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Tobacco: Harm-Reduction Approaches to Smoking

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Tobacco: Harm-Reduction Approaches to Smoking Tobacco: harm-reduction approaches to smoking Issued: June 2013 NICE public health guidance 45 guidance.nice.org.uk/ph45 NICE has accredited the process used by the Centre for Public Health Excellence at NICE to produce guidance. Accreditation is valid for 5 years from January 2010 and applies to guidance produced since April 2009 using the processes described in NICE's 'Methods for the development of NICE public health guidance' (2009). More information on accreditation can be viewed at www.nice.org.uk/ accreditation © NICE 2013 Tobacco: harm-reduction approaches to smoking NICE public health guidance 45 Contents Introduction: scope and purpose of this guidance...................................................................... 6 What is this guidance about? ................................................................................................................ 6 Who is this guidance for?...................................................................................................................... 7 1 Recommendations ................................................................................................................. 8 Context.................................................................................................................................................. 8 Definitions.............................................................................................................................................. 8 Whose health will benefit? .................................................................................................................... 9 Recommendation 1 Raising awareness of licensed nicotine-containing products................................ 10 Recommendation 2 Self-help materials ................................................................................................ 11 Recommendation 3 Choosing a harm-reduction approach................................................................... 13 Recommendation 4 Behavioural support ............................................................................................. 14 Recommendation 5 Advising on licensed nicotine-containing products ............................................... 15 Recommendation 6 Supplying licensed nicotine-containing products ................................................. 17 Recommendation 7 Follow-up appointments........................................................................................ 17 Recommendation 8 Supporting temporary abstinence ........................................................................ 18 Recommendation 9 People in closed institutions.................................................................................. 19 Recommendation 10 Staff working in closed institutions ...................................................................... 20 Recommendation 11 Commissioning stop smoking services ............................................................... 20 Recommendation 12 Education and training for practitioners ............................................................. 22 Recommendation 13 Point-of-sale promotion of licensed nicotine-containing products....................... 22 Recommendation 14 Manufacturer information on licensed nicotine-containing products ................... 23 2 Public health need and practice .............................................................................................. 24 Introduction............................................................................................................................................ 24 Children and young people ................................................................................................................... 25 Stopping smoking.................................................................................................................................. 25 Reducing cigarette consumption........................................................................................................... 26 © NICE 2013. All rights reserved. Last modified June 2013 Page 2 of 103 Tobacco: harm-reduction approaches to smoking NICE public health guidance 45 3 Considerations ........................................................................................................................ 28 Background ........................................................................................................................................... 28 Stop smoking services .......................................................................................................................... 29 Nicotine-containing products................................................................................................................. 29 The evidence......................................................................................................................................... 30 Economics............................................................................................................................................. 31 4 Recommendations for research .............................................................................................. 34 5 Related NICE guidance........................................................................................................... 36 Published .............................................................................................................................................. 36 Under development............................................................................................................................... 36 6 Glossary ................................................................................................................................. 37 Behavioural support for tobacco harm reduction ................................................................................. 37 Closed institution................................................................................................................................... 37 Compensatory smoking......................................................................................................................... 37 Cutting down prior to stopping (cut down to quit).................................................................................. 37 Licensed nicotine-containing products .................................................................................................. 37 Nicotine-containing products ................................................................................................................ 37 Nicotine replacement therapy (NRT) products ...................................................................................... 38 Pharmacotherapies ............................................................................................................................... 38 Point-of-sale ......................................................................................................................................... 38 Quality ................................................................................................................................................... 38 Safety .................................................................................................................................................... 38 Self-help materials................................................................................................................................. 38 Smoking reduction ................................................................................................................................ 39 Stopping in one step (abrupt quit) ......................................................................................................... 39 Stop smoking services .......................................................................................................................... 39 Temporary abstinence .......................................................................................................................... 39 © NICE 2013. All rights reserved. Last modified June 2013 Page 3 of 103 Tobacco: harm-reduction approaches to smoking NICE public health guidance 45 7 References .............................................................................................................................. 40 8 Summary of the methods used to develop this guidance........................................................ 43 Introduction............................................................................................................................................ 43 Guidance development ......................................................................................................................... 43 Key questions........................................................................................................................................ 44 Reviewing the evidence ....................................................................................................................... 45 Cost effectiveness ................................................................................................................................. 49 Fieldwork............................................................................................................................................... 50 How the PDG formulated the recommendations..................................................................................
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