Recommendations

• Cessation interventions (counseling and pharmacotherapy) should be covered under both public and private health insurance plans.
• In regions or countries where cost is a barrier to access, effective population-based tobacco control interventions (e.g. higher tobacco taxes, smoke-free policies) and low-cost individual-level interventions (e.g. brief doctor’s advice, counseling via phone, email, or chat rooms, the use of self-help materials) should be utilized to help smokers quit and maintain abstinence.
• Smoking cessation promotion is cost-effective when NRT products are used. NRT combined with face-to-face or telephone counseling is more cost-effective compared to NRT or counseling alone; therefore, the combination should be promoted when economically feasible.
• As a viable, effective and cost-effective treatment, NRT should be available and affordable for general sale (over-the-counter, OTC).
• Smoking cessation services should be made available above all to population groups with higher prevalence of tobacco use (e.g. low income groups, the less educated, those diagnosed with mental illness). Such a focus would reduce the disparities in health attributable to tobacco use. Interventions must be tailored to reach high-risk populations, including pregnant women, youth who use tobacco, itinerant workers, language minorities, those mentally ill, and other groups for which recruitment into cessation programs is a special challenge. In light of the obstacle that longer smoking duration poses to successful cessation, programs to prevent uptake and to prompt early cessation are crucial.
• Research should continue on factors affecting cessation among youth, the costs and cost-effectiveness of smoking cessation interventions as well as of cessation interventions for non-cigarette forms of tobacco (smokeless tobacco, cigar or pipe smoking).
• Given the very limited research on the economics of smoking cessation, development of adequate surveillance systems should be a priority and research and evaluation should be included as key elements.
• Simple briefs outlining the social and economic benefits of smoking cessation should be prepared and disseminated among political decision-makers to promote understanding and to support the drafting and implementation of strong public policies and effective public health strategies.