Smoking: Reducing the harm
Quitting smoking is always the best option, however, some smokers are not
yet ready or willing to quit and continue to inflict harm on themselves and the
people around them. The NICE Guidance on Harm Reduction PHG52 offers an
alternative approach to working with these smokers through:
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•
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long term provision of licensed nicotine containing products (NCP) for
smokers not able to quit in one step
cutting down to quit using nicotine containing products
temporary abstinence from smoking to protect others and improve
outcome of medical interventions
Half of all long term smokers will die prematurely, losing on average 10 years of life. The
best thing smokers can do to protect their health is to quit now, completely and forever.
However, not all smokers are ready to take that step.
Many smokers are not yet ready to quit
While most smokers want to reduce the harm they do to themselves and others, many
are not ready to quit. Two thirds of people who smoke say they want to stop but only a
little over a third of smokers will try to quit in a given year [1].
Prior to May 2013 and the publication of the NICE Guidance on Harm Reduction there
were few options available to health professionals to offer these smokers.
Deprived communities have most to gain
Smokers who live in high smoking prevalence communities find it harder to quit than
others. They have fewer friends and family members who have successfully quit
smoking and are more likely to be heavily addicted, which can undermine successful
quit attempts. There are particularly high smoking rates among many disadvantaged
groups including those on low incomes and those with mental health problems.
Sick from smoking but unable to quit
Even when diagnosed with a serious health condition such as heart disease, lung
cancer or COPD smokers can still find it hard to quit. People living with long term
medical conditions which are exacerbated by their smoking sometimes need additional
support to enable them to abstain from smoking either completely or at the time of
specific medical interventions such as surgery. Supporting people to abstain in this way
improves medical outcomes and reduces complications.
Poor understanding about NCP
Among smokers, health professionals and the general public there are misconceptions
about the harm which pure nicotine products can cause. While people smoke for the
nicotine it is the tar in tobacco which kills people. A better understanding of the safety of
pure nicotine products could improve their level of use which will lead to better outcomes
for those trying to quit or cut down.
1. Lader D (2009) Smoking-related behaviour and attitudes, 2008/09. Opinions survey report 40
What councils can do
The NICE Guidance on Harm Reduction is among
the first attempts in the world to set out a structured
approach to offering smokers for whom quitting in
one step has not been a success an alternative
approach. Its purpose is to:
1.
2.
3.
4.
Raise awareness of nicotine containing
products and ensure that the public and
health professionals know the licensed
products are effective and safe to use.
Provide materials for the public about
harm reduction to ensure smokers are aware
of the benefits of harm reduction.
Provide support to stop smoking services
on the delivery of harm reduction while
ensuring that their work to support people to
quit in one step is not undermined.
Highlight the training needs for health staff
particularly in relation to their awareness of
nicotine containing products and how to
support smokers in different circumstances.
Implementation of the guidance
This is an emerging area for public health and practice continues to be developed.
There are many things which could be done to implement the guidance over time but
several measures which local areas could implement immediately. These include:
1. Ensure that stop smoking services retain their core role supporting people to quit
2. Provide information to the public, stop smoking service staff, health and council
staff.
3. Ensure local stop smoking services welcome smokers who have been
independently using harm reduction approaches and provide them with advice in
line with NICE Guidance.
4. Target specific high prevalence groups with additional support in line with NICE
guidance.
5. Embed a harm reduction approach work on smokefree homes to ensure children
are protected from secondhand smoke and that fire risks are reduced.
The NICE Guidance on Harm
Reduction provides alternative routes
for smokers who are not willing or able
to engage in quitting in one step.
It has the potential to make a difference
to the lives of the most disadvantaged
groups.
It is supported by separate briefings on
the following:
 Smoking: health inequalities
 Smoking: quitting
 Smoking: children
 ASH brief: permitting e-cigarette use
on your premises
May 2013