Key findings

1. An international public health treaty on tobacco control came into force on 27 February 2005. This is the world's first public health treaty, the World Health Organization Framework Convention on Tobacco Control (FCTC), which was unanimously adopted by WHO's 192 Member States in May 2003. Currently, 152 Parties (countries) have ratified the FCTC; ratification binds a Member State to implement the provisions of the treaty. Article 14 covers tobacco cessation and treatment strategies.
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2. Increasing tobacco cessation is essential if we are to reduce the morbidity and mortality caused by tobacco use within the next 30 to 50 years. For example, the World Health Organization Tobacco Free Initiative states "Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2020. Half the people that smoke today - that is about 650 million people - will eventually be killed by tobacco."
   All of these are current tobacco users and, therefore, only interventions that encourage and enable them to stop will reduce this morbidity and mortality in the short to medium term.
   
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3. To be most effective, tobacco control efforts should be truly comprehensive, and include for example, mass media campaigns on tobacco and health issues, tobacco product advertising bans, increased taxation on tobacco products, bans on smoking in the workplace/public places and systematic access to treatment. The use of misleading labeling on tobacco products, for example, 'light' and 'mild', which may dissuade smokers from quitting and therefore undermine treatment, should also be banned. These policies act together to increase motivation to quit, encourage quit attempts, reduce per capita consumption, and help maintain abstinence. Treatment programs complement other tobacco control policies by enhancing/creating the availability of cessation support, thereby increasing the chances that a quit attempt will be successful. As the number of former tobacco users increases, support for tobacco control measures increases, with a positive impact on national health.
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4. A system of effective and cost effective smoking cessation support/treatment includes a range of treatments from minimal to intense (see Efficacy section). 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.
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5. Treatment is more likely to be offered and used if integrated into healthcare systems, including a system to identify smokers or tobacco users.
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6. Tobacco dependence and withdrawal syndromes are classified as substance use disorders under the World Health Organization International Classification of Diseases (ICD 10). The American Psychiatric Association has come to similar conclusions in its Diagnostic and Statistical Manual of Mental Disorders (DSM IV), although it uses the terms 'nicotine dependence' and 'nicotine withdrawal'. The more common general term used to describe these diseases is addiction. Official recognition of smoking as a dependence is important in encouraging governments to offer treatment to smokers.
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7. Evidence is emerging in high-income countries that smoking cessation interventions are very cost-effective in producing population health gain, compared with other preventive and medical interventions (see Economics section). The findings support the role of the healthcare system in prioritizing and funding smoking cessation interventions.
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