New Worldwide Survey Shows Few Smokers Have Access to Cessation Support

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Preliminary results from a new survey of tobacco dependence treatment and treatment guidelines around the world were presented today at Global Bridges’ preconference workshop “Role of Health Care Systems and Providers in Changing Tobacco Dependence Treatment and Tobacco Policy” at the 15th World Conference on Tobacco OR Health in Singapore.

This survey is being conducted by a team from the University of Nottingham in the UK and Harvard University, and it is a repeat of the survey they conducted in 2007. Essentially, the survey results are similar to those from five years ago.

Findings

More countries have published treatment guidelines now, which you would expect since it’s an FCTC obligation. But the headline finding — that the vast majority of tobacco users around the world do not have access to cessation support — remains the same as in 2007.

Only 46% of the countries responding to the survey — and note that the findings will overestimate treatment provision, as low and middle income countries are underrepresented among respondents — have mass media campaigns promoting cessation. Such campaigns are really a prerequisite for generating demand for cessation support, along with other measures like advertising bans, smoke-free legislation, a tax policy and strong health warnings.

Other findings include:

  • Only 41% of countries have a government official responsible for treatment.
  • Just 44% of countries have a quitline.
  • Countries were asked if tobacco users could get help to stop in various settings; the responses showed that cessation support is easily available in very few settings: primary care, pharmacies, workplaces and hospitals.
  • Medications are not easily affordable in many countries, though nicotine gum is the most accessible.
  • Very few countries mandate the recording of tobacco use in medical notes, which would also seem to be a prerequisite for embedding brief advice into health care systems.
  • Less than half of respondents offer help to health care professionals to stop using tobacco, even though smoking rates are known to be extremely high in some professions. For example, 49% of Slovakian general practitioners smoke.

Analysis

These findings are not really surprising, so perhaps the key questions are:

  • What are the barriers to providing cessation support?
  • Why aren’t more countries implementing FCTC Article 14, the “O” of MPOWER? Why is it still an orphan?

One answer is that the majority of low and middle income countries may not be ready yet to invest seriously in treatment, as they have not yet implemented the policies that drive demand for support. Many of them will also cite concern about money, and the fact that they cannot afford treatment services.

Part of the answer to those concerns is to emphasise that they should adopt the spirit of the FCTC Article 14 guidelines and MPOWER by prioritising low-cost interventions that have a broad reach, including brief advice and quitlines. Another might be to urge them to licence cytisine, which has been shown to be effective in a recent clinical trial and is potentially available for as little as $10 a month per course.

Martin Raw is special lecturer at the UK Centre for Tobacco Control Studies at the University of Nottingham, UK; visiting professor at the National Institute of Alcohol and Drug Policies in Sao Paulo, Brazil; and deputy manager of www.treatobacco.net.

Martin Raw does not accept funding from the manufacturers of stop-smoking medications.