The missing link in tobacco control

• Published in: Canadian Medical Association journal (CMAJ) 2008-07, Vol.179 (2), p.123-124
• Main Authors: Ebbert, Jon O, Hays, J Taylor
• Format: Article
• Language: English
• Subjects: Bupropion; Care and treatment; Disease prevention; Drug therapy; Female; Global Health; Health aspects; Humans; Intervention; Male; Nicotiana; Primary Prevention - methods; Risk Factors; Sensitivity and Specificity; Smoking - mortality; Smoking cessation; Smoking cessation programs; Smoking Prevention; Substance abuse; Survival Rate; Tobacco; Tobacco Industry - legislation & jurisprudence; Tobacco Use Disorder - prevention & control
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.080855

For countries that lack essential health care infrastructure, the challenges of treating tobacco dependence are substantial and clear. However, for industrialized nations with both the resources and infrastructure to substantially improve public health, barriers to widespread dissemination of effective treatments of tobacco dependence are insidious and multifaceted. Within the clinical setting, barriers include a primary emphasis on medically urgent issues, lack of time and support, inadequate training and low self-confidence among providers, and low rates of reimbursement for tobacco-treatment services.6 At the population level, barriers include a lack of political will to restrict tobacco companies and to promote and disseminate the most effective tobacco control policies (e.g., smoke-free indoor air policies and higher tobacco taxes). In addition, local governments often divert funding intended for tobaccotreatment services to make up for budget shortfalls. However, many governments have invested political and fiscal capital to assist the expansion of "quitlines" - telephone counselling services for tobacco users. Tobacco quitlines have been shown to increase abstinence rates compared with minimal or no counselling, and to engage large numbers of smokers.5 Tobacco quitlines frequently recommend or provide nicotine replacement therapy to callers. They also provide a potential platform for the dissemination of effective pharmacotherapies. In another paper in this issue of CMAJ, Cunningham and Selby7 address the issues of dissemination head-on by assessing the receptiveness of smokers to receiving nicotine replacement therapy. Through a Canadian population survey using random digit dialing, the authors contacted 825 daily smokers and asked whether they would be interested in receiving free nicotine replacement therapy and, if so, how they would use it. Most of the respondents expressed an interest. Among these smokers, virtually all indicated they would use it to "quit for good," and more than 60% would begin use within 1 week of receiving it. Interestingly, 57.8% of the smokers who intended to reduce their smoking, and 42.4% of those who intended to maintain their smoking, said they would also be receptive to receiving nicotine replacement therapy. As the authors appropriately highlight, self-reports of intention do not predict behaviour. But this study opens the door to the development of programs to disseminate effective pharmacotherapies to a large num