INTERNATIONAL COLLABORATING CENTER

Opportunities and Threats to Cessation Success

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

Pointing out

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.

Emphasized that nicotine

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

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 !

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...

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.

Summary

of Dr. Harry Lando’s Presentation

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.

Important Tobacco Control Research Projects will focus on the following six areas:

Tax measures for the control of tobacco consumption
Measures for the control of illicit trade
Measures for the control of electronic cigarettes
Measures for the prevention of smoking initiation
Smoking cessation measures
Monitoring and evaluation of the enforcement of the Tobacco Product Control Act (B.E. 2560)

ach of the research project areas consists of various research questions as follows:

Research issues in tax measures for the control of tobacco consumption
- The effects of tax re-structuring including adjustment of the excise tax rates in the Excise Tax Act (B.E. 2560)
- The effects and adjustments of tobacco industries within the country and in foreign countries
- Effects on tobacco growers
- Effects on tobacco consumption, such as smoking initiation, brand-switching, change of product types such as hand-rolled or illegal tobacco products
The elasticity of demand of different types of tobacco based on price change and impacts on various populations
Guidelines for the tax rate adjustment of hand-rolled and other tobacco products
- The health effects of smoking hand-rolled tobacco compared with smoking other tobacco products
- The proportion of production, distribution and consumption of various types of shredded tobacco
Study of permission of tobacco sales at retail, limiting access to tobacco retail stores in various countries and the effects of access to retail stores on the consumption of tobacco among Thai youth

Research issues in measures for the control of illicit trade

Assess the situation regarding prevention of illegal sales of tobacco in Thailand, according to the Protocol on the Elimination of Illicit Trade in Tobacco Products of the World Health Organization
Study the monitoring system and investigation of tobacco trafficking (tracking and tracing system) in other countries and analyze the appropriate guidelines for Thailand
The estimated amount and value of illegal cigarettes in Thailand with comparisons based on various methodologies
The relationship between tax rate adjustments in Thailand and smuggling in the tobacco trade. How much does it take to make the tax measures less effective than they should be? What is the proportion?
Survey of smoking behaviors and import of smuggled tobacco products at port of entry comparing foreign and Thai tourists

Research issues in Electronic Cigarette control measures

Perception and accessibility of new types of electronic cigarettes in youth groups
Review of vapor composition of electronic cigarettes and their health impacts
Review of whether the electronic cigarette is actually an aid in quitting smoking
Review of electronic cigarette control measures in various countries
Survey of electronic cigarette use in various populations in Thailand
The effect of electronic cigarettes on smoking initiation and smoking cessation in Thailand

Research issues in measures for the prevention of smoking initiation

Monitor and assess law enforcement on issues related to youth, such as no tobacco sales to minors under 20, no single stick sales, no CSR and controlling new forms of tobacco products.
Analyze the factors causing ineffective law enforcement, in terms of banning smoking and restricting youth access to tobacco products
Study the effects of smoking on child development and the health of children in families with smokers
Study the physical factors, communities, and social culture that contributes to youth smoking initiation
Study the new tactics and strategies of the tobacco industry that lures youth into smoking.
Effective communication so youth understand and can out-smart tobacco industry marketing strategies regarding new tobacco products and their harms
Preventing access to the tobacco product cycle among urban and rural youth in the groups with high tobacco problems.
Effects of access to retail shops on youth smoking behavior

Research issues in smoking cessation measures

Monitoring, assessing, and lessons-learned from the project “3 years – 3 million quit smoking throughout Thailand”
Assessment, screening and access to the quit smoking service of the health service system of the risk- group population
Integration of smoking cessation into different community levels through district and sub-district hospitals
Integration of smoking cessation into risk areas such as prisons, workers’ camps, and crowded communities through targeting them by the Health Service System
Comparing the effectiveness of various forms of smoking cessation in Thailand
Comparing the effectiveness of smoking cessation provided by health professionals versus other groups who have been trained to provide assistance in smoking cessation

Monitoring and evaluation of the enforcement of the Tobacco Product Control Act (B.E. 2560)

Assessment of law enforcement at community levels – at district – provincial level regarding the main points: selling single sticks, point of sale, sale of cigarettes to youth under 20 years of age, smoke-free public places, and implementation mechanism of the provincial board of tobacco control
Progress on the control and disclosure of ingredients in tobacco product components in Thailand