The Project

IntroductionWork PackagesProject Outcomes
TOB-G project aims to develop and implement an innovative and cost effective approach to prevent chronic diseases related to tobacco dependence. The specialized guidelines for high risks groups will be developed according to ENSP’s evidence based and good practices in tobacco cessation. High risk populations are considered those who suffer from cardiovascular diseases, COPD, type 2 diabetes, adolescents & pregnant women.

The project fits perfectly the objectives and priorities of the 3rd Health Programme, as it will assist health professionals to provide guidance and targeted prevention to high risk populations engaged to the unfavourable dependency addiction of smoking. Training primary care physicians addresses the lack of specialist doctors in EU and increases access to tobacco cessation specialists. TOB-G project will enhance the overall European capacity in the treatment of tobacco dependence, thus, in the prevention of chronic diseases, through offering smoking cessation tools, appropriately assessed and fitted to the specific needs of high risk groups.

The developed guidelines will contain strategies and quit_smokingrecommendations designed to assist health professionals in delivering and supporting effective treatment of dependence on tobacco. Recommendations will be made as a result of scientific reviews and evidence of good practices from scientific groups that will consist of health professionals of different expertise.

To monitor the quality of the approach a pilot implementation of the tobacco cessation will be conducting for each group. The assessment of the effectiveness of the tobacco cessation guidelines will be the primary aim of the scientific groups and will be measured by the number of people quitting smoking after the pilot implementation. Since the tobacco cessation guidelines will be addressed to health professionals, the partnership will develop and implement an e-learning training for guidelines use.

Professor Panagiotis Behrakis MD, PhD, FCCP, is the Project Coordinator and the Principal Investigator of the TOB-G EU funded project, as well as the PI of many EU projects including HEART, EUREST, PRECISE, DIRECT, and is actively involved in other projects such as (EPACTT, TACK-SHS). Former Professor at Athens and Harvard Universities, he is now the Director of the Institute of Public Health of the American College of Greece and of the George D.Behrakis Research Lab of the Hellenic Cancer Society. Also, he is the President of the Scientific Committee of European Network for Smoking and Tobacco Prevention, Chief Editor of the “Tobacco Prevention and Cessation” journal and member of the Board of the American College of Chest Physicians.

The project is divided in six Work Packages to ensure the smooth and successful implementation and delivery of the project’s results.

TOB-G workpackages

WP1 Coordination of the project

The first work package contains all the monitoring and coordinating activities for the proper management of the project. Collaborative group meetings, a steering committee and the management team are established while an external advisory board has been composed to provide validation of the outputs of the project.

 WP2 Dissemination of the project

The consortium has developed a dissemination strategy from the early staged of the project to ensure the dissemination of the project’s results to the competent authorities and experts. The second work package aims at stimulating the interest and attention of the scientific community as well as that of the policy makers both at national and European level. The dissemination activities include among others, activities as dissemination & exploitation planning, contacting medical associations, potentially interested organizations and experts on the field in each participating country and personal contact networks, participation to annual conferences of medical professions in national and European level, address informative letters to scientific communities and health professionals of the different target groups in the Union (gynecologists, cardiologists, diabetologists, endocrinologists, pathologist etc.), organize consultation meetings and presentation of the results in a conference conducted by the coordinators of the project and use of social media and online tools – newsletters, press releases, website, logo etc.

WP3 Evaluation of the project

Crucial for the efficient implementation of the project is the evaluation strategy. The third work package includes the evaluation strategy to be followed throughout the project’s lifecycle and specifies the procedures and standards for the implementation, monitoring and evaluation of the project, according to specific performance & quality indicators. Action to be taken under this work package are: Quality control, evaluation and validation planning to specify methods and tools, training material and evaluation, technical system Validation & Evaluation (e-learning and professional networking platform, quality assurance methods throughout project duration and summative evaluation of project outcomes at the end.

WP4 Development of the project/ development of a specialized set of tobacco control guidelines for five (5) high-risk groups

The fourth work package aims to develop a specialised set of tobacco cessation guidelines for five different high risk groups, addressed to health professionals. These groups are composed of people who suffer or are likely to develop cardiovascular diseases, chronic respiratory diseases and diabetes, as well as, adolescents and pregnant women. Moreover, this work package will provide the basic methodological framework for the implementation of the next phases of the project.

 Situation analysis and needs assessment

The starting point of the project is for the partnership to perform a situation analysis and assessment of the problem addressed in order to set the grounds for the development and implementation of the specialized guidelines for tobacco cessation. This part will make use of: (a) literature review about smoking habits in the Union focus on each high risk group, how much they smoke, reasons for not stopping smoking etc; (b) collection of information for tobacco cessation guidelines and tobacco cessation services across the Union (c) experts workshops for each target group.

Development of the specialized set of tobacco cessation guidelines for five high risk groups.

The tobacco cessation guidelines will be addressed to health professionals which are the primary target group. The development of those guidelines will be based on: a) ENSP guidelines: which provide valid scientific base and proven good practices and b) ERS Tobacco Control Committee (TCC which provides useful informative material and scientific reviews of the health hazards of smoking through their website SmokeHaz. Each tobacco cessation guideline will be addressed to a different high risk group which faces different health risks and needs special treatment. Thus, the guidelines developed which will be addressed to a different group of health professionals will take into consideration each professions’ needs and challenges.

WP5 Pilot implementation of tobacco cessation guidelines

The fifth work package aims to pilot the tobacco cessation guidelines produced by the scientific groups, so as to assess their effectiveness and usefulness and acquire important feedback for improvements. Piloting the tobacco cessation guidelines is a crucial phase of this project since it will provide valuable information to the scientific groups responsible for its implementation, so as to assess and correct the guidelines.  The final guidelines are expected to be a coherent cost effective approach to tobacco cessation for high risk groups.

WP6 Training of health professionals

The sixth work package includes all the necessary activities in order to develop an e-learning platform and to deliver an on-line course, addressed to health professionals, so as to use the tobacco cessation guidelines successfully for the benefit of the patients that belong to each high risk population. One of the aims of the project is to develop health professional’s skills on smoking cessation. Thus, training health professionals to use the guidelines and provide each health profession with specific information about each high risk group is the foundation for the success of the project. In this framework, the project intents to:

(a) Improve health literacy of health professionals by obtaining new skills and knowledge about smoking related health risks and tobacco cessation programs

(b) Give the opportunity to health professionals from different expertise to participate in online forums in order to exchange experience, ideas and queries

(c) Produce training e-learning material addressed to health professionals in all European countries available in the web-site of the project for each health profession separately

Methodology infographic



The main project outcome is a set of smoking cessation guidelines that will be developed based on the specific needs of high risk groups which are the target group of the project. The guidelines developed will contain strategies and recommendations designed to assist health professionals in delivering and supporting effective treatment of tobacco dependence. Recommendations will be made as a result of scientific reviews and evidence of good practices   from scientific groups that will consist of health professionals of different expertise in Europe.


An e-course addressed to health professionals will be developed based on the finalized Tobacco Cessation Guidelines. The e-course will be hosted on an e-learning platform designed for the needs of the TOB-G project. The e-course and the platform will be available after the end of the project.

E-learning training sessions will be offered to a minimum of 100 health professionals at the end of the project on how to successfully implement the Tobacco Cessation Guidelines to their patients.











The expected impact of the TOB-G project outcomes will be:

  • More effective and appropriate treatment of tobacco dependence
  • Quicker diagnosis of tobacco related diseases
  • Long term prevention of tobacco related diseases (healthier babies and adults, less medical complications, fewer deaths);
  • Better trained physicians and practitioners
  • Promote healthy lifestyles &
  • Promote healthy role-models.











The final version of the TOB.g guidelines have been developed and released to the general public. The “Tobacco Cessation Guidelines for High Risk Populations” is a result of scientific and evidence-based research conducted by working groups of health professionals and experts in tobacco cessation for the subgroups of the project.

Editor of the book is.Prof. Panagiotis K. Behrakis and co-editors are Constantine Vardavas and Sophia Papadakis.

The Tobacco cessation guidelines contain 5 chapters with specialized smoking cessation interventions for:

(a) During Pregnancy and the Postpartum Period (authors: Victoria Vivilaki and Andriani Loukopoulou)

(b) Adolescents (authors Anastasios Fotiou, Myrto Stavrou and Anna Kokkevi),

(c) Patients with Diabetes (Lucia Maria Lotrean),

(d) Patients with Chronic Obstructive Pulmonary Disease (author Antigona Carmen Trofor),

(e) Patients with Cardiovascular Diseases (author Christina Maria Gavrilescu).

The guidelines contain related literature and recommendations for each group.

The Table of Contents for each chapter is now available.

1. Smoking Cessation during Pregnancy and the Postpartum Period

Executive summary

Key concepts in the chapter

  1. Tobacco Use and Cessation in Pregnancy

1.1 Statistics on prevalence of tobacco use in the postpartum period

1.2 Rates of Cessation in Pregnancy

1.3 Post-partum relapse rates

  1. Health Effects of Smoking in Pregnancy

2.1 The effects of smoking on the fetus

2.2 The effects of maternal smoking on the health of infants and children

2.3 Second-hand and third-hand smoke exposure

2.4 Health Benefits of Smoking Cessation during Pregnancy

  1. Factors associated with perinatal smoking cessation

3.1 Nicotine Metabolism during pregnancy and during breastfeeding

3.2 Maternal Stress and Mood Disorders

3.3 Partner/Significant Others Tobacco Use

  1. The Role of Health Professionals

4.1 Midwives

4.2 Nurses

4.3 Primary health care – General Practice, Obstetricians & Gynaecologists

4.4 Specialized Smoking Cessation Services

  1. Assessment of Nicotine Use in Pregnancy

5.1 Assessment of second-hand Smoke Exposure

5.2 Biochemical Validation of Smoking Cessation

5.3 Fagerstrom Test for Nicotine Dependence (FTND)

5.4 Assessment of Motivation to Quit

  1. Counselling Interventions for Smoking Cessation During Pregnancy

6.1 Cognitive –Behavioural Interventions

6.2 The “Stages of Change” – Transtheoretical Model

6.3 Evidence for Various Intervention Approaches

6.4 Quitlines

6.5 Relapse Prevention in the Postpartum Period

  1. Quit Smoking Medications

7.1 Nicotine Replacement Therapy

7.2 Bupropion

7.3 Varenicline


2. Smoking Cessation among Adolescents

Executive summary

  1. Introduction
  2. Factors influencing adolescent smoking cessation
  3. Evidence and recommendations

3.1.  Health care / clinical settings

3.1.1.  Behavioural interventions in health care settings

3.1.2.  Pharmacological approaches in health care settings

3.1.3.  Other interventions in health care settings

3.2.  School settings

3.2.1.  Behavioural interventions in school settings

3.2.2.  Combines behavioural and pharmacological treatments in the school setting

3.3.  Information Communications Technology (ICT) Interventions

3.4.  Other community settings

Appendix A – Key recommendations in existing Guidelines


3. Smoking Cessation in Patients with Diabetes

Key Messages

  1. The basis for smoking cessation among diabetic patients

1.1.  Smoking as a risk factor for diabetes mellitus

1.2.  Statistics about smoking prevalence and smoking patterns among diabetes patients

1.3.  Effects of active smoking among diabetic patients

1.4.  Specific health concerns after quitting smoking

1.5.  Passive smoking and the risk for diabetes mellitus

1.6.  Barriers for quitting smoking and risk factors for relapse among diabetic patients

2. Interventions for smoking cessation in diabetic patients

2.1.  Integrating Smoking cessation treatment into diabetes management

2.2.  Non-pharmacological interventions

2.2.1.  Types of interventions

2.2.2.  Setting Specific Interventions

2.3.  Pharmacological Interventions

2.3.1 Nicotine Replacement Therapy (NRT)

2.3.2 Bupropion

23.3 Varenicline

2.4.  Cost-effectiveness


4. Smocking Cessation in Patients with Chronic Obstructive Pulmonary Disease (COPD)

1. The basis for smoking cessation in COPD

1.1. Preface

1.2. COPD – A tobacco induced disease

1.3. Second-hand smoke exposure and risk of COPD

1.4. Statistics on prevalence and burden of COPD and tobacco use

1.5. Benefits of smoking cessation in COPD patients

1.6. Smokers with COPD: what makes it a hard to treat disease?

2.    Smoking cessation interventions effective in COPD

2.1. Integrating smoking assessment and cessation into routine primary and secondary care of COPD patients

2.2. Non pharmacological smoking cessation interventions in COPD

2.3. Pharmacological smoking cessation interventions in COPD

2.4. Cost-effectiveness of Smoking Cessation in COPD

3.    Setting Specific Interventions for Smoking Cessation in COPD Patients

3.1. Pharmacist-led interventions

3.2. Nurse-led Interventions

3.3. Smoking cessation in hospitalized patients

3.4. Smoking cessation in respiratory out-patients

3.5. Rehabilitation programs in COPD

3.6. Family-focused interventions for COPD patients


5. Smoking Cessation in Patients with Cardiovascular Diseases
  1. Tobacco use and cardiovascular diseases
  2. 1.1. Burden of CVD and Tobacco Use1.2. Smoking as major modifiable cardiovascular risk factor1.3. Pathogenic pathways linking smoking to cardiovascular diseases1.4. Environmental Tobacco Smoke or Second Hand Smoke and CVD risk1.5. Cardiovascular biomarkers and tobacco exposure

    1.6. Benefits of smoking cessation for CVD

    1.7. Treating tobacco use as a high priority cardiovascular risk factor

    1.8. The need for smoking cessation into routine primary and secondary CVD care

    2. Smoking cessation interventions effective in CVD

    2.1.  Behavioural Interventions

    2.2.  Pharmacologic interventions

    2.2.1.  NRT

    2.2.2.  Bupropion

    2.2.3.  Varenicline

    2.3.  Setting specific interventions for smoking cessation in CVD patients

    2.3.1.  Primary care settings, including physicians’ and dentists’ office

    2.3.2.  Secondary care/ hospitalized patients

    3. Smoking Cessation in CVD Sub-Populations

    3.1.  Hypertensive patients

    3.2.  Peripheral arterial disease

    3.3.  Women

    3.4.  Elderly CVD Patients


6. Full Guidelines


CMT Prooptiki Ltd


The Hellenic Center for Disease Control and Prevention

The Hellenic Center for Disease Control and Prevention (KEELPNO) is a main National Public Health
Organization in Greece working, also, on prevention, increasing awareness of community; on health promotion; and on giving an emphasis upon issues related to tobacco cessation. KEELPNO’s highly qualified, multidisciplinary personnel has a strong experience in managing and coordinating projects on Public Health sector and it is comprised by experts on financial, project and risk management.

LEAD: Panagiotis K. Behrakis, Constantine Vardavas




European Network for Smoking and Tobacco Prevention

ENSP is a European network with significant experience on matters relevant to tobacco prevention and
cessation and members from most of the EU Member States, as well as other European countries. ENSP, which has published general Smoking Cessation Guidelines, serves also as a platformof best practices for policy analysis, advocacy, research and capacity‐building.

LEAD: Cornel Radu Loghin, Dominick Nguyen




The Tobacco Free Research Institute Ireland

TFRI is an Irish organization, aiming at providing an evidence base for creating a tobacco free society. TFRI has experience in research and monitoring of tobacco related issues throughout Europe and has published scientific papers on cessation services, while it has also delivered Smoking Cessation Services in Dublin.

LEAD: Luke Clancy


CMT Prooptiki Ltd

CMT Prooptiki Ltd

CMT is a consulting firm with significant experience in the health care sector offering among other evaluation services on interventions, projects and programmes mainly in issues relevant to health promotion and policy.

LEAD: Tasos Mastroyiannakis




S.C.ANLET MED S.R.L. has specialized on clinical research in respiratory diseases and offers consultancy and training services, as well as support in the field of tobacco use and addiction.

LEAD: Antigona Trofor


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