WHO Fact Sheet No 222
April 1999
TOBACCO DEPENDENCE
The worldwide epidemic of tobacco-related disease and death continues to
worsen as tobacco use spreads. Millions of lives could be saved with effective
treatment for tobacco dependence. However, such treatment is currently
unavailable for many tobacco users throughout the world. For this reason, the
World Health Organization, in preparation for World No-Tobacco Day 1999 (May
31), offers the following information and recommendations to governments,
organizations, health-care professionals, and tobacco users and non-users
worldwide.
About tobacco and treatment
Tobacco use is widespread. At least one-third of the global adult
population, or 1.1 billion people, use tobacco. Although overall tobacco use is
decreasing in many developed countries, it is increasing in most developing
countries. An estimated 48% of men and 7% of women in developing countries
smoke; in industrialized countries, 42% of men and 24% of women smoke,
representing a marked increase among women. Tobacco use is a paediatric
epidemic, as well. Most tobacco use starts during childhood and adolescence.
Tobacco kills. A long-term tobacco user has a 50% chance of dying
prematurely from tobacco-caused disease. Each year, tobacco causes some 4
million premature deaths, with 1 million of these occurring in countries that
can least afford the health-care burden. This epidemic is predicted to kill 250
million children and adolescents who are alive today, a third of whom live in
developing countries. By the year 2030, tobacco likely will be the world's
leading cause of death and disability, killing more than 10 million people
annually and claiming more lives than HIV, tuberculosis, maternal mortality,
motor vehicle accidents, suicide, and homicide combined.
Tobacco products are highly addictive. Because tobacco products are
carefully designed to undermine efforts to quit using them, quitting is not
simply a matter of choice for the majority of tobacco users. Instead, it
involves a struggle to overcome an addiction. Tobacco use typically is woven
into everyday life, and can be physiologically, psychologically, and socially
reinforcing. Many factors combine with tobacco's addictive capacity to make
quitting difficult, including media depictions and cultural and societal
acceptance of tobacco use.
Quitting tobacco at any point in life provides both immediate benefits and
substantial long-term benefits to health. No amount of tobacco use is safe.
Abstinence from tobacco products and freedom from exposure to second-hand smoke
are necessary for maximizing health and minimizing risk. Effective treatment
for tobacco dependence can significantly improve overall public health within
only a few years.
The currently available, proven treatment methods work. Hundreds of
controlled scientific studies have demonstrated that treatment can help tobacco
users achieve permanent abstinence. Effective treatment can involve a variety
of methods, such as a combination of behavioural treatment and pharmacotherapy
(nicotine replacement and non-nicotine medications). Population-based methods
such as telephone helplines and national and international tobacco-free days
also can help deliver treatment.
Implementing treatment
1. Make Treatment a Priority. Governments should rank treatment as an
important public-health priority.
2. Make Treatment Available. Health-care systems should offer
practical interventions to all tobacco users, regardless of economic level,
age, and sex. This effort includes preventing and treating tobacco use in
children and adolescents, reducing family exposure to tobacco, and providing
treatment medications when appropriate. This process is facilitated by
incorporating tobacco dependence treatment into drug abuse treatment,
reproductive and maternal-child services, and other programs.
3. Assess Tobacco Use and Offer Treatment. Health-care providers
should assess and document tobacco use and should provide treatment as an
essential part of quality health care. Health-care providers should assume
responsibility for learning about tobacco use and treatment, and for providing
proven interventions. Providers, educators, and community leaders should take
advantage of teachable moments and opportunities for prevention and
intervention.
4. Health-care professionals should set an example for their peers and
patients by quitting tobacco use. Governments and education systems can
help this process by funding treatment and education programs for health
professionals in training.
5. Fund Effective Treatment. Governments and health care
organizations should fund treatment based on methods that have been
demonstrated to be effective, and should make treatment widely available.
Increasing the institutional and human capacity for providing this service
involves training health-care workers to deliver treatment, implementing
curriculum for students in the health professions, developing resource centres,
encouraging the creation and maintenance of centres of excellence in treating
tobacco dependence, and reducing the barriers between tobacco users and
treatment.
6. Motivate Tobacco Users. Governments, health providers, and
community groups share a responsibility for motivating tobacco users to quit
and remain abstinent. They should educate the public about the health risks of
tobacco use, encourage tobacco users to seek treatment, and help make treatment
available, affordable, and accessible.
7. Monitor and Regulate Tobacco. Governments should monitor and
report on tobacco use, and should tax and regulate the sale and marketing of
tobacco products. These efforts reduce initiation of tobacco use and help fund
effective treatments. Responsible regulation of tobacco products reduces
tobacco use and limits risk. Regulatory authorities should prohibit marketing
strategies that give false reassurances about minimized health risks and divert
attention from quitting. Additionally, all possible steps should be taken to
reduce the harmfulness of tobacco products. Governments should collaborate to
provide meaningful and accurate ratings of nicotine and other chemicals in
tobacco products, and to reduce the toxicity and addictiveness of those
products. Treatment medications should be at least as accessible as tobacco
products.
8. Develop New Treatments. Investing in the science and technology of
treatment improves the efficacy of treatment for those in diverse populations
and under-served groups. Effective treatments should be developed for groups
for whom treatment has not been available, such as children and adolescents.
Universal application of all of these measures is the most effective
approach to tobacco treatment. The current escalation in tobacco use and in
tobacco-related death and disease can only be reversed by investment in
comprehensive tobacco control, which includes treatment for tobacco dependence.
Governments, health-care and education systems, community and religious groups,
as well as news and entertainment media should collaborate in promoting tobacco
treatment.
World No-Tobacco Day on May 31, 1999, provides the opportunity for
governments, health-professional bodies, and the media to join with WHO in
committing themselves to take local, national, and global action that could
bend the trend of the tobacco epidemic.
(This statement, which is based upon the best available scientific
information, was written by a group of experts from developed and developing
countries hosted by the Mayo Clinic Nicotine Dependence Center and prepared for
WHO to disseminate worldwide.
For further information, contact WHO's
Office of Public Information, Geneva. Telephone (41 22) 791 2584. Fax (41 22)
791 4858. E-Mail: inf@who.int
All WHO Press Releases, Fact Sheets and
Features as well as other information on this subject can be obtained on
Internet on the WHO home page http://www.who.int/
|
