Appendix B: gaps in the evidence

Appendix B: gaps in the evidence

PHIAC identified a number of gaps in the evidence related to the specific interventions under examination. However, this does not mean these are the only research priorities in relation to smoking cessation activities as a whole. A broader examination of smoking cessation, including research priorities, will be undertaken as part of the development of NICE's programme guidance on smoking cessation. The draft scope for this work was published on the NICE website in March 2006.

Specific gaps in the evidence are set out below. These are based on the full set of evidence statements that can be found in the synopsis and full review.

1. Effectiveness of brief cessation advice in relation to age, gender, socioeconomic status and ethnicity.

2. Cost effectiveness.

3. Patterns of stop smoking attempts, including the use of aids. In particular:

a. the effectiveness of brief advice with and without cessation aids

b. why brief advice does not work with pregnant smokers

c. the absolute and relative effectiveness of brief advice delivered by different health professionals, and brief advice and NRT offered by nurses and pharmacists from spring 2006

d. the influence of previous failures to quit on the effectiveness of subsequent brief advice

e. the effectiveness of brief advice delivered via the Internet

f. the effectiveness of brief advice with children and adolescents

g. the effectiveness of brief advice with smokeless tobacco users

h. the effectiveness of brief advice in a range of settings beyond primary care, including A&E departments, workplaces and community pharmacies

i. the effectiveness of brief advice of less than 2 minutes

j. the effectiveness of a brief, multi-component intervention based on the five 'A's[22].

4. The effectiveness of brief interventions in light of the wider (and changing) context of tobacco control in England. This includes greater exposure to mass media anti-smoking campaigns, wider access to smoking cessation services and more extensive restrictions on smoking in public places.

The Committee made 5 recommendations for research. These are listed in section 5.

[22] National guidelines define a model brief intervention as consisting of the following questions and actions: Ask if the person smokes; Advise them to quit; Assess their willingness to make a quit attempt; Assist them by providing treatment (e.g. behavioural support, NRT or Bupropion) and arranging follow-up or; Arrange referral to an NHS specialist smoking cessation service. Raw M, McNeill A, West R (1998) Smoking cessation guidelines for health professionals. A guide to effective smoking cessation interventions for the healthcare system. Thorax 53: Suppl. S11-S19.