1 Cancer Research UK smoking cessation programme at UCL: Robert West University College London London October 2007

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) monthly surveys of adult population of England, with 3m and 6m follow up of each sample 2.Analysing data from existing and ongoing studies (EOS) Health Survey for England, ATTEMPT cohort, ITC study, clinical trials, Maudsley database 3.Smoking Cessation Research Clinic Network (SCRCN) mentoring and collecting data from network of top NHS stop smoking services 4.Tabex smoking cessation trial (TASC) RCT of cytisine vs placebo in Warsaw 5.‘Nicotine Cannon’ development study (NCDS) pharmacokinetic studies and studies of effect on withdrawal symptoms and motivation to smoke 6.Process of cessation studies (PCS) qualitative research, surveys and longitudinal studies

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)

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