HEALTH PROFESSIONALS

Health professionals have the greatest potential of any group in society to promote the reduction of tobacco use, according to the World Health Organization (WHO). Yet, there is still a misperception of nicotine’s harms among health-care professionals, which is not in the best interest of their patients.

QUITTING TOBACCO

The World Health Organization (WHO) reports: “Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double a tobacco user's chance of successfully quitting. Currently however, only 23 countries provide comprehensive cessation services with full or partial cost-coverage to assist tobacco users to quit. This represents just 32% of the world's population.”

Studies show that few people understand the specific health risks of tobacco, which include lung cancer, heart disease and stroke. Concise advice from health professionals can increase quitting success rates by up to 30%, while intensive advice increases the chance of quitting by 84%.

Under WHO’s Framework Convention on Tobacco Control (FCTC), countries are mandated to treat tobacco use and dependence. WHO provides capacity building and training packages to help governments establish or strengthen their national tobacco cessation systems. These include:

Integrating brief tobacco interventions into their primary care systems;
Developing national toll-free quit lines; and
Initiating m-Cessation projects.

Offering help to quit is also one of the five key interventions in the MPOWER package of technical measures and resources, which the WHO introduced in 2007.

SMOKING CESSATION TOOLKIT FOR PRIMARY CARE HEALTH PROFESSIONALS

The WHO has made a toolkit for smoking cessation interventions in primary care publicly available. It covers:

The unique role of health professionals in tobacco control
Counselling methods for complete smoking cessation, including the five A’s

FIVE A'S OF QUITTING ASK Systematically identify all tobacco users at every visit.

ADVISE Persuade all tobacco users that they need to quit.

ASSESS Determine readiness to make a quit attempt.

ASSIST Help the patient with a quit plan.

ARRANGE Schedule follow-up contacts or referral to specialist support.

HARM REDUCTION COUNSELLING

Despite best efforts, the fact remains that more than 70% of smokers want to quit; only 44% actually attempt to quit and merely 4 to 7% succeed.”

Where quitting has been impossible, tobacco harm reduction is the next best alternative for people who smoke cigarettes. Recommendations to health professionals:

Be reassured that harm reduction is endorsed in Article 1 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC), which is supported by many scientists and policy experts worldwide.
Tobacco and nicotine products can be placed on a continuum of harm – from the most harmful of combusted tobacco – to much lower harms of non-combustible nicotine delivery with or without tobacco, including Nicotine Replacement Therapy (NRT).
When counselling people who smoke:
- Be mindful of your ethical responsibilities as a health professional.
- First, do no harm. It is an opportunity lost, by not advising your patients about the dangers of smoking.
- Show empathy, encourage perseverance: Reassure patients, not to be too hard on themselves if they have been unsuccessful in quitting.
- On average, six to seven efforts are needed to quit smoking. The key is not to stop trying.
- Focus on finding a solution and reducing harm in each individual patient, including reduced risk products.
- Become fluent in the language of tobacco harm reduction ─ aside from the term ‘quit’, add words like ‘switch’.
- Gain understanding of reduced harm products.

For net public health benefit, the trend towards switching from high-risk smoked products such as cigarettes – to low risk, smoke-free products such as e-cigarettes, heated tobacco products and smokeless tobacco, should be accelerated.READ MORE
Understand the basic mechanism of nicotine absorption and distribution in the body. This needs to be considered when prescribing medicinal nicotine for patients or recommending reduced risk nicotine alternatives like e-cigarettes.READ MORE
E-cigarettes, also known as vaping, are smokeless, reduced-nicotine products that have been proven 95% less harmful than combustible tobacco. Vaping is highly effective in helping smokers quit and supports long-term smoking relapse prevention.READ MORE
Quantify the dependence on nicotine – to help reinforce the need to quit smoking. Here, a useful test is the Fagerström test for cigarette dependence.READ MORE
Oral Nicotine Pouches, including Nicotine Replacement Products (NRTs), play an important role in smoking cessation to help reduce smoking-related death and disease.READ MORE

ADDITIONAL READING:

Anti-tobacco group wants ‘balance’ in vaping policies and media coverage

Kenneth Warner and David JK Balfour

Tobacco Harm reduction in the 21st Century

O'Leary and Polosa

Nicotine without smoke - Tobacco Harm Reduction

Royal College of Physicians