Overcoming barriers to disseminate effective smoking cessation treatments globally

Sudhanshu Patwardhan,Jed E Rose

doi:10.1108/dat-01-2020-0001

Abstract

Purpose The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies. Design/methodology/approach A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally. Findings Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling. Originality/value Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.

Highlights

Low uptake and success of smoking cessation treatments and services by women who smoke during pregnancy remains an unaddressed challenge (Smokefree in Pregnancy Challenge Group, 2019). This is compounded by the fact that there is limited clinical trial data on varenicline’s safety for use among pregnant women who smoke (Tran et al, 2020)
We need a medication that is more effective than nicotine replacement therapy (NRT) or bupropion but does not have the side effect profile exhibited by varenicline
The authors’ latest research in the UK and India suggests that myths persist among health-care practitioners’ (HCPs) about the role of nicotine in the harms from tobacco smoking, where more than 50% of the sampled HCPs wrongly believing that nicotine from tobacco smoke causes cancer

Summary

Introduction

Smoking is a leading cause of preventable death and disease globally. “Smoking cessation” or “quitting smoking” is to completely stop smoking combustible cigarettes. Nicotine is the addictive element of tobacco, but it is the tar and other toxicants in tobacco smoke, not nicotine, that cause most of the harm. The principle of tobacco harm reduction, where adult smokers eventually completely switch to non-combustible nicotine-containing products, can be applied to achieve and maintain cessation (adapted from ASH UK). (Information about the authors can be found at the end of this article.). The full terms of this licence may be seen at: http://creativecommons. org/licences/by/4.0/legalcode

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