1 Recommendations

This document constitutes the Institute's formal guidance on how to encourage and support employees to stop smoking.

The recommendations in this section are presented without any reference to evidence statements. Appendix A repeats the recommendations and lists their linked evidence statements.

Reducing smoking and tobacco-related harm is a key government strategy for improving the health of people in England and reducing health inequalities. After 1 July 2007, smoking will be prohibited in virtually all enclosed public places and workplaces in England. This includes vehicles used for business and any rooms or shelters previously set aside for smoking (if they are enclosed or substantially enclosed, according to the definition of the law). Failure to comply will be an offence.

Employers are not legally obliged to help employees to stop smoking. However, employers that do provide cessation support could reduce the risk of non-compliance with the law, as well as taking advantage of the opportunity it offers to improve people's health. They will be promoting healthy living and no smoking within society, as well as benefiting from reduced sickness absence and increased productivity.

The following smoking cessation interventions, as defined below, have been proven to be effective.

Brief interventions

Brief interventions for smoking cessation involve opportunistic advice, discussion, negotiation or encouragement and are delivered by a range of primary and community care professionals, typically within 5–10 minutes. The package provided depends on a number of factors including the individual's willingness to quit, how acceptable they find the intervention and previous methods they have used. It may include one or more of the following:

  • simple opportunistic advice

  • an assessment of the individual's commitment to quit

  • pharmacotherapy and/or behavioural support

  • self-help material

  • referral to more intensive support such as the NHS Stop Smoking Services.

(NICE 2006a; NICE 2006b).

Individual behavioural counselling

This is a face to face encounter between someone who smokes and a counsellor trained in assisting smoking cessation.
(Lancaster and Stead 2005a; NICE 2006b; NICE 2006c)

Group behaviour therapy

Group behaviour therapy programmes involve scheduled meetings where people who smoke receive information, advice and encouragement and some form of behavioural intervention (for example, cognitive behavioural therapy) delivered over at least two sessions.
(NICE 2006b; NICE 2006c; Stead and Lancaster 2005)

Pharmacotherapies

Stop smoking advisers and healthcare professionals may recommend and prescribe nicotine replacement therapy (NRT) or bupropion as an aid to help people to quit smoking, along with giving advice, encouragement and support. Before prescribing a treatment, they take into account the person's intention and motivation to quit and how likely it is they will follow the course of treatment. They also consider which treatments the individual prefers, whether they have attempted to stop before (and how), and if there are medical reasons why they should not be prescribed NRT or bupropion.
(NICE 2002; NICE 2006b)

Self-help materials

Self-help materials comprise any manual or structured programme, in written or electronic format, that can be used by individuals in a quit attempt without the help of health professionals, counsellors or group support. Materials can be aimed at anyone who smokes, particular populations (for example, certain age or ethnic groups) or may be interactively tailored to individual need. (Lancaster and Stead 2005b; NICE 2006b)

Telephone counselling and quitlines

Telephone counselling and quitlines provide proactive or reactive advice, encouragement and support over the telephone to anyone who smokes who wants to quit, or who has recently quit.
(Stead et al 2006;NICE 2006b; NICE 2006c)

Recommendation 1

Who should take action?

Employers.

What action should they take?

  • Publicise the interventions identified in this guidance and make information on local stop smoking support services widely available at work. This information should include details on the type of help available, when and where, and how to access the services.

  • Be responsive to individual needs and preferences. Where feasible, and where there is sufficient demand, provide on-site stop smoking support.

  • Allow staff to attend smoking cessation services during working hours without loss of pay.

  • Develop a smoking cessation policy in collaboration with staff and their representatives as one element of an overall smokefree workplace policy.

Recommendation 2

Who should take action?

Employees who want to stop smoking.

What action should they take?

Contact local smoking cessation services, such as the NHS Stop Smoking Services, for information, advice and support.

Recommendation 3

Who should take action?

Employees and their representatives.

What action should they take?

Encourage employers to provide advice, guidance and support to help employees who want to stop smoking.

Recommendation 4

Who should take action?

All those offering smoking cessation services including the NHS, independent or commercial organisations and employers.

What action should they take?

  • Offer one or more interventions that have been proven to be effective (see above).

  • Ensure smoking cessation support and treatment is delivered only by staff who have received training that complies with the 'Standard for training in smoking cessation treatments').

  • Ensure smoking cessation support and treatment is tailored to the employee's needs and preferences, taking into account their circumstances and offering locations and schedules to suit them.

Recommendation 5

Who should take action?

Managers of NHS Stop Smoking Services.

What action should they take?

  • Offer support to employers who want to help their employees to stop smoking. Where appropriate and feasible, provide support on the employer's premises.

  • If initial demand exceeds the resources available, focus on the following:

    • small and medium-sized enterprises (SMEs)

    • enterprises where a high proportion of employees are on low pay

    • enterprises where a high proportion of employees are from a disadvantaged background

    • enterprises where a high proportion of employees are heavy smokers.

Recommendation 6

Who should take action?

Strategic health authorities and primary care trusts.

What action should they take?

Ensure local NHS Stop Smoking Services are able to respond to fluctuations in demand, particularly before and after implementation of smokefree legislation.