Cancer Research UK smoking
cessation programme at UCL: 20072012
Robert West
University College London
London
October 2007
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Aim and approach
• To discover and disseminate improved
methods of encouraging and helping
smokers to stop
• To focus on topics that provide the
greatest potential benefit, fill gaps in the
literature and make best use of data sets
and resources available to the team
Groups of studies
1.
Smoking Toolkit Study (STS)
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2.
monthly surveys of adult population of England, with 3m and 6m
follow up of each sample
Analysing data from existing and ongoing studies (EOS)
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3.
Health Survey for England, ATTEMPT cohort, ITC study, clinical trials,
Maudsley database
Smoking Cessation Research Clinic Network (SCRCN)
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4.
mentoring and collecting data from network of top NHS stop smoking
services
Tabex smoking cessation trial (TASC)
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RCT of cytisine vs placebo in Warsaw
‘Nicotine Cannon’ development study (NCDS)
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6.
pharmacokinetic studies and studies of effect on withdrawal
symptoms and motivation to smoke
Process of cessation studies (PCS)
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qualitative research, surveys and longitudinal studies
1. What effect, if any, do national events have on
smoking cessation rates and by what mechanism?
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No Smoking Day (STS)
‘Smoke-free’ (STS, EOS: ITC study)
Changes in the cost of NRT (STS)
Changes in the cost of smoking (STS)
the New Year (STS)
increasing the legal age for tobacco sales (STS)
introducing a new treatment (STS)
changing accessibility of existing treatments (STS)
media campaigns (STS)
changes in product licenses of existing smoking cessation
products (STS, EOS: ITC)
2. What features of stop smoking services are
associated with higher throughput and success
rates?
• Are clinics run by specialists more effective than behavioural support
provided by ‘level 2’ advisors? (SCRCN)
• Can one identify more effective smoking cessation advisors and use
selection and/or training to raise the overall level of effectiveness?
(SCRCN)
• What are the most effective strategies for recruiting ‘motivated’
smokers to the stop smoking service without loss of effectiveness?
(SCRCN)
• What are the most effective methods of getting GPs to encourage
smokers to use the stop smoking services? (SCRCN)
• How far is client satisfaction associated with throughput and success
rates of services? (SCRCN)
3. What options are there for more effective or more
cost-effective treatment to aid cessation
• Does prescribing a standard course of Tabex (cytisine) increase the
likelihood of success of a quit attempt? (TASC)
• Does the ‘nicotine cannon’ reduce motivation to smoke in abstaining
smokers better than existing NRT products in a way that is
acceptable to them? (NCDS)
• How effective is the nicotine nasal spray when taken without
behavioural support? (EOS: Maudsley database)
• How far does combination NRT improve on single NRT forms?
(EOS: Maudsley database)
• What, if any, relapse prevention strategies in current use are helpful
in promoting long-term cessation? (SCRCN)
4. What are the various routes by which smokers
achieve lasting success at stopping smoking?
• What proportion of successful quit attempts involve ‘long-term’ NRT
use? (STS)
• Are ‘unplanned’ quits more likely to be successful and if so why?
(STS, PCS)
• Does it make a difference to success rates if one tries to stop
gradually or abruptly and does this vary by smoker characteristics?
(STS)
• How far and in what way does a change in ‘identity’ contribute to
success at stopping smoking? (STS, PCS)
• How far do lapses and then relapse result from a decision to resume
smoking? (PCS, STS)
• How far do pre-abstinence measures derived from the PRIME
theory of motivation predict the experience of and success at
stopping smoking compared with existing measures? (PCS, STS)
5. How do smoking and quitting patterns vary by
personal and socio-demographic factors?
• How far can social class differences in cessation rates be attributed
to differences in motivation to stop or other factors such as the
social milieu and nicotine dependence? (STS)
• How far and in what way does experience of and diagnosis of
physical illness influence smoking cessation? (EOS: HSE,
ATTEMPT)
• How is saliva cotinine distributed in the population and how does
this vary by sociodemographic factors? (EOS:HSE)
• What influence does having recently made an attempt to stop
smoking have on the chances of success of a new quit attempt?
(EOS: ATTEMPT)
• To what exent are different smoker characteristics associated with
early versus late relapse? (EOS: CEASE trial)
• What is the best measure of nicotine dependence? (EOS:
Varenicline trial)
6. What are the short- to medium-term costs and
benefits of stopping smoking?
• Does stopping smoking improve mental health and subjective
wellbeing? (EOS: ATTEMPT, STS, CEASE trial)
• What underlies the short-term increase in healthcare costs on
stopping smoking? (EOS: ATTEMPT)
10: What mediates and moderates the effect of
successful aids to cessation?
• How far do reduction in subjective motivation to smoke (SMS)
and/or blocking of nicotine’s rewarding action mediate the improved
efficacy of varenicline over bupropion? (EOS: varenicline trials)
• How far is the effectiveness of different smoking cessation aids
(NRT, bupropion, varenicline) moderated by personal and
sociodemographic factors such as social class, age, gender, and
nicotine dependence? (EOS: STS, Maudsley database, SCRCN,
ATTEMPT)
• How far does having failed to quit using smoking cessation
treatment reduce the chances of success with the same treatment
on a subsequent occasion? (EOS: Maudsley database, STS,
ATTEMPT)
Conclusions
• The programme:
– targets issues that combine improved understanding
of mechanisms with improved interventions to
promote cessation
– includes studies that span a range of methods:
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cohort studies
cross sectional surveys
laboratory studies
qualitative research
clinical trials