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Evidence for Smoking Cessation

Dr. Elinor Wilson

Heart and Stroke Foundation of Canada

With a total population in the Americas of 720.8 million people, 444.3 million in Latin America and the Caribbean alone, cardiovasular disease and stroke are the leading causes of death in 31 of the 35 countries that report mortality statistics.

The prevalence of tobacco smoking in Latin America and the Caribbean is 37% for men and 20% for women, with some populations reaching a rate as high as 50%.

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 of "prevention, protection and cessation" is commonly used to try to counter the tobacco industry.

Experience in both the United States and Canada 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. Moreover, there is some resistance to legislation to protect the public from secondhand smoke, especially in Latin America where people have not been as sensitized to the public health messages. Therefore, at least in the short term, smoking cessation is where the main gains will be made in tobacco control. Not only does smoking cessation assist the individual trying to quit, but it also allows adults who have quit to become better role models for children and creates a population more amenable to tobacco regulation. Latin America is ready for a concerted effort in smoking cessation.

Given the potential impact of smoking cessation interventions by health professionals, the US Agency for Health Care Policy and Research 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 at every intervention with the clinician and the health system 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. a
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").a

a. 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.

Currently, the InterAmerican Heart Foundation has developed and is implementing a multi-year, regional IAHF strategy aimed at clinicians and patients to reduce the prevalence of tobacco use in the Americas, particularly Latin America and the Caribbean, in conjunction with and by complementing the work of PAHO, CLACCTA and other organizations interested in tobacco control.

There is a massive epidemic of cardiovascular disease coming in Latin America. We need to dramatically reduce smoking rates to curtail the resulting epidemic of disease and, eventually, death caused by use of tobacco products.



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