Man smoking a cigarette

Stoptober 2020 is here, and there has never been a better time to quit

Words provided by Solutions 4 Health, editorially reviewed by National Health Executive

While Covid-19 brings challenges for stop smoking services, online support and an AI-powered robo-coach mean there's never been a better time to help people kick the habit

Smokers are up to fourteen times more likely to have serious complications from Covid-19 than non-smokers according to recent research in China. The pandemic presents a clear need for accessible stop smoking services, but health care providers are facing unprecedented challenges in meeting them. Advances in technology have led to the evolution and upscaling of remote services which are perfectly placed to support smokers to become quitters, even amidst a possible second wave of Covid-19. An exciting new artificial intelligence app called Quit with Bella and online support from experienced quit-smoking advisors are providing a life-line to current services and the people who need them most.

Smoking affects the lungs, and so does Covid-19. The repeated hand-to-mouth action provides an easy route of infection, and smoking weakens the immune system, which may explain the higher chance of complications and needing treatment in intensive care. Notably, the risks are worse for those with co-morbidities such as being overweight or having a heart condition or chronic obstructive pulmonary disease (COPD). Smoking often exists alongside these conditions or even causes them.

The pandemic appears to be having mixed effects on attitudes to health and lifestyle behaviours. On the one hand, the link between smoking, Covid-19 and health more broadly is not lost on the public. An estimated one million people kicked the habit in the months leading to July and some local stop smoking services are reporting an increase in uptake. On the other hand, stress, anxiety and depression are triggers for increased smoking and relapsing back into smoking.

Smoking is a notoriously difficult habit to break without behavioural support, and smokers are four times more likely to quit when they have support. There are inequalities in smoking prevalence and access to stop smoking services, and these are being exacerbated by the pandemic and the economic uncertainty that comes with it.

People from Black, Asian and minority ethnic (BAME) communities and economically disadvantaged groups, as well as people with mental health problems and the LGBTQ community, are all more likely to smoke, and some are also less likely to use or have access to stop smoking services, particularly those with mental health or substance misuse issues, or ADHD or Autism. In addition, some communities are more likely to contract Covid-19 and have worse outcomes if they smoke, are overweight, or have type 2 diabetes or other long term conditions. Smoking shisha carries all the health risks of smoking and is more common among some BAME communities.

Smoking is the leading cause of preventable death and ill health, it drives inequalities and costs the NHS in England £2.6bn a year. Stop smoking services can bring immediate savings to hospitals because they can offer immediate improvements to health.

The need and demand for accessible stop smoking services is there, and while the loss of face-to-face services poses a challenge for support provision, services that function remotely are coming into their own.

Solutions 4 Health are the UK's largest provider of stop smoking services, with almost 20 years of experience supporting smokers to become quitters. When Covid-19 began to spread around the globe, they upscaled their remote services to meet the surge in demand. Their online face chat, phone and text services and ground-breaking artificial intelligence (AI) app, Quit with Bella, are now supporting more people than ever through their quit attempts, providing timely and cost-effective solutions to the challenges faced by quitters and service providers.

Solutions 4 Health Smokefreelife advisors are highly trained in providing personalised support using motivational interviewing, goal setting, normative feedback and cognitive bias retraining in line with the NHS Centre for Smoking Cessation and Training (NCSCT) and National Institute for Health and Care Excellence (NICE) guidelines. Advisors are available remotely to offer the same advice, support and nicotine replacement therapy (NRT) as they would do face-to-face. They take a holistic and integrated approach, tailoring the programme to each individual, for example, offering weight management sessions to make lifestyle changes.

These remote services have added bonuses: they provide privacy for those who might not want to attend a clinic in a public place, and they negate the need for travel, time and access to appointments.

Saleen Ahmed-Khan, Head of Integrated Lifestyle Services at Solutions 4 Health, explains: “We’re seeing that Covid is affecting some groups more than others, particularly BAME and disadvantaged communities. We’ve always been creative in how we reach people who need us, and our online, phone and video support, and posting of NRT directly to people's homes, ensured that that there was no disruption for existing users when lockdown was announced, and new clients have benefitted from this too." 

Solutions 4 Health have channelled their years of quit support experience into their app, Quit with Bella, which uses artificial intelligence to provide quitters with their very own personalised robo-coach. Users are able to have human-like conversations with Bella to get evidence-based advice and support whenever they need it, 24/7. Bella can even provide vouchers for free NRT and e-cigarettes in commissioned areas.

Keshav Sankla, AI Programme Lead, added: "We developed Quit with Bella to provide an evidence-based stop smoking service at scale, and to equip people with their own robot advisor that they could access whenever they needed to. It's great to see that it's supporting thousands of people to give up, and helping people who would not normally engage in a traditional service."

The app, which launched in early 2018, was created using the wealth of data amassed over 10 years of service provision and insights from over 200 stop smoking advisors, along with the NCSCT and NICE guidelines, advice from stop smoking experts and user feedback. Bella uses the same evidence-based techniques that a real person would.

Bella can also support existing staff and services. Some people like to use a combination of person-led support in office hours and Bella out of hours, and she frees up staff time for clients who really need one-to-one attention. There is also no time limit on how long people can work with Bella, as she can provide support beyond the usual 12-weeks.

4 week quit rates with Bella are similar to the gold standard one-to-one services according to a recent independent evaluation in Dudley. The app reaches those in priority areas who may not have engaged with a traditional service, and the costs were also much lower, showing that Bella can provide a cost-effective and evidence-based service at scale.

In September alone, Quit with Bella was shortlisted for Best use of AI by The Digital Impact Awards 2020, who set the industry-wide benchmark for digital engagement, and by the HTN (health tech newspaper) Awards 2020, celebrating technology and innovations in health and care. The app has appeared in WHO workshops on Artificial AI, and is currently recognised and recommended by commissioners around the country. Bella is the world’s first AI-powered stop smoking robo-coach, and the only AI-powered service in routine use in smoking cessation services in England.

Bal Kaur, Acting Director of Public Health, Dudley Council, said: “The app is reaching high risk groups within our ethnic communities, younger people, and those who are sick, disabled or unemployed.

Elizabeth West, Stop Smoking Manager in Oxford, added: "Quit with Bella has already helped over 200 people to quit smoking in Oxfordshire… not only that, but it has supported our stop smoking advisors to support more people."

While Covid-19 is testing individuals and healthcare services to their limits, there are solutions available to make better health and well-being a reality, and Stoptober is an excellent time to put them into practice.  

Learn more at and Solutions 4 Health Smokefreelife.

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