NICE guidance advises prioritising specific groups who are at high risk of tobacco-related harm. These include people with mental health problems, those who misuse substances and those with health conditions caused or made worse by smoking, or people with a smoking-related illness. Services also need to reach populations with a high prevalence of smoking-related morbidity or a particularly high susceptibility to harm, people in disadvantaged or custodial settings and women who are pregnant.

People who want to quit

With people who are ready to quit, NICE recommends:

• Discussing how to stop smoking
• Setting out the pharmacotherapy and behavioural options, taking into consideration previous use of stop smoking aids, and the adverse effects and contraindications of the different medications
• Explaining that a combination of varenicline and behavioural support or a combination of short-acting and long-acting nicotine replacement therapy (NRT) are likely to be most effective
• Agreeing an approach to stopping smoking that best suits the person’s preferences. Review this approach at future visits.

People who are not ready to quit

If people are not ready to stop smoking, the guidelines stress the importance of making sure they understand that stopping smoking reduces the risks of developing smokingrelated illnesses. Smokers should be encouraged to consider adopting a harm reduction approach and to seek help to quit smoking completely.