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Tobacco and Cancer Programme International Union Against Cancer 3, Rue du Conseil-Général, 1205 Geneva, Switzerland Tel: (4122) 809 1830, Fax: (4122) 809 1810 E-mail: tobacco-control@globalink.org | Tobacco and Cancer Programme |
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UICC Tobacco Control Fact Sheet 9
The use of tobacco is the major preventable cause of disease and premature death in countries where it is widespread. If present worldwide trends in tobacco use continue, 1 in 10 people alive today will die from tobacco-related diseases caused by constituents of tobacco smoke such as tar and carbon monoxide. By the year 2020 more than 10 million people will die each year from diseases caused by their use of tobacco products, unless large-scale smoking cessation can be achieved.
Smoking cessation strategies are vital components of a comprehensive programme that is designed to tackle the problem of tobacco-related diseases. While campaigns designed to stop young people from starting the tobacco habit, and mass media campaigns aimed at encouraging those smokers who can stop easily to do so are of great importance, they are not the whole answer to a really effective smoking control strategy. Even though millions of smokers have given up since the health consequences of smoking became known, many adults still smoke, although surveys have shown that at least two-thirds of them wish to give up. In fact, dependence on nicotine is a fundamental problem for many users. Nicotine dependence is a medical disorder recognized by major health organizations. The processes that determine this addiction are similar to those that determine addiction to heroin and cocaine.
The 1988 Report of the US Surgeon General very clearly states that:
The First European Conference on Tobacco Policy in 1988 states in its charter against tobacco for Europe that:
If every citizen has the right to receive encouragement, health-care professionals have a duty to provide counselling and treat tobacco dependence as they would any other disease or addiction. They should advise patients to stop using tobacco products and provide medical treatment for nicotine dependence when necessary. In particular, general practitioners should be identifying tobacco users, diagnosing the extent of their nicotine dependence and offering appropriate advice and treatment. Both behavioural measures to encourage motivation to quit and pharmacological treatment to alleviate nicotine withdrawal symptoms should be used.
Current Interventions to Help People Stop Smoking
The long-term goal for cessation interventions is to help as many smokers as possible to stop, which implies that the approach should be widely applicable. Intensive and minimal approaches can be of value and both need to be included in an overall smoking cessation strategy. As the 1988 Report of the US Surgeon General (US Department of Health and Human Services, 1988) stated
"no single intervention constitutes a generally effective method …"
A number of specific interventions can be used to help smokers quit.
Self-Help Literature: this is by far the most widely available intervention for helping people to stop smoking. Books and leaflets help smokers plan their attempt to stop and are a useful adjunct to mass media campaigns. Information on the health hazards of smoking, the "hows and whys" of stopping smoking, and information on coping strategies can be included.
Financial Incentives: calculating the cost of a year's supply of cigarettes can be quite effective in reinforcing a person's decision to stop smoking, and cigarette consumption does appear to decline as a result of substantial increases in cigarette prices.
Local Community Campaigns: ongoing public education and information programmes are a very important component of a smoking control programme. It is easy to overlook the constant reinforcement provided from health educators at community level, which does so much to ensure the effectiveness of "National No Smoking" campaigns.
Lifestyle Programmes: these target specific risk factors, such as heart disease.
Mass Media: for many people stopping smoking is not easy and takes a reasonable degree of effort over a considerable length of time. The mass media can play an important role in creating an awareness of smoking as a health issue and reinforcing medical evidence against smoking.
National Campaigns: a "National No Smoking Day" provides a focal point for a multitude of activities at local and national level. The aims are to encourage people to participate by stopping for just one day, and it is hoped that those who take part will quit for good. Since its introduction in the UK there has been an increase in the number of smokers participating in the day, from 13% to 18% in 1990.
Telephone Help-Lines: these meet the further demand for information generated by a "National No Smoking Day" and other community campaigns.
Health-Care Professionals: the main component of a successful smoking cessation programme is health-care professionals. They have two important roles in smoking cessation. Firstly, to model non-smoking behaviour and secondly, to help patients stop smoking. Indeed, encouraging and supporting patients in their attempts to stop smoking should be the duty of any doctor or health-care professional working in a hospital or the community. However, intervention by the primary health-care professional is probably the most important of many approaches that need to be improved. A major constraint is the brevity of medical consultation, and one solution is the greater involvement of nurses in preventive care. Community nurses and health visitors, likewise, have a vital role to play.
Training: there is an urgent need for the introduction of training programmes for health professionals and others who wish to acquire the appropriate skills in smoking cessation interventions.
Workplace: many opportunities exist in the workplace for occupational health staff and others to address the issue of smoking. In the UK smoking cessation is being helped by requests from management in an attempt to make the transition from a smoking to a non-smoking workplace acceptable to all staff.
Pharmacists: pharmacists are increasingly involved in giving health advice and have at their disposal a wide range of materials which may be helpful to people wishing to stop smoking.
Pharmacological Support: tobacco smoking is a complex combination of behaviours driven by pharmacological, psychological and social factors. On its own, nicotine replacement therapy will not stop anyone from smoking, but it relies on the decision of the person to be prepared to stop, and to work hard at translating that into practice.
Stop-Smoking Groups necessarily deal with a relatively small proportion of the smoking population. However, those who participate in such groups tend to be heavier smokers who perceive themselves to be particularly dependent on nicotine, and group support can provide a useful adjunct to an overall "stop smoking programme" at community level.
Specialist Stop-Smoking Centres: as smoking cessation programmes are aimed at people who live and work in the community, the provision of a community stop-smoking advisory centre is the best means of ensuring that every smoker has easy access to the level of advice that is needed. Moreover, such centres can play an important role in research, clinical trials and evaluation.
Smoking Cessation Programmes for Young People: it should be recognized that young people can also become dependent upon the smoking habit and can quickly develop an addiction to tobacco. However, a different approach to cessation may be required with this age group and more research into effective interventions is needed. Even so, it is clear that simple cessation advice should be incorporated into existing smoking prevention programmes aimed at young people.
UICC Recommendation
It is obvious that smoking cessation must recognize the differing needs of smokers, and no intervention can be used in isolation to deal with all these aspects.
Acknowledgement
This Tobacco Control Fact Sheet is based on Fact Sheets produced by Action on Smoking and Health (ASH), United Kingdom
References
Useful reading
All published by the:
Ulster Cancer Foundation
40/42 Eglantine Avenue
Belfast BT9 6DX, N. Ireland
Tel. 44 1232 663281
Fax. 44 1232 660081
March 1993
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Tobacco and Cancer Programme International Union Against Cancer 3, Rue du Conseil-Général, 1205 Geneva, Switzerland Tel: (4122) 809 1830, Fax: (4122) 809 1810 E-mail: tobacco-control@globalink.org | Tobacco and Cancer Programme |
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