, by Michele Bloch, MD, Ph.D., NCI Division of Cancer Management and Population Sciences and Mark Parascandola, Ph.D., MPH, Center for Global Health
Tobacco use is one of the world’s leading causes of death. Despite progress in reducing tobacco use, especially in high-income countries such as the United States, the global death toll remains enormous. The World Health Organization (WHO) estimates that more than 8 million deaths a year are attributed to tobacco use, including more than 1.2 million deaths among non-smokers exposed to secondhand smoke. Because tobacco is a leading cause of cancer deaths, strong implementation of effective tobacco control measures is critical to reducing the global cancer burden. The WHO has established World No Tobacco Day, which is celebrated every year on 31 May, to raise awareness of the extraordinary health hazards of tobacco use. This year’s World No Tobacco Day theme – “Commit to Quitting” – is an opportunity to highlight the importance of quitting and to encourage countries, health systems and public and private organizations to reach the world’s 1.3 million tobacco users to help quit.
The U.S. Surgeon-General has found that, regardless of age or duration of smoking, quitting reduces the risk of disease and increases life expectancy. Furthermore, because quitting reduces the significant financial burden of tobacco use, people who quit have more money to spend on food, housing, health care, children’s education and other household needs. Quitting also reduces the risk that families will lose the earning capacity of working-age adults – often the “breadwinners” for families – through tobacco-related illness or death. As a result, quitting tobacco benefits the individual, the family, and the community. However, it is often difficult to quit smoking. Many people who used tobacco as children or adolescents started, a time when the brain is still developing and when nicotine exposure can facilitate later tobacco dependence(1). Fortunately, there are many effective strategies to help tobacco users quit forever.
The aim of the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) – the first international treaty negotiated under the auspices of the WHO – is to improve global health by preventing and controlling tobacco use. Evidence-based policies promoted by the WHO FCTC are a particularly powerful tool for promoting cessation at the population level. As explained in NCI’s Tobacco Control Monograph 21, The Economics of Tobacco Use and Tobacco Control, published in 2016 in collaboration with the WHO, “Tobacco control policies, such as increased taxes, anti-smoking media campaigns, and comprehensive smoking-free policies, increase the demand for treatment for tobacco dependence and the rates of subsequent cessation. ”
Research conducted over many decades and in many countries has established that significant increases in excise duty and price of tobacco products are the single most consistently effective tool to reduce tobacco use. As a result, significantly higher tobacco taxes motivate tobacco users to quit and reduce both the frequency and intensity of consumption among continuing users. In addition, evidence shows that robust tax policies can be even more effective in low- and middle-income countries (LMICs) and for low-income populations in high-income countries. However, most countries still have to use tobacco taxes to the full capacity recommended by the WHO.
Mass media campaigns against tobacco also increase cessation rates and the use of cessation cessation lines and smoking cessation treatments. In the United States, the Centers for Disease Control and Prevention’s Tips from Former Smokers® campaign, which includes the “stories of real people living with smoking-related illnesses and disabilities”, has helped an estimated 1 million people quit smoking and helped reduce smoking-related health care costs by an estimated $ 7.3 billion between 2012-2018 . Media campaigns are particularly important in LMICs, where awareness of the health risks of tobacco use and resources to quit are generally low.
Comprehensive non-smoking policies eliminate secondhand smoke exposure, a cause of serious illness and death, including cancer deaths, among non-smokers. Non-smoking policies are particularly beneficial for infants, children and women, who (in many countries) are much less likely than men to smoke themselves. But the benefits of non-smoking policies are much wider; they promote social norms against tobacco use and facilitate quitting by encouraging quitting attempts among smokers and increasing the likelihood of successful cessation among those who try. The WHO FCTC requires that parties to the treaty implement comprehensive non-smoking policies, and many have already done so. In the United States, it is estimated that 60% of the population is protected by comprehensive non-smoking laws.
In addition to policy levers, providing cessation assistance to tobacco users is both effective and cost-effective. Healthcare systems play a central role in promoting cessation and in providing treatment for tobacco dependence. Every encounter with the health care system is an opportunity to look for tobacco use and offer secondhand smoke and offer help to quit. In addition to the inclusion of primary care interventions, cessation counseling and treatment can be provided as part of health services for specific populations, including pregnant women, people living with HIV / AIDS, and people receiving treatment for tuberculosis, diabetes and other chronic health conditions, among many others. Addressing tobacco use is also important in the context of cancer care(2) because stopping can improve outcomes for cancer patients. In 2017, the NCI launched the Cancer Center Cessation Initiative to help NCI-designated Cancer Centers regularly address the tobacco cessation with their patients.
Telephone stop lines and digital health modalities are effective ways to dramatically expand the reach of the healthcare system. In the U.S., quitting assistance is available by calling 1-800-QUIT-NOW and through NCI’s Smokefree.gov initiative, in addition to resources available through states and locations. Stoplines and innovative use of technology, such as the delivery of strike support through text messaging and mobile applications, have given particular promise to LMICs and hard-to-reach populations given the strong penetration of mobile phones worldwide.
Healthcare workers – doctors, nurses, dentists, pharmacists and others – are important role models for tobacco-free norms and are often the people who provide motivation and guidance to quit. However, far too many healthcare workers are themselves tobacco users. A recent systematic review of studies conducted in 63 countries estimated that the overall prevalence of tobacco use among health care workers was 21%, including 31% of men and 17% of women. Healthcare workers who use tobacco are less likely to address tobacco dependence among their patients, and less likely to be effective at doing so.
World No Tobacco Day 2021 is accompanied by a year-long campaign – focusing in particular on high-burden countries such as the US – to help as many as 100 million tobacco users quit. World No Tobacco Day is an opportunity for NCI to emphasize that, despite progress, tobacco use remains a leading cause of cancer deaths in the US and around the world, and that quitting can be life-saving, regardless of the person’s age or duration. of use. tobacco. Countries that implement evidence-based policies and help people who use tobacco to quit can expect to reap significant benefits, including reduced cancer deaths, reduced health care costs, and improved economic status for individuals, families, and communities.