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Proceedings INGCAT International
NGO MObilisation Meeting
Geneva, 15-16 May, 1999.

Health Care and Smoking Cessation
Dr. Jean-Francio Etter
Institut de Medecine Sociale et Preventive, Universite de Geneve

Given the long delay between smoking initiation and the occurrence of smoking related diseases, most smoking related diseases, most smoking attributable deaths in the next 30 years will occur in persons who already smoke today. Consequently, the implementation of effective smoking cessation interventions on a wide scale seems necessary.

Since large numbers of smokers are in contact with the health care system every year, health care settings are an adequate place to implement smoking cessation interventions. Several guidelines for smoking cessation were issued in recent years, including guidelines from the British Thoracic Society, the U.S. Department of Health and Human Services, and the American Psychiatric Association. These guidelines recommend that health care systems should be modified to routinely intervene with tobacco users. Advice to clinicians includes:

- Assess smoking behavior in all patients at every visit,
- Advice all smokers to quit,
- Assist patients in smoking cessation, in particular by organizing follow-up and prescribing nicotine replacement therapy.

The AHCPR and BTS guidelines also formulate recommendations for health care administrators, commissioners, insurers and purchasers, including the funding of smoking cessation services and therapies, training programs, and evaluating these interventions. These guidelines could be used as basic working documents for NGOs present at the meeting.

At present, the implementation of the guidelines recommendations in health care settings is far from perfect. There is a role for NGOs in encouraging the implementation of smoking cessation interventions in population settings and health care settings.

Working group report
Jean-Francois Etter, Facilitator NGOs: American Cancer Society, International Council on Alcohol and Addictions, International Council of Nurse. International Federation of Pharmaceutical Manufacturers Associations, Smoking and Heath Action Foundation, International Union Against Cancer, World Heart Federation, World Self Medication Industry

Long-term goals:

  • Education about cessation should be provided to all health professionals (especially doctors, nurses and pharmacists), policy makers, smokers, and prevention experts.

  • Barriers to aiding cessation need to be addressed. These include: lack of reimbursement and time for practitioners, priority given to fight the onset of tobacco use, little funding for education or information about cessation treatments, little involvement by NGOs. few clinics, high cost of nicotine replacement therapy and difficulty of access to it. Tobacco control policy should include regulatory changes.

  • There must be a global approach to tobacco control that includes cessation as a public health issue, and community wide basis.

Short term activities:
Suggestions for INCGAT

· Network so that more NGOs become active in tobacco control.

  • INGCAT should issue an authoritative statement about cessation, which must
    -get endorsement form credible sources (WHO, American Cancer Society, etc.),
    -encourage NGOs to adopt and endorse 3-4 feasible priority activities. -provide NGOs with expert knowledge, and
    -take into account the different culture and priorities of NGOs.

  • Mobilise NGOs to participate at the 11th World Conference on Tobacco or Health, in Chicago in August 2000.

Suggestions for health care professionals and settings:

  • Decrease the prevalence of tobacco use among health care professionals.

  • Include education on risks and treatments in all health curriculums.

  • Encourage all health professionals to be routinely active in tobacco control.
    -Practicing the 4 As: Ask about tobacco use, Advise not to smoke, Assist those ready to quit, Arrange for more intensive therapy if so desired'
    -recording tobacco use as vital sign;
    -measuring level of dependence.

  • Provide smoke-free facilities.

  • Survey prevalence of tobacco use, motivation re: quitting and dependence level of all staff.

  • Increase and improve the use of all cessation methods.

Suggestions for policy changes:

  • Tobacco control requires a global approach and strategy: and this is true for cessation.

  • Regulatory changes are recommended concerning cessation treatment products' Classifications, availability and indications for use. Provision of reimbursement possibilities need to be considered.

  • Governments and health professionals should be responsible to provide the best available treatment for tobacco use. Non-intervention should not be an option for governments, and malpractice on the part of health professionals.

  • Policies related to cessation should be synergistic with other tobacco control approaches. Suggestions concerning the Framework Convention:

  • Tobacco dependence should be recognised as a disease that requires appropriate treatment.

  • The must be appropriate treatment for tobacco dependence.

  • Tobacco should be more regulated.

 
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