In 2018, 14.7% of adults in the UK smoked cigarettes. Rates were higher than average for some groups, including those in routine and manual occupations, and those with mental health conditions. Although this is a decline of more than 5 percentage points since 2011, smoking is still the main cause of preventable illness and premature death in England (Office for National Statistics [2018] Adult smoking habits in the UK). In 2017/2018, an estimated 4% (489,300) of NHS hospital admissions in England, and an estimated 16% (77,800) of all deaths, were attributed to smoking (NHS Digital 2019 Statistics on smoking, England).

Treating smoking-related illness is estimated to cost the NHS £2.6 billion a year and the wider cost to society is around £11 billion a year (NHS England Health matters: tobacco and alcohol CQUIN).

In 1 in 5 local authorities, the specialist service has been replaced by an integrated lifestyle service (Action on Smoking and Health and Cancer Research UK's Stepping up: the response of stop smoking services in England to the COVID-19 pandemic).

This guideline forms a single source for tobacco guidance that updates and replaces NICE's guidelines on:

  • smoking: workplace interventions (PH5, 2007)

  • smoking: preventing uptake in children and young people (PH14, 2008)

  • smoking prevention in schools (PH23, 2010)

  • smoking: stopping in pregnancy and after childbirth (PH26, 2010)

  • smokeless tobacco: South Asian communities (PH39, 2012)

  • smoking: harm reduction (PH45, 2013)

  • smoking: acute, maternity and mental health services (PH48, 2013)

  • stop-smoking interventions and services (NG92, 2018).

This guideline includes recommendations on harm reduction, which was previously covered by PH45. In PH45, harm reduction included cutting down before stopping smoking, cutting down longer term, temporary abstinence, or stopping smoking altogether by switching to a medicinally licensed nicotine-containing product. In the current guideline, switching completely from smoking to any nicotine-containing product is considered to be stopping smoking rather than harm reduction.

The approaches for harm reduction in this guideline should not detract from providing the highly cost-effective interventions to help people stop smoking altogether. Instead, recommendations on harm reduction are intended to support and extend the reach and impact of existing stop-smoking support. Although existing evidence is not clear about the health benefits of smoking reduction, people who reduce the amount they smoke are more likely to stop smoking eventually.

This guideline was developed between 2019 and 2021. There has not been anything published to date on COVID‑19 that the committee considered to have an impact on this guideline. We have highlighted in the rationale sections any recommendations that are affected by temporary changes in practice because of COVID‑19. The committee further noted that some stop-smoking support may now be being delivered by phone or video rather than face to face, but this is not stopping the services from being delivered.

  • National Institute for Health and Care Excellence (NICE)