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Best Practice Guide: Finding The Right Alternative

Best Practice Guide: Finding The Right Alternative

INTRODUCTION

Breaking a habit as powerful as smoking is one of the greatest challenges a person can undertake. The fact you are reading this is a great first step and shows that you are ready to explore your options and embrace change.

Beyond making the decision to try and quit, knowing which route to go down can be complex to decipher and often a little intimidating. This booklet exists solely to provide you with the facts you need to make an informed decision about why you should quit, as well as which alternative best suits your lifestyle and therefore has the greatest chance of success.

WHY SHOULD I CONSIDER FINDING AN ALTERNATIVE?

It is well understood that smoking is harmful to your health and beyond. Below, we will list some of the best-known reasons people decide to put down cigarettes for good, and the impacts smoking can, and will have on your health if you decide to continue the habit.

Smoking is the single biggest cause of preventable death in the UK, which according to the NHS (1) directly or indirectly causes around 75,000 deaths every year (equalling 200 deaths per day).

Aside from death, as many as one million UK residents suffer from a debilitating chronic disease, and 500,000 hospital admissions are caused as a direct effect of smoking. With over 7000 chemicals present in cigarette smoke, 69 of them are known to cause cancer (carcinogens), which impact both yourself and those around you when you smoke.

SMOKING RELATED DISEASE AND ILLNESSES

Leading health organisations, including the NHS, state that smoking significantly increases your risk of developing over 50 serious health conditions, the most dangerous of which we discuss below. If you wish to read further around any of the topics we mention, see our resource list at the end of this guide.

CANCER:

Cancer is a highly debilitating condition where cells in a specific part of the body mutate, causing them to grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including your organs.

Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis.

One in two people will develop some form of cancer during their lifetime. According to the NHS, the four most common types are (1 & 2): breast cancer, lung cancer, prostate cancer & bowel cancer.

The link between smoking and cancer is unavoidable, with seven out of every 10 cases of lung cancer being caused by smoking. In 2015 smoking caused 37,400 (3) (27%) of all circulatory disease related deaths.

CORONARY HEART DISEASE (CHD):

CHD is a condition where fatty substances build up within crucial areas of your blood vessels. While CHD cannot be cured, the NHS cites stopping smoking and carrying out regular exercise as the most effective methods of reducing and managing the symptoms (5).

HEART ATTACK:

A heart attack is a serious medical emergency in which the blood supply to the heart is blocked, most commonly by a blood clot. According to the NHS, the leading cause of heart attacks in the UK is Coronary Heart Disease (CHD as described above) with stopping smoking being the primary method of preventing CHD (6).

STROKE:

A stroke is a very serious medical condition which occurs when the brain’s blood supply is restricted, or cut-off. Strokes are considered a highly damaging medical emergency requiring immediate treatment. The NHS highlights not smoking as one of the four primary methods of avoiding the risk of having a stroke, alongside maintaining a healthy diet, and taking part in exercise. In 2015, smoking caused 16,400 (13%) of all circulatory disease related deaths (2,7,8).

RESPIRATORY ILLNESS:

Smoking damages the lungs over time, which impacts their ability to function normally. This can influence general movement and makes exercise challenging due to a reduced lung capacity. This reduces the amount of oxygen you can take in which is vital for proper muscle and organ functionality. It can also lead to conditions such as Chronic obstructive pulmonary disease.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD):

COPD is the collective name for a group of lung conditions that cause breathing difficulties of varying severity. Many people can suffer from COPD for years without realising before their symptoms progress, and stopping smoking is essential to prevent the worsening of COPD symptoms. It is important to note that once damaged in this way the lungs can never fully recover (9,2,10).

THE COSTS

Taxation on tobacco products has steadily increased since the 1980s, with the government looking to continue increasing tax rates over the coming years. Due to this, smoking has rapidly become one of life’s most expensive habits.

However, while it is widely accepted that cigarettes are expensive at a personal level, there are even steeper costs being paid by organisations like the NHS. This is because they are fighting to cope with the volume of patients admitted daily due to smoking-related illness, as well as the ongoing cost of care and treatment thereafter.

THE PERSONAL COST:

The NHS has created a handy tool to help you calculate your personal smoking expenditure, however here we will examine the cost of a light, average and heavy smoking habit as well as the amount of tar that would build up annually based on the consumption metrics.

You can use this baseline to compare the cost of smoking with leading alternatives like vaping, patches, gums and other NRTs (nicotine replacement therapies) which we will cover in the next section.

We will base these examples on the current (2021) average UK cost of a packet of cigarettes (£9.91 (11)) over the course of 30 years, examining the cost at five-year intervals (12 see table below).

Cost of smoking over time, table is of breakdown, based on average cost of a pack of cigarettes

The data here speaks for itself. What could you achieve with this money if it was put in your hands today? Buy a house? A car? The only way to find out is to break the habit.

HIDDEN COSTS (13):

While the above covers the known cost of smoking, there are even more hidden costs that can impact your personal finances.

Being identified as a smoker can have a negative impact on how certain organisations and services are made available to you.

INSURANCE POLICIES:

Smoking, in many cases, can more than double the cost of your insurance premiums. The frequency of your habit is of no consequence to policy providers, they do not care if you smoke one per day or forty, if you have smoked at all in the last 12 months, you will be considered a smoker.

Insurance companies make checks against applicants to discover if they are telling the truth about smoking and are likely to investigate medical history if a claim is made on a policy. If a person is found to have been dishonest in their application, it is likely the claim will be rejected.

The most common policy types to be impacted by your status as a smoker are:

LIFE AND CRITICAL ILLNESS INSURANCE:

Research by moneysupermarket.com (13) reveals that a 30-year-old man with £150,000 worth of critical illness and life insurance could save, £9.90 per month, or £2,970 over the 25 year term if they made the decision to go smoke-free.

HOME INSURANCE:

Many home insurers will increase the premium of anyone classed as a smoker. This is done to account for the significantly higher risk of domestic fire caused by occupying smokers, a well-known statistic in the public eye.

It is worth noting however that depending on your insurance provider, being classed as a vaper often carries the same penalties as those who identify as a smoker, which can be an important factor when deciding the best alternative for your own lifestyle.

CARELESS DRIVING:

If faced with charges of dangerous or careless driving, smoking at the wheel will be deemed as an offence. If this is proven in court, you may face a fine in excess of £2,000 and a mandatory three to nine points on your driving license. This will not only increase your cost to insure the vehicle, but if six points are received during your first two years of driving, you will lose your licence.

CAR INSURANCE:

Most insurers will charge you more for car cover if they know you are a smoker as they recognise it as a distraction at the wheel.

RESALE VALUE:

Signs of tobacco use in a car, be it stains, smells or burns can directly impact the list of factors that diminish the value of a vehicle.

LOSS OF EARNINGS:

From as far back as 2012, studies have showcased findings that smokers at that time were far more likely to have time off from work. This can be especially damaging to the livelihood of those who do not receive sick-pay entitlement.

However, even recent research carried out by Landman Economics (2020) (15) and presented by leading charity Action on Smoking and Health (ASH) found that “smoking has a significant negative impact on individual earnings and employment prospects, with long-term smokers being 7.5% less likely to be employed than non-smokers and smokers earning, on average, 6.8% less than nonsmokers.”

The cumulative impact of these effects across the UK amounts to £14.1bn lost in income to smokers every year (16).

HOW CAN I FIND THE RIGHT ALTERNATIVE?

Smoking cessation has become a major facet of modern-day healthcare services. Multiple organisations, from the NHS to private healthcare firms, actively drive public awareness and education around smoking, its dangers and the best alternatives to the habit. Global attitudes are now more united than ever before in their goal to reduce smoking throughout society.

The UK is actively working towards achieving a “smoke free generation” via the rollout of a progressive “tobacco control plan. (17)” This plan is already underway and strives to reduce smoking among 15-year-olds from 8% to 3%, reduce smoking among adults in England from 15.5% to 12% or less, reduce smoking in pregnancy from 10.7% to 6% or less and reduce the “inequality gap in smoking prevalence, between those in routine and manual occupations and the general population – all by the end of 2022. (17)”

With significant action being taken and goals laid out by the government, UK smokers have more access to alternative products and stop smoking services than ever before. In this section we will explore the facts regarding the leading smoking alternatives available currently so that you can make an informed decision about your own journey.

NICOTINE REPLACEMENT THERAPY (NRT)

WHAT IS NRT?

NRT is a collective name for a variety of smoking cessation products that provide an alternative way to deliver nicotine without the implied risks of smoking. Ultimately, NRT therapy helps to reduce the effect of withdrawal symptoms and manage cravings through the replacement of tobacco.

The vast majority of all stop smoking services available to the public, prescribe forms of medically licenced NRTs alongside behavioural therapies. However, there are also over the counter versions of NRT products that can be purchased in pharmacies, convenience stores and supermarkets.

Wherever you acquire NRT products, always ensure you consult your GP and thoroughly read any instructional information provided. NRT will involve the use of one, or a combination of the following products.

(18) DERMAL (SKIN) PATCHES (Available over the counter)

These are special adhesive patches that are designed to be worn for long periods of time. They slowly release nicotine into the body dermally (via the skin) to help you supress cravings throughout the day.

NICOTINE GUM (Available over the counter)

Simple in essence yet found to be effective by many, nicotine gum is medicated chewing gum that releases a dose of nicotine when consumed which is absorbed sublingually (under the tongue) and orally.

INHALATORS & NASAL SPRAYS (Prescription only)

Most commonly taking the form of a plastic cigarette-style tube, the user inhales using the device to deliver a quick hit of nicotine which is absorbed through the mouth and lungs, or nose and throat in the instance of nasal sprays. Inhalators are the closest form of traditional NRT to vaping. Both methods are typically only available on prescription following consultation with your GP.

TABLETS, ORAL STRIPS & LOZENGES (Available over the counter and via prescription)

All of these NRTs are taken orally, they are placed in the mouth and release a dose of nicotine as they dissolve. Lozenges, tablets and strips release nicotine which is absorbed sub-lingually (under the tongue). Sublingual absorption is scientifically proven to take effect faster.

HOW EFFECTIVE IS NRT AND IS IT SAFE?

The effectiveness of any given NRT treatment can vary depending on a combination of factors. The products themselves come in varying nicotine strengths which you should take care to match to your needs. This alone could have a major impact on how effective the treatment will be for you personally. If you aren’t using a product with adequate dosing to suppress your cravings then relapse is far more likely.

A study hosted by the Australian Academic Press, and supported by Cancer Research UK, compared the effectiveness of different NRT methods. It displayed that when comparing nasal sprays, gums, lozenges and tablets, that the nasal spray was the most effective; delivering the most nicotine in the shortest time.

SmokeFree.Gov and the NHS state that most often, a combination of NRT therapies is the most effective way to relieve cravings; utilising a patch to manage background cravings while also using an inhalator or lozenge to deal with any sudden powerful cravings brought about during stressful events or other environmental, personal and social factors.

It is also stated that greater success can be had when pairing NRT with behavioural therapy if the habitual actions of smoking prove as difficult to overcome as the nicotine craving itself.

However, NHS data over the past 11 years has shown a distinct reduction in NRT usage during quit attempts within the UK (see. Figure below). (19,-23)

Smokers using item during quit attempted - sourced table

We can also see from NHS data that the number of smokers setting a quit date using the Stop Smoking Services available has also been reducing since around 2011/2012. (19-23)

self reported quit success rate table - sourced table

It is widely documented that NRT treatments are typically safe for use by most people, with minimal side effects reported, however you must carefully consider whether they are an acceptable alternative to the dangers posed by smoking itself. The NHS has stated that NRT is safe for use by the following groups: (20,24)

  • Adults and children over 12 years of age – although children under 18 should not use the lozenges without getting medical advice first.
  • Pregnant women – your doctor may suggest NRT if they think it would help you quit during pregnancy.
  • Breastfeeding women – your doctor can advise you how to do this safely.

Ultimately, your GP should be the primary point of contact when considering incorporating NRTs into your lifestyle, especially for those who have suffered from a heart attack, stroke, kidney or liver problems.

The potential side-effects (20,24) recorded for most NRT therapies can include:

  • Irritation and redness of the skin
  • Dizziness
  • Nausea
  • Headaches
  • Racing heartbeat
  • Muscle pain or stiffness
  • Difficulty sleeping
  • Unpleasant aftertaste
  • Complications to dental work
  • Jaw pain
  • Coughing and sneezing
  • Runny nose
  • Watering eyes
  • Hiccups

You should always remember that nausea, racing heartbeat, trouble sleeping, and headaches are side-effects directly caused by the nicotine itself and not the method of delivery.

In most cases the prevalence of nicotine overdose as described above is very rare, and in many cases, the side-effects of NRT will subside after one to two weeks of treatment as the body adjusts, if they present themselves at all.

If any of these side-effects persist and become more severe, your GP should be contacted immediately as it is likely the NRT will need to be changed and your quitting plan amended.

E-CIGARETTES AND VAPING

A relatively new and often misunderstood phenomenon in nicotine delivery, vaping has risen rapidly from an experimental rumour from overseas to an international household name, with 2.7 million adult vapers in the UK alone (25) – a figure that is rising year-on-year.

Vaping shares many similarities with smoking, satisfying both nicotine cravings and the hand-to-mouth action synonymous with oral fixation (the habit of needing to lift something to your mouth and inhale to receive nicotine).

There are, however, several factors to be considered when choosing vaping as an alternative to ensure it is the best option for you. Despite its popularity there have been a number of myths driving public misconception and distrust of vaping; in fact, only one in three adults in England knows that vaping is far less harmful than smoking according to the UK Government. (26)

WHAT IS VAPING?

Vaping is the process of using an e-cigarette to vaporise nicotine-containing e-liquid. The aerosol created is inhaled, much like cigarette smoke, and then absorbed into the blood. There are a vast number of vaping devices and e-liquids available on the market which makes choosing where to start quite daunting. However, some companies offer starter kits that can make it easier to engage and experiment with vaping.

Different combinations of coils and e-liquids create different vaping experiences that must be tailored to your own needs - we will explain the basics below. Vaping also comes with various control points that allow you to tailor your experience to your desired preferences. This can be done by adjusting the following:

  • Power output
  • Coils type
  • E-liquid variety (HVG, standard 50-50, nic salt)
  • Flavour
  • Nicotine strength

To learn more about vaping in detail and how best to get started, you can read our Best Practice Guide: How To Vape Properly (coming soon).

THE MOST COMMON VAPING DEVICES AVAILABLE

HAVE YOU CONSIDERED YOUR LIFESTYLE?

Your lifestyle is a major factor in determining the best device for your needs – those with an active routine involving regular travel may prefer smaller, more compact pod-style devices over some of the bulkier alternatives. Combining these defining factors will instantly narrow your options and help refine your decision, as well as increase the chance of it being a successful one.

ALL-IN-ONE (AIO)

AIO devices, also known as “pen style ” devices, are compact and pocket friendly with a wide array of features available (subject to brand) and are often only compatible with one coil type.

POD

Pod devices are the most discreet and compact devices available today and have become very popular in recent years due to their simple design, compact size and enhanced portability.

MOD

Mods are larger, high-powered devices that can be combined with different tanks and often feature advanced customisation options.

POD-MOD

Pod-mods offer a hybridisation of elements offered by pods and mods alike with higher power output and more advanced features.

CARTOMISERS

Ancient in terms of vaping history but still decidedly popular and often the most widely-seen example, these small low-power devices are designed to look like a traditional cigarette and are often disposable.

E-LIQUID

Made from four primary ingredients: Propylene Glycol (PG), Vegetable Glycerol (VG), flavouring and nicotine, blended in differing amounts to create the different types of e-liquid available to consumers:

  • 50/50 – Standard e-liquid available in a range of strengths and flavours, ideal for use in most device types.
  • Nicotine Salt – These e-liquids are the same as 50/50s but utilise special nicotine, delivering greater smoothness and longer lasting satisfaction.
  • High Vegetable Glycerol (HVG) – These have a higher volume of VG which produces bigger clouds, however prevents higher nicotine strengths, only for use in more powerful devices.

IS VAPING EFFECTIVE AND IS IT SAFE?

Owing partially to myths and misconceptions around its safety and a lack of significant long-form research, vaping has not yet been fully adopted as a part of the UK’s national stop smoking services. This, however, is on the verge of changing as global attitudes shift, with several major organisations now rallying for vaping to be recognised as a viable alternative option for those looking to stop smoking.

In fact, research has found on multiple occasions that vaping is a more effective alternative than traditional NRTs. A 2019 study by the National Institute for Health Research states:

“Smokers who use NHS stop smoking services appear almost twice as likely to be successful for a year if they use e-cigarettes than if they use nicotine replacement therapy (NRT) products. (27)”

Similarly, in 2019, a randomised study comparing the effectiveness of e-cigarettes against NRTs and smoking found that “both e-cigarettes and nicotine-replacement products were perceived to be less satisfying than cigarettes. However, e-cigarettes provided greater satisfaction and were rated as more helpful to refrain from smoking than nicotine-replacement products. (28)”

Further showcasing the shift in attitudes towards viewing vaping as a possible alternative for cessation, a new landmark trial is currently underway in UK hospitals across the nation, in conjunction with the NHS (29). The trial will provide smokers visiting A&E departments the opportunity to receive a free vaping starter kit and relevant advice on quitting, to further assess if e-cigarettes are a viable option for improving the quit rate of patients.

E-cigarettes are not currently available on the NHS outside of trials, however, should it find success, there is a strong possibility that vaping technology will be incorporated into broader, official NHS schemes as an arm of their quit smoking service provision, as the UK works towards the government-led goal of a smoke-free future.

With Yorkshire Cancer Research’s landmark investigative film Vaping Demystified in recent memory, this study marks yet another step towards debunking vaping myths and cementing its place as a publicly viable cessation option. (30)

This trial came into reality following the latest update by PHE in February 2021 to their ongoing e-cigarette evidence review, which found vaping to be the most popular way for smokers to quit, with 27.2% using e-cigarettes, while only 18.2% utilised traditional NRT like patches and gums. The subsequent reports highlight a number of key stats that are the driving influence behind the enaction of the trial detailed above:

  • Nicotine vaping products were the most popular aid (27.2%) used by smokers trying to quit in England in 2020.
  • It is estimated that in 2017, more than 50,000 smokers stopped smoking with the aid of a vaping product who would otherwise have carried on smoking.
  • 38% of smokers in 2020 believed that vaping is as harmful as smoking – 15% believed that vaping is more harmful.
  • Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates according to the NHS – between 59.7% and 74% in 2019 and 2020.

There is now more evidence than ever which positions vaping as a less harmful alternative to cigarettes. Most famously evidenced by Public Health England’s landmark 2015 study which declared vaping to be “95% less harmful than smoking cigarettes. (31)”

Yorkshire Cancer Research recently produced an investigative film, bringing together leading minds in healthcare, smoking cessation and wellbeing. Combining their experiences and research to debunk some of the most dividing myths surrounding vaping and its safety.

FAQS (27,30)

Are vaping products regulated?

The UK has strict regulations on vaping products under the Tobacco and Related Products Regulations 2016 (TRPR), ensuring that vaping products are subject to maximum standards of quality and safety, as well as packaging and labelling requirements to provide consumers with the information they need to make informed choices.

I’ve heard that vaping products can cause harm to your lungs. Is this true?

There have been stories in the media about an outbreak of lung injury called EVALI in the USA. These cases of EVALI were caused by people using vaping products with homemade e-liquids that contained a chemical called vitamin E acetate.

There have also been stories that vaping products cause a disease called ‘popcorn lung’. This disease is caused by a chemical flavouring called diacetyl, which is banned in e-liquids in the UK under the TRPR.

I’ve read that vaping is just as dangerous as smoking. Is this true?

Vaping is significantly less harmful than smoking. Switching completely from smoking to vaping is likely to have substantial health benefits over continued smoking.

I have heard that vaping products can explode and cause fires. Is this true?

Fires caused by vaping products are rare and about as likely as fires caused by mobile phones. The risk of fire from vaping products is considerably lower than the risk of fire caused by cigarettes, which are the leading cause of death in domestic households, causing around 2000 house fires a year.

It took a long time for the dangers of smoking to be fully realised. How do we really know if vaping products are safe?

Vaping products have been available in the UK since 2007. They are currently one of the most widely researched scientific topics. There is substantial evidence on the short-term impact of their use, which has shown that they are far less harmful than smoking and an effective and popular stop smoking aid.

The long-term impacts of vaping require more research, however, through extensive evidence, Public Health England has repeatedly found that vaping is significantly less harmful than smoking.

OUR SOURCES

  1. https://www.nhs.uk/common-health-questions/lifestyle/what-arethe-health-risks-of-smoking/
  2. (NHS 2020: Statistics on Smoking, England 2020).
  3. (ASH 2020: Smoking Statistics, 2020).
  4. (ASH 2017: Smoking and Cancer, 2017).
  5. https://www.bupa.co.uk/health-information/heart-bloodcirculation/coronary-heart-disease
  6. https://www.bupa.co.uk/health-information/heart-bloodcirculation/heart-attack
  7. https://www.nhs.uk/conditions/stroke/
  8. (ASH 2016: Smoking, the Heart and Circulation, 2016).
  9. https://www.nhs.uk/conditions/chronic-obstructive-pulmonarydisease-copd/
  10. (ASH 2015: Smoking and Respiratory Disease, 2015).
  11. https://www.statista.com/statistics/415034/cigarette-pricesacross-europe/
  12. https://www.nhsinform.scot/stopping-smoking/calculate-mysavings
  13. www.moneysupermarket.com/c/news/stoptober-quitsmoking-and-saveone-hundred-and-thirty-five-thousandpounds/00171054/
  14. https://ash.org.uk/information-and-resources/reportssubmissions/reports/smokingemployability/
  15. https://ash.org.uk/wp-content/uploads/2020/08/ LandmanEconomics-smoking-employment-earnings-technicalreport.pdf
  16. https://www.ashscotland.org.uk/media/6684/Smoking%20 and%20Debt.pdf
  17. https://www.gov.uk/government/publications/towards-a-smokefree-generation-tobacco-control-plan-for-england
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/
  19. https://smokefree.gov/tools-tips/how-to-quit/using-nicotinereplacement-therapy
  20. https://www.nhs.uk/conditions/stop-smoking-treatments/
  21. https://bmjopen.bmj.com/content/10/4/e036339
  22. https://www.ucl.ac.uk/hbrc/tobacco/pubs/Nicotine%20 absorption%20from%20seven%20current%20NRP_28.pdf
  23. NHS: Statistics on NHS Stop Smoking Services in England 2019 Q1-Q3 – Apr 2018 to Dec 2019
  24. https://www.webmd.com/smoking-cessation/nicotinereplacement-therapy
  25. https://www.gov.uk/government/publications/vaping-in-englandevidence-update-february-2021/vaping-in-england-2021- evidence-update-summary
  26. https://publichealthmatters.blog.gov.uk/2020/03/05/8-things-toknow-about-e-cigarettes/
  27. https://evidence.nihr.ac.uk/alert/e-cigarettes-helped-moresmokers-quit-than-nicotine-replacement-therapy/
  28. https://www.nejm.org/doi/full/10.1056/NEJMoa1808779
  29. https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-tostop-smoking/
  30. https://yorkshirecancerresearch.org.uk/vaping-demystified
  31. https://assets.publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/733022/Ecigarettes_an_ evidence_update_A_report_commissioned_by_Public_Health_ England_FINAL.pdf

HOW TO CONTACT A STOP SMOKING ADVISER

Your GP can refer you, or you can phone your local stop smoking service to make an appointment with an adviser.

In England: Call the free Smokefree National Helpline on 0300 123 1044

In Scotland: Call the free Smokeline on 0800 84 84 84

In Wales: Call the free Help Me Quit helpline on 0800 085 2219

In Northern Ireland: Call a provider in the town or city where you live (telephone numbers can be found on the Want2Stop website)

To download a copy of our guide, click here. 


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