Opportunities and Threats to Cessation Success

16 May 2014

Presenter : Professor Harry Lando is Distinguished International Professor, Division of Epidemiology and Community Health, University of Minnesota. In addition to his many awards, professional memberships, appointments, editorial accomplishments and consultancies, he has authored or co-authored over two hundred research articles, with cessation as one area of main focus since 1975.

Agenda : The meeting occurred from 13:00-16:30 hours on the afternoon of 4 August, 2011 at the Tobacco Control Research and Knowledge Management Center (TRC). After the introduction of Dr. Harry Lando, there were two brief presentations providing background regarding smoking cessation practice in Thailand:

  • Dr. Suthat Rungruanhiranya presented, “Background on cessation efforts in Thailand”
  • Dr. Jintana Unipan presented, “Quitline 1600”

Summary of Dr. Harry Lando’s Presentation :
Dr. Lando began by pointing out that cessation measures can reduce the projected deaths from tobacco-related disease worldwide by 180 million deaths by 2050 if projected cessation efforts are successful.
He emphasized that nicotine dependence is classified as a disorder in major international classifications of diseases, and that WHO recognizes that many smokers who wish to quit benefit from cessation assistance. After outlining the complex and dangerous nature of tobacco dependence, he reviewed the cessation guidelines of Article 14 of the Framework Convention on Tobacco Control (FCTC). He noted that national health and education programs should include tobacco dependence treatment since it has numerous benefits and is cost effective. Treatment includes clinical practice guidelines that provide content and implementation details to ensure a coordinated national plan.

Unfortunately, the WHO Global Report on the Tobacco Epidemic reports that only 9 of 173 countries (5%) have tobacco dependence treatment services fully available. Thus, more needs to be done including training more health professionals, adapting interventions to local circumstances, and giving cessation advice and support outside health care settings through population-level campaigns and quitlines.

Next, Dr. Lando stressed the role of health professionals in using the 5 As (Ask, Advise, Assess, Assist, Arrange) or the 2 As + R (Ask, Advise and Refer) methods. He discussed intensive behavioral support and current medications used to enable patient success in cessation efforts. He noted the usefulness of quitlines especially for dependent vulnerable smokers. Though 1-3 % of smokers quit without assistance, quit rates are considerably better with support.
Finally, Dr. Lando reviewed the barriers to the use of cessation services including cost, limited access, lack of service awareness, and failure to create consumer demand for this service. Each of these barriers can be addressed using more effective and efficient measures. This includes cost reductions of services and using complementary FCTC measures to boost cessation demand. In turn, cessation success also boosts other FCTC objectives. For example, former smokers are often strong supporters of smoke-free public places.
In conclusion, opportunities for cessation include :

  • Ensuring training in cessation methods for all health professionals
  • Boosting free access to cessation support and medications
  • Providing innovative research that shows best practices and leads to cessation improvements
  • Dr. Lando noted that there are great opportunities for including cessation as an integral part of a comprehensive tobacco control program, and he urges Thai cessation professionals to continue their work to build more accessible and coordinated cessation services.

Presentation Discussion :
Following Dr. Lando’s presentation, there was a discussion session on cessation research and practice followed by a group picture of the meeting participants.
Submitted by Stephen Hamann, TRC