Boost treatment for tobacco dependence

This year, the World No Tobacco Day’s (WNTD-May 31) focus will be on plain packaging of tobacco products.

Several tobacco control measures were introduced in India during the last couple of years including a ban on tobacco products advertising, smoking at public places, text and pictorial health warnings on tobacco products.

The Secretariat of the WHO Framework Convention on Tobacco Control is now calling countries to get ready for plain (standardised) packaging of tobacco products on the No Tobacco Day. Plain packaging is an important demand reduction measure that reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of tobacco advertising and promotion, limits misleading packaging and labelling, and increases the effectiveness of health warnings.

This promises to be a preventive measure that will reduce prevalence of tobacco use in many countries including India. These are all good and positive demand side measures taken by an active health ministry in spite of severe opposition by the tobacco industry.

The questions still unanswered though are:  Are these active measures which will persuade tobacco users to quit? More importantly, are tobacco users quitting? Is quitting easy? Are users replacing tobacco with more dangerous and or addictive materials?
Plain packaging and pictorial warning are important in the fight against tobacco. However, these are not just the only reasons why users will quit using tobacco which is one of most addictive substances known to mankind. Studies conducted in 2013 in Gujarat and Andhra Pradesh reveals that about half of the patients who were tobacco users intend to quit tobacco due to personal health reasons.

Motivational factors

The findings of our study are clear: education, age, and number of quit attempts are important factors determining quitting behaviour. Motivational factors affecting quitting focussed on concerns for personal health, and setting an example for children. Other factors such as smoke-free laws and pictorial warnings were not reported as significant factors determining “setting a quit date”.

Similarly, other studies conducted across different states reported that price of tobacco, workplace restrictions etc were the least important reasons for thinking about quitting among tobacco users. 

That is not to suggest that measures such as increased taxation, smoke free laws, pictorial warnings and plain packaging should be discouraged, what we are suggesting is that demand side measures also need to be accentuated by active supply side measures such as offering tobacco users proven interventions such as active counselling and/ or pharmacotherapy for aiding quitting. Quitting tobacco is a dynamic process involving repeated attempts to quit.

There is a strong and urgent need for skilled cessation support via the health care providers/doctors in India. This can be judged from the finding that a quarter of the current tobacco users had made unsuccessful quit attempts in the past and many among them expressed a wish to quit tobacco in the future.

Many of these tobacco users present at health facilities with associated problems ranging from chronic cough to more serious infections like tuberculosis and a host of respiratory ailments and cardiovascular diseases.

It is highly unethical for doctors to treat these ailments while not offering treatment for tobacco dependence. Numerous studies have pointed out the fact that doctors are simply not offering evidence-based interventions such as simple advice and/or the use of pharmacotherapy to patients who are addicted to tobacco.

Part of the reason is doctors think quitting tobacco is a will power issue and does not warrant medical intervention. Nothing could be further than the truth. Tobacco is even more addictive than cocaine and other dangerous drugs. Doctors also think patients who want to quit are not serious enough and it is a waste of their time.

However, strong association has been observed between previous quit attempts with the “intention to quit” and “quitting.” It can be reasonably assumed that if skilled systematic support could be provided during the abstinence period, then the successful quit rates will increase in the future.

This WNTD, tobacco control advocates should actively promote tobacco dependence treatment along with plain packaging in order to curb the tobacco menace in the country.

(The writer is a senior public health specialist at Public Health Foundation of India and works on integrating tobacco cessation into primary healthcare)