Policy

Policy section last updated: February 2011

Suggested citation style: Treatobacco.net. Safety section, Key finding on NRT and cardiovascular disease, http://www.treatobacco.net/en/page_171.html, accessed 18.02.11.

Introduction

The purpose of this policy section is to provide information on policies concerning the treatment of tobacco dependence and to highlight important policy documents. This is a review of the main policy options for the treatment of tobacco dependence and of policies in place. It is based on the evidence presented largely from other sources and hence strength of evidence statements are not given here. Sources of evidence supporting this summary appear in the next level of this section.

Terminology

For the sake of brevity, the term smoking, where used, should be taken to include all tobacco use. It is true that the vast majority of tobacco dependence treatment studies have been conducted on cigarettes smokers with the intent of assisting smoking cessation efforts and it is plausible that treatment models will need to be adjusted to address dependence to other tobacco products. Nonetheless, the major biological commonality across tobacco products is dependence to nicotine and therefore, it is recommended that other forms of treatment for nicotine dependence sustained by different tobacco products build on what is known in the treatment of cigarette smoking. This is recommended to clinicians and policy makers as a “going forward” approach but it clearly also highlights the need for further research on nicotine dependence sustained by the use of noncigarette forms of tobacco.

A range of tobacco control strategies can encourage smokers to make attempts to quit. These include taxation, smoke-free policies, advertising bans, mass media and media advocacy campaigns, product regulation, restrictions on sales outlets, labeling policies and consumer education. These strategies must therefore be included when considering policies that impact on cessation. It is important to recognize that different individuals may respond to different approaches and that approaches must be relevant and feasible with consideration given to the population and the country or region. The key guiding principle should be to achieve a diverse mix of evidence based principles to the greatest extent possible, e.g., combining education, taxation, clean air laws, and providing access to treatment.

The term smoking cessation includes all tobacco cessation, whether it occurs as a result of broader tobacco control measures or individual support of dependent smokers through treatment or outside of treatment, e.g., spontaneous cessation, and cessation in response to illness or increased cost of cigarettes. Tobacco dependence treatment is the narrower activity of helping and supporting tobacco users overcome their dependence on nicotine and may be most effective in the context of comprehensive tobacco control efforts including education, workplace smoking restrictions, and increased tobacco product cost. The definition of tobacco dependence treatment below, which includes a definition of smoking cessation specialist, is based on the World Health Organization's European guidelines (Raw et al., 2002):

"Tobacco dependence treatment includes (singly or in combination) behavioral and pharmacological interventions, such as brief advice and counseling, intensive support, and administration of pharmaceuticals, that contribute to reducing or overcoming tobacco dependence in individuals and in the population as a whole. A smoking cessation specialist is someone trained and paid to deliver skilled support to smokers who need help in stopping, over and above brief opportunistic advice. They need not be medically trained but should not be offering this support unpaid and squeezed into their normal work, as the evidence suggests that this is not effective".

Some of the strategies outlined in the second paragraph above may have a synergistic effect with tobacco dependence treatment policies, so that when implemented together they have a greater impact on successful quitting than if implemented alone. This is discussed further under Key Finding 3 below.

Article 14 of the Framework Convention on Tobacco Control (FCTC) concerns tobacco dependence treatment and is described in detail under the first key finding.

Raw M, Anderson P, Batra A, Dubois G, Harrington P, Hirsch A, Le Houezec J, McNeill A, Milner D, Poetschke Langer M, Zatonski W. World Health Organization. European Partnership Project to Reduce Tobacco Dependence. WHO Europe evidence based recommendations on the treatment of tobacco dependence. Tob Control. 2002; 11(1): 44-46.