About this guidance

Why is this guidance being produced?

NICE public health guidance makes recommendations on the promotion of good health and the prevention of ill health.

The Department of Health (DH) asked the National Institute for Health and Care Excellence (NICE) to produce this guidance.

The guidance should be implemented alongside other guidance and regulations (for more details see Implementation and Related NICE guidance respectively).

How was this guidance developed?

The recommendations are based on the best available evidence. They were developed by the Programme Development Group (PDG).

Members of the PDG are listed in Membership of the Programme Development Group and the NICE project team.

For information on how NICE public health guidance is developed, see the NICE public health guidance process and methods guides.

What evidence is the guidance based on?

The evidence that the PDG considered included:

  • Evidence reviews:

    • Review 1: 'Safety, risks and pharmacokinetics profiles of tobacco harm reduction technologies' was carried out by Cedar, Cardiff and Vale University Health Board. The principal authors were: Stephen Jones, Andrew Cleves, Fiona Morgan, Kathleen Withers, Judith White and Megan Dale.

    • Review 2: 'The effectiveness of tobacco harm reduction approaches with the intention of quitting (that is, cutting down to quit or reduction to stop smoking), with and without assistance' was carried out by the Support Unit for Research Evidence (SURE), Cardiff University. The principal authors were: Fiona Morgan, Alison Weightman, Sarah Whitehead, Helen Morgan, Ben Carter, Ellie Byrne, Ruth Turley and Andrew Cleves.

    • Review 3: 'The effectiveness of long-term harm reduction approaches without the prior intention of quitting' was carried out by SURE. The principal authors were: Fiona Morgan, Alison Weightman, Sarah Whitehead, Helen Morgan, Ben Carter, Stephen Jones, Ellie Byrne and Ruth Turley.

    • Review 4: 'Barriers and facilitators to implementing tobacco harm reduction approaches (including user and provider perspectives)' was carried out by SURE. The principal authors were: Ruth Turley, Helen Morgan, Jane Noyes, Alison Weightman, Fiona Morgan, Sarah Whitehead and Elizabeth Halstead.

    • Review 5 'Long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly' was carried out by SURE. The principal authors were: Helen Morgan, Fiona Morgan, Alison Weightman and Sarah Whitehead.

  • Review of economic evaluations: 'A rapid review of economic evidence on tobacco harm reduction strategies' was carried out by Mapi Values and York Health Economics Consortium. The principal authors were: Paul Truman, Kristel Janssen, Margreet van Eerd, Evelien Bergrath and Catherine Mulvany.

  • Economic modelling: 'An economic evaluation of different interventions to promote tobacco harm reduction', and a supplementary analysis entitled 'An economic evaluation of different interventions to promote tobacco harm reduction: supplementary report', was carried out Mapi Values and York Health Economics Consortium. The principal authors were: Matthew Taylor, Paul Truman, Kristel Janssen, Margreet van Eerd, Evelien Bergrath and Catherine Mulvany.

  • Expert papers:

    • Expert paper 1: 'Electronic cigarettes: nicotine delivery, efficacy in smoking cessation and potential for harm reduction' by Maciej L Goniewicz, Queen Mary University of London

    • Expert paper 2: 'The prevalence and "effectiveness" of the use of NRT for smoking reduction and temporary abstinence among English smokers' by Emma Beard, University College London

    • Expert paper 3: 'Routes to quit' by Melanie McIlver, National Centre for Smoking Cessation and Training

    • Expert paper 4: 'Harm reduction – views from a smokers' panel' by Ann McNeill, UK Centre for Tobacco Control Studies

    • Expert paper 5: 'Smokefree mental health review' by Ian Gray, Chartered Institute of Environmental Health and Hilary Wareing, Co-Director, Tobacco Control Collaborating Centre

    • Expert paper 6: 'Prison service tobacco policy' by Suzy Dymond-White, National Offender Management Service (NOMS)

    • Expert paper 7: 'Harm reduction: mapping the ripples' by Gerard Hastings, Institute for Social Marketing and the Centre for Tobacco Control Research, University of Stirling

    • Expert paper 8a: 'E-cigarettes: views from UK smoking cessation practitioners' by Deborah Arnott, Action on Smoking and Health (ASH)

    • Expert paper 8b: 'E-cigarette use in Great Britain: 2010 and 2012' by Deborah Arnott, Action on Smoking and Health (ASH)

Note: the views expressed in the expert papers above are the views of the authors and not those of NICE.

  • Expert testimony:

    • Chris Marriott, King's College London, provided verbal commentary on review 1.

  • Fieldwork report: 'Tobacco: Harm-reduction Approaches to Smoking – Final Fieldwork Report' was carried out by ICF GHK.

The reviews, expert papers and economic analysis are available.

In some cases the evidence was insufficient and the PDG has made recommendations for future research.

Status of this guidance

The draft guidance, including the recommendations, was released for consultation in October 2012. At its meeting in February 2013, the PDG amended the guidance in light of comments from stakeholders and experts and the fieldwork. The guidance was signed off by the NICE Guidance Executive in April 2013.

The guidance is available on NICE's website. The recommendations will also be available in a pathway for professionals whose remit includes public health and for interested members of the public.

Implementation

NICE guidance can help:

NICE has developed tools to help organisations put this guidance into practice.

Updating the recommendations

This guidance will be reviewed 3 years after publication to determine whether all or part of it should be updated. Information on the progress of any update will be posted at the NICE website.

Changes after publication

September 2015: Minor maintenance.

July 2013: The guidance was updated in July 2013 to reflect the MHRA decision that all nicotine-containing products should be regulated. This is expected to come into effect in 2016. For further details, see the MHRA website.

Your responsibility

This guidance represents the views of the Institute and was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.

Copyright

© National Institute for Health and Care Excellence 2013. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.

ISBN: 978-1-4731-0159-3

  • National Institute for Health and Care Excellence (NICE)