Smoking cessation therapy provision in primary and secondary care in the UK

Lead Research Organisation: King's College London
Department Name: Ctr for Global Health


During my undergraduate degree, I carried out biomedical
research on tobacco and worked with patients who
developed smoking-induced COPD. In 2016, I delivered the
Smoke Free Arts campaign to raise awareness about the
tobacco industry's involvement in funding UK arts
institutions. I have seen both the physically debilitating effect
of tobacco, and the political environment tobacco companies
operate in to keep people addicted to their harmful products.
My proposed PhD is a timely, mixed methods project
investigating smoking cessation therapy provision and ecigarettes in Pathway 3: Health, Biopolitics & Social
Inequality, considering two ESRC priorities (1): mental health,
and innovation in health and social care.
Smoking prevalence has reduced considerably over the past
decades in England, with an estimated prevalence of 14.9%
amongst adults in 2017 (2). However, smoking remains one
of the leading preventable causes of illness and premature
death (3). In England, smoking results in 78,000 deaths
annually (2) and there were 484,700 hospital admissions
attributable to smoking in 2016/7 (2). Smokers see their GP
35% more than non-smokers (3) and are an expensive
burden on society, costing the NHS £2.5bn and wider society
£4.1bn annually (3). Surprisingly, it wasn't until 2014 that
secondary care hospitals started to monitor systematically
the smoking status of their inpatients and develop a smoking
cessation pathway (4). The Tobacco Control Plan (TCP) for
England (2017-22) highlighted smoking as one of the largest
causes of health inequalities (3) as smoking prevalence
remains significantly higher in disadvantaged groups,
including those with mental health conditions (5)(6). The TCP
aims to result in a 'smokefree generation' with a target
smoking prevalence of 5% or lower by 2022 (3), by reducing
smoking in young people, more disadvantaged people
(including those with mental health conditions), pregnant
women, and by harnessing the capacity of smokers to use
less harmful alternatives to stop smoking (7). In the UK,
comprehensive tobacco control strategies exist and there
are several licensed smoking cessation therapies helping
smokers to quit (8). More recently, unlicensed e-cigarettes
have become the most popular cessation aid (9). Providing
smoking cessation therapies through primary and secondary
care helps ensure that they reach smokers requiring them
the most. A recent Royal College of Physicians (RCP) report
argued that the NHS should deliver default, opt-out,
systematic interventions for all smokers at the point of
service contact (10) and a 2018 National Institute for Health
and Care Excellence (NICE) update advised that smokers
should not be discouraged from using e-cigarettes to stop
smoking (11). The 2019 NHS Long Term Plan outlined that
the NHS will improve smoking cessation services for
inpatients in secondary care, pregnant women, and people
accessing mental health services (12).


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Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000703/1 01/10/2017 30/09/2027
2314529 Studentship ES/P000703/1 01/10/2019 30/09/2023 Bernadett Erika Tildy