FACTSHEET #5

FCA Framework Convention Alliance

for Tobacco Control

TO B A C C O C E S S AT I O N & T R E AT M E N T

orldwide, 1.3 billion people smoke and, unless urgent given year, as few as 3% actually achieve

W action is taken, 650 million of them will die prematurely

long-term abstinence.6
■ Surveys in the United States have
due to tobacco use.1 According to the World Health Organization, found up to 70% of tobacco users
report a strong interest in quitting.7
“Current statistics indicate that it will not be possible to reduce
■ A 2002 report indicated that 45.6%
tobacco-related deaths over the next 30-50 years, unless adult of Australian smokers intended to
quit smoking in the next six months.8
smokers are encouraged to quit.”2 Millions of people quit every
■ A 2003 study on behalf of Ireland’s
year, but many more don’t and quit attempt success rates Office of Tobacco Control, indicated
that 76% of Irish smokers intend to
remain low. Tobacco cessation can be a cost effective method quit. Sixty-seven percent of those
wishing to quit have previously
of disease prevention for adults. In the United States, for attempted to quit.9
example, it is more cost effective than mammograms, pap Implementing the FCTC
smears, and screenings for colorectal cancer or hypertension.3 Article 14 of the FCTC calls on coun-
tries to “promote cessation of tobacco
use and adequate treatment for tobacco
Nicotine: lating for years. In 2000, The Royal dependence.” Given the diversity of
The Basis Of Addiction College of Physicians summarized this countries’ economic situations, regula-
Tobacco contains nicotine, a powerful body of research by concluding that tory regimes and health care systems,
and highly addictive substance. Most nicotine is an addictive drug on par the effort to treat tobacco dependence
tobacco products deliver nicotine to the with heroin and cocaine and that the requires a multi-faceted approach.
brain very effectively, bringing on the primary purpose of smoking tobacco is Therefore, a tobacco control program
rapid onset and maintenance of addic- to deliver a dose of nicotine rapidly to should not only encourage tobacco
tion. This addiction leads to the unfor- the brain.5 Studies from numerous users to quit but also provide assistance
tunate situation where an otherwise countries show that although an over- in doing so. Treatment services can be
rational, motivated, knowledgeable whelming majority of tobacco users provided through health care providers,
person who understands the risks of want to quit, less than half make a quit schools, government agencies and com-
tobacco, continues to use it.4 attempt each year, and very few of those munity organizations. These services
succeed in quitting long-term. While can include:
Evidence of the dependence-producing up to 40% of those using tobacco will
properties of tobacco has been accumu- make a serious quit attempt in any ■ Health education, through tobacco

product packaging, the media, schools, community groups
and health care providers, should describe the health haz-
ards of smoking and provide cessation strategies.
■ Counseling is effective in helping smokers to quit.
Intensive behavioral support by appropriately trained
smoking cessation counselors is the most effective non-
pharmacological intervention for smokers who are strongly
motivated to quit.10 The U.S. Centers for Disease Control
and Prevention recommends identification of and advice to
smokers, provision of brief counseling and full range of
treatment services including pharmaceutical aids, intensive
behavioral counseling and follow up visits for cessation.11
Among services recommended by the U.S. Preventive
Services Task Force, tobacco cessation counseling is ranked
in the highest priority category, with the lowest usage
rate.12 To date counseling has not been utilized to maxi-
mum effect.
■ Many Maternal and Child Health Clinics provide successful
smoking cessation programs. Pregnancy is an appropriate
time to achieve smoking cessation and successful interven-
tions produce clear, short term and cost effective bene-
fits.13 Pregnancy also offers multiple windows of opportu-
nity for smoking cessation intervention.14 The most effec-
tive interventions are done during routine pre-natal visits.
Using messages and self-help materials tailored for preg-
nant smokers substantially increases abstinence rates during
pregnancy.15 Successful interventions for post-partum ces-
sation initiated toward the end of the pregnancy shift
motivation from protecting the pregnancy to protecting
the woman’s post-partum health and to the ultimate goal
of creating a smoke-free family.16
■ Governments can require tobacco companies to promi-
nently present cessation-oriented messages on all cigarette
packages and at points-of-sale. These messages could
include telephone numbers of “quit-lines” which smokers
can call for advice about quitting. A meta-analysis in the
United States revealed quit-line counseling increased smok-
ers’ chances of long-term abstinence by about 30%.17
Because they can be designed with few barriers to their use
(i.e., availability in many languages, extended hours of
operation, no transportation requirements), quit-lines have
potential to reach a wide range of smokers in countries
which have adequate telephone services.
FACTSHEET #5
■ Governments can ‘level the regulatory playing field’
between tobacco products and pharmaceutical nicotine
products. In most countries, tobacco products are largely
unregulated while products that help people quit are classi-
fied as pharmaceuticals and are strictly regulated. In the
words of the World Health Organization, it is important
“to ensure that the future market for nicotine does not
continue to be dominated by the most contaminated prod-
uct, the cigarette.”18 While regulatory approval of different
nicotine-based treatments should vary according to their
risk and benefits, overzealous regulation of such products
should be tempered by the fact that in most countries ciga-
rettes remain widely available and heavily promoted.19
■ Governments must provide protection from secondhand
smoke. Smoke-free public transit, health care institutions,
education and sports facilities, workplaces and places of
public assembly motivate and reinforce attempts at quitting.
■ In countries where publicly funded health insurance exists,
consideration should be given to making evidence-based
tobacco dependence treatments reimbursable. Lack of
insurance coverage and lack of access and availability serve
as barriers to the use of these treatments. Each country has
to weigh costs versus benefits, but in some cases extending
tobacco treatment insurance coverage to all would be a
positive step. Where available, insurance coverage increases
the likelihood that smokers will use intensive services.20
■ Although they are very costly and not available in many
parts of the world, pharmacological aids such as nicotine
replacement therapy (NRT), including nicotine gum,
inhaler, nasal spray, lozenge and patch, as well as bupropi-
on (an anti-depressant), can be utilized to assist tobacco
users to quit. NRT delivers low doses of nicotine without
delivering the many other harmful substances found in
tobacco smoke and can significantly increase the success
rate of other cessation efforts.21 Although it is self-adminis-
tered, high costs and regulatory issues can impede access to
NRT.22
The Important Role of Health Care Providers
Article 14 of the FCTC calls on governments to incorporate
the “diagnosis and treatment of tobacco dependence and
counseling services on cessation of tobacco use in national
health and educational programmes.” As the International
 FACTSHEET #5

Union Against Cancer states, health-care professionals “have ers to cessation efforts through its significant economic and
a duty to provide counseling and treat tobacco dependence as political resources.
they would any other disease or addiction.”23 There is evi-
Lack of significant regulation has allowed the industry to cre-
dence indicating that treatments for tobacco use, including
ate and promote products, such as “light” or “low tar” ciga-
counseling and medication, are highly effective in a clinical
rettes, that purport to offer harm reduction but do not
practice setting.
reduce overall disease risks. The heavy promotion of these
Yet many healthcare providers lack the proper tools to treat products to health conscious smokers “at risk” of quitting
tobacco dependence. A research paper on the United smoking has served to manipulate their addiction by offering
Kingdom’s 24 medical schools, for example, found that there justification for continued smoking, even though there is no
was no mention of smoking or smoking cessation in the pub- evidence these products reduce the risk of disease.
lished curriculum material of 10 of those schools.24 In the
Either directly, or through bogus front groups, the tobacco
United States, one study found that only 15% of tobacco
industry attacks scientific evidence on the effects of smoking
users who saw a physician in the prior year were offered assis-
and states publicly that smoking is either not as harmful as
tance with quitting, while only 3% were scheduled for a fol-
critics contend or that “everything” is harmful. Several com-
low-up appointment to address the topic.25 If prevention and
panies still do not admit that smoking is addictive. These
management of smoking are to become part of mainstream
public relations strategies are so far removed from science
medicine, medical students and staff must be educated and
they would not work for most consumer products. Yet smok-
trained in the necessary skills to enable them to treat tobacco
ers are often strongly motivated to find ways to justify their
addiction in their patients.26
dependence to smoking, and while others might recognize
Tobacco Industry Impediments To Cessation these strategies as attempts to trick consumers, smokers may
view them as a beacon of hope in their efforts to justify con-
In addition to the impediments to cessation caused by gov-
tinued smoking thereby avoiding the hardship of a cessation
ernment policies (or lack thereof ) and the addictive nature of
attempt.27
nicotine, the tobacco industry itself presents numerous barri-

Resources on the World Wide Web:

Agency for Healthcare Research and Quality, Treating Tobacco Use and Dependence: A Clinical Practice Guideline, 2000
www.surgeongeneral.gov/tobacco/default.htm
Ontario Medical Association, Rethinking Stop-Smoking Medications: Myths and Facts, 1999;
www.oma.org/phealth/stopsmoke.htm
QuitNet (resources to help tobacco users quit)
www.quitnet.org/qn_main.jtml

Endnotes
1. World Health Organization. The World Health Report — Shaping the
Future. (2003). <http://www.who.int/whr/2003/en/>
2. World Health Organization. Policy Recommendations for Smoking
Cessation and Treatment of Tobacco Dependence. 2003.
<http://www.who.int/tobacco/resources/publications/tobacco_depend-
ence/en/>
3. A. Coffield, et al. “Priorities Among Recommended Clinical Preventive
Services.” American Journal of Preventive Medicine. Vol. 21 (2001), p.1-10.
4. Pan American Health Organization (PAHO). “Nicotine Addiction and
Smoking Cessation.” Policy Brief, (1999).
<http://165.158.1.110/english/hpp/wntd_policy.htm>
5. Royal College of Physicians. Nicotine Addiction in Britain. (London: Royal
College of Physicians; 2000).
6. PAHO, op cit.
7. Ibid.
8. New South Wales Department of Health. Facts about smoking. (2002).
<http://www.health.nsw.gov.au/public-health/health-
promotion/tobacco/facts/>
9. ”Survey reveals 76% of Irish smokers want to quit.” Office of Tobacco
Control. (April 3, 2003). <http://www.otc.ie/article.asp?article=49>
10. Time Coleman. “ABC of Smoking Cessation.” British Medical Journal.
(February 2004).
11. Pbert, et al. “Development of state wide tobacco treatment specialist
training and certification programme for Massachusetts.” Tobacco
Control. Vol. 9, No. 4 (December, 2000), p. 372–381.
12. A. Coffield, et al. “Priorities Among Recommended Clinical Preventive
Services.” American Journal of Preventive Medicine. Vol. 21 (2001), p. 1–10.
13. C. Melvin, et al. “Recommended cessation counseling for pregnant
women who smoke: a review of the evidence.” Tobacco Control. Vol. 9,
Suppl 3, (September 2000), p. iii80–iii84.
14. C. DiClemente, et al. “The process of pregnancy smoking cessation: impli-
cations for interventions.” Tobacco Control. Vol. 9, Suppl 3, (September
2000), p. iii16–iii21.
15. AHRQ U.S. Preventative Services Task Force Recommendations Statement.
“Counseling to Prevent Tobacco Use and Tobacco-Caused Disease.” (2004).
Framework Convention Alliance on Tobacco Control
Rue Henri-Christiné 5, Case Postale 567, CH-1211 Genève, Switzerland
tel. 41-22-321-0011; 1-202-352-3284 fax. 41-22-329-1127 e-mail: fca@globalink.org
Adapted and updated with permission from the 2000 World Conference on Tobacco OR Health fact sheets. June 2005.
FACTSHEET #5
16. C. DiClemente, “The process of pregnancy smoking cessation: implica-
tions for interventions.” Tobacco Control. Vol. 9, Suppl 3, (September
2000), p. iii16–iii21.
17. M.C. Foire, W.C. Bailey, S.J. Cohen. Treating Tobacco Use and
Dependence: Clinical Practice Guideline. (Rockville, Md: Public Health
Service; 2000).
18. World Health Organization Scientific Advisory Committee on Tobacco
Product Regulation (SACTob). SACTob Recommendation on Nicotine and
the Regulation in Tobacco and non-Tobacco Products.
<whqlibdoc.who.int/publications/2003/9241590920.pdf>
19. World Health Organization, Regional Office for Europe. Conference on the
Regulation of Tobacco Dependence Treatment Products. (Helsinki, Finland,
October 19, 1999). <http://www.who.dk/tobacco/treatment.htm>
20. ”Preventing 3 Million Premature Deaths and Helping 5 Million Smokers
Quit: A National Action Plan for Tobacco Cessation.” American Journal of
Public Health. Vol. 94, (2004), p. 205–210
21. PAHO, op cit.
22. World Bank. Curbing the Epidemic: Governments and the Economics of
Tobacco Control. (1999). <http://www1.worldbank.org/tobacco/reports.htm>
23. International Union Against Cancer. Helping Smokers Stop: Ensuring Wide
Availability of Smoking Cessation Interventions. Fact Sheet #9, (1993).
<http://www.globalink.org/tobacco/fact_sheets/09fact.htm>
24. E. Roddy et al. “A study of smoking and smoking cessation on the curric-
ula of UK medical schools.” Tobacco Control. Vol. 13, No. 1, (March
2004), p. 74–77.
25. Agency for Healthcare Research and Quality, Treating Tobacco Use and
Dependence. A Clinical Practice Guideline. (2000) <http://www.surgeon-
general.gov/tobacco/default.htm>
26. ”A study of smoking and smoking cessation on the curricula of UK med-
ical schools. Tobacco Control. Vol. 13, No. 1, (March 2004), p. 74.
27. Pan American Health Organization. Policy Brief: Nicotine Addiction and
Smoking Cessation. (1999). <http://165.158.1.110/english/hpp/wntd_
policy.htm>
www.fctc.org