Tobacco smoking: Health impact, prevalence, correlates and interventions

Abstract

Background and objectives: Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the extent and nature of harms caused by smoking, the benefits of stopping, patterns of smoking, psychological, pharmacological and social factors that contribute to uptake and maintenance of smoking, the effectiveness of population and individual level interventions aimed at combatting tobacco smoking, and the effectiveness of methods used to reduce the harm caused by continued use of tobacco or nicotine in some form. Results and conclusions: Smoking behaviour is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behaviour. Raising immediate concerns about smoking by tax increases, social marketing and brief advice from health professionals can increase the rate at which smokers try to stop. Providing behavioural and pharmacological support can improve the rate at which those quit attempts succeed. Implementing national programmes containing these components are effective in reducing tobacco smoking prevalence and reducing smoking-related death and disease.

Health behaviour: Current issues and challenges

“…Rhodes et al (2017) found little evidence that mode of delivery moderated the effectiveness of physical activity interventions, although West (2017) noted that the chances of stopping smoking are highest when smokers use specialist face-toface behavioural support (along with either varenicline or nicotine replacement therapy). Online interventions are typically found to have small, but significant, effects on health behaviour (Webb et al, 2010), in line with many health behaviour interventions delivered via other modalities.…”

“…For example, as Kunstche et al (2017) note, increasing the price of alcohol (through minimum pricing legislation or increased taxation) is the most effective policy instrument to reduce alcohol consumption at a population level. West (2017) also highlight that increasing the cost of smoking is likely to lead to reduced levels of smoking given that for every 10% increase in the cost there is a corresponding 4% decrease in the number of cigarettes purchased. Considering changes to the physical environment, Kunstche et al (2017) highlight that there is some evidence that restricting alcohol sales on US college campuses, for example through reducing outlet density and hours of sales, can reduce student drinking.…”

“…Unfortunately, although there is a growing body of research that details variations in health behaviours across the population, there is also considerable unevenness in the data and its availability. A lot more is known about the distribution of behaviours such as smoking (West, 2017) and physical activity (Rhodes et al, 2017) than about binge drinking (Kuntsche et al, 2017) and healthy diet (de Ridder et al, 2017). The surveillance of health 6 behaviours using standard definitions and measures across countries (as is being explored in the EU) could contribute to furthering our understanding of both the determinants and consequences of these behaviours.…”

“…However, such comparisons of data across countries are dependent on common approaches to defining and measuring health behaviours. Unfortunately we are some way from such common approaches in relation to diet (de Ridder et al, 2017) and binge drinking (Kuntsche et al, 2017) although we may be somewhat closer in relation to smoking (West, 2017) and physical activity (Rhodes et al, 2017).…”

“…Of more consequence may be the application of definitions of health behaviours in health recommendation to different groups. For example, Rhodes et al (2017) West (2017) points out that the focus on daily, 7 day or 28 day prevalence of smoking and the inclusion of cigarillos or not compromises comparisons of smoking data across countries. In addition, Kuntsche et al (2017) comment on the problems of making comparisons between countries when the countries differ in the average amount of alcohol in a served unit or standard drink (varying between 6 and 12 grams of pure ethanol) and the period over which recall is requested (from 7 days to 12 months).…”