Quality statement 2: Advice about nicotine

Quality statement

People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Rationale

Nicotine is the main addictive chemical that makes stopping smoking difficult, but it is primarily the toxins and carcinogens in tobacco smoke – not the nicotine – that cause illness and death. People who smoke often have misconceptions about the role of nicotine in causing harm, and this can act as a barrier that prevents them from considering the use of licensed nicotine‑containing products.

Quality measures

Structure

Evidence of local arrangements and protocols to ensure that people who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Data source: Local data collection.

Process

Proportion of people identified as being unwilling or not ready to stop smoking who are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Numerator – the number in the denominator who are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Denominator – the number of people identified as being unwilling or not ready to stop smoking.

Data source: Local data collection.

Outcome

Awareness of people who smoke that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

What the quality statement means for service users

People who aren't ready or don't want to quit smoking are advised that nicotine isn't the primary cause of health problems associated with smoking.

Source guidance

Definitions of terms used in this quality statement

People who are unwilling or not ready to stop smoking

This includes people who:

  • may not be able (or do not want) to stop smoking in one step

  • may want to stop smoking, without necessarily giving up nicotine

  • may not be ready to stop smoking, but want to reduce the amount they smoke.

[Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups.