[ Scientific Activities - Actividades Científicas ]Summary of a Presentation on Tobacco Control
Dr. Elinor Wilson
PanAmerican Health Organization
The Tobacco Epidemic
The current 3.5 million annual deaths worldwide from tobacco will increase to 10 million deaths by 2025 unless concerted action is taken immediately. Further, as marketing by multi-national tobacco companies is curtailed in developed countries, these companies are turning more and more to ever-growing markets in the developing nations, including Latin America and the Caribbean.
The Comprehensive Approach
The comprehensive approach of ôprevention, protection and cessationö is commonly used to try to counter the marketing efforts of the tobacco industry. The premise is that if you use this three-pronged approach to prevent youth from starting to smoke, protect people from secondhand smoke and help smokers quit smoking, it should be possible, over the long term, to counter the epidemic.
However, experience has shown that tobacco use prevention efforts have not been as effective as had been hoped. Smoking rates are actually increasing in young people, many of whom will go on to smoke for at least 20 years. There is also some resistance to legislation to protect the public from secondhand smoke. Therefore, at least in the short term, smoking cessation is where the main gains will be made in tobacco control, and certainly the approach that will have the most immediate impact on morbidity and mortality rates. In addition, as smoking cessation also allows adults who have quit to become better role models for children and creates a population more amenable to tobacco regulation, it can arguably be considered the foundation of the comprehensive approach to tobacco control.
The Evidence for Increased Efforts in Cessation
Given the overwhelming scientific evidence confirming that tobacco use is responsible for this growing and global epidemic of death and disease, the 10th World Conference on Tobacco or Health, held in Beijing, China, August 24-28, 1997 made the following resolution with respect to stopping tobacco use:
"The conference recommends that, given the only way to save millions of lives by reducing the projected global tobacco-related death toll, which is over 100 million deaths over the next twenty years; i. the public health community make strenuous efforts to help people stop using tobacco products."
In addition, given the potential impact of smoking cessation interventions by health professionals, The U.S. Agency for Health Care Policy and Research recently published "Smoking Cessation, Clinical Practice Guideline Number 18". It states:
"Tobacco use has an enormous impact on health . . . yet smokers enter and exit the health care system each day without receiving treatment for this important health risk. Clinicians have unique access to individuals who use tobacco ... [and should] be offered motivational interventions and effective treatments to overcome this powerful addiction." (Adapted from p. 3, "Smoking Cessation, Clinical Practice Guideline Number 18.")
After an exhaustive and systematic review and analysis of the scientific literature, the guideline's principal findings are:
1. Every person who smokes should be offered smoking cessation treatment at every office visit.
2. Clinicians should ask and record the tobacco-use status of every patient.
3. Cessation treatments even as brief as 3 minutes a visit are effective.
4. More intense treatment is more effective in producing long-term abstinence from tobacco.
5. Nicotine replacement therapy (nicotine patches or gum), clinician-delivered social support, and skills training are particularly effective components of smoking cessation treatment. (As this guideline went to press, nicotine nasal spray was approved for use in the United States by the Food and Drug Administration, joining the nicotine patch and gum as effective available interventions).
6. Health care systems should make institutional changes that result in the systematic identification of, and intervention with, all tobacco users at every visit. (p. 3, "Smoking Cessation, Clinical Practice Guideline Number 18")
Background on the Guide Your Patients to a Smoke Free Future Program
The Guide Your Patients to a Smoke Free Future (GYP) program addresses all of the above recommendations. It has been adopted to use within the InterAmerican Heart Foundation (IAHF) for the Latin American culture. The program is based on the following major principles:
1. Counseling to change health behaviour, including:
- understanding Prochaska's stages of change;
- using stage-matched change techniques; and
- building and maintaining motivation.
2. The most effective approach to counseling uses the following key elements:
3. Health professional education in the treatment of nicotine addiction.
4. Environmental changes that can be made in the office, clinic or hospital that allow for the systematic identification and intervention with every tobacco user.
There is a massive epidemic of cardiovascular disease coming in Latin America. The IAHF and its member organizations are trying to address in a very short time what took 30 years to learn about in the developed world. We need to dramatically reduce smoking rates to curtail the resulting epidemic of disease and, eventually, death caused by use of tobacco products. In keeping with the current scientific literature, the IAHF has chosen to emphasize professional education in smoking cessation interventions in its plans for the coming years. However, only a comprehensive and collaborative approach of prevention, protection and cessation that incorporates public awareness, professional education and effective public policy will curb the marketing efforts of the tobacco industry in the long run. It is therefore incumbent upon all of our organizations to share information on our tobacco control efforts and work together whenever possible to reduce the effects of the worldwide tobacco epidemic.
By the year 2020 CVD will be the leading cause of death in all countries with the exception of sub-Sahara Africa.
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