Key findings

An international public health treaty on tobacco control

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, 172 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.
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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.
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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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8. In countries where the tobacco control movement is long-standing and well established and where the health consequences of tobacco use are broadly understood and accepted, the majority of tobacco users want to stop their tobacco use and one-third or more cigarette smokers attempt to quit annually. However, even in countries where tobacco control policies are well advanced, only a very small percentage of cigarette smokers each year achieve lasting abstinence and leave the pool of smokers by cessation (0.5-5%) as opposed to death. This is because most attempts to stop are unsuccessful, partly because nicotine dependence is a chronic, relapsing disorder. In addition, many tobacco users attempt to stop without any behavioral or pharmacological assistance.
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9. Post-certification training increases the likelihood of healthcare professionals intervening with smokers. Since their interventions have themselves been shown to be effective, then training seems very likely to improve outcomes, although this has not been directly demonstrated through research.
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10. Mass media campaigning (such as the use of advertising or news coverage on the health risks of smoking) that motivates tobacco users to quitcan encourage tobacco users to seek help in giving up.
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11. Cost of pharmacological treatments appears to influence usage, with lower cost increasing usage.
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12. Increasing the availability (i.e. moving from prescription-only to pharmacy or general sale, where appropriate) of pharmacological treatments increases usage. This probably increases overall cessation attempts and successful cessation efforts although the data for this are as yet inconclusive.
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13. Although cessation is the primary approved indication for the use of NRT products by national regulatory authorities and the European Union, having an indication for NRT products to be used alongside a reduction in cigarette consumption, as a first step towards quitting, can help attract more smokers into quit attempts and reduce the harm from their smoking.
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14. Harm reduction approaches can reduce the harm caused by tobacco use for those who cannot or will not stop.
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15. Increasing cessation of tobacco use is likely to support efforts to prevent young people from using tobacco.
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