10 Gaps in the evidence

10 Gaps in the evidence

The Programme Development Group (PDG) identified a number of gaps in the evidence related to the programmes under examination based on an assessment of the evidence, stakeholder and expert comment and fieldwork These gaps are set out below.

1. Health professionals' and service users' views about the barriers to, and facilitators for, implementing tobacco harm-reduction strategies.
(Evidence review 4)

2. Service users' and providers' views on offering free NRT and its potential impact on the success of tobacco harm-reduction strategies.
(Evidence review 4)

3. GPs' and other prescribers' attitudes towards (and views on) the barriers to and facilitators for using licensed nicotine-containing products.
(Evidence review 4)

4. The pharmacokinetics of new nicotine containing products such as electronic cigarettes
(Evidence review 1)

5. The safety and long-term use of licensed nicotine-containing products among different subgroups. This includes potential drug interactions and contraindications.
(Evidence review 1)

6. The effectiveness and cost effectiveness of the following in relation to helping people cut down prior to stopping smoking or trying to reduce the amount they smoke:

  • different combinations of licensed nicotine-containing products

  • other nicotine delivery systems

  • using products for more than a year

  • group support models as part of a 'cutting down prior to stopping smoking' approach

  • consumer-driven harm reduction, such as social norms and product demand

  • different initiatives to prevent relapse.

(Evidence reviews 2 and 3)

7. The effectiveness and cost effectiveness of different behavioural strategies to support different harm-reduction approaches.
(Evidence reviews 2 and 3)

8. The effectiveness and cost effectiveness of self-help materials.
(Evidence reviews 2 and 3)

9. The health benefits of smoking reduction, rates of relapse and progression to stopping smoking among people who have opted to reduce the amount they smoke.

10. The long-term psychological effects of nicotine use in relation to smoking status and the harm-reduction approach used. (In relation to people who have not cut down, those who have reduced the amount they smoke and people who have stopped smoking and switched to licensed nicotine products.)

11. The extent to which compensatory smoking occurs when someone is trying to cut down prior to stopping smoking or trying to reduce the amount they smoke. (Compensatory smoking includes taking deeper inhalations or smoking more of the cigarette). For example, there is a lack of data on whether the behaviour persists over time, and whether the amount of compensation differs across groups. (It could differ by the degree of nicotine addiction, amount of cigarettes smoked and whether or not NRT is used.)
(Evidence reviews 2 and 3)

12. The effect of population-level polices and interventions to support harm reduction.
(Evidence reviews 2, 3, 4 and 5)

13. The impact of different marketing strategies on the uptake of harm- reduction approaches.
(Evidence reviews 2, 3, 4 and 5)

14. Data on:

  • services offering harm reduction strategies

  • level of compliance with different tobacco harm-reduction strategies

  • relapse rates following an attempt to cut down, temporary abstinence and quitting completely – and whether smoking increases following a relapse

  • combined use of NRT and cigarettes as a harm-reduction approach

  • long-term health effects of a harm-reduction approach

  • behavioural effects of long–term nicotine use

  • alcohol use and its association with the motivation to stop smoking, cut down prior to stopping or reduce the amount they smoke.

15. The relationship between pharmacokinetic profiles and user responses to new nicotine-containing products, such as electronic cigarettes.

The Group made 10 recommendations for research into areas that it believes will be a priority for developing future guidance. These are listed in Recommendations for research.

  • National Institute for Health and Care Excellence (NICE)