Cancer Research UK smoking cessation programme at UCL: 20072012

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Cancer Research UK smoking cessation programme at
UCL 2007-2012

• 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

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Groups of studies

• Smoking Toolkit Study (STS)
• monthly surveys of adult population of England,
  with 3m and 6m follow up of each sample
• Analysing data from existing and ongoing studies
  (EOS)
• Health Survey for England, ATTEMPT cohort, ITC
  study, clinical trials, Maudsley database
• Smoking Cessation Research Clinic Network (SCRCN)
• mentoring and collecting data from network of top
  NHS stop smoking services
• Tabex smoking cessation trial (TASC)
• RCT of cytisine vs placebo in Warsaw
• Nicotine Cannon development study (NCDS)
• pharmacokinetic studies and studies of effect on
  withdrawal symptoms and motivation to smoke
• Process of cessation studies (PCS)
• qualitative research, surveys and longitudinal
  studies

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1. What effect, if any, do national events have
on smoking cessation rates and by what mechanism?

• 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)

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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)

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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)

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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)

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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? (EOSHSE)
• 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)

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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)

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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 nicotines
  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)

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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
• cohort studies
• cross sectional surveys
• laboratory studies
• qualitative research
• clinical trials