Smoking cessation: health system challenges and opportunities

Abstract

The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation. We argue that the provision of smoking cessation services in clinical settings is a fundamental clinical responsibility and permits the opportunity to more effectively assist with cessation. The role of clinicians in prioritising smoking cessation is essential in all settings. Clinical benefits of implementing cessation services in hospital settings have been recognised for three decades—but have not been consistently provided. The Ottawa Model for Smoking Cessation has used an ‘organisational change’ approach to its introduction and has served as the basis for the introduction of cessation programmes in hospital and primary care settings in Canada and elsewhere. The significance of smoking cessation dwarfs that of many preventive interventions in primary care. Compelling evidence attests to the importance of providing cessation services as part of cancer treatment, but implementation of such programmes has been slow. We recognise that the provision of such services must reflect the realities and resources of a particular health system. In low-income and middle-income countries, access to treatment facilities pose unique challenges. The integration of cessation programmes with tuberculosis control services may offer opportunities; and standardisation of peri-operative care to include smoking cessation may not require additional resources. Mobile phones afford unique opportunities for interactive cessation programming. Health system change is fundamental to improving the provision of cessation services; clinicians can be powerful advocates for such change.

Prevalence of non-communicable diseases and its association with tobacco smoking cessation intention among current smokers in Shanghai, China

“…Smoking cessation is the most powerful and cost-effective intervention, which improves the overall health and quality of life among smokers, especially those with NCD 34 . In this study, less than half of current smokers had intention to quit in a year, which was lower than the findings in previous studies 15 , 19 .…”

The estimated influence of assumed physicians’ advice for tobacco smoking cessation among current smokers in Shanghai, China: A cross-sectional study

“…This study demonstrated that smokers with NCD were more sensitive to the assumed smoking cessation advice from physicians, these findings are consistent in the subgroup analysis (both in male and female smokers, and in smokers of all ages), this might be due to the fact that smokers with NDC were worried about their disease progression. A previous study showed that illness can be a powerful motivation to quit among smokers 9 . So, in order to curb the high smoking prevalence and promote smoking cessation, it is crucial to pay special attention to smokers with NCD, provide professional smoking cessation counselling, psychological support and individualized treatment based in the clinical setting, which can effectively improve the success of smoking cessation among current smokers.…”

“…The finding in this study was in line with previous studies 5,22 . A robust body of literature has demonstrated that brief smoking cessation advice from a healthcare provider during usual medical consultation could encourage smoking cessation 9,20,21,39 .…”

“…The finding in this study was in line with previous studies 5 , 22 . A robust body of literature has demonstrated that brief smoking cessation advice from a healthcare provider during usual medical consultation could encourage smoking cessation 9 , 20 , 21 , 39 . A meta-analysis showed that the smoking cessation rate among smokers who followed physicians’ advice was apparently higher than those without physicians’ advice 34 .…”

“…In order to respond to the globalization of the tobacco epidemic, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was adopted by the 56th World Health Assembly in 2003 and became international law in 2005 8 . The WHO FCTC and its associated guidelines provide the foundation for tobacco control management and implementation 9 . In 2008, the WHO identified 6 evidence-based tobacco control measures to reduce tobacco use at the country level 10 .…”