Last updated February 2011 Policy treatobacco.net

Last updated February 2011 Policy section ChairTom Houston Ohio Health Nicotine Dependence Program at McConnell Heart Health Center, USA Peter AndersonIndependent Consultant on Public Health, Spain Mike CummingsDepartment of Health Behavior, Roswell Park Cancer Institute, USAJoe GitchellPinney Associates Inc, USANatasha HerreraCentro Médico Docente la Trinidad, Venezuela Tai Hing Lam School of Public Health and Department of Community Medicine, University of Hong Kong, ChinaAnn McNeill Division of Epidemiology and Public Health, University of Nottingham, UK David SweanorSmoking and Health Action Foundation, Canada

Last updated February 2011 Purpose To provide information on policies concerning the treatment of tobacco dependence and to signpost important policy documents.

Last updated February 2011 Evidence Base Based on evidence presented largely in the other databases. Strength of evidence statements therefore not given.

Last updated February 2011 Terminology Treatment includes (singly or in combination) behavioural & pharmacological interventions e.g. education, brief counselling & advice, intensive support, administration of pharmaceuticals or other interventions that contribute to reducing/overcoming tobacco dependence in individuals & in the population.

Last updated February 2011 Key Findings Tobacco treatment essential for impact on public health within next 30 to 50 years.

Last updated February Year Estimated cumulative tobacco deaths with different intervention strategies Tobacco deaths (millions) Baseline If proportion of young adults taking up smoking halves by 2020 If adult consumption halves by 2020 World Bank. Curbing the epidemic: Governments and the economics of tobacco control. World Bank Publications, p80. Unless Current Smokers Quit, Tobacco Deaths will Rise Dramatically in the Next 50 years

Last updated February 2011 Key Findings Other tobacco control approaches e.g. taxation, smoke- free workplaces etc.: –increase motivation to quit; –encourage smokers to make quit attempts & access treatments; –help maintain abstinence. Treatment policies complement these approaches by enhancing treatment availability & increasing chances of quit attempts succeeding. To be most effective, tobacco control policy interventions must be truly comprehensive.

Last updated February 2011 Key Findings Tobacco dependence & withdrawal syndromes classified as substance use disorders under WHO ICD 10. Nicotine dependence & withdrawal classified similarly under APA DSM IV. More common general term is addiction.

Last updated February 2011 Key Findings In countries where tobacco control policies are well established: –majority of tobacco users want to stop; –one-third or more attempt annually to quit; –but, only 1-5% of smokers stop for good each year. Effective treatment interventions increase the chances of quit attempts succeeding.

Last updated February 2011 Key Findings A range of effective & cost-effective treatments exist which should be integrated into health care systems. These include: –a system to identify tobacco users; –routine advice to stop by health care professionals; –intensive support given individually or in groups; –pharmacological approaches.

Last updated February 2011 Key Findings Advertising that motivates tobacco users to quit encourages them to seek help in giving up. Cost, availability & promotion of pharmaceutical treatments influence usage.

Last updated February 2011 Key Findings Post-certification training increases the likelihood of intervening with smokers but not yet been shown to influence outcome.

Last updated February 2011 Key Findings Harm reduction approaches can reduce the harm caused by tobacco use for those who cannot or will not stop.

Last updated February 2011 Recommendations Treatment is essential component of an integrated tobacco strategy. A full range of effective treatments should be offered and made accessible to all tobacco users. Treatment should be integrated into & funded within healthcare systems. Education & training in cessation of tobacco use should be in the curricula of health professionals.

Last updated February 2011 Recommendations A range of indicated uses for treatments should be offered that is consistent with the evidence on efficacy, scientific understanding of the nature of tobacco use and relapse, and consumer choice. Regulatory barriers should be reformed (for example access to treatment products is much more restricted than is access to tobacco products). Campaigns should increase public awareness of the benefits of quitting & the options available.

Last updated February 2011 Areas for future research The relationship between tobacco control policies, availability of treatment programs, and tobacco users' desires to quit. The population impact of strategies to encourage use of pharmacological treatments for purposes other than cessation (e.g. temporary relief of withdrawal symptoms and for harm reduction), and the impact of such uses on quitting.

Last updated February 2011 Areas for Future Research (cont.) Research on the cost-effectiveness of tobacco dependence treatments, especially in lower-income countries. Cessation approaches to adolescent and pregnant tobacco users. Cessation in special population groups, including mentally ill and patients with other addictions. Continue exploration of policy related to harm reduction.