In 2019, the Government set an ambition for England to be smoke-free by 2030.¹ In Scotland the target is 2034.² Wales and Northern Ireland have similar smoke-free strategies, but have not set a target date.^3,4 A closer look at this shows that smoke-free is being defined as less than five per cent of the adult population smoking tobacco with smokers either quitting or moving to reduced risk products, such as nicotine replacement therapy (NRT) products, or smoking alternatives, e.g. e-cigarettes.

These are ambitious targets, but incredibly important. Despite smoking rates in Great Britain halving over the last 35 years, smoking is the leading cause of ill health and early death.¹ About half of all lifelong smokers die prematurely, losing on average around 10 years of life. In 2016 alone, there were around 78,000 deaths attributable to smoking, representing 16 per cent of all deaths across the UK.⁵

Why is smoking so harmful?

Many smokers continue to smoke because they are dependent on nicotine. While nicotine is the addictive substance in cigarettes, it is some of the thousands of other chemicals in cigarette smoke that cause almost all the damage. Smoking can affect every part of the body and increases a person’s risk of developing more than 50 serious health conditions; some of these can cause irreversible long-term damage and others can be fatal.⁶

Ideally, people would never start smoking. However, for those that do smoke, it’s important to take every opportunity to advise them to quit. There are different options available to help support people who want to quit, including prescription medicines available from the GP, the Boots Stop Smoking Clinic, and NRT programmes which gradually reduce the amount of nicotine a person is exposed to. All of these options are more successful if behavioural support is also offered.⁷

Harm reduction

Harm reduction, when applied to smoking, is about using alternative methods to deliver nicotine without the toxic chemicals associated with cigarettes.

Harm reduction can be helpful for 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.

Nicotine levels in licensed nicotine-containing products, such as NRT, are much lower than in tobacco, and the way these products deliver nicotine makes them less addictive than smoking tobacco. NRT is therefore an effective way of reducing the harm from tobacco for both the person smoking and those around them. NRT products have been demonstrated in trials to be safe to use for at least five years.⁸

E-cigarettes & supporting stopping smoking

A recent safety review concluded that the risk of adverse health effects from vaping is expected to be much lower compared to cigarettes.⁹ Public Health England’s ‘Vaping in England’ report suggests that many people find vaping products useful for quit attempts, either on their own or alongside licensed products.¹⁰ However, just 29 per cent of current smokers believe that vaping is less harmful than smoking.¹⁰ This belief could be influenced by EVALI in the US (see box below).

E-cigarette or vaping product use associated lung injury (EVALI)¹¹ is an inflammatory response in the lungs triggered by inhaled substances, which can lead to serious illness and even death. There were a significant number of cases in the US in 2019/2020, resulting in negative publicity for e-cigarettes.

However, e-cigarettes are not licensed medicines and so cannot make claims to help someone stop smoking. When speaking to customers, you should make it clear that e-cigarettes are to be used as an alternative to smoking.

E-cigarette safety

You should advise customers to only buy e-cigarettes from reputable sources and ensure that the product is registered with the MHRA. All e-cigarettes sold by Boots are registered with the MHRA.

When selling nicotine-containing e-cigarettes, explain that:⁹

• Although these products are not licensed medicines, they are regulated by the Tobacco and Related Products Regulations 2016
• Many people have found them helpful to quit smoking, although they can't make marketing claims for this
• People using e-cigarettes should stop smoking tobacco completely
• The evidence suggests that e-cigarettes are substantially less harmful to health than smoking but are not risk-free
• The evidence in this area is still developing
• E-cigarettes cannot be sold to anyone under 18 years.

Advising customers

For many smokers, it may take 30 or more quit attempts before being successful.¹²

Whether your customer is planning to give up smoking completely or going smoke-free, there's a great deal of advice and tips you can give them. Encourage your customers to:¹³

• Make a plan – set a date and stick to it. Advise them that they may want to think about any upcoming events and occasions that may be challenging and have a plan for how they will deal with these
• Identify when they are likely to crave cigarettes and plan some coping strategies – cravings generally last approximately five minutes
• Get moving – a review of scientific studies has proved exercise, even a five minute walk or stretch, may reduce cigarette cravings¹³
• Get some support – give up with a friend or family member or find a local stop smoking service to access for support.

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