Tobacco Control Policies – Do they work?

September 24, 2020

Dr. Stamatoula Tsikrika opened the session on Tobacco Control Policies. To expand the fight against the tobacco epidemic, WHO has introduced the MPOWER package of six proven policies, she said. MPOWER focuses on reducing tobacco demand, which, if adopted at the highest level, would achieve the global tobacco control target of 30% relative reduction by 2020.

Effective policy and programmatic interventions that work to reduce the demand for tobacco products and death, disease, and economic costs that result from their use, are highly cost-effective, but unfortunately are underutilized, she added.

“More prominent package warning labels are effective in increasing awareness of health risks, promoting quit attempts, and increasing quit success. Furthermore, graphic warnings are more effective than text warnings”, Dr Tsikrika pointed out. On the other hand, control of illicit trade in tobacco products is the key supply-side policy to reduce tobacco use and its health and economic consequences.

The market power of tobacco companies has increased in recent years, she noted, creating new challenges for tobacco control efforts.

“Although it seems that controlling the global tobacco epidemic shows some progress, concerted efforts will be required to ensure that progress is maintained or accelerated”.

Tobacco control and smoking prevention must be priority issues for public health, Dr Tsikrika concluded. Prevention is more effective than cessation and prevention activities should target young children, prior to smoking initiation age.

Young people are particularly vulnerable to become addicted, Dr. Lion Shahab noted, because developing brain is affected more strongly by exposure to addictive substances and they also are more easily influenced by peers and marketing.

Very few people start smoking after the age of 21 (~10%), but the last decade we see an upward shift in initiation age from <18 to 18-21 years from 70/30 to 65/35, he added. Data show that prevalence of dependence and long-term health consequences both decrease as the age of smoking onset increases.

According to surveys, tobacco advertising/promotion leads to increased adolescent smoking, Dr. Shahab continued, and point-of-sale display ban is associated with a significant reduction in experimentation.

Existing tobacco control strategies can be effective and impactful, he concluded. “Interventions, family- and school-based, have shown to reduce smoking initiation more than 20%, campaigns 30-40% and policy change that combines age of sale increase with point-of-sale display ban leads to 30-40% reduction of smoking initiation”.

Four in 5 smokers say that they would not smoke if they had their life over again and 3 in 5 had tried to quit in the last five years, Dr. Georgios Goumas underlined.

The impact of a reduction in 35% of the prevalence of smoking prevented nearly 25,000 CHD deaths in England and Wales between 1981-2000, he continued, while the percentage of smokers who quit smoking increases when the support and the pharmacotherapy they need is added to their effort.

“Results from a review including 20 studies showed a 36% reduction in crude relative risk of mortality for patients with CHD who quit compared with those who continued smoking”, Dr. Goumas mentioned.

The strength of an individual’s nicotine dependence is a key predictor of how likely the individual is to relapse after stopping smoking, he pointed out.

People who smoke about one cigarette each day have about 40-50% of the excess CHD and stroke risk associated with smoking 20 cigarettes per day, Dr. Goumas added, concluding that hospitalization for an acute cardiovascular event provides an important opportunity for quitting smoking. Smokers are often strongly motivated to quit because the risks of smoking are now personal, he said.

Most of smokers know that they should quit, 70% want to quit, 40% have attempted to quit, but only 3%-5% manage to quit without medical help, Dr. Paraskevi Katsaounou said, and only 5% of Europeans have attempted to quit using medical support or smoking cessation services.

She stressed that the industry aggressively promotes e-cigarettes as a safe smoking-cessation tool, but “there is insufficient evidence that e-cigarettes could be effective for smoking cessation, since pragmatic RCTs show that quitting rates are very low. Most e-cigarette users are dual users, using e-cigarette as a supplement and not as a cessation tool”.

Nicotine Replacement Therapy use for tobacco harm reduction is evidence-based, extremely safe and less addictive than e-cigarettes, Dr. Katsaounou noted.

Therefore, in the context of smoking cessation, clinics optimal behavioral and pharmaceutical treatments should be promoted before recourse to e-cigarettes, she proposed.