What does evidence-based behavioural support for smoking cessation look like?

1. What does evidence-based behavioural support for smoking cessation look like? Robert West University College London UK Centre for Tobacco Control Studies National Centre for Smoking Cessation and Training June 2013

3. Essential features of a stop smoking service • It is for smokers who want help with stopping • It combines behavioural support and pharmacotherapy • Behavioural support • multiple sessions provided by a trained specialist taking the smoker through the first 4 weeks of abstinence at least • Pharmacotherapy • NRT, bupropion or varenicline for 8-12 weeks • It is monitored using information on • smokers • treatment provided • outcomes (using ‘Russell Standard’)

4. What a good stop smoking service delivers • Per 5,000 smokers treated • A benefit of: • 1,000 long-term ex-smokers • 2,000 healthy life years • £16 million in savings to society per year • For an outlay of: • £1.25 million including medicines There is almost no other public service that can provide this scale of benefit at so little cost

5. Performance of the services 2001-2012 816444 84501

6. Relative success rate in England by ‘route to quit’ Significantly better than no aid adjusting for confounding variables, p<0.001 Data from www.smokinginengland.info; based on smokers who tried to stop in the past year who report still not smoking at the survey adjusting for other predictors of success (age, dependence, time since quit attempt, social grade, recent prior quit attempts, abrupt vs gradual cessation): N=11,584

7. CO-verified success rates by PCT 2011-12

8. Optimal service configuration • Data from 126,890 treatment episodes in 24 stop-smoking services were used to assess the association between intervention characteristics and 4-week CO verified success rates adjusting for key smoking characteristics • Major independent predictors of success were: • specialist treatment rather than primary care • group rather than one-to-one • use of varenicline or combination NRT rather than single NRT

9. Relative medication effectiveness varies across services Brose et al, 2013

10. Optimal components of behavioural support • Examined ‘behaviour change techniques’ specified in treatment manuals of 43 stop-smoking services and associated inclusion of each of these with success rates • BCTs found to be linked to success rates were: • Strengthen ex-smoker identity • Measure CO • Reward abstinence • Advise on changing routine • Advise on coping with cravings • Advise on medication use • Ask about experiences when using medication • Give options for additional support • Elicit client views

11. Differences in effectiveness between practitioners • Data from 46,237 one-to-one treatment episodes delivered by stop-smoking specialists were used to assess differences in 4-week CO verified success rates between them adjusting for all other factors Differences between practitioners accounted for 7.6% of the variance in success rates, a larger differences than is typically found between active and placebo NRT

12. Variation in 4-week success rates between practitioners Brose et al, 2012

13. Why specialists get better success rates than non-specialists • Data from survey of 573 specialists and 466 non-specialists were used to identify factors mediating the differences in success rates • Factors found to be important were: • greater use of abrupt rather than gradual cessation approach • stronger emphasis on medication use • number of days training received • number of sessions observed when starting out • better supervision

14. What does evidence-based behavioural support look like? • Schedules at least 6 weekly sessions starting before the quit date • Strongly recommends (and provides) varenicline or combination NRT • Strongly recommends abrupt cessation • Includes a set of evidence-based behaviour change techniques • Delivered by advisors who are well trained, supported and supervised

15. A new book for smokers on how to stop • Most smokers want to stop but do not know the best ways of doing it • There are a few very popular self-help guides; these put forward a particular method which is not evidence-based (e.g. Allan Carr’s Easy Way) • There is a need for a book will can act as the trusted source for smokers on how best to stop • The book must communicate the science of stopping smoking to the widest possible readership in a way that is engaging and accessible

16. Bringing the science of stopping smoking to smokers A new book for smokers Launch date December 2013