Guidance

Update information

Update information

January 2023: We have amended the recommendation on carbon monoxide testing at antenatal appointments to reduce the number of tests for women with low carbon monoxide readings and no history of smoking, in line with new NHS England guidance. This recommendation is marked [2023].

August 2022: We have reviewed the evidence on Allen Carr's Easyway to stop smoking in-person seminar for people who smoke.

Recommendations updated as a result of this review are marked [2021, amended 2022].

November 2021: This guideline 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).

We have reviewed the evidence and made new recommendations, if relevant, on:

  • digital and mass-media stop-smoking campaigns for preventing uptake

  • proxy purchasing and supply of illicit tobacco

  • impact of e‑cigarettes on future smoking behaviour

  • Smokefree Class Competitions for preventing uptake (no recommendations made)

  • opt-out referral to stop-smoking support in pregnancy

  • incentives for stopping smoking in pregnancy

  • effectiveness, safety and acceptability of nicotine replacement therapy and e‑cigarettes for stopping smoking in pregnancy

  • effectiveness of treatments for stopping smoking

  • barriers and facilitators to using e‑cigarettes for stopping smoking

  • long-term health effects of using e‑cigarettes

  • relapse prevention.

These recommendations are marked [2021].

We have also made some changes without an evidence review (marked as amended 2021) to:

  • avoid duplicating other NICE guidance, and remove duplication or improve alignment between recommendations from different guidelines

  • remove any recommendations about providing information or tailoring support and treatment that overlap with the general principles in NICE's guideline on patient experience in adult NHS services

  • remove prevention strategies that are no longer standard practice or considered appropriate, particularly fear-based messaging for children and young people

  • change the emphasis of prevention campaigns to support policy rather than enforcement

  • remove mention of the ASSIST (A Stop Smoking in Schools Trial) intervention, because current evidence has not been evaluated

  • clarify who should be taking action

  • clarify where mention of health problems relates specifically to smoking-related problems

  • reflect uncertainty about the impact of long-term use of licensed nicotine-containing products

  • clarify expected minor side effects from stopping smoking, so these are not mistaken for effects of licensed nicotine-containing products or other interventions

  • clarify what interventions were intended to be used in recommendations that previously talked about 'pharmacotherapies'

  • clarify reasons for monitoring prescribed medicines in people who are stopping or trying to stop smoking

  • remove mention of people in custodial settings, because these are now all smokefree.

For more information about how the original guidelines were amalgamated and any changes that were made to the recommendations, see the summary of deleted and amended recommendations.

Minor changes since publication

May 2023: We removed the repeat of the explanation about the effectiveness and safety of nicotine-containing e-cigarettes from the recommendations section to avoid duplication. This information is still included in the section on why the committee made the recommendations.

March 2023: We checked the impact of helping pregnant smokers quit: a multi-centre randomised controlled trial of e-cigarette and nicotine patches on the recommendations on supporting women to stop smoking in pregnancy. We did not update the recommendations, but added more information to the section on why the committee made the recommendations to explain the uncertainty about the effectiveness and safety of nicotine-containing e-cigarettes. We also explained this in the recommendations section. For more information, see the surveillance decision.

ISBN: 978-1-4731-4971-7

  • National Institute for Health and Care Excellence (NICE)