World No Tobacco Day 2021: Quitters are winners but do people receive equal help to quit?

More than 8 million people die of tobacco use each year. So today, 31^st May, we observe World No Tobacco Day by bringing awareness to interventions that help people quit.

Over 80% of the world’s 1.3 billion smokers live in low and middle-income countries.¹ In most countries, smoking prevalence is negatively associated with education levels, affluence, and mental health.² Further, there are inequalities in the interventions, awareness and support programs available across countries and communities.¹

Can we move towards a smoke free future for all?

The World Health Organization (WHO) launched World No Tobacco Day in 1987 to bring global awareness to diseases and the premature deaths caused by tobacco use. Despite some progress to reduce smoking prevalence in high-income countries over the last few decades, the impact on the most deprived smokers with underlying health conditions is worsening and there has been a steady decrease in available support to quit and reduced attention to the problem.³

In England, smoking prevalence is up to four times higher amongst adults with underlying issues such as mental illness, homelessness and substance dependence.³ These inequalities have led to plans to achieve a smoke-free future with the development of the Tobacco Control Plan to be published this summer. This plan has the aim to decrease smoking prevalence to less than 5% by 2030. This poses quite the challenge as currently it is around 14.5%.⁴ To achieve this ambitious goal, extra effort and attention are needed to help smokers.

What role can pharma play?

The combination of pharmacological support integrated with behavioral therapies and community-based interventions is most effective in getting people to quit smoking.⁵ This provides an opportunity for pharma companies to create support programs to deliver alongside their pharmacological products. These programs may require a reasonable investment, but the likely return includes a higher quit rate, a positive response on clinical outcomes and additional market value for their products.

Insights from a world leading expert

For World No Tobacco Day, we spoke to one of the world’s leading experts of Tobacco cessation, Professor Robert West. He is an Emeritus Professor from the University College London (UCL), teaching and researching in the Department of Epidemiology and Public Health. He has been involved in developing evidence-based guidelines on smoking cessation for health professionals and is an active researcher in clinical and behavioral aids to smoking cessation.

Q1) I was really interested to read in your recent paper (Birch et al. 2020) that COVID-19 has been a trigger for some people to quit smoking. In your view, how could we best support people who want to quit smoking during the pandemic?

The evidence is clear that a combination of behavioural and pharmacological support gives the best chances of stopping smoking and I do not think this would be any different for people trying to stop because of worries about Covid-19. Unfortunately, this support is either not available or affordable for most people, which is something that governments need to address. However, there are affordable treatments available which are safe and very effective. One of these is called cytisine – a tablet that is very effective in reducing cravings and helping with quitting and costs very little.

Q2) This paper also discussed the conflicting information and lack of evidence for the idea that nicotine could have a protective effect against COVID-19. People may also have misconceptions about the safety of e-cigarettes. How important is it to address beliefs such as these in smoking cessation interventions? Does addressing misconceptions about nicotine and e-cigarettes help people to quit?

It is very important to ensure that people have accurate information about things affecting their health, but also to acknowledge uncertainty when it exists. With regard to nicotine being protective against Covid the evidence is complex and it is not clear what is going on. With e-cigarettes we can be very confidence that they are a lot less harmful than smoking but almost certainly carry some risk.

Q3) The UK is seen as an example of successful smoking cessation policies and interventions in the past decade. However, smoking-related diseases still affect a great number of people especially people from the poorest and most socially disadvantaged communities. We know that COVID-19 has increased inequalities and exacerbated this scenario (Marmot et al. 2020). What should the main priorities be for helping smokers from socially disadvantaged communities to quit?

We should ensure that everyone who wants or needs support for quitting gets the best evidence-based help to do so. Unfortunately, this is no longer the case as the services that used to be available to smokers are no longer available in many areas.

Learn more about World No Tobacco Day and their listed events here.

References:

1. WHO. Tobacco. WHO International. Accessed on 27 May 2020 https://www.who.int/news-room/fact-sheets/detail/tobacco

2. Action on smoking and health. Fact Sheets. ASH. 1 September 2019. https://ash.org.uk/wp-content/uploads/2019/08/ASH-Factsheet_Mental-Health_v3-2019-27-August-1.pdf

3. Marmot, Michael. “Health equity in England: The Marmot review 10 years on.” BMJ. 368 (2020).

4. Sharon Cox. “Sharon Cox: Are we ready to achieve a smoke free future?. BMJ. 20 April 2021. https://blogs.bmj.com/bmj/2021/04/20/sharon-cox-are-we-ready-to-achieve-a-smoke-free-future/

5. Ziedonis, D., Das, S., & Larkin, C. (2017). Tobacco use disorder and treatment: New challenges and opportunities. Dialogues in Clinical Neuroscience, 19(3)271–280.