ beliefs about how best to treat alcohol
use disorder. European Addiction Research,
19, 245-251. doi: 10.1159/000346672.
76. Brown J, Michie S, Raupach T, West R (2013)
Prevalence and characteristics of smokers
interested in internet-based smoking cessation
interventions: cross-sectional findings from a
UTARG Output
A whole-hospital approach involving online training in
very brief advice on smoking for front line staff and
electronic referral significantly increases identification
of smoking patients and referral to stop smoking
services.
The failure of the PORTSS trial to show an effect of
offering free NRT to callers to a telephone helpline
cannot be explained by high levels of use of NRT by
participants in the control condition.
In general there appears to be no difference in attrition
rates in active and control groups in major randomised
trials.
While smoking cessation is associated with increased
life satisfaction and happiness, attempts at smoking
reduction do not appear to be.
Between 2004 and 2010 only a small proportion of
tobacco control advertisements in England used the
most effective strategies – negative health effect
messages and testimonials from real-life smokers. The
intensity of campaigns was below international
recommendations.
Smoking cessation does not appear to be associated
with a substantial short-term increase or decrease in
health-care utilisation after adjusting for pre-cessation
morbidities
Strength of urges to smoke decline exponentially over
time following smoking cessation, though some
smokers report strong urges after 6 months of
abstinence, and urges are still reported by a third of
smokers after 12 months.
Smokers in the Netherlands are less than half as likely
to receive advice to quit from their GP than smokers in
England. In both countries, light smokers are less
likely to receive advice to quit from their GP than
moderate-to-heavy smokers
In Germany, with an advanced undergraduate medical
curriculum, more than a quarter of fifth year students
believe that willpower alone is more effective than
comprehensive treatment programmes to overcome
alcohol use disorder.
Almost half of all smokers in England are interested in
using online smoking cessation interventions yet fewer
than 1% have used them to support a quit attempt in
the past year. Interest is not associated with social
Page 10
national household survey. Journal of Medical
Internet Research, 15(3):e50. doi:
10.2196/jmir.2342.*
77. Sarkar B, Arora M, Gupta V, Reddy K (2013)
Determinants of Tobacco Cessation Behaviour
among Smokers and Smokeless Tobacco Users
in the States of Gujarat and Andhra Pradesh,
India. Asian Pacific Journal of Cancer Control,
14, 1993-1999.
78. Fidler J, Ferguson S, Brown J, Stapleton J,
West R (2013) How does rate of smoking
cessation vary by age, gender and social grade?
Findings from a population survey in England.
Addiction, 108, 1680-5. doi:
10.1111/add.12241.*
79. Brose L, Tombor I, Shahab L, West R (2013)
The effect of reducing the threshold for carbon
monoxide validation of smoking abstinence –
evidence from the English Stop Smoking
Services. Addictive Behaviors, 38, 2529-31.
doi: 10.1016/j.addbeh.2013.04.006. ^
80. Beard E, Bruguera, C, Brown J, McNeill A,
West R (2013) Was the expansion of the
marketing licence for nicotine replacement
therapy in the UK to include smoking
reduction associated with changes in use and
incidence of quit attempts? Nicotine &
Tobacco Research, 15, 1777-81. doi:
10.1093/ntr/ntt044.
81. Kotz D, Brown J, West R (2013) Predictive
validity of the Motivation To Stop Scale. Drug
and Alcohol Dependence, 128, 15-19. doi:
10.1016/j.drugalcdep.2012.07.012.*
82. Gould G, Munn J, Watters T, McEwen A,
Clough A (2013) Knowledge and views about
maternal tobacco smoking and barriers for
cessation in Aboriginal and Torres Strait
Islanders: a systematic review and metaethnography. Nicotine & Tobacco Research,
15, 863-874. doi: 10.1093/ntr/nts211.
83. Shahab L, Sarkar B, West R (2013) The acute
effects of yogic breathing exercises on craving
and withdrawal symptoms in abstaining
smokers. Psychopharmacology, 225, 875-882.
doi: 10.1007/s00213-012-2876-9.
84. Lorencatto F, West R, Stavri Z, Michie S
(2013) How well is intervention content
described in published reports of smoking
cessation interventions? Nicotine & Tobacco
Research, 1273-1282. doi: 10.1093/ntr/nts266.
85. Wee LH, Bulgiba A, Shahab L, Vangeli E,
West R (2013) Understanding smokers’ beliefs
UTARG Output
grade but is associated with being younger, more
highly motivated, more cigarette dependent, having
attempted to quit recently, having regular internet and
handheld computer access and having recently
searched for online smoking cessation information and
support.
Smokeless tobacco users in India and tobacco users
with lower educational level are less likely to try to
quit compared with smokers and tobacco users with
higher educational level.
The incidence of smoking cessation in England
appears to be greater in young and old adults
compared to those in middle age. Women and higher
social grade smokers show a greater incidence of
quitting than men and those from lower social grades
specifically in young adulthood
Reducing the threshold for expired-air CO
concentration to validate abstinence would have a
minimal effect on success rates unless the threshold
were reduced substantially which would likely
increase error of measurement.
Expansion of the UK marketing licence for NRT to
include smoking reduction without the intention of
quitting was not associated with an increase in use of
NRT for this purpose. It was followed by a reduction
in the incidence of quit attempts (although not their
success) though this may have been a continuation of a
pre-existing decline.
The Motivation to Stop Scale provides strong and
accurate prediction of quit attempts and is a candidate
for a standard measure for use in population surveys.
Aboriginal and Torres Strait Islanders have limited
knowledge of the harms of maternal smoking and
there are significant barriers to their achieving
cessation.
Yogic breathing exercises can acutely reduce cigarette
cravings in a controlled environment but it is not clear
whether this effect generalises beyond the laboratory.
Published reports of evaluations of smoking cessation
behavioural support interventions typically mention
fewer than half the behaviour change techniques
specified in the intervention manuals; this deficit in
reporting could be remedied by journals insisting on
full manuals being provided as supplementary
electronic files.
A new model of behaviour changed (SNAP based on
the PRIME Theory of motivation can be used as a
Page 11
and feelings about smoking and quitting during basis for assessing potentially important aspects of
a quit attempt: a preliminary evaluation of the
smokers’ beliefs and feelings about stopping based on
SNAP model. Journal of Smoking Cessation, 8, interview data.
17-23. doi:
http://dx.doi.org/10.1017/jsc.2013.3.
86. Brose L, West R, Michie S, McEwen A (2013)
Validation of content of an online knowledge
training program. Nicotine & Tobacco
Research, 15, 997-998. doi:
10.1093/ntr/nts258. ^
87. Ferguson J, Docherty G, Bauld L, Lewis S,
Lorgelly P, Boyd KA, McEwen A, Coleman
T (2012) Effect of offering different levels of
support and free nicotine replacement
therapy via an English national telephone
quitline: randomised controlled trial. BMJ,
344, e1696. doi: 10.1136/bmj.e1696.
88. Aveyard P, Begh R, Parsons A, West R
(2012) Brief opportunistic smoking cessation
interventions: a systematic review and metaanalysis to compare advice to quit and offer
of assistance. Addiction, 107, 1066-1073.
DOI: 10.1111/j.1360-0443.2011.03770.x.
89. Gould G, McEwen A, Watters T, Clough A,
van der Zwan R (2012) Should anti-tobacco
messages be culturally targeted for indigenous
populations? A systematic review and narrative
synthesis. Nicotine & Tobacco Research,
22(4):e7. doi: 10.1136/tobaccocontrol-2012050436.
90. McDermott M, Beard E, Brose L, West R,
McEwen A (2012) Factors associated with
differences in quit rates between specialist and
community stop-smoking practitioners in the
English stop-smoking services. Nicotine &
Tobacco Research, 15, 1239-47. doi:
10.1093/ntr/nts262. ^
91. McNeill A, Amos A, McEwen A, Ferguson J,
Croghan E (2012) Developing the evidence
base for addressing inequalities and smoking in
the United Kingdom. Addiction, 107 Suppl 2,
1-7. doi: 10.1111/j.1360-0443.2012.04080.x.^
92. McEwen A, Hackshaw L, Jones L, Laverty L,
Amos A, Robinson J (2012) Evaluation of a
programme to increase referrals to stopsmoking services using Children’s Centres and
smoke-free family schemes. Addiction, 107
Suppl 2, 8-17. doi: 10.1111/j.13600443.2012.04081.x.^
93. Beard E, Michie S, Fidler J, West R. (2012).
Use of nicotine replacement therapy in
situations involving temporary abstinence from
smoking: a national survey of English smokers.
UTARG Output
Formative multiple choice questions following
elements of an online training programme for stop
smoking practitioners shows very high levels of
understanding and short-term memory of what is being
taught.
An attempt to improve the effectiveness of the
English NHS telephone support programme by
adding more sessions and offering free nicotine
replacement therapy did not yield a detectable
improvement in quit rates.
An offer of help with stopping by a GP appears to
be more effective than advice to stop in promoting
smoking cessation
Although Indigenous people have good recall of
generic anti-tobacco messages, culturally targeted
messages are preferred. New Zealand Maori may be
less responsive to holistic targeted campaigns, despite
their additional benefits, compared to generic fear
campaigns. Culturally targeted internet or mobile
phone messages appear to be as effective in American
Indians and Maori as generic messages in the general
population. There is little research comparing the
effect of culturally targeted versus generic messages
with similar message content in Indigenous people
"Specialist" practitioners in the English stopsmoking services report higher success rates than
"community" practitioners and this is at least in part
attributable to more extensive training and supervision
and greater adherence to evidence-based practice
including advising on medication usage and promoting
abrupt rather than gradual quitting
A set of pilot projects funded by the English
Department of Health has identified ways in which
stop-smoking services to disadvantages groups can be
improved but without significant additional resources
it is unlikely that progress will be made.
Routine recording of smoking status and appropriate
follow-up by trained staff in Children's Centres can
lead to significant numbers of clients attending stopsmoking services, although relatively few
stop smoking.
The most common occasions of temporary abstinence
when NRT is used are when at home and while
travelling. Use of NRT in situations when one is
unable to smoke may increase propensity to quit
Page 12
Addictive Behaviors, 38, 1876-1879. doi:
10.1016/j.addbeh.2012.09.013.*
94. McDermott M, Thompson H, West R, Kenyon
J, McEwen A (2012) Translating evidencebased guidelines into practice: A survey of
practices of commissioners and managers of
the English Stop Smoking Services. BMC
Health Services Research, 12, 121. ^
95. Brose L, McEwen A, West R (2012) Does it
matter who you see to help you stop smoking?
Short-term quit rates across specialist Stop
Smoking Practitioners in England. Addiction,
107, 2029-2036. doi: 10.1111/j.13600443.2012.03935.x. ^
96. Beard E, Aveyard P, McNeill A, Michie S,
Fidler J, Brown J, West R (2012) Mediation
analysis of the association between use of NRT
for smoking reduction and attempts to stop
smoking. Psychology and Health, 27, 11181133. doi: 10.1080/08870446.2012.685739. *
97. Strobel L, Schneider N, Krampe K, Beißbarth
N, Pukrop T, Anders S, West R, Aveyard P,
Raupach T (2012) German medical students
lack knowledge of how to treat smoking and
problem drinking. Addiction, 107, 1878-1882.
doi: 10.1111/j.1360-0443.2012.03907.x.
98. Raupach T, West R, Brown T (2012) The most
‘successful’ method for failing to quit smoking
is unassisted cessation. Nicotine & Tobacco
Research, 15, 748-9. doi: 10.1093/ntr/nts164.*
99. Beard E, Brown J, Aveyard P, West R (2012)
Assessing the association between the use of
NRT for smoking reduction and attempts to
quit smoking using propensity score matching.
Drug and Alcohol Dependence, 126, 354-361.
doi: 10.1016/j.drugalcdep.2012.05.039. *
100.
Jarvis M, Cohen J, Delnevo C, Giovino G
(2012) Dispelling myths about gender
differences in smoking cessation: population
data from the USA, Canada and Britain.
Tobacco Control, 22, 356-60. doi:
10.1136/tobaccocontrol-2011-050279.
101.
Giovino G, Mirza S, Samet J, Gupta P,
Jarvis M, Bhala N, Peto R, Zatonski W, Hsia J,
Morton J, Palipudi K (2012) Tobacco use in 3
billion individuals from 16 countries: an
analysis of nationally representative cross
sectional household surveys. Lancet, 380, 668679. doi: 10.1016/S0140-6736(12)61085-X.
102.
Beard E, McDermott M, McEwen A, West
R (2012) Beliefs of stop smoking practitioners
in United Kingdom on the use of nicotine
replacement therapy for smoking reduction.
Nicotine & Tobacco Research, 14, 639-647.
doi: 10.1093/ntr/ntr260.^
103.
Brown J, Michie S, Geraghty A, Miller S,
UTARG Output
smoking regardless of the specific type of situation
and whether NRT is rated by the smoker as helpful in
that situation.
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
There are substantial differences in short-term success
between individual specialist stop-smoking
practitioners that are not explained by client
demographics, intervention type or medication.
If use of nicotine products to help reduce smoking or
cope with periods of temporary abstinence promotes
subsequent quit attempts, it probably does not do so by
increasing confidence in ability to quit or reducing
enjoyment of smoking; it may do so by increasing
motivation to quit.
Curriculum coverage in German medical schools of
alcohol use disorders and smoking is half that of
diabetes and hypertension, and in the final year of their
undergraduate training most students reported
inadequate knowledge of how to intervene to address
them.
The fact that most smokers who quit did so unaided
tells us nothing about whether this is the best way to
do it, as is evidenced by the fact that most smokers
whose quit attempts failed also tried unaided.
The increased likelihood of subsequently trying to stop
smoking among smokers who use NRT to aid SR
versus those who try to reduce without NRT remains
after the two groups have been matched on
motivational and other potentially relevant variables.
Contrary to popular mythology, men are not more
likely to stop smoking than women in the US, Canada
and Britain.
In the countries participating in the Global Adult
Tobacco Survey (GATS - Bangladesh, Brazil, China,
Egypt, India, Mexico, Philippines, Poland, Russia,
Thailand, Turkey, Ukraine, Uruguay, and Vietnam)
male smoking prevalence is 40.7% and female
prevalence 5.0%. The proportion of ever smokers who
have quit is less than 20%.
A significant minority of stop smoking practitioners
and stop smoking managers believe that NRT use for
SR can be harmful to health and undermine smoking
cessation. These beliefs should be addressed,
especially if the use of NRT in these ways is provided
as a route to quitting in SSSs
Systematic application of theory, evidence, web-
Page 13
Yardley L, Gardner B, Shahab L, Stapleton J,
West R (2012) A pilot study of StopAdvisor: a
theory-based interactive internet-based
smoking cessation intervention aimed across
the social spectrum. Addictive Behaviors, 37,
1365-1370. doi: 10.1016/j.addbeh.2012.05.016.
104.
Michie S, Brown J, Geraghty A, Miller S,
Yardley L, Gardner B, Shahab L, McEwen A,
Stapleton J, West R (2012) Development of
StopAdvisor: a theory-based interactive
internet-based smoking cessation intervention.
Translational Behavioral Medicine, 2, 263-275.
doi: 10.1007/s13142-012-0135-6.
105.
Black A, Beard E, Brown J, Fidler J, West
R (2012) Beliefs about the harms of long-term
use of nicotine replacement therapy:
perceptions of smokers in England. Addiction,
107, 2037-2042. doi: 10.1111/j.13600443.2012.03955.x. *
106.
Lorencatto F, West R, Michie S (2012)
Specifying evidence-based behavior change
techniques to aid smoking cessation in
pregnancy. Nicotine & Tobacco Research, 14,
1019-1026. doi: 10.1093/ntr/ntr324. ^
107.
Beard E, Mcneill A, Aveyard P, Fidler F,
Michie S, West R (2012) Association between
the use of nicotine replacement therapy for
harm reduction and smoking cessation: a
prospective study of English smokers. Tobacco
Control, doi:10.1136/tobaccocontrol-2011050007.*
108.
Ferri CP, West R, Moriyama TS, et al.
(2012) Tobacco use and dementia: evidence
from the 1066 dementia population-based
surveys in Latin America, China and India.
International Journal of Geriatric Psychiatry,
26, 1177-88. doi: 10.1002/gps.2661.
109.
Michie S, Free C, West R (2012)
Characterising the ‘Txt2Stop’ smoking
cessation text messaging intervention in terms
of behaviour change techniques. Journal of
Smoking Cessation, 7, 55-60.
doi: http://dx.doi.org/10.1017/jsc.2012.12.
110.
Beard E, West R (2012) Pilot study of the
use of personal carbon monoxide monitoring to
achieve radical smoking reduction. Journal of
Smoking Cessation, 7, 12-17.
doi: http://dx.doi.org/10.1017/jsc.2012.6.
111.
Sims M, Mindell J, Jarvis M, Feyerabend
UTARG Output
design expertise, and user-testing has resulted in a
website that shows sufficiently promising efficacy and
usability to warrant evaluation in a RCT. The website
appears to be similarly effective and acceptable to
users across the social spectrum
The systematic and transparent application of theory,
evidence, web-design expertise and user-testing within
an open-source development platform can provide a
basis for multi-phase optimisation contributing to an
‘incremental technology’ of behaviour change
A significant minority of smokers in England believe
that the use of NRT for a year or more is harmful.
However, belief that long-term NRT use can cause
health harm does not appear to act as a deterrent to
using it in a quit attempt or for smoking reduction.
Whilst behaviour change techniques associated with
effective smoking cessation support in pregnancy can
be identified from high quality RCTs, English StopSmoking Services appear to use only a proportion of
these.
The use of nicotine replacement therapy for smoking
reduction or temporary abstinence appears to be
positively associated with subsequent attempts to quit
smoking and abstinence among smokers in England,
despite very little apparent effect on daily cigarette
consumption. With replication, these findings support
the potential benefit of using NRT for harm reduction
but primarily as a means of promoting cessation.
Dementia in developing countries appears to be
positively associated with history of tobacco smoking
but not smokeless tobacco use. Selective quitting in
later life may bias estimation of associations
An analysis of the content of Txt2Stop, the first
automated text messaging intervention found to help
smokers to stop, shows that its primary focus is on
helping smokers with avoiding and managing urges to
smoke and maintaining engagement with the
intervention, and to a lesser degree on maintaining
motivation to stop. Little attention is given to
promoting effective use of adjuvant behaviours such as
use of nicotine replacement therapy. As new
interventions of this kind are developed it will be
possible to compare their effectiveness and relate this
to standardised descriptions of their content using this
system.
Personal monitoring of expired-air carbon monoxide
concentrations of smoke exposure may be useful in
helping smokers to reduce the amount they smoke.
The impact of England's smokefree legislation on
Page 14
C, Wardle H, Gilmore A (2012) Did smokefree
legislation in England reduce exposure to
secondhand smoke among non-smoking
adults? Cotinine analysis from the Health
Survey for England. Environmental Health
Perspectives, 120, 425-430. doi:
10.1136/tobaccocontrol-2012-050582.
112.
Bauld L, Ferguson J, McEwen A, Hiscock
R (2012) Evaluation of a drop-in rolling-group
model of support to stop smoking. Addiction,
107, 1687-1695. DOI: 10.1111/j.13600443.2012.03861.x.
113.
Beard E, Vangeli E, Michie S, West R
(2012) The use of Nicotine Replacement
Therapy for smoking reduction and temporary
abstinence: An interview study. Nicotine &
Tobacco Research, 14, 849-856. doi:
10.1093/ntr/ntr297.*
114.
Hackshaw, L., Bauld, L. & McEwen, A.
(2012) Stop smoking service clients’ views
following the introduction of smoke-free
legislation in England. Journal of Smoking
Cessation, 7, 1-8. doi:
http://dx.doi.org/10.1017/jsc.2012.4.
115.
Brose LS, West R, Michie S & McEwen
(2012). Evaluation of face-to-face courses in
behavioural support for Stop Smoking
Practitioners. Journal of Smoking Cessation, 7,
25-30. doi: dx.doi.org/10.1017/jsc.2012.6.
116.
Beard E, West R (2012) Use of nicotine
replacement therapy for smoking reduction and
temporary abstinence: an update of Beard et al
2011. Addiction, 107, 1186-1187. doi:
10.1111/j.1360-0443.2012.03839.x.
117.
Stapleton J, West R (2012) A direct
method and ICER tables for the estimation of
the cost-effectiveness of smoking cessation
interventions in general populations:
application to a new cytisine trial and other
examples. Nicotine & Tobacco Research, 14,
463-471. doi: 10.1093/ntr/ntr236.
118.
Zhang C, Xiao D, West R, Michie S,
Troughton R, Hajek P, Chen W (2012)
Evaluation of 3-day smoking cessation training
course for doctors from 38 cities in China.
Chinese Medical Journal, 125, 1338-1340.
119.
Brose L, West R, Michie S, Kenyon J,
McEwen A (2012) Effectiveness of an online
knowledge training and assessment program
for Stop-Smoking Practitioners. Nicotine and
Tobacco Research, 14, 849-856.
UTARG Output
secondhand smoke exposure was above and beyond
the underlying long-term decline in secondhand smoke
exposure and demonstrates the positive effect of the
legislation. However, some population subgroups
appear not to have benefitted significantly from the
legislation.
A wholly state-reimbursed clinical stop- service
providing behavioural support and medication in a
region of high economic and social disadvantage has
reached a significant proportion of the
smoking population. Long-term success rates are
lower than are found typically in clinical trials, but
higher than would be expected if the smokers were to
try and quit unaided.
Smokers use a variety of methods to reduce cigarette
consumption including increasing the interval between
cigarettes and attempting non-daily smoking. They
also modify how they smoke the cigarette, trying to
inhale less or stub out the cigarette early. Nicotine
patches are attractive for smoking reduction because
they are discreet, easy to use and have a prolonged
effect. Smokers have little knowledge of restrictions
on use described in the product labelling.
Smokers clinic clients support smoke-free legislation
and report reductions in smoking and an increase in
quit attempts after introduction of the ban.
The NCSCT skills training course appears to result in
a substantial improvement in confidence in ability to
deliver smoking cessation support and trainees
evaluate it highly.
If smokers use nicotine replacement therapy (NRT) for
both temporary abstinence and smoking reduction they
are more likely to go on to try to stop smoking than if
they use NRT for either alone.
This paper provides for the first time a set of look-up
tables for policy makers to estimate the costeffectiveness of smoking cessation interventions based
on the effect size and age profile of the population.
A 3-day training course for doctors in China on
helping smokers to stop is effective at increasing
knowledge and confidence in delivering stop-smoking
advice and support.
Knowledge required to deliver effective stop smoking
intervention is improved by using the National Centre
for Smoking Cessation and Training online training
program for English smoking cessation practitioners.
Practitioners with all levels of prior knowledge
Page 15
doi:10.1093/ntr/ntr286.^
120.
McDermott M, West R, Brose L, McEwen
A (2012) Self-reported practices, attitudes and
levels of training of practitioners in the English
NHS Stop Smoking Services. Addictive
Behaviors, 37, 498-506.
doi: 10.1016/j.addbeh.2012.01.003.^
121.
Michie S, Whittington C, Hamoudi Z,
Zarnani F, Tober G, West R (2012) Behaviour
change techniques to reduce excessive alcohol
use and their associations with outcome.
Addiction, 107, 1431-1440.
doi: 10.1111/j.1360-0443.2012.03845.x.
122.
Zatonski W, Przewozniak K, Sulkowska U,
West R, Wojtyla A (2012) Tobacco smoking in
countries of the European Union. Annals of
Agricultural and Environmental Medicine, 19,
181-192.
123.
Kotz D, Fidler J, West R (2012) Very low
rate and light smokers: smoking patterns and
cessation-related behaviour in England, 20062011. Addiction, 107, 995-1002.
doi: 10.1111/j.1360-443.2011.03739.x.*
124.
Shahab L, West R (2012) Differences in
happiness between smokers, ex-smokers and
never smokers: cross-sectional findings from a
national household survey. Drug and Alcohol
Dependence, 121, 38-44.
doi:10.1016/j.drugalcdep.2011.08.011.*
Programme grant 2007-2011
125.
West R, Zatonski W, Cedzynska M,
Lewandowska D, Pazik J, Aveyard P,
Stapleton J (2011) Randomised placebocontrolled trial of cytisine for smoking
cessation. New England Journal of
Medicine, 365 (13), 1193-200.
126.
Hajek P, McRobbie H, Myers K,
Stapleton JA, Dhanji AR (2011) Use of
varenicline for 4 weeks before quitting
smoking: decrease in ad lib smoking and
increase in smoking cessation rates.
Archives of Internal Medicine, 171(8), 770-7.
doi:10.1001/archinternmed.2011.138.
127.
Batty D, Shipley M, Kivimaki M, Dzvey
Smith G, West R (2011) Impact of smoking
cessation advice on future smoking
behaviour, morbidity and mortality: up to
40 years of follow-up of the first randomised
controlled trial of a general population
sample. Archives of Internal Medicine,
171(21), 1950-1951.
doi:10.1001/archinternmed.2011.543.
128.
Brose L, West R, McDermott M, Fidler
J, Croghan E, McEwen A (2011) What
UTARG Output
benefit.
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.
It is possible to identify reliably specific behaviour
change techniques recommended for interventions to
reduce excessive alcohol consumption. Of these,
promoting self-monitoring emerges from randomised
trial evidence as an important factor in effectiveness.
Restricting the analysis to daily smokers aged 20-64
produces a map of Europe in which variation in
prevalence between individual countries within
regions is as important as variation across regions.
Survey methods need to be harmonised across
countries to enable comparisons involving all ages and
non-daily as well as daily smoker.
Very low rate (<1cpd) and light (1-9cpd) smokers in
England are at least as motivated to quit as heavier
smokers. Although they use cessation medication less
than heavier smokers and are more likely to succeed,
they still use such medication and fail in quit attempts
to a substantial degree.
After a year of abstinence, ex-smokers report similar
level of happiness and life satisfaction to neversmokers and considerably higher than current smokers.
Cytisine is an effective aid to smoking cessation
which because of its very low cost could advance
smoking cessation globally.
Using varenicline for four weeks prior to a quit
attempt can reduce the enjoyment of smoking and
smoke intake during the pre-quit period and
increase the 12-week abstinence rate.
A 40-year follow up of mortality in smokers who
took part in an RCT of brief advice from a
physician to promote smoking cessation gives a
point estimate of the effect of the intervention of a
increase in life expectancy of 0.4 life years.
Routine clinic data support findings from
randomised controlled trials that smokers receiving
Page 16
makes for an effective stop-smoking service?
Thorax. 66(10), 924-6.
doi:10.1136/thoraxjnl-2011-200251.^
129.
Kotz D, Stapleton J, Owen L, West R.
(2011). How cost-effective is "No Smoking
Day"? Tobacco Control, 20(4), 302-4. Doi:
10.1136/tc.2009.034397*
130.
Michie S, M van Stratten, West R (2011)
The behaviour change wheel: A new method
for characterising and designing behaviour
change interventions. Implementation
Science, 6, 42. doi:10.1186/1748-5908-6-42.
131.
Stapleton JA, Sutherland G (2011)
Treating heavy smokers in primary care
with the nicotine nasal spray: randomized
placebo-controlled trial. Addiction, 106(4),
824-32. doi: 10.1111/j.13600443.2010.03274.x.
132.
Beard E, McNeill A, Aveyard P, Michie
S, West R. (2011) Use of Nicotine
Replacement Therapy for smoking
reduction and during enforced temporary
abstinence: a national survey of English
smokers. Addiction, 106 (1), 197-204.
doi:10.1111/j.1360-0443.2010.03215.x.*
133.
Wee LH, Shahab L, Bulgiba A, West R
(2011) Conflict About Quitting Predicts the
Decision to Stop Smoking Gradually or
Abruptly: Evidence From Stop Smoking
Clinics in Malaysia. Journal of Smoking
Cessation, 6, 37-44. doi: 10.1375/jsc.6.1.37.
134.
Vangeli E, Stapleton J, Smit E, Borland R,
West R (2011) Predictors of attempts to stop
smoking and their success: A systematic
review. Addiction, 106 (12), 2110-21.
doi: 10.1111/j.1360-443.2011.03565.x.
135.
Carpenter M, Sterba K, Boatright A, West
R (2011) ‘Closet’ Quit Attempts: Prevalence,
Correlates and Association with Outcome.
Addiction, 106(12):2214-20. doi:
10.1111/j.1360-0443.2011.03538.x.
136.
Fidler J, Shahab L, West O, Jarvis M,
McEwen A, Stapleton J, Vangeli E, West R
(2011) ‘The Smoking Toolkit Study’: A
national study of smoking and smoking
cessation in England. BMC Public Health, 11,
479. doi:10.1186/1471-2458-11-479.*
137.
Beard E, Fidler J, West R (2011) Is use of
nicotine replacement therapy while continuing
to smoke associated with increased nicotine
UTARG Output
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-toone and single NRT.
From the increase in rate of quit attempts made
during the month in which No Smoking Day occurs
relative to months either side, it can be estimated
that this event contributes about 6,000 long-term
ex-smokers each year with a discounted cost per
resulting life year gained of less than £100.
Interventions and policies to change behaviour can
be usefully characterised by means of a ‘Behaviour
Change Wheel’ comprising: a ‘behaviour system’
at the hub, encircled by intervention functions and
then by policy categories.
Nicotine nasal spray is effective when given in
primary care. The benefit appears to be lower than
in a specialist clinic but similar to that with the
nicotine patch. Nicotine nasal spray appears to be
especially helpful for more dependent smokers.
Continuing treatment of those initially failing doers
is not beneficial.
Use of nicotine replacement therapy (NRT) to aid
smoking reduction and in situation of enforced
abstinence is common in England and is strongly
associated with a recent history of quit attempts.
Nicotine patch and gum are the most commonly
used forms of NRT for these purposes.
Conflict about quitting appears to be measurable as a
single dimension and is associated with a greater
likelihood of trying to quit gradually rather than
abruptly.
Studies from a number of countries have shown that
motivation to stop and past quit attempts strongly
predict attempts to stop while measures of nicotine
dependence strongly predict failure of those attempts;
thus different mechanisms largely underlie quit
attempts and success of quit attempts and policies to
enable these need to address this.
Attempting to quit smoking without telling anyone in
advance appears common and does not appear to
impede success. These findings do not support blanket
advice to smokers to tell others about their quit
attempts in advance.
There is reason to believe that the STS findings (see
www.smokinginengland.info) are generalisable to the
adult population of England.
Nicotine intake in smokers using nicotine replacement
therapy for smoking reduction or to aid temporary
abstinence is similar to that in smokers not doing so,
Page 17
intake? Evidence from a population sample.
Psychopharmacology, 218 (3), 609-610. doi:
10.1007/s00213-011-2359-4.*
138.
West R, Evans A, Michie S (2011)
Behaviour change techniques used in groupbased behavioural support by the English StopSmoking Services and preliminary assessment
of association with short-term quit outcomes.
Nicotine & Tobacco Research, 13, 1316-1320.
doi: 10.1093/ntr/ntr120. ^
139.
Vangeli E, West R (2012) Transition
towards a ‘non-smoker’ identity following
smoking cessation: An interpretative
phenomenological analysis. British Journal of
Health Psychology, 17, 171-184.
doi: 10.1111/j.2044-8287.2011.02031.x.
140.
Fidler J, Stapleton J, West R (2011)
Variation in saliva cotinine as a function of
self-reported attempts to reduce cigarette
consumption. Psychopharmacology, 217(4),
587-93. doi: 10.1007/s00213-011-2317-1.*
141.
Stapleton JA, Sutherland G, O’Gara C,
Spirling LI, Ball D. (2011) Association
between DRD2/ANKK1 Taq1A Genotypes,
Depression and Smoking Cessation with
Nicotine Replacement Therapy.
Pharmacogenetics and Genomics, 21(8):44753. doi: 10.1097/FPC.0b013e328347473a.
142.
Kotz D, Fidler J, West R (2011) Did the
introduction of varenicline in England
substitute for or add to the use of other
smoking cessation medications? Nicotine &
Tobacco Research, 13(9): 793-9. doi:
10.1093/ntr/ntr075. *
143.
Shahab L, McEwen A, West R (2011)
Acceptability and effectiveness for withdrawal
symptom relief of a novel oral nicotine
delivery device: a randomised crossover trial.
Psychopharmacology, 216(2), 187-96. doi:
10.1007/s00213-011-2204-9.
144.
Bolam B, Gunnall D, West R (2011) Does
smoking cessation cause depression and
anxiety? Findings from the ATTEMPT cohort.
Nicotine and Tobacco Research, 13 (3), 209214. doi: 10.1093/ntr/ntq244.
145.
Ussher M, Aveyard P, Reid F, West R,
Evans P, Clow A, Hucklebridge F, Fuller J,
Ibison J, Steptoe A (2011) A randomised
placebo-controlled trial of oral hydrocortisone
for treating tobacco withdrawal symptoms.
Psychopharmacology. 216, 43-51. doi:
10.1007/s00213-011-2191.
146.
Wee LH, Shahab L, Bulgiba A, West R
UTARG Output
despite no difference in cigarette consumption. This
suggests that smokers using nicotine replacement
therapy while smoking smoke each cigarette less
intensively.
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 shortterm self-reported quit rates when included in
treatment manuals of English Stop-Smoking Services.
It appears useful to distinguish two levels of ‘nonsmoker’ identity: a surface level comprising the simple
label and a deep level made up of often conflicting
thoughts and feelings about oneself in relation to
smoking. An absolute ‘non-smoker’ identity does not
appear to be necessary for long-term abstinence.
Saliva cotinine concentrations show moderate-to-high
stability within subjects over a 3-month period.
Smokers’ reports of attempting to cut down their
smoking are associated with small decreases in this
daily cigarette consumption but no detectable change
in nicotine intake.
Those having a Taq1A variant allele and a history of
depression are likely to experience particular difficulty
when trying to stop smoking and may require
treatment other than standard doses of nicotine
replacement. This finding might explain previous
conflicting results for Taq1A and smoking cessation in
studies where depression history was not measured,
and may help explain the underlying link between
depression and smoking.
Use of varenicline increased substantially after it was
approved by NICE and added to, rather than
substituted for, use of other prescription medications,
but this was against a background of a reduced
incidence of quit attempts over the study period.
A novel nicotine delivery system, the Nicotine
Cannon, appears to provide at least a good relief from
acute craving and withdrawal symptoms, as the
comparable licensed NRT product but with higher
levels of acceptability to users.
Stopping smoking does not appear to increase the risk
of symptoms of depression and anxiety in those free
from symptoms when they were smoking.
Hydrocortisone does not appear to be effective in
relieving urges to smoke or withdrawal symptoms in
abstaining smokers.
Success rates of smokers attending smokers clinics in
Page 18
(2011) Stop smoking clinics in Malaysia:
characteristics of attendees and predictors of
success. Addictive Behaviors, 36, 400-403.
doi:10.1016/j.addbeh.2010.11.011.
147.
Ussher M, Doshi R, Sampuran A, West R
(2011) Cardiovascular risk factors in patients
with schizophrenia receiving continuous
medical care. Community Mental Health
Journal, 47(6), 688-693. doi: 10.1007/s10597011-9376-y.
148.
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.^
149.
Wee LH, West R, Awang B, Shahab L
(2011) Predictors of 3-month abstinence in
smokers attending stop-smoking clinics in
Malaysia. Nicotine and Tobacco Research, 13
(2), 151-6. doi: 10.1093/ntr/ntq221.
150.
Smit, E, Fidler J, West R (2011) The role
of desire, duty and intention in predicting
attempts to quit smoking. Addiction, 106 (4),
844-51. doi: 10.1111/j.13600443.2010.03317.x.*
151.
Kotz D, Fidler JA, West R. (2011)
Estimating the rate of usage of varenicline and
other medication for smoking cessation.
Addiction, 106, 1868-1869. doi:
10.1111/j.1360-0443.2011.03486.x.
152.
Fidler J, West R (2011) Enjoyment of
smoking and urges to smoke as predictors of
attempts and success of attempts to stop
smoking: a longitudinal study. Drug and
Alcohol Dependence. 115, 30-34.
doi:10.1016/j.drugalcdep.2010.10.009.*
153.
Fidler J, Shahab L, West R (2010) Strength
of urges to smoke as a measure of severity of
cigarette dependence: comparison with the
Fagerstrom Test for Nicotine Dependence and
its components. Addiction, 106 (3), 631-638.
doi: 10.1111/j.1360-0443.2010.03226.x.*
154.
Shahab L, West R, McNeill A (2011) A
randomised controlled trial of adding expired
carbon-monoxide feedback to brief stop
smoking advice: evaluation of cognitive and
behavioural effects. Health Psychology, 30, 4957. doi: 10.1037/a0021821.
155.
Moody C, Mackintosh A, West R (2010)
Adolescents’ awareness of, and involvement
UTARG Output
Malaysia are higher in those who are older, and have
previously managed to stop for longer and lower in
those who have higher baseline expired-air CO
concentrations. Adjusting for these variables there
remain large differences in the success rates of
different clinics. Scores on the Fagerstrom Test for
Cigarette Dependence do not appear to be related to
success.
Patients receiving continuous psychiatric care have
very high levels of cardiovascular risk, particularly
high rates of smoking and low rates of physical
activity.
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.
Unlike in western samples, strength of motivation to
stop appears to predict success of quit attempts in
Malaysian smokers attending smokers clinics whereas
the Fagerstrom Test for Cigarette Dependence, the
most commonly used measure of nicotine dependence,
does not.
Desire and intention and intention to stop smoking
independently positively predict quit attempts while
sense that one ought to stop appears to undermine their
effect.
The introduction of varenicline did not reduce
prescription NRT use but only appeared to in a paper
by Langley et al because there was a coincident but
unrelated decrease in the overall incidence of attempts
to stop smoking.
Enjoyment appears to be the major barrier to attempts
to stop whereas cigarette dependence as indexed by
strength of urges to smoke on normal smoking days is
the main barrier to success of later quit attempts.
A simple rating of strength of urges to smoke during a
normal smoking day predicts success of subsequent
quit attempt better than the Fagerstrom Test for
Cigarette Dependence which is the current measure of
choice for cigarette dependence.
Expired-air carbon-monoxide concentration feedback
enhances the effect of brief quit advice on cognitive
antecedents of behaviour change and smoking
cessation rates but further research is required to
confirm the longevity of this effect and its
applicability to smokers with low self-efficacy.
Even in a country, such as the UK, that is purported to
have a comprehensive, well-resourced illicit tobacco
Page 19
with, illicit tobacco in the United Kingdom.
Tobacco Control, 19(6), 521-522. doi:
10.1136/tc.2009.034967. Online. 18/11/2010.
156.
Berg C, An L, Kirch M, Guo H, Thomas J,
Patten C, Ahluwalia J, West R (2010) Failure
to report quit attempts: Implications for
research and clinical practice. Addictive
Behaviors, 35, 900-904.
doi:10.1016/j.addbeh.2010.06.009.*
157.
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/s12160010-9235-z.^
158.
Fidler JA, West R. (2010) Changes in
smoking prevalence in 16-17 year old versus
older adults following a rise in legal age of
sale: findings from an English population
study. Addiction, 105(11), 1984-8. doi:
10.1111/j.1360-0443.2010.03039.*
159.
McEwen A, West R (2010) The PRIME
approach to giving up smoking. Practice
Nursing, 21(3): 145 - 153
160.
Coleman, T., Agboola, S., Leonardi-Bee,
J., Taylor, M., McEwen, A. & McNeill, A.
(2010) Relapse Prevention in UK Stop
Smoking Services: Current Practice,
Systematic Reviews of Effectiveness and Cost
Effectiveness Analysis. Health Technology
Assessment, 14, 1-181.
doi:10.3310/htal14490.^
161.
Agboola, S.A., Coleman, T.J., LeonardiBee, 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: 10.1186/1472-6963-10214.^
162.
Vangeli E, Stapleton J, West R (2010)
Smoking intentions and mood preceding lapse
after completion of treatment to aid cessation.
Patient Education and Counselling, 81(2), 267271. doi:10.1016/j.pec.2010.01.024.
163.
Powell J, Dawkins L, West R, Powell J,
Pickering A (2010) Relapse to smoking during
unaided cessation: Clinical, cognitive, and
motivational predictors. Psychopharmacology,
212, 537–549. doi: 10.1007/s00213- 010-19758.
164.
Bobrova N, West R, Bobak M (2010)
UTARG Output
strategy high numbers of youth are both aware of and
involved with the illicit tobacco trade, which threatens
to undermine the progress made in reducing smoking
prevalence
Failed quit attempts are quickly forgotten if they last
only a short period of time. Almost two thirds of quit
attempts that last between one day and one week fail
to be reported after 3 months.
It is possible to identify competences recommended
for behavioural support for smoking cessation and
subsets of these supported by different types of
evidence. This approach can form the basis for
development of assessment and training of stop
smoking specialists.
Following an increase in the legal age of sale from age
16 to age 18 in England a greater fall in prevalence
was observed among 16-17 year olds than in older age
groups, suggesting that such legislation may
significantly reduce smoking prevalence.
Most smokers experience discomfort about their
smoking and at various times switch between not
planning to stop, planning to stop, attempting to stop
and thinking of themselves as having stopped.
Transitions can occur between any of these states and
any other very rapidly.
Extending pharmacotherapy treatment (such as
nicotine replacement therapy, bupropion or
varenicline) after smokers have stopped smoking using
these drugs, is both effective and cost effective for
preventing relapse to smoking. Many English StopSmoking Services are using relapse prevention
interventions for which there is no evidence of benefit.
Most NHS Stop-Smoking Services appear to provide
relapse prevention interventions for clients despite
there being no evidence that these are effective
Relapse to smoking appears to occur mostly in the
context of negative rather than positive mood, and
immediate urges to smoke. The intention is usually
only to smoke for a limited time but buying cigarettes
to relapse is common.
Saliva cotinine functions better than the Fagerstrom
Test for Cigarette Dependence as a measure of
dependence in predicting short- and medium-term
abstinence in unaided quitters. In addition, attentional
bias to smoking cues and anti-saccade errors (a
measure of ability to control impulses) predict shortterm abstinence. Low impulse control and cue
reactivity also predict medium-term abstinence.
Large differences exist between Russian men’s and
Page 20
Gender differences in drinking practices in
middle aged and older Russians. Alcohol and
Alcoholism, 45, 573-580. doi:
10.1093/alcalc/agq069.
165.
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.^
166.
Vangeli E, Stapleton J, West R (2010)
Residual attraction to smoking and smoker
identity following smoking cessation. Nicotine
and Tobacco Research, 12, 865-865. doi:
10.1093/ntr/ntq104.
167.
West R, Walia A, Hyder N, Shahab L,
Michie S (2010) Behaviour change techniques
used by the English Stop Smoking Services
and their associations with short-term quit
outcomes. Nicotine and Tobacco Research, 12,
742-747. doi:10.1093/ntr/ntq074.^
168.
Shahab L, Mindel J, Poulter S, West R
(2010) Hypertension and its identification
among current, past and never smokers in an
English population sample. European Journal
of Cardiovascular Prevention and
Rehabilitation, 17, 63-70. doi:
10.1097/HJR.0b013e32832f3b42.
169.
West R, Ussher M (2010) Is the 10-item
Questionnaire of Smoking Urges (QSU-brief)
more sensitive to abstinence than shorter
craving measures? Psychopharmacology, 208,
427-432. doi: 10.1007/s00213-009-1742-x.
170.
Gardner B, West R. (2010) Public support
in England for raising the price of cigarettes to
fund tobacco control activities. Tobacco
Control, 19, 331-333.
doi:10.1136/tc.2009.033274.*
171.
Ashley,D.L.,O'Connor,R.J., Bernert,J.T,
Watson,C.H., Polzin,G.M., Jain,R.B.,
Hammond,D., Hatsukami,D., Giovino,G.A.,
Cummings,K.M., McNeill,A., Shahab,L.,
King,B., Fong,G.T., Zhang,L., Xia,Y., Yan,Z.,
McCraw,J.M. (2010). Effect of Differing
Levels of Tobacco-Specific Nitrosamines in
Cigarette Smoke on the Levels of Biomarkers
in Smokers. Cancer Epidemiology Biomarkers
and Prevention, 19, 1389-98. doi:
10.1158/1055-9965.EPI-10-0084.
172.
Shahab L, West R. (2010). Public support
in England for a total ban on the sale of
tobacco products. Tobacco Control, 19, 143-7.
doi:10.1136/tc.2009.033415.*
UTARG Output
women’s drinking patterns; these differences may be
largely explained by gender roles.
Telephoning smokers from GP lists is a cost-effective
method of prompting quit attempts using NHS StopSmoking Services.
A significant minority of smokers who stop with the
aid of group support in a smokers clinic report an
attraction to smoking years after they have quit and
some retain elements of a smoker identity. Identity
change appears in many cases to be gradual rather than
abrupt.
There is wide variability in the behaviour change
techniques used by the English Stop-Smoking Services
and this, and the number of sessions scheduled for
treatment explains a significant proportion of the
variation in success rates. In particular, emphasis in
service treatment manuals on measuring expired-air
carbon monoxide concentrations, advising on use of
medication, relapse prevention and coping and helping
the smoker develop an ex-smoker identity are
associated with higher success rates.
Hypertension is detected less frequently among
smokers than nonsmokers. Receiving a diagnosis
seems to motivate cessation.
Single item ratings of craving perform at least as well
as the 10-item Questionnaire on Smoking Urges in
terms of sensitivity to abstinence and reliability.
70% of English adults are in favour of raising the price
of cigarettes with funds going towards tobacco control.
Lowering the levels of tobacco-specific nitrosamines
in the mainstream smoke of cigarettes through the use
of specific tobacco types and known curing practices
can significantly reduce the exposure of smokers to
this known carcinogen and thus possibly harm caused
by smoking.
Nearly half of the English adult population support a
movement towards a complete ban of the sale of
tobacco in England with younger, female non-smokers
in London expressing the greatest level of support.
Page 21
173.
Raupach T, Shahab L, Eimer S, Puls M,
Hasenfuß G, Andreas S. (2010). Increasing use
of nicotine replacement therapy by a simple
intervention: An exploratory trial. Substance
Use and Misuse, 45, 403-13. doi:
10.3109/10826080903452496.
174.
Hackshaw L, McEwen A, West R, Bauld
L. (2010) Quit attempts in response to smokefree legislation in England. Tobacco Control,
19, 160-4. doi:10.1136/tc.2009.032656.*
175.
West R, May S, McEwen A, McRobbie H,
Hajek P, Vangeli E. (2010) A randomised trial
of glucose tablets to aid smoking cessation.
Psychopharmacology, 207:631-5. doi:
10.1007/s00213-009-1692-3.
176.
Georgiades C, West R. (2009). Time spent
with urges to smoke and strength of urges as
independent predictors of self-rated difficulty
not smoking during abstinence. Journal of
Smoking Cessation, 4, 48–51. doi:
10.1375/jsc.4.1.48.
177.
Jarvis MJ, Mindell J, Gilmore A,
Feyerabend C, West R. (2009). Smoke-free
homes in England: prevalence, trends and
validation by cotinine in children. Tobacco
Control, 18, 491-5.
doi:10.1136/tc.2009.031328.
178.
McEwen A, Straus L (2009) Counterfeit
tobacco in London: local crime needs an
international solution. Trends in Organized
Crime, 12, 251-259. doi: 10.1007/s12117-0099068-y.
179.
Shahab L, McEwen A. (2009). Online
support for smoking cessation: a systematic
review of the literature. Addiction, 104, 1792804. doi: 10.1111/j.1360-0443.2009.02710.x.
180.
van Jaarsveld C, Fidler J, Steptoe A,
Boniface D, Wardle J. (2009). Perceived stress
and weight gain in adolescents: A longitudinal
analysis. Obesity, 17, 2155-61.
doi:10.1038/oby.2009.183.
181.
West R (2009). The multiple facets of
cigarette addiction and what they mean for
encouraging and helping smokers to stop.
COPD: The Journal of Chronic Obstructive
Disease, 6, 277-83.
doi:10.1080/15412550903049181.
182.
Aubin H-J, Berlin I, Smadja E, West R.
(2009) Factors Associated with Higher Body
Mass Index, Weight Concern, and Weight Gain
in a Multinational Cohort Study of Smokers
Intending to Quit. International Journal of
Environmental and Public Health Research, 6,
943-57. doi:10.3390/ijerph6030943.
UTARG Output
An intervention aimed at increasing knowledge of
nicotine dependence among participants of a
cognitive-behavioural smoking cessation programme
can lead to increased use of nicotine products.
The implementation of Smoke-Free was associated
with a temporary increase in attempts to stop smoking
that was similar across the social gradient.
Chewing glucose tablets may aid long-term cessation
in smokers who are also using nicotine replacement
therapy or bupropion.
Time spent with urges to smoke and strength of urges
are both independently associated with perceived
difficulty not smoking during an attempt at smoking
abstinence, whereas other withdrawal symptoms such
as irritability are not.
Even before the smoke-free legislation was enacted in
England in 2007, smokers and non-smokers were
increasingly making their homes smoke-free and this
led to a reduction in smoke exposure to young children
in those households.
Local initiatives to deal with Kurdish refugee street
sellers of counterfeit tobacco in Islington, North
London, have been ineffective, with little agreement
amongst local agencies as to what constitutes the
‘problem’, and with local shoppers giving a higher
priority to other neighbourhood issues.
Web-based, tailored, interactive smoking cessation
interventions are effective compared with noninteractive, untailored booklet or email interventions
but there are large variations in effectiveness across
interventions studied.
Stress in early childhood may lead to higher BMI
during adolescence.
Cigarette addiction involves several components
relating to different parts of the motivational system:
cues driven urges to smoke, a need to smoke arising
from ‘nicotine hunger’ and withdrawal symptoms,
wanting to smoke because of anticipated pleasure,
positive evaluations of smoking including beliefs that
it helps with stress, and a positive smoker identity.
High baseline BMI appears to be associated with
recent quit attempts, high weight concerns and high
cigarette consumption. Weight gain is associated with
low income, being single and number of cigarette-free
days, but not with baseline weight concerns and
confidence in preventing weight gain. Quit attempts
are more frequent in smokers with a high BMI and low
Page 22
183.
Dawkins L, Powell JH, Pickering A,
Powell J, West R (2009) Patterns of change in
withdrawal symptoms, desire to smoke, reward
motivation and response inhibition across 3
months of smoking abstinence. Addiction, 104,
850-8. doi: 10.1111/j.1360-0443.2009.02522.x.
184.
Etter J-F, Stapleton J. (2009) Citations to
trials of nicotine replacement therapy were
biased toward positive results and high-impactfactor journals. J Clin Epidemiol, 62, 831-7.
doi: 10.1016/j.jclinepi.2008.09.015.
185.
Ferguson S, Shiffman S.Gitchell J,
Sembower M.A. West R (2009) Unplanned
quit attempts--results from a U.S. sample of
smokers and ex-smokers. Nicotine and
Tobacco Research, 11, 827-32 doi:
10.1093/ntr/ntp072.
186.
Fidler J, West R (2009) Self-perceived
smoking motives and their correlates in a
general population sample. Nicotine and
Tobacco Research, 11, 1182-8. doi:
10.1093/ntr/ntp120.*
187.
Grainge M, Shahab L, Hammond D,
O’Connor R, McNeill A. (2009). First
Cigarette on Waking and Time of Day as
Predictors of Puffing Behaviour in UK Adult
Smokers. Drug & Alcohol Dependence, 101,
191-195. doi:
10.1016/j.drugalcdep.2009.01.013.
188.
Kotz D, Fidler J, West R. (2009) Factors
associated with the use of aids to cessation in
English smokers. Addiction, 104, 1403-10. doi:
10.1111/j.1360-0443.2009.02639.x.*
189.
Kotz D, Schayck O, West R, Huibers M.
(2009) What mediates the effect of
confrontational counselling on smoking in
smokers with COPD? Patient Education and
Counselling, 76, 16-24.
doi:10.1016/j.pec.2008.11.017.
190.
Kotz D, West R. (2009) Explaining the
social gradient in smoking cessation: It's not in
the trying, but in the succeeding. Tobacco
Control, 18, 43-6. doi:
10.1136/tc.2008.025981.*
191.
May S, Arnoldi H, Bauld L, Ferguson J,
Stead M, McEwen A. (2009) How to measure
client satisfaction with Stop Smoking Services:
a pilot project in the NHS. Journal of Smoking
Cessation, 4, 52-58. doi:10.1375/jsc.4.1.52.
192.
McEwen A, West R (2009) Do
implementation issues influence the
UTARG Output
weight concerns.
Appetitive processes and related affective states
appear to improve in smokers who remain nicotinefree for 3 months, whereas ability to inhibit responding
does not. Poor inhibitory control may constitute a
long-term risk factor for relapse and could be a target
for intervention.
Trials of nicotine replacement therapies with
statistically significant results tend to be published in
journals with higher impact factors than trials with
non-significant results.
Approximately half of quit attempts made in the US do
not involve any pre-planning and people who report
unplanned quit attempts are more likely still to be
abstinence at the time of being surveyed than those
who report pre-planning
Enjoyment and stress relief are the most common
reasons given for continued smoking by smokers in
the general population, with men more likely to report
enjoyment and women tending to cite stress relief.
Smokers who report enjoying smoking and liking
being a smoker are less likely to make a quit attempt.
Contrary to what is commonly assumed, the first
cigarette of the day is smoked less, not more,
intensively than subsequent cigarettes.
In England, half of all attempts to quit smoking are
aided by some form of pharmacological or behavioural
treatment. However, the use of the most effective
treatment option (the NHS Stop-Smoking Services) is
low, despite it being free of charge. Factors associated
with an increased use of aids to cessation are being
female, older, and smoking more cigarettes smoked
per day.
Confrontational counselling increases risk perceptions
and self-efficacy, and decreases risk denial in smokers
with previously undetected chronic obstructive
pulmonary disease. These changes in mediators are
associated with a higher likelihood of smoking
cessation.
Smokers from lower social grades in England are no
less likely to try to stop smoking than those from
higher social grades but they are less likely to succeed
if they try.
Satisfaction with stop-smoking services can be reliably
assessed using a newly developed scale designed for
that purpose
Making it more effortful and time-consuming to get a
smoking cessation medication can substantially reduce
Page 23
effectiveness of medications? The case of
nicotine replacement therapy and bupropion in
UK Stop Smoking Services. BMC Public
Health, 21, 28. doi:10.1186/1471-2458-9-28.
193.
McEwen A, West R, Gaiger M (2009)
Nicotine absorption from seven current
nicotine replacement products and new widebore nicotine delivery device. Journal of
Smoking Cessation, 3, 117-123.
doi:10.1375/jsc.3.2.117.
194.
McEwen A, Straus L, Croker H. (2009)
Dietary beliefs and behaviour of a UK Somali
population. Journal of Human Nutrition and
Dietetics, 22, 116-21. doi: 10.1111/j.1365277X.2008.00939.x.
195.
Raupach T, Shahab L, Baetzing S,
Hoffmann B, Hasenfuss G, West R, Andreas S.
(2009) Medical students lack basic knowledge
about smoking: findings from two European
medical schools. Nicotine and Tobacco
Research, 11, 92-8. doi:10.1093/ntr/ntn007.
196.
Sanderson S, Waller J, Jarvis M,
Humphries S, Wardle J. (2009) Awareness of
lifestyle risk factors for cancer and heart
disease among adults in the UK. Patient Educ
Couns, 74, 221-7.
doi:10.1016/j.pec.2008.08.003.
197.
Shahab L, Hammond D, Borland R,
Cummings K, West R, McNeill A. (2009). The
impact of changing nicotine replacement
therapy licensing laws in the United Kingdom:
findings from the International Tobacco
Control Four Country Survey Addiction, 104,
1420-1427. doi: 10.1111/j.13600443.2009.02641.x.
198.
Shahab L, West R. (2009) Do ex-smokers
report feeling happier following smoking
cessation? Evidence from a cross-sectional
survey. Nicotine and Tobacco Research, 11,
553-557. doi: 10.1093/ntr/ntp031.*
199.
Shahab L, West R, McNeill A. (2009). A
comparison of exposure to carcinogens among
roll-your-own and factory-made cigarette
smokers. Addiction Biology, 14, 315-20. doi:
10.1111/j.1369-1600.2009.00157.x.
200.
Stapleton J. (2009) Do the 10 UK suicides
among those taking the smoking cessation drug
varenicline suggest a causal link? Addiction,
104, 864-5. doi: 10.1111/j.13600443.2009.02567.x.
201.
Stapleton J, Keaney F, Sutherland G.
(2009) Illicit drug use as a predictor of
smoking cessation treatment outcome. Nicotine
Tob Res, 11, 685-689. doi: 10.1093/ntr/ntp050.
202.
Straus L, McEwen A. (2009) Somali
women’s experience of childbirth in the UK:
UTARG Output
its effectiveness.
A new nicotine delivery device that allows improved
inhalation of nicotine vapour can provide high doses
of nicotine with a rate of absorption slightly slower
than nicotine nasal spray.
Fruit and vegetable consumption is low in the Somali
population in London and there is uncertainty about
what constitutes a healthy diet. Cultural factors such as
the traditional Somali diet, social associations of food
and lack of appropriate information may play a role in
this.
Medical students in both the UK and Germany lack
relevant basic information about smoking and health
and the effectiveness of cessation methods.
In the UK, public awareness of the links between
lifestyles and commonly feared diseases is inadequate.
Extending the licence for nicotine replacement therapy
products to include their use for gradual cessation had
minimal impact on usage for this purpose.
Ex-smokers overwhelmingly report being happier than
when they were smoking.
There appear to be no differences in the toxin intake
between manufactured and hand-rolled cigarette
smokers but women have higher concentrations of
these toxins in their system irrespective of the cigarette
type smoked.
The reported rate of suicides while using varenicline is
no higher than would expected in smokers in general.
Illicit drug use appears to have a significant
detrimental effect on the success of an attempt to stop
smoking.
Mismanagement of female circumcision leads to
problems at birth for many Somali women; the
Page 24
the views of Somali health workers.
Midwifery, 25, 181-6.
doi:10.1016/j.midw.2007.02.002.
203.
Ussher M, Cropley M, Playle S, Mohidin
R, West R (2009) Effect of isometric exercise
and body scanning on cigarette cravings and
withdrawal symptoms. Addiction, 104, 1251-7
doi: 10.1111/j.1360-0443.2009.02605.x.
204.
Zhou X, Nonnemaker J, Sherrill B,
Gilsenan A, Coste F, West R (2009) Attempts
to quit smoking and relapse: factors associated
with success or failure from the ATTEMPT
cohort study. Addictive Behaviours, 34, 36573. doi:10.1016/j.addbeh.2008.11.013.
205.
Fidler J, Jarvis M, Mindell J, West R
(2008) Nicotine intake in cigarette smokers in
England: distribution and demographic
correlates. Cancer Epidemiology Biomarkers
and Prevention, 17, 3331-6. doi: 10.1158/10559965.EPI-08-0296.
206.
Fidler J, West R, van Jaarsveld C, Jarvis
MJ, Wardle J. (2008) Smoking status of step
parents as a risk factor for smoking in
adolescence. Addiction, 103, 496-501. doi:
10.1111/j.1360-0443.2007.02086.x.
207.
Jarvis MJ, Fidler J, Mindell J, Feyerabend
C, West R (2008) Assessing smoking status in
children, adolescents and adults: cotinine
cutpoints revisited. Addiction, 103, 1553-61.
doi: 10.1111/j.1360-0443.2008.02297.x.
208.
McEwen A, West R, McRobbie H (2008)
Motives for smoking and their correlates in
clients attending Stop Smoking treatment
services. Nicotine and Tobacco Research, 10,
843-50. doi: 10.1080/14622200802027248.
209.
McEwen A, Straus L, Ussher M. (2008)
Physical inactivity of a Somali population in
London. Journal of Public Health, 30, 110.
doi:10.1093/pubmed/fdm075.
210.
McEwen A, West R, Gaiger M. (2008)
Nicotine absorption from seven current
nicotine replacement products and a new widebore nicotine delivery device. Journal of
Smoking Cessation, 3, 117-23.
doi: 10.1375/jsc.3.2.117.
211.
O’Gara C, Knight J, Stapleton JA. Luty J,
Neale B, Nash M, Heuzo-Diaz P, Hoda F,
Cohen S, Sutherland G, Collier D, Sham P,
Ball D, McGuffin P, Craig I. (2008)
Association of serotonin transporter genes,
neuroticism and smoking behaviours. Journal
of Human Genetics, 53, 239-46.
doi: 10.1007/s10038-007-0243-1.
UTARG Output
importance of Somalia’s oral culture is not recognised
when addressing communication barriers and
continuity of care is lacking.
Isometric exercise, and a mental exercise that involves
focusing attention on breathing and on different parts
of the body while relaxing, reduces desire to smoke
compared with sitting doing nothing.
Quit attempts are less likely to succeed if they are
made within 3 months of an earlier attempt.
After adjusting for cigarette consumption, nicotine
intake in English adults is greatest in middle age,
males and those with highest levels of economic
deprivation.
Smoking behaviour of step-fathers is at least as strong
a risk factor for smoking initiation as smoking
behaviour of natural fathers.
The optimal cutpoint for saliva cotinine varies with
sociodemographic group but overall is around 13ng/ml
Enjoyment and stress relied are important self-reported
motives for smoking in smokers clinic clients but they
do not predict relapse following attempts to stop.
Low levels of physical activity are reported among
Somalis in London; apparently due to changes in
lifestyle since immigration and a misperception that
‘sweating’ has health benefits irrespective of whether
it is produced through exercise or not (e.g. using a
sauna).
Of current acute delivery nicotine replacement therapy
products currently on the market, the 4mg lozenge
appears to produce the highest per unit plasma nicotine
concentrations, the 2mg gum delivers the lowest
concentrations and the nicotine nasal spray delivers
nicotine the fastest. A new inhalation device, the
Nicotine Cannon, could deliver nicotine rapidly in a
manner that may be readily tolerated by users.
Although neuroticism appears to be significantly
associated with cigarette consumption and failure to
stop smoking, genotype does not affect this
relationship. This does not support initial interest in
utilising 5HTTLPR genotypes in combination with
neuroticism ratings for predicting outcome in smoking
cessation clinical settings.
Page 25
212.
Raupach T, Shahab L, Neubert K,
Hasenfuß G, Andreas S. (2008). Implementing
a hospital-based smoking cessation
programme: evidence for a learning effect.
Patient Education & Counselling, 70, 199-204.
doi: 10.1016/j.pec.2007.10.005.
213.
Sanderson S, Humphries S, Hubbart C,
Hughes E, Jarvis MJ, Wardle J. (2008)
Psychological and behavioural impact of
genetic testing smokers for lung cancer risk: a
phase II exploratory trial. J Health Psychol, 13,
481-94. doi: 10.1177/1359105308088519.
214.
Shahab L, West R, McNeill A. (2008) The
feasibility of measuring puffing behaviour in
Roll-Your-Own cigarette smokers. Tobacco
Control, 17 Suppl 1, 17-23.
doi:10.1136/tc.2007.021824.
215.
Shahab L, Hammond D, O’Connor R,
Cummings K, Borland R, King B, McNeill A.
(2008) The reliability and validity of selfreported puffing behaviour: evidence from a
cross-national study. Nicotine & Tobacco
Research, 10, 867-74. doi: 10.1080/
14622200802027156 .
216.
Stapleton JA, Watson L, Spirling LI, Smith
R, Milbrandt A, Radcliffe M, Sutherland G.
(2008) Varenicline in the routine treatment of
tobacco dependence: a pre-post comparison
with Nicotine Replacement Therapy and an
evaluation in those with mental illness.
Addiction, 103, 146-54. doi: 10.1111/j.13600443.2007.02083.x.
217.
Thyrian J, Panagiotakos D,
Polychronopoulos E, West R, Zatonski W,
John U. (2008) The relationship between
smokers´ motivation to quit and intensity of
tobacco control at the population level; a
comparison of five European countries. BMC
Public Health, 8, 2. doi: 10.1186/1471-2458-82.
218.
Ussher M, Aveyard P, Coleman T, Straus
L, West R, Marcus B, Lewis B, Manyonda I.
(2008) Physical activity as an aid to smoking
cessation during pregnancy: two feasibility
studies. BMC Public Health, 8, 328. doi:
10.1186/1471-2458-8-328.
219.
Vangeli E, West R. (2008)
Sociodemographic differences in triggers to
quit smoking: Findings from a national survey.
Tobacco Control, 17, 410-415.
doi:10.1136/tc.2008.025650.*
220.
Vogt F, McEwen A, Michie S. (2008)
What GPs can do to deliver more brief
smoking cessation advice: an exploratory
study. Journal of Smoking Cessation, 3, 10-6.
doi: 10.1375/jsc.3.2.110.
UTARG Output
Stop-smoking practitioners appear to show a learning
effect with time that leads to better smoking cessation
rates.
Research into the risks and benefits for individuals of
emerging lifestyle-related genetic susceptibility tests is
important and feasible to carry out.
The measurement of puffing behaviour using a
topography device is feasible, but is less practicable
for roll-your-own than factory-made cigarettes.
Smokers have a more accurate perception of the
puffing time and number of puffs taken than the
intensity and depth of each puff or their actual smoke
exposure.
With group support varenicline appears to improve
success rates over those achieved with nicotine
replacement therapy, and is equally effective and safe
in those with and without a mental illness.
Extent of tobacco control activity in countries in
Europe varies considerably, as does population-level
motivation to stop. However, there does not appear to
be a direct association between the two.
Pregnant smokers are likely to take up the offer of
exercise classes and advice as a way of helping them
stop smoking
There are significant differences in reported triggers
for quit attempts as a function of sociodemographic
factors; smokers with higher SES are more likely to
report concern about future health whereas those from
lower SES are more likely to cite cost and current
health problems.
GPs appear to judge approximately a quarter of
smokers they see in routine consultations as being in a
state where it would be inappropriate to raise the topic
of smoking.
Page 26
221.
West R, Baker CL, Cappelleri JC,
Bushmakin AG. (2008) Effect of varenicline
and bupropion SR on craving, nicotine
withdrawal symptoms, and rewarding effects
of smoking during a quit attempt.
Psychopharmacology, 197, 371-7
doi:10.1007/s00213-007-1041-3.
222.
West R, Stapleton J. (2008) Clinical and
public health significance of treatments to aid
smoking cessation. European Respiratory
Review, 17, 1-6. doi:
10.1183/09059180.00011005.
223.
West R, Townsend J, Joossens L, Arnott
D, Lewis S (2008) Why combating tobacco
smuggling is a priority: Tobacco smuggling is
killing many times more people in the UK than
smuggling of all illicit drugs put together.
British Medical Journal, 337, 1933.
doi:10.1136/bmj.a1933.
224.
West R, West A (2008) Vers un modèle
synthétique de la motivation (théorie PRIME)
et son application dans la compréhension des
addictions. Alcoologie et Addictologie, 30, 3745.
225.
Dawkins L, Powell JH, West R, Powell J,
Pickering A. (2007) A double-blind placebo
controlled experimental study of nicotine: II effects on response inhibition and executive
functioning. Psychopharmacology, 190, 45767. doi: 10.1007/s00213-006-0634-6.
226.
Etter JF, Burri M, Stapleton JA (2007) The
impact of pharmaceutical company funding on
results of randomized trials of nicotine
replacement therapy for smoking cessation: a
meta-analysis. Addiction, 102, 815-22. doi:
10.1111/j.1360-0443.2007.01822.x.
227.
Fidler JA, West R, Van Jaarsveld CH,
Jarvis MJ, Wardle J. (2007) Does smoking in
adolescence affect body mass index, waist or
height? Findings from a longitudinal study.
Addiction. 102, 1493-501. doi: 10.1111/j.13600443.2007.01910.x.
228.
Holloway E, West R (2007) Integrated
breathing and relaxation training (the Papworth
Method) for adults with asthma in primary
care: a randomised controlled trial. Thorax. 62,
1039-42. doi:10.1136/thx.2006.076430.
229.
May S, West R, Hajek P, McEwen A,
McRobbie H (2007) Social support and success
at stopping smoking. Journal of Smoking
Cessation. 2, 47-53. doi: 10.1375/jsc.2.2.47.
230.
O’Gara C, Stapleton JA, Sutherland G,
Guindalini C, Neale B, Breen G, Ball D (2007)
Dopamine transporter polymorphisms
associated with short-term response to smoking
cessation treatment. Pharmacogenetics and
Genomics. 17, 61-7. doi: 10.1097/01.fpc.
UTARG Output
Varenicline’s superiority over bupropion in aiding
cessation may be linked to its superior effect on
craving relief and stronger action in blocking the
rewarding effect of smoking should a lapse occur.
Failure of a quit attempt after the mid-30s can be
expected to cost 6-7 years of life.
Smuggling of tobacco and cigarettes is estimated to be
leading to the death of some 4 times more people than
smuggling of all illicit drugs put together, because of
its effect in keeping the price down.
Understanding addiction requires a model that
combines learning theory, decision theory and selfcontrol theory. PRIME Theory offers such a model
using terms that are close to ones used in everyday
discourse.
Nicotine withdrawal impairs capacity voluntarily to
inhibit low level impulses.
Published trials of nicotine replacement therapy
funded by pharmaceutical companies have
significantly larger effect sizes than others but all
show clear evidence of effectiveness.
Taking up smoking in adolescence is associated with a
lower body mass index subsequently.
The Papworth Method of breathing control and
relaxation reduces symptoms of hyperventilation and
breathing disorder in adults with asthma.
There is no evidence to date that social support plays a
significant role in aiding smoking cessation.
There is modest evidence of a medium-sized effect of
DAT1 genotype on the ability to stop smoking early in
a smoking cessation attempt. If the effect is real this
suggests that the primary utility of DAT1 screening in
this field will be in the identification of those most at
risk of early relapse after quitting.
Page 27
0000236328. 18928.4c.
231.
Shahab L, Hall S, Marteau TM (2007)
Showing smokers with vascular disease images
of their arteries to motivate cessation: a pilot
study. British Journal of Health Psychology.
12, 275-83. doi: 10.1348/135910706X109684.
232.
Stapleton JA, Sutherland G, O’Gara C
(2007) Association between dopamine
transporter genotypes and smoking cessation:
A meta analysis. Addiction Biology. 12, 221-6.
doi: 10.1111/j.1369-1600.2007.00058.x.
233.
Straus L, McEwen A. & Croker H. (2007)
Smoking prevalence and attitudes of a Somali
population in London. Journal of Smoking
Cessation, 2, 68-72. doi: 10.1375/jsc.2.2.68.
234.
Aveyard P, West R (2007) Management of
smoking cessation. BMJ. 335, 37-41.
doi:10.1136/bmj.39252.591806.47.
235.
Tonnesen P, Carrozzi L, Fagerstrom KO,
Gratziou C, Jimenez-Ruiz C, Nardini S, Viegi
G, Lazzaro C, Campell IA, Dagli E, West R.
(2007) Smoking cessation in patients with
respiratory diseases: a high priority, integral
component of therapy. European Respiratory
Journal. 207, 390-417. doi:
10.1183/?09031936.00060806.
236.
Ussher M, West R, McEwen A, Taylor A,
Steptoe A. (2007) Randomized controlled trial
of physical activity counseling as an aid to
smoking cessation: 12 month follow-up.
Addictive Behaviors. 32, 3060-4.
doi:10.1016/j.addbeh. 2007.04.009.
237.
van Jaarsveld CH, Fidler, JA, Simon AE,
Wardle, J (2007) Persistent impact of pubertal
timing on trends in smoking, food choice,
activity, and stress in adolescence.
Psychosomatic Medicine. 69, 798-806. doi:
10.1097/PSY.0b013e31 81576106.
238.
West R, Zatonski W, Przewozniak K,
Jarvis M (2007) Can we trust national smoking
prevalence figures? Discrepancies between
biochemically-assessed and self-reported
smoking rates in three countries. Cancer
Epidemiology Biomarkers & Prevention. 16,
820-2. doi: 10.1158/1055-9965.EPI-06-0679.
239.
West R, Zhou X (2007) Is nicotine
replacement therapy for smoking cessation
effective in the "real world"? Findings from a
prospective multinational cohort study. Thorax.
62, 998-1002. doi:10.1136/thx.2007.078758.
UTARG Output
Personalised biomarker feedback can increase
intentions to stop smoking and motivate smokers to
engage in various smoking cessation behaviours if
they have high self-efficacy.
The DAT1 3'UTR VNTR polymorphism appears to be
associated with an increased probability of smoking
cessation. One or more variant 9-repeat alleles relative
to the more common 10-repeat allele confers a greater
likelihood of cessation, indicative of lower dependence
on tobacco.
Smoking rates in the Somali population appear to be
higher than in the UK general population and higher
still among men over 40 years old and those that
regularly use qat; there is little knowledge of smoking
cessation services.
The combination of behavioural support and
medication such as varenicline or nicotine replacement
therapy improves the chances of success of quit
attempts by 300%; a smoker who tries to stop at least
once a year using this method at the age of 20 has an
80% chance of becoming a permanent ex-smoker by
the age of 40.
Clinicians treating smokers with chronic obstructive
pulmonary disease should regard treatment for
nicotine dependence as an integral and continuing part
of their care plan, repeatedly offering behavioural
support and medication.
Establishing a plan with smokers to increase physical
activity as part of behavioural support for smoking
cessation appears to have no effect on long-term
cessation rates.
Early maturing adolescents are more likely to exhibit
unhealthy behaviours, especially smoking. This
increased risk is maintained throughout adolescence.
Self-reported smoking prevalence in national surveys
underestimates true smoking prevalence by different
amounts in different countries.
When adjusting for likely confounding factors such as
nicotine dependence, use of nicotine replacement
therapy without formal behavioural support is
associated with an increased probability of long-term
abstinence from cigarettes in smokers not taking part
in clinical trials.
Page 28
Editorials, trial protocols and opinion pieces in refereed journals
1.
2.
Beard E, Brown J, West R, Acton C, Brennan
A, Drummond C, Hickman M, Holmes J,
Kaner E, Lock K, Walmsley M, Michie S
(2015) Protocol for a national monthly
survey of alcohol use in England: ‘The
Alcohol Toolkit Study’. BMC Public Health,
15, 230. doi: 10.1186/s12889-015-1542-7.
EQUIPT Project Team EQUIPT: protocol
of a comparative effectiveness research
study evaluating cross-context
transferability of economic evidence on
tobacco control. (2014) BMJ Open, 4, 11,
e006945. doi: 10.1136/bmjopen-2014006945.
3.
4.
5.
Fucito L, Bars M, Forray A, Rojewski A,
Shiffman S, Selby P, West R, Foulds J, Toll
B (2014) Addressing the evidence for FDA
nicotine replacement therapy label changes:
A policy statement of the association for the
treatment of tobacco use and dependence and
the society for research on nicotine and
tobacco. Nicotine & Tobacco Research, 16,
909-914. doi: 10.1093/ntr/ntu087.
Courtney R, Bradford D, Martire K,
Bonevski B, Borland R, Doran C, Hall W,
Farrell M, Siapush M, Sanson-Fisher R, West
R, Mattick R (2014) A randomized clinical
trial of a financial education intervention
with nicotine replacement therapy (NRT) for
low socio-economic status Australian
smokers: A study protocol. Addiction, 109,
1602-11. doi: 10.1111/add.12669.
West R, Brown J (2014) Electronic
cigarettes: fact and faction. British Journal of
General Practice, 64, 442-3. doi:
10.3399/bjgp14X681253.
6.
Brown J, West R (2014) Animal farm must
give way to doublethink when studying
addiction. Addiction, 109, 1214-5. doi:
10.1111/add.12553.
7.
Sarkar B, Shahab L, Arora M, Lorencatto F,
Reddy S, West R (2013) A cluster
randomised controlled trial of a brief tobacco
cessation intervention for low income
communities in India: Study Protocol.
Addiction, 109, 371-8. doi:
10.1111/add.12420.
Aveyard P, West R (2013) Cytisine and the
failure to market and regulate for human
health. Thorax, 68, 989. doi:
10.1136/thoraxjnl-2013-203246.
8.
UTARG Output
The Alcohol Toolkit Study will improve
understanding of population level factors influencing
alcohol consumption and be an important resource for
policy evaluation and planning
This study develops and evaluates a Europe-wide
model and tool for calculating return on investment
from tobacco control interventions.
This report summarizes the FDA announcement,
reviews the evidence for further revisions to current
FDA NRT guidelines, and makes recommendations
for over-the-counter (OTC) NRT labeling to allow for
(1) combined use of faster-acting NRT medications
with nicotine patch, (2) nicotine patch use prior to
quit date or NRT for smoking reduction as part of a
quit attempt, and (3) prolonged NRT for up to 6
months without healthcare provider consultation.
This is the first intervention study to evaluate the
potential of co-managing financial stress as a means
of enhancing smokers' capacity to quit smoking. Such
an intervention may provide a scalable intervention to
help low SES smokers to quit.
Data are being misinterpreted and imprecise and
misleading language being used to describe results in
order to support fixed positions on electronic
cigarettes. Public health and the reputation of public
health science is undermined by this kind of
behaviour.
Characterising addiction as a ‘brain disorder’, as
proposed in a recent Nature editorial, is as limiting
and problematic as characterising it as a ‘social
problem’. Modern models of addiction have been
formulated that allow the multiple facets of addiction
to be integrated and these should be used.
The first ever randomised trial of brief opportunistic
advice for tobacco cessation in a low or middle
income country will be carried out, If the intervention
is successful it could provide a basis for adoption in
India and beyond of a low-cost high-reach public
health intervention that could save many thousands of
lives.
With a rational drug regulatory system, cytisine
would be licensed for sale worldwide without the
requirement for further studies, but failing that the
UK government should fund the one further study
Page 29
9.
10.
Brown, J., Michie, S., Raupach, T., & West,
R. (2013). Should public health bodies stop
commissioning research from market
research companies that serve the tobacco
industry? Addiction, 109, 1-2. doi:
10.1111/add.12302.
West R (2013) Addiction: a global problem
requiring a global science. International
Journal of Prevention and Treatment of
Substance Use Disorders. doi:
http://dx.doi.org/10.4038/ijptsud.v1i1.5906.
11.
Cattaruzza M, West R (2013) Why do
doctors and medical students smoke when
they must know how harmful it is? European
Journal of Public Health, 23, 188-9. doi:
10.1093/eurpub/ckt001.
12.
West R, Marteau T (2013) The commercial
determinants of health. Addiction, 108, 686687. doi: 10.1111/add.12118.
Michie S, Spring B, West R (2013) Moving
from theory to practice and back in social and
health psychology. Health Psychology, 32,
581-585. doi: 10.1037/a0030205.
13.
14.
Michie S, West R. (2013). Behaviour change
theory and evidence: a presentation to
government. Health Psychology Review. 7,122. doi:10.1080/17437199.2011.649445.
15.
Brown J, Michie S, West R (2013) The case
of stop smoking services in England. British
Journal of Psychiatry, 202, 74. doi:
10.1192/bjp.202.1.74.
16.
Michie S, Brown J, Geraghty AWA, et al. A
randomised controlled trial of a theory-based
interactive internet-based smoking cessation
UTARG Output
that is required and so save itself tens of millions of
pounds each year in stop-smoking medicine costs.
Market research companies who do work for tobacco
industry clients should not be used by public health
organisations.
Research into understanding, preventing and treating
addiction has focused on western, English-speaking
cultures. Yet addiction is a global problem. There is
an urgent need for studies that test western models
and assumptions in order to arrive at a truly global
science that is relevant to the majority of the world’s
population.
Smoking prevalence in doctors in countries such as
Italy is high. Surprising as it may seem knowledge of
the harms of smoking is low and may be one factor.
A simple ‘risk acceptance’ ladder could be a useful
tool in identifying what kind of intervention is needed
to reduce such risky behaviour. It starts with ‘I did
not know’, then goes through ‘I heard but did not
believe’, and then ‘I believed but did not care very
much’ all the way through to ‘I cared and want to
change but find it very hard’.
The profit motive arguably has a more pervasive and
damaging influence on public health than social
status.
For advances in social psychology to translate into
progressive improvements in interventions and
realized gains in public health, theories should: 1) be
explicitly linked to the major theories from which
they draw; 2) reflect the context-sensitivity and
dynamic nature of the intervention target; 3) show
convincing evidence of improved effectiveness of
interventions they spawn according to rigorous
criteria; and 4) address the full translation process,
including implementation by healthcare providers and
engagement by the target population.
Government policies relating to behaviour change
need to go beyond the ‘nudge’ doctrine’ and embrace
a comprehensive analysis of what is required for
change to occur linked to selection from the full
range of intervention functions and policies available
in the Behaviour Change Wheel.
The English stop smoking services are an example of
an evidence-based individual level behaviour change
intervention implemented at a population level –
treating more than 600,000 smokers each year.
Performance is variable but the National Centre for
Smoking Cessation and Training has a run a
successful programme of establishing best practice,
disseminating it and evaluating the effects of this
dissemination.
Protocol for a trial to assess a new interactive
internet-based intervention (StopAdvisor) for
smoking cessation that was designed with particular
Page 30
17.
18.
19.
intervention (‘StopAdvisor’): Study protocol.
Journal of Smoking Cessation.
2013;8(02):63-70. doi: 10.1017/jsc.2013.21.
Ussher M, Aveyard P, Manyonda I, Lewis S,
West R, Lewis B, Marcus B, Taylor A,
Barton P, Coleman T (2012) Trials, 13, 186
Raupach T, Brown J (2012) Treatment of
tobacco addiction and the cardiovascular
specialist. Current Opinion in Cardiology, 27,
525-532. doi:
10.1097/HCO.0b013e328356db00.
Sarkar B, Reddy S (2012) Priorities for
tobacco control research in India. Addiction,
107, 2066-2068. doi: 10.1111/j.13600443.2012.03942.x.
20.
Brown J, Raupach T, West R (2012) GPs
have a key role to play in helping patients to
stop smoking. The Practitioner, 256, 23-25
21.
Lingford-Hughes A, Welch A, Peters L, Nutt
D, Ball D, Buntwal N, Chick J, Crome I,
Daly C, Dar K, Day E, Duka T, Finch E, Law
F, Marshall E, Munafo M, Myles J, Porter S,
Raistrick D, Reed L, Reid A, Sell L, Sinclair
J, Tyrer P, West R, Williams T, Winstock A
(2012) BAP updated guidelines: evidencebased guidelines for the pharmacological
management of substance abuse, harmful use,
addiction and comorbidity: recommendations
from BAP. Journal of Psychopharmacology,
26, 899-952. doi:
10.1177/0269881112444324.
Hughes J, Cummings K, Foulds J, Shiffman
S, West R (2012) Effectiveness of nicotine
replacement therapy: a rebuttal. Addiction,
107, 1527-1528. doi: 10.1111/j.13600443.2012.03925.x.
22.
attention directed to people with low socioeconomic
status.
LEAP is a pragmatic randomised controlled trial to
assess the effect of exercise counselling to help
pregnant smokers to stop.
Treatment tobacco addiction in smokers with
cardiovascular disease is one of the most important
interventions available in terms of preventing acute
cardiac events. Effective treatments are available but
often not used.
The enormity of the tobacco epidemic in India, which
has a population greater than the United States and
Europe combined, merits a huge scaling-up of
research efforts that can inform, support and evaluate
tobacco control. Research is needed to underpin all
the World Health Organization’s MPOWER
recommendations. Prioritization and coordination of
the research efforts are critical to success and
ensuring value for money. Apart from the sheer size
of the country and its population, its cultural and
regional diversity present particular challenges.
A review of the evidence suggests that GPs should
offer help to all smokers without first asking them
whether they are interested in quitting or advising
them to stop.
There is strong evidence for a range of
pharmacological and psychological interventions to
help people recover from substance abuse problems
and addiction. In the case of cigarette addiction these
include: nicotine replacement therapy, bupropion,
varenicline, nortriptyline and cytisine, face-to-face
individual and group-based behavioural support,
telephone support, text messaging and websites.
A recent study by Alpert did not, as the authors
claimed, find that nicotine replacement therapy is
ineffective in the long term. If it found anything, it
confirmed that once people have quit for several
months using a given method, the rate of relapse after
that is roughly constant so that any gains achieved by
a particular method in the arly months are preserved
proportionately.
The Dutch government should reconsider its decision
to reverse tobacco control legislation and cut back on
tobacco control activities; the Netherlands is already
on one the worst European countries in terms of
smoking prevalence and ignorance of the harmfulness
of tobacco.
Arnott D, Berteletti F, Britton J, Cardone A,
Clancy L, Craig L, Fong G, Glantz S,
Joossens L, Rudolphie M, Rutger M, Smith
S, Stam H, West R, Willemsen M (2012) Can
the Dutch government really be abandoning
smokers to their fate? Lancet, 9811, 121-122.
doi: 10.1016/S0140-6736(11)61855-2.
Programme grant 2007-2011
24. West R (2011) Preventing tobacco companies There is good reason to believe that preventing
from advertising using their packaging could tobacco companies to advertise their products through
23.
UTARG Output
Page 31
be an important component of comprehensive
tobacco control. Drug and Alcohol Review,
30, 681-682. doi: 10.1111/j.14653362.2011.00369.x.
25.
West R (2011) ‘Payment by results’ and
smoking cessation support. Addiction, 106,
1730-1731. doi: 10.1111/j.13600443.2011.03541.x.
26.
Bonevski B, Paul C, D'Este C, Sanson-Fisher
R, West R, Girgis A, Siahpush M, Carter R
(2011) RCT of a client-centred, caseworkerdelivered smoking cessation intervention for
a socially disadvantaged population. BMC
Public Health, 11, 70. doi: 10.1186/14712458-11-70.
27.
West R, Miller P (2011) What is the purpose
of diagnosing addiction or dependence and
what does this mean for establishing
diagnostic criteria? Addiction. 106(5), 863-5.
doi: 10.1111/j.1360-0443.2011.03377.x.
28.
Britton J, McNeill A, Arnott D, West R,
Godfrey C Drugs and harm to society.
Lancet, 377(9765), 551. doi:10.1016/S01406736(11)60192—x.
29.
West R (2010) The potential contribution of
health psychology to developing effective
interventions to reduce tobacco smoking.
Psychology and Health, 25(8), 889-892. doi:
10.1080/08870446.2010.523991.
30.
West R, McNeill A, Britton J, Bauld L, Raw
M, Hajek P, Arnott D, Jarvis M, Stapleton J
(2010) Should smokers be offered assistance
with stopping? Addiction. 105, 1867-2040.
doi: 10.1111/j.1360-0443.2010.03111.x.
UTARG Output
their packaging will significantly reduce the
attractiveness of cigarettes. Data arising from
implementation of this policy in Australia will be
helpful in determining how much effort and resource
other countries should put into it given all the other
policies they could be pursuing.
Payment by results for smoking cessation support
will lead to a serious deterioration in service
provision without a set of key safeguards: only
paying for successes above what could have been
achieved by medication alone, varying the tariff to
take account of differences in quit rates of different
types of smoker, and only using providers that have
been through an accreditation process which
demonstrates that they offer optimal evidence-based
support and their claimed quit rates are accurate
A trial will be conducted to assess the effectiveness
of a client-centred, caseworker-delivered intervention
in helping smokers from socially disadvantaged
populations in NSW Australia to stop.
Given that the main purpose of diagnosing people as
‘addicted’ is to enable them to receive appropriate
treatment, such a diagnosis should be applied to
anyone who is engaging in, or at high risk of
returning to, a behaviour known to have significant
addictive potential in a way that is causing or likely to
cause harm. Current and proposed diagnostic DSM
criteria are arguably overly complex and do not meet
the clinical or public health need.
The ranking of drugs in terms of harm proposed by
David Nutt and colleagues is fundamentally flawed in
failing to account for the harms from tobacco, which
is not surprising given the subjective nature of the
process leading to the rankings and the lack of a
tobacco expert on the panel.
The field of Health Psychology is rich in innovative
ideas and theories that can help explain smoking
behaviour and develop interventions but as yet has
not yielded interventions that are better than can be
achieved by a simple model of smoking as involving
a balance between concerns about the harms and
costs of smoking and the desire (sometimes very
strong) to smoke driven by pharmacological and
social reward and punishment. Systematic reviews of
key issues are needed to establish a firm evidence
base on which to move theory and practice forward.
There are several fallacies in arguments against
helping smokers to stop such that it is unnecessary
because most smokers stop without help, findings
from randomised trials do not generalise to the ‘real
world’ and aiding cessation is less cost-effective than
other tobacco control measures. These are easily dealt
with and once this is done it is possible to have a
Page 32
31.
Aveyard P, Amos A, Bauld L, Britton J,
Coleman T, Cocherty G, Godfrey C, Hajek P,
Hastings G, McNeill A, Lewis S, Munafo M,
West R (2010) Is the UK’s coalition
Government serious about public health?
Lancet, 376, 589. doi:10.1016/ S01406736(10)61288-3.
32.
Stapleton JA (2010) The Scandal of Smoking
and Mental Illness. Addiction 105: 11901. doi: 10.1111/j.1360-0443.2010.03025.x.
Abraham C, Kelly M, West R, Michie S.
(2009) The UK National Institute for Health
and Clinical Excellence (NICE) Public
Health Guidance on Behaviour Change: A
Brief Introduction, Psychology, Health &
Medicine, 14, 1-8. doi:
10.1080/13548500802537903.
33. Arnott D, McEwen A. (2009) Illicit tobacco:
An international problem with an
international solution. Addiction, 104, 155-7.
doi: 10.1111/j.1360-0443.2008.02407.x.
34.
Coleman T, McEwen A, Bauld L, Ferguson
J, Lorgelly P, Lewis S. (2009) Protocol for
the Proactive Or Reactive Telephone
Smoking CeSsation Support (PORTSSS)
trial. Trials, 10, 26. doi: 10.1186/1745-621510-26.
35.
Edwards G, Babor T, Darke S, Hall W,
Marsden J, Miller P, West R. (2009) Drug
trafficking: time to abolish the death penalty.
Addiction, 104, 1267-9. doi: 10.1111/j.13600443.2009.02625.x.
36.
Gilmore A, Britton J, Arnott D, Ashcroft R,
Jarvis M. (2009) The place for harm
reduction and product regulation in UK
tobacco control policy. J Public Health 31, 310. doi:10.1093/pubmed/fdn105.
Lindson N, Aveyard P, Ingram J, Inglis J,
Beach J, West R, Michie S. (2009) Rapid
reduction versus abrupt quitting for smokers
who want to stop soon: a randomised
controlled non-inferiority trial. Trials, 10, 69
doi:10.1186/1745-6215-10-69.
37.
UTARG Output
constructive debate about the role of cessation
assistance in a comprehensive tobacco control
strategy.
The UK’s tobacco control strategy is evidence based
and has yielded a 25% reduction in prevalence in the
past 10 years but there is a risk that this is now being
undermined by government cuts.
People with mental illness have been neglected in
tobacco control policies. The prevalence of smoking
among people with mental illness is about 3 times
higher than in the general population and dependence
levels are also higher. Cessation efforts need to be redirected to provide more help to those with mental
illness.
Based on an analysis of the limitations of the
available evidence base, research recommendations
advise researchers on how to improve the quality of
research into behaviour change interventions
(including evaluations) and thereby advance the
science of behaviour change.
Trade in illicit tobacco results from a lack of control
on the international movement of cigarettes and is run
by criminal organisations with relatively
sophisticated systems for distributing smuggled
cigarettes. An effective solution to such a
sophisticated international criminal trade will be
provided by a protocol to the WHO Framework
Convention on Tobacco Control (FCTC).
The PORTSSS trial will provide high quality
evidence to determine the most appropriate kind of
counselling which should be provided via the NHS
Smoking Helpline and also whether or not an
additional offer of cost-free nicotine replacement
therapy is effective and cost effective for smoking
cessation.
There are no moral or empirical grounds for retaining
the death penalty for drug trafficking; it is important
for researchers to join a concerted campaign to end
this practice.
For harm reduction to work in the UK, a nicotine
product regulation authority is first needed. The
public health community needs to drive this debate
because failure to do so would let the tobacco
industry gain the upper hand.
A non-inferiority randomised trial of rapid reduction
versus standard abrupt cessation will be conducted
among smokers who want to stop smoking. In the
reduction arm, participants will be advised to reduce
smoking consumption by half in the first week and to
25% of baseline in the second, leading up to a quit
Page 33
38.
39.
McEwen A, Percival J. (2009) Interventions
to trigger quit attempts. Practice Nursing, 20,
120-5.
Stapleton JA (2009) Trial comes too late as
psychiatric side effects end hope for
rimonabant. Addiction 104, 277-8. doi:
10.1111/j.1360-0443.2008.02487.x.
40.
McEwen A, Vangeli E. (2008) The
Prescriber’s role in Smoking Cessation.
Prescriber, 19, 48-56.
41.
Spirling L, Stapleton JA, Sutherland G.
(2008) Suicidal ideation and varenicline: a
possible case of mistaken adverse drug
reaction? Clin. Psychiatry, 69, 1834-5.
Etter J-F, Lukas R, Benowitz N, West R,
Dresler C. (2008) Cytisine for smoking
cessation: a research agenda. Drug and
Alcohol Dependence, 92, 3-8.
doi:10.1016/j.drugalcdep.2007.06.017.
42.
43.
44.
45.
46.
47.
48.
day at which participants will stop smoking
completely. This will be assisted by nicotine patches
and an acute form of nicotine replacement therapy.
Unsolicited practice nurse advice can be important in
triggering quit attempts.
The first published trial of rimonabant for smoking
cessation leaves many unanswered questions
regarding efficacy that now may never be answered
due to a significant incidence of psychiatric side
effects.
Prescribers need not engage in lengthy counselling
sessions to help smokers to stop. They need only give
very brief advice to stop accompanied by a referral to
the NHS Stop Smoking Service. If that is not
acceptable to the smoker then a prescription for
medication should be offered.
Suicidal ideation while taking varenicline to stop
smoking is likely to be attributable to tobacco
withdrawal rather than an adverse drug reaction.
New studies are necessary to define the nicotinic
receptor interaction profile of cytisine, to establish its
pharmacokinetics and pharmacodynamics in humans,
to determine whether animals self-administer
cytisine, and to ascertain whether cytisine is safe and
effective as a smoking cessation drug.
West R. (2008) Finding better ways of
The Tobacco Research Group carries out a wide
motivating and assisting smokers to stop:
range of studies aimed at finding better ways of
Research at the CRUK Health Behaviour
encouraging and helping smokers to stop. These
Research Centre. European Health
include epidemiological studies looking at smoking
Psychologist, 10, 54-8.
and smoking cessation in the general population,
clinical trials of smoking cessation aids, experimental
studies looking at craving and withdrawal symptoms
and how these can be mitigated, and qualitative
research examining the process of smoking cessation.
Stapleton JA (2008) Breaking away from a
Since first introduced in the early 1980s the
narrow prescribing protocol for medicinal
prescribing protocol for nicotine replacement has
nicotine Addiction 103(4):564-565.
remained unchallenged and under-researched. New
doi: 10.1111/j.1360-0443.2008.02170.x.
data should promote further research to optimise
smoking cessation with nicotine replacement.
Hall W, West R (2008) Thinking about the Whereas a simple ban on the sale of smoked tobacco
unthinkable a de facto prohibition on smoked may be unthinkable, a de facto ban is achievable and
tobacco products. Addiction. 103, 873-874. a worthwhile goal by making use of smoked tobacco
doi: 10.1111/j.1360-0443.2007.02129.x.
expensive, unrewarding and inconvenient and
facilitating use of much safer alternatives.
Stapleton JA. (2008) Breaking away from a
Variations to the standard treatment protocols for
narrow prescribing protocol for medicinal
nicotine replacement therapies have the potential to
nicotine. Addiction, 103, 564-66. doi:
considerably improve smoking cessation rates.
10.1111/j.1360-0443.2008.02170.x.
Britton J, McNeill A, Arnott D, West R,
Nicotine use, in the form of cigarette smoking, merits
Godfrey C. (2007) Assessing drug-related
a higher ranking in the league table of addictive drugs
harm. Lancet, 369, 1856-7.
than was proposed by David Nutt and colleagues in
doi:10.1016 /S0140-6736(07)60842-3.
an article in the Lancet.
West R (2007) Interventions to promote
smoking cessation. BMJ Health Intelligence
UTARG Output
A range of interventions have proven effectiveness
and cost-effectiveness in aiding smoking cessation
Page 34
49.
50.
http://healthintelligence.bmj.com
West R (2007) The clinical significance of
‘small’ effects of smoking cessation
treatments. Addiction. 102, 506-9. doi:
10.1111/j.1360-0443.2007.01750.x.
West R (2007) What lessons can be learned
from tobacco control for combating the
growing prevalence of obesity? Obesity
Reviews. 8 (Suppl 1), 145-50. doi:
10.1111/j.1467-789X.2007.00334.x.
and these should be routinely offered to all smokers
An increase of as little as 1 percentage point in
abstinence for 6 months (which would translate to 0.5
percentage points permanent cessation) is highly
clinically significant .
There may be scope to make a significant impact
through providing better information and campaigns
designed to change norms and raise public concerns
about patterns of behaviour that lead to over-eating.
However, even if that is successful, it is unlikely that
the problem will be adequately addressed without
more coercive measures directed either at consumers
or suppliers, or both.
Book chapters, books and published reports
Current programme grant
1. West R (2015) The importance of maintaining downward pressure on smoking prevalence through
comprehensive tobacco control. Report to All Party Parliamentary Group on Smoking and Health.
London: ASH.
2. Christmas S, Michie S, West R (2015) Thinking About Behavior Change. London: Silverback Publishing.
3. Michie S, Atkins L, West R (2015) The Behaviour Change Wheel: A Guide to Designing Interventions.
London: Silverback Publishing.
4. Michie S, West R, Campbell R, Brown J, Gainforth H (2014) ABC of Behaviour Change Theories.
London: Silverback Publishing.
5. West R, Hajek P, McNeill A, Brown J, Arnott D. Electronic cigarettes: what we know so far. Briefing
report to UK All-Party Parliamentary Group on Pharmacy2014.
6. West R (2013) The SmokeFree Formula. London: Orion.
7. Arnott D, McIlvar M, Mcewen A (2013) Tobacco Use in Gerada C, RCGP Guide to the Management of
Substance Misuse in Primary Care. London: Royal College of General practitioners.
8. West R, Brown J (2013) Theory of Addiction. 2nd Edition. Oxford: Wiley-Blackwell.
9. Attwood, A., Aveyard, P., Bauld, L., Britton, J., Hajek, P., Hastings, G., McNeill, A., Munafò, M.,
Murray, R., Shahab, L., West, R., (2013) Tobacco. In: Principles of Addiction: Comprehensive Addictive
Behaviors and Disorders. Elsevier Inc., San Diego: Academic Press, pp. 767–776.
10. West R (2013) Models of Addiction. Lisbon: EMCDDA.
11. McIlvar M, Williams I, McEwen A, West R (2012) Development of an Independent Audit Process for
Providers of Stop Smoking Support. London: NCSCT.
Programme grant 2007-2011
12. Shahab L, Beard E, Gardner B (2012) BCT analysis of existing cost-effective interventions. Report to
the NICE Behaviour Change Programme Guidance Committee.
13. West R (2011) Overcoming state addiction to tobacco. In H Ghodse, H Herman, M Maj, N Sartorius
(Eds) Substance Abuse Disorders Edited by Hamid Ghodse, Helen Herrman, Mario Maj and Norman
Sartorius. London: Wiley
14. West R, Michie S (2010) Behaviour change: the importance of seeing the whole picture and a critique of
‘Nudge’. Evidence to House of Lords Behaviour Change Inquiry.
15. Michie S, West R (2010) Behaviour change interventions: evidence and applications Evidence to House
of Lords Behaviour Change Inquiry: Follow-up to 16 November Evidence Session
16. Shahab L, West R. (2010) Smoking. In: D. French, A.A. Kaptein, K. Vedhara, & J. Weinman (Eds)
Health Psychology. Oxford, UK: Wiley-Blackwell.
17. Shahab L, Fidler J. (2010). Tobacco-related disorders. in P Sturmey, M Hersen M. (Eds) Handbook of
Evidence-Based Practice in Clinical Psychology. New York: Wiley.
18. West R, Shahab L (2010) Smoking cessation. In Killoran A & Kelly M (Eds) Effectiveness and
efficiency in public health: systematic approaches to evidence and practice. Oxford University Press
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19. West R (2010) Why is it so hard to quit? The Advisor. Autumn 2010
20. West R (2010) The role of mass media campaigns in evidence-based tobacco control. In Arnott D (Ed)
All Party Parliamentary Group Report on Tobacco Control in England. London: ASH.
21. West R (2010) Evidence-based tobacco control: why England still needs it and what it is. In Arnott D
(Ed) All Party Parliamentary Group Report on Tobacco Control in England. London: ASH.
22. Amos A, Angus K, Bostock Y, Fidler J, Hastings G (2009) A Review of Young People and Smoking in
England. Public Health Research Consortium, http://www.york.ac.uk/phrc/papers.htm
23. West R. (2009) Experimental design issues in addiction. In Miller P, Strang J & Miller P (Eds) Addiction
Research Methods. London: Wiley.
24. West R. (2009) Possible application of PRIME Theory of motivation to promote safer driving. In
Behavioural Studies in Road Safety 17. London: DfT
25. West R, Stenius K (2008) Use and abuse of citations. In Babor T, Stenius K, Savva S, O’Reilly J (Eds)
Publishing Addiction Science. London: ISAJE.
26. May S, McEwen A. (2008) NHS Stop Smoking Service CO-verification Project - A Report for the
Department of Health. London: Smoking Cessation Service research network (SCSRN).
27. McEwen A, Arnoldi H, Bauld L, May S, Ferguson J, Stead L. (2008) Client satisfaction survey: pilot
project report. London: Smoking Cessation Service research network (SCSRN).
28. McEwen A, McRobbie H, Preston A. (2008) The Stop Smoking Handbook. Dorchester, Exchange
Supplies.
29. Shahab L, McEwen A. (2008) Online Support for Smoking Cessation - A Report for the Department of
Health. London: Smoking Cessation Service research network (SCSRN).
30. Shahab L. (2008). Epidemiology of tobacco smoking – a growing concern. In M. Miravitlles (Ed) Hot
topics in respiratory medicine (Issue 8). Modena, Italy: FB Communications.
31. Owen L (Chair), Beal J, Collett S, Fullard B, Kay E, MacDonald S, McEwen A. (2007) NICE –
Smoking cessation training resource for the dental teams. CD-ROM. London: National Institute for
Health and Clinical Excellence.
32. Shahab L. (2007) Socioeconomic status and health. In S Ayers et al (Eds) Cambridge Handbook of
Health Psychology (2nd Edition). Cambridge: Cambridge University Press.
33. Watt R, Andrews F, Beal J, Bose A, Dyer T, Jenner T, Lowe C, McEwen A, Owen L, Read J, Slater M,
Zoitopoulos L. (2007) Smokefree and smiling: helping dental patients to quit tobacco. London:
Department of Health.West R, Shiffman S (2007) Smoking Cessation (2nd Editions). Oxford: Health
Press.
34. West R. (2007) The PRIME Theory of motivation as a possible foundation for addiction treatment. In J
Henningfield, P Santora and W (Eds) Drug Addiction Treatment in the 21st Century: Science and Policy
Issues. Baltimore: John’s Hopkins University Press.
35. West R, Hardy A (2007) Stigma. In S Ayers et al (Eds) Cambridge Handbook of Psychology Health and
Medicine (2nd Edition). Cambridge: Cambridge University Press.
36. West R, Hardy A (2007) Tobacco use. In S Ayers et al (Eds) Cambridge Handbook of Psychology
Health and Medicine (2nd Edition). Cambridge: Cambridge University Press.
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