Action on Health and Smoking. New official smoking figures show progress, but Government cannot be complacent. 2021. (accessed 1 August 2023)

Beard E, West R, Michie S, Brown J. Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2006 and 2017. Addiction. 2020; 115:(5)961-974

Benowitz NL, Wilson Peng M. Non-nicotine pharmacotherapy for smoking cessation: mechanisms and prospects. CNS Drugs. 2000; 13:(4)265-285

British Thoracic Society. BTS Audit of hospital-based Tobacco Dependency Treatment Services finds modest improvement since 2019. 2022. (accessed 1 August 2023)

Britton J, Arnott D, McNeill A, Hopkinson N Nicotine without smoke—putting electronic cigarettes in context. BMJ. 2016; 353

Cahill K, Lindson-Hawley N, Thomas KH, Fanshawe TR, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016; 2016:(5)

Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013; 2015:(7)

Campbell K, Coleman-Haynes T, Bowker K, Cooper SE, Connelly S, Coleman T. Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2020; 5:(5)

Chamberlain C, O’Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2017; 2020:(3)

Chan GCK, Stjepanovi D, Lim C, Sun T, Shanmuga Anandan A, Connor JP, Gartner C, Hall WD, Leung J. A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation. Addict Behav. 2021; 119

Claire R, Chamberlain C, Davey MA, Cooper SE, Berlin I, Leonardi-Bee J, Coleman T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2020; 2020:(3)

Crane D, Ubhi HK, Brown J, West R. Relative effectiveness of a full versus reduced version of the ‘Smoke Free’ mobile application for smoking cessation: a randomised controlled trial. F1000 Res. 2018; 7

Smoking kills. A White Paper on tobacco.London: Stationery Office; 1998

The NHS plan: a plan for investment, a plan for reform.London: Stationery Office; 2000

Faseru B, Richter KP, Scheuermann TS, Park EW. Enhancing partner support to improve smoking cessation. Cochrane Database Syst Rev. 2018; 2018:(9)

Fiore MC. US public health service clinical practice guideline: treating tobacco use and dependence. Respiratory Care. 2000; 45:(10)1200-1262

Gentry S, Forouhi NG, Notley C. Are electronic cigarettes an effective aid to smoking cessation or reduction among vulnerable groups? A systematic review of quantitative and qualitative evidence. Nicotine Tob Res. 2019; 21:(5)602-616

GBD Compare.Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME); 2019

Guo K, Zhou L, Shang X Varenicline and related interventions on smoking cessation: a systematic review and network meta-analysis. Drug and Alcohol Dependence. 2022;

Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016; 9:(9)

Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018; 2019:(1)

Hartmann-Boyce J, Butler AR, Theodoulou A, Onakpoya IJ, Hajek P, Bullen C, Rigotti NA, Lindson N. Biomarkers of potential harm in people switching from smoking tobacco to exclusive e-cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e-cigarettes for smoking cessation.: Addiction; 2022

Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev. 2021; 10:(10)

Howes S, Hartmann-Boyce J, Livingstone-Banks J, Hong B, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2020; 4:(4)

Jackson S, Brown J, Norris E, Livingstone-Banks J, Hayes E, Lindson N. Mindfulness for smoking cessation. Cochrane Database Syst Rev. 2022; 4:(4)

Kotlyar M, Golding M, Hatsukami DK, Jamerson BD. Effect of nonnicotine pharmacotherapy on smoking behavior. Pharmacotherapy. 2001; 21:(12)1530-1548

Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2017; 3:(3)

Lee PN, Fariss MW. A systematic review of possible serious adverse health effects of nicotine replacement therapy. Arch Toxicol. 2017; 91:(4)1565-1594

Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019; 2019:(4)

Lindson-Hawley N, Hartmann-Boyce J, Fanshawe TR, Begh R, Farley A, Lancaster T. Interventions to reduce harm from continued tobacco use. Cochrane Database Syst Rev. 2016; 2016:(12)

Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual versus abrupt smoking cessation: a randomized, controlled noninferiority trial. Ann Intern Med. 2016; 164:(9)585-592

Liu X, Lu W, Liao S, Deng Z, Zhang Z, Liu Y, Lu W. Efficiency and adverse events of electronic cigarettes. Medicine (Baltimore). 2018; 97:(19)

McNeil A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update. A report commissioned by Public Health England. Public Health Eng. 2015; 111:14-15

Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. Public Health Guidance. No. 10, February. 2018;

London National Centre for Smoking Cessation and Training. Training courses and resources. 2021. (accessed 1 August 2023)

National Centre for Smoking Cessation and Training. Stopping smoking during pregnancy. 2019. (accessed 1 August 2023)

NHS Digital. Statistics on NHS Stop Smoking Services in England. 2022. (accessed 1 August 2023)

Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. The Indian Journal of Medical Research. 148:(4)

NHS. NHS stop smoking services help you quit. 2022. (accessed 1 August 2023)

Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Hartmann-Boyce J. Incentives for smoking cessation. Cochrane Database of Systematic Reviews. 2019; (7)

General household survey, 2006.: UK Data Archive, Office for National Statistics; Colchester, Essex

Office for National Statistics. Proportion of Current Smokers in the UK. 2022. (accessed 1 August 2023)

Papke RL, Heinemann SF. Partial agonist properties of cytisine on neuronal nicotinic receptors containing the beta 2 subunit. Molecular Pharmacology. 1994; 45:(1)142-149

Peckham E, Brabyn S, Cook L, Tew G, Gilbody S. Smoking cessation in severe mental ill health: what works? An updated systematic review and meta-analysis. BMC psychiatry. 2017; 17:(1)1-18

Percival J, Bialous SA, Chan S, Sarna L. November. International efforts in tobacco control. Seminars in Oncology Nursing. 2003; 19:(4)301-308

Pirie K, Peto R, Reeves GK, Green J, Beral V. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. The Lancet. 2013; 381:(9861)133-141

Raw M, McNeill ANN, West R. Smoking Cessation Guidelines for Health Professionals: A guide to effective smoking cessation interventions for the health care system. Thorax. 1998; 53:S1-S18

Rice V, Heath L, Livingstone-Banks J, Hartmann-Boyce J. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2017;

Smoking and Mental Health.London2013

Simpson CR, Hippisley-Cox J, Sheikh A. Trends in the epidemiology of smoking recorded in UK general practice. British Journal of General Practice. 2010; 60:(572)e121-e127

Slater YE, Houlihan LM, Maskell PD Halogenated cytisine derivatives as agonists at human neuronal nicotinic acetylcholine receptor subtypes. Neuropharmacology. 2003; 44:(4)503-515

Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008; (2)

Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 2015; (10)

Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2016; (3)

Stead LF, Carroll AJ, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane database of systematic reviews. 2017; (3)

Szatkowski L, McNeill A. Diverging trends in smoking behaviors according to mental health status. Nicotine & Tobacco Research. 2015; 17:(3)356-360

Taylor GM, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2017; (9)

Thomas KH, Martin RM, Davies NM, Metcalfe C, Windmeijer F, Gunnell D. Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study. BMH. 2013;

Ussher MH, Faulkner GEJ, Angus K, Hartmann-Boyce J, Taylor AH. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2019;

Walker N, Howe C, Glover M, McRobbie H, Barnes J, Nosa V, Parag V, Bassett B, Bullen C. Cytisine versus nicotine for smoking cessation. New England Journal of Medicine. 2014; 371:(25)2353-2362

West R, Zatonski W, Cedzynska M, Lewandowska D, Pazik J, Aveyard P, Stapleton J. Placebo-controlled trial of cytisine for smoking cessation. New England Journal of Medicine. 2011; 365:(13)1193-1200

West R. Assessing smoking cessation performance in NHS stop smoking services: the Russell standard (clinical).London: National Centre for Smoking Cessation and Training; 2005

West R, Shiffman S. Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review. Psychopharmacology. 2001; 155:115-122

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev. 2019; 10:(10)

Whyte F, Kearney N. Enhancing the nurse’s role in tobacco control.: Tobacco Control Factsheets; 2003

Wu Q, Gilbody S, Peckham E, Brabyn S, Parrott S. Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis. Addiction. 2016; 111:(9)1554-1567

Zhong Z, Zhao S, Zhao Y, Xia S. Combination therapy of varenicline and bupropion in smoking cessation: A meta-analysis of the randomized controlled trials. Comprehensive Psychiatry. 2019; 95

An evidence-based guide to smoking cessation therapies

02 August 2023
Volume 5 · Issue 8


Despite a general decline in smoking in the UK, prevalence remains high in certain groups such as young adults, pregnant women, those who have a mental Illness and those from socio-economically disadvantaged backgrounds. These groups are also more likely to benefit from targeted smoking cessation interventions. Clinical contact between health professionals and patients who smoke creates an opportunity for offering cessation interventions and to reduce smoking-related harm. This article summarises evidence reported in high-quality systematic reviews on smoking cessation interventions that could be offered by health professionals coming in to contact with patients who smoke. The evidence presented here suggests that brief advice by a health professional is beneficial in achieving smoking cessation and so is intensive behavioural support, alone or in combination with pharmacotherapies (nicotine replacement therapies [NRTs], bupropion and varenicline). Pharmacotherapies are also effective individually in achieving smoking cessation; a combination of NRTs (oral or skin patch) can be particularly helpful among highly dependent smokers. Pharmacotherapies in combination with behavioural support delivered in healthcare settings are more effective than when used alone and delivered in community settings, respectively. Electronic cigarettes are also effective in achieving smoking cessation and are more effective than NRT.

In the 1970s, around 50% of the UK’s population smoked tobacco in one form or another. The proportion dropped rapidly to a third by the 1990s and has since been declining at a slower rate (Office for National Statistics (ONS), 2021). Smoking prevalence in the UK has now fallen to 13.3% (Action on Smoking (ASH), 2021). However, this reduction is not evident across socio-economic groups. Unemployed adults (25.7%) and people who have no qualifications (28.2%) make up a higher proportion of current smokers (ONS, 2021), with smoking one of the principal causes of the health divide across the socio-economic strata. Higher smoking prevalence is also observed in people with a mental Illness (40%), who are more than twice as likely to smoke than the general population (Royal College of Physicians, 2013).

Register now to continue reading

Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month