Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Smoking Cessation amongst Adults in United Kingdom Introduction Tobacco smoking is a major contributor to many serious diseases that eventually lead to death in the United Kingdom (UK). According to Office of National Statistics (ONS) (2017), 7.4 million of United Kingdom’s population are smokers and 19.7 percent of these smokers are adult with age-range of 25 to 34 years. Tobacco cigarettes contain nicotine. Nicotine changes the balance of two chemicals namely noreadrenaline and dopamine which are found in human the brain. The sudden change on the levels of these chemicals after inhalation may result in changes in mood which could result in reduction of stress, anxiety and increase in pleasure (National Health Service (NHS), 2018a). Transmission of nicotine by inhalation of tobacco is the fastest way of distributing nicotine into the bloodstream according to Action on Smoking and Health (ASH) (2019). Therefore, these facts indicate that smoking cigarettes could be profoundly addictive due to the rapid delivery of the desired effects to its users without taking into consideration any adverse effects on the human body and health. Cigarette smoking harms human health; and stopping has proven hard to do alone. According to Health and Social Care Information Centre (HSCIC) (2017), in 2017 there were 146,234 people who started to try to quit smoking, only 49 percent successfully managed to stay away from using cigarretes and 33 percent of the individuals who successfully managed to stop smoking utilised licensed nicotine containing products. The government came up with tobacco control plan for England to assist its people to stop smoking; the elements of the plan include making tobacco more expensive, restraining tobacco related publicity, efficient control of tobacco products, developing alertness on harm caused by smoking and lowering the instance to be exposed to second-hand smoke (Public Health England, 2015). Smoking cessation services and interventions are being offered by the NHS. Affirmed by National Institute for Health and Care Excellence (NICE) (2019), there are few evidenced-based interventions for smoking available in the UK for adults which include behavioural support, bupropion, nicotine replacement therapy (NRT), varenicline and very brief advices (VBA). These interventions are available to individuals who seek help through their general practitioner and to those who are being referred to health professionals for assistance; some of the interventions are combined to be able to achieve the desired goal which is to ultimately forgo smoking tobacco. This paper will discuss the different kinds of NRT available for adults in the United Kingdom. Nicotine replacement therapy (NRT) includes few ways to supplement smoking. It helps to fight the urge to consume or inhale tobacco and also to reduce the effects of withdrawal. In addition, it will help individuals to slowly redu.

1. Efficacy of Nicotine Replacement Therapy (NRT) to Aid
Cigarette Smoking Cessation amongst Adults in United
Kingdom
Introduction
Tobacco smoking is a major contributor to many serious
diseases that eventually lead to death in the United Kingdom
(UK). According to Office of National Statistics (ONS) (2017),
7.4 million of United Kingdom’s population are smokers and
19.7 percent of these smokers are adult with age-range of 25 to
34 years. Tobacco cigarettes contain nicotine. Nicotine changes
the balance of two chemicals namely noreadrenaline and
dopamine which are found in human the brain. The sudden
change on the levels of these chemicals after inhalation may
result in changes in mood which could result in reduction of
stress, anxiety and increase in pleasure (National Health Service
(NHS), 2018a). Transmission of nicotine by inhalation of
tobacco is the fastest way of distributing nicotine into the
bloodstream according to Action on Smoking and Health (ASH)
(2019). Therefore, these facts indicate that smoking cigarettes
could be profoundly addictive due to the rapid delivery of the
desired effects to its users without taking into consideration any
adverse effects on the human body and health.
Cigarette smoking harms human health; and stopping has proven
hard to do alone. According to Health and Social Care
Information Centre (HSCIC) (2017), in 2017 there were 146,234
people who started to try to quit smoking, only 49 percent
successfully managed to stay away from using cigarretes and 33
percent of the individuals who successfully managed to stop
smoking utilised licensed nicotine containing products. The
government came up with tobacco control plan for England to
assist its people to stop smoking; the elements of the plan
include making tobacco more expensive, restraining tobacco
related publicity, efficient control of tobacco products,

2. developing alertness on harm caused by smoking and lowering
the instance to be exposed to second-hand smoke (Public Health
England, 2015).
Smoking cessation services and interventions are being offered
by the NHS. Affirmed by National Institute for Health and Care
Excellence (NICE) (2019), there are few evidenced-based
interventions for smoking available in the UK for adults which
include behavioural support, bupropion, nicotine replacement
therapy (NRT), varenicline and very brief advices (VBA). These
interventions are available to individuals who seek help through
their general practitioner and to those who are being referred to
health professionals for assistance; some of the interventions
are combined to be able to achieve the desired goal which is to
ultimately forgo smoking tobacco.
This paper will discuss the different kinds of NRT available for
adults in the United Kingdom. Nicotine replacement therapy
(NRT) includes few ways to supplement smoking. It helps to
fight the urge to consume or inhale tobacco and also to reduce
the effects of withdrawal. In addition, it will help individuals to
slowly reduce their consumption and ultimately give-up
smoking.According to NICE (2019b) and National Centre for
Smoking Cessation and Training (NCSCT) (2019), the available
formulations of NRT available for adults in the UK include
gum, inhalers, lozenges, nasal sprays, oral sprays, sublingual
tablets, and transdermal patches. Upon consideration of the
seven primary research papers which are tabulated in Appendix
1, the effectiveness of NRT used by adults in United Kingdom
will be critically analysed and recommendations for alternative
interventions for smoking cessation will be offered as part of
the conclusion.
Rationale
Nurses provide care for patients who are hospitalised for
different kinds of reasons. Many have complex illnesses and
comorbidities which are always taken into consideration whilst
they are in the hospital to be able to plan for an individualised
care for the specific that patient. Being a student nurse the

3. author noticed that most of the patients still continue to practice
their normal lifestyle whilst admitted in the hospital and being
treated for a specific illness; unfortunately, some of the
patients’ daily habits which includes cigarette smoking is still
being forged ahead despite of the known side effects and harm
it could cause to a person’s health. According to Smokefree
(2019), smoking cigarettes damage almost all organs of the
body. Nicotine has negative effect on human brain, skin, heart,
lungs, stomach, muscles, bones, blood and immune system. The
author believes that smoking cessation campaign needs to be
made stronger either in wellness centres or in the clinical areas
in the UK. Hughes et al (2013) suggested that being admitted in
the hospital the smokers experienced higher level of motivation
to try to quit their vices and be more likely to adhere to
interventions offered by the health professionals or their local
stop-smoking services. Being aware of the efficacy of the
intervention (NRT) available in the UK will equip nurses with
up-to-date and evidence-based information to encourage
smokers to quit by encouraging them to seek help and try
different techniques like NRT to cease smoking.
Cigarette smoking place the public into many health risks, both
first-hand and second-hand smoke. Royal College of Physician
(RCP) (2010) stated that exposure to second-hand smoke has a
huge impact on human’s health. RCP’s 2010 report found that
every year there were 300,000 general doctor consultations and
9,500 admissions in the hospital were results of being exposed
to cigarette smoke. Some of the leading cause of death in
United Kingdom can be associated with smoking cigarettes.
Action on Smoking and Health (ASH) (2019) identified that
there were approximately 79,000 deaths from avoidable
illnesses in the United Kingdom is associated to smoking.
Aim
The aim of the paper is to find out the efficacy of nicotine
replacement therapy (NRT) focusing specifically on adults in
the United Kingdom. In addition, to be able to indicate an in-

4. depth comprehension of the different kinds of NRT available for
smokers in the UK in which boosted the success of abstinence
from cigarette smoking. According to Wakefield (2015), to
inhibit coming up with a wide range of topic that could lead to
disorganised search strategy and insignificant information, the
research question must have some extent of focus.
Method
The author electronically searched the Cumulative Index to
Nursing and Allied Health Literature (CINAHL), British
Nursing Database, Cochrane library, BMC Nursing and
MEDLINE for primary research articles conducted to find out
the effectiveness of nicotine replacement therapy (NRT) in the
United Kingdom from at least January 2008 to January 2019.
Boolean Operators were used using keywords like NRT,
smoking cessation and United Kingdom to filter the searches.
Limiters and expanders which include randomised controlled
trials and smoking cessation were applied on the search
database to be able to narrow down the number of results found
on the searches (see Appendix 2).
The author also scrutinized the reference lists of each of the
literature found related to the topic at hand. Google Scholar was
also exploited to search for related published research and other
related articles that was found useful throughout the essay.
Cronin et al (2008) elaborated that to be able to generate
valuable information from electronic and computer databases
keywords needs to be meticulously considered. According to
Smith and Noble (2016), conducting a literature review should
be as comprehensive as possible, within the known restrains of
the topic and attempted in an orderly manner. Precise exclusion
and inclusion criteria must be developed in order to be able to
select valid related studies. The literature search yielded 6
primary researches which are controlled randomised trials that
were utilised to undertake the literature review on the efficacy
of NRT to aid smoking cessation in the United Kingdom. All
papers obtained were screened for relevance to the topic at hand

5. and credibility of its authors. The papers were also critiqued
and critically appraised using Caldwell’s critiquing framework
for health research (see Appendix 3). According to Caldwell et
al (2005), ability to critically critique published researches is
necessary to be able to establish the efficiency of the specific
paper on the preferred area of work. Having the ability to
scrutinize a piece of article is an important skill to be able to
provide valid, current and evidenced-based literature review.
Secondary, opinionated and non-evidenced-based articles were
disregarded.
In conclusion, it is crucial to be able to use appropriate
keywords, filters, limiters and expanders on the literature search
to be able to accumulate significant and relevant papers to
tackle a research question. The tabularized lists of primary
research articles are presented in Appendix 1.
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Aveyard, P., Johnson, C., Parsons, A., and Murphy, M. (2008)
‘Nortriptyline plus nicotine replacement versus placebo plus
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First, pp. 1-10.
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Beard, E., McNeill, A., Aveyard, P. et al (2011) ‘Use of
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enforced temporary abstinence:a national survey of English
smokers’, Addiction, 106, pp. 197-204.
https://onlinelibrary-wiley-
com.ezproxy.mdx.ac.uk/doi/epdf/10.1111/j.1360-
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Klonizakis, M., Crank, H., Gumber, A. and Brose, L. (2017)
‘Smokers making a quit attempt using e-cigarettes with or
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Impact on cardiovascular function (ISME-NRT) - a study
protocol’, BMC Public Health, 17(293), pp. 1-9.
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s
12889-017-4206-y.
Lindson-Hawley, N., Coleman, T., Docherty, G. et al (2014)
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review-ns.29.29.44.e8957

9. Appendix 1
Summary table of articles reviewed and included in the
literature review
#
Studies included
Country of publication
Study aims
Design:
Sample:
Data collection:
Analysis methods:
Key findings
1
Aveyard, P., Johnson, C., Parsons, A., and Murphy, M. (2008)
‘Nortriptyline plus nicotine replacement versus placebo plus
nicotine replacement for smoking cessation: pragmatic
randomised controlled trial’, British Medical Journa:Online
First, pp. 1-10.
https://www.bmj.com/content/bmj/336/7655/1223.full.pdf
United Kingdom

10. To identify the xxxxx xxxxxx xxxxxxx.
Design:
Sample:
Data collection:
Analysis methods:
2
Beard, E., McNeill, A., Aveyard, P. et al (2011) ‘Use of
nicotine replacement therapy for smokingreduction and during
enforced temporary abstinence:a national survey of English
smokers’, Addiction, 106, pp. 197-204.
https://onlinelibrary-wiley-
com.ezproxy.mdx.ac.uk/doi/epdf/10.1111/j.1360-
0443.2010.03215.x
United Kingdom
To identify the xxxxx xxxxxx xxxxxxx.
Design:
Sample:
Data collection:
Analysis methods:
3
Klonizakis, M., Crank, H., Gumber, A. and Brose, L. (2017)
‘Smokers making a quit attempt using e-cigarettes with or
without nicotine or prescription nicotine replacement therapy:
Impact on cardiovascular function (ISME-NRT) - a study
protocol’, BMC Public Health, 17(293), pp. 1-9.
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s
12889-017-4206-y
United Kingdom
To identify the xxxxx xxxxxx xxxxxxx.
Design:
Sample:
Data collection:

11. Analysis methods:
4
Lindson-Hawley, N., Coleman, T., Docherty, G. et al (2014)
‘Nicotine patch preloading for smoking cessation (the
preloading trial): study protocol for a randomized controlled
trial’, Trials, 15(296), pp. 1-
18.https://trialsjournal.biomedcentral.com/track/pdf/10.1186/17
45-6215-15-296
United Kingdom
To identify the xxxxx xxxxxx xxxxxxx.
Design:
Sample:
Data collection:
Analysis methods:
5
Lindson-Hawley, N., Shinkins, B., West, R. et al (2016) ‘Does
cigarette reduction while using nicotine replacement therapy
prior to a quit attempt predict abstinence following quit date?’,
Addiction, 111(7), pp. 1275-1282.
https://onlinelibrary-wiley-
com.ezproxy.mdx.ac.uk/doi/full/10.1111/add.13330
United Kingdom
6
Silla, K., Beard, E. and Shahab, L. (2014) ‘Nicotine
replacement therapy use among smokers and ex-smokers:
associated attitudes and beliefs: a qualitative study’, BMC
Public Health, 14(1311), pp. 1-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364650/

12. United Kingdom
7
Stapleton, J., West, R., Hajek, P. et al (2013) ‘Randomised trial
of nicotine replacement therapy (NRT), bupropion and NRT
plus bupropion for smoking cessation: effectiveness in clinical
practice’, Addiction, 108, pp. 2193-2201.
https://onlinelibrary-wiley-
com.ezproxy.mdx.ac.uk/doi/pdf/10.1111/add.12
United Kingdom
Appendix 2 (search results)
Appendix 3

13. Caldwell et al (2005) Critiquing Framework