Collective approaches to reduce smoking

The main approaches to reduce tobacco smoking are (WHO-HEN, 2003):

• price increases through higher taxes;
• advertising and promotional bans;
• smoking restrictions;
• consumer education campaigns; and
• smoking cessation therapies.

Collective approaches to reduce smoking require particular attention. They are described in more detail in the EUphact Smoking policies.

Individual approaches to smoking cessation

An individual approach to smoking cessation includes pharmacotherapies and behavioural therapies. They are most effective when combined with collective interventions.

Pharmacotherapy increases the probability of long-term cessation

Only 3% of smokers manage to quit smoking using will power alone (ASH, 2006). Success depends to a great extent on motivation, but a combination of pharmacotherapy and behavioural therapy probably yields the best results.

Nicotine replacement therapy

Nicotine replacement therapy (NRT) in the form of patches, chewing gum, lozenges, inhalers and nasal sprays helps relieve the withdrawal symptoms that prevent many smokers from quitting. This therapy contains nicotine, but does not contain the other harmful substances found in cigarettes, such as tar, carbon monoxide, nitrosamines.

Non-nicotine pharmacotherapy

Non-nicotine pharmacotherapy includes different types of drugs. Two of the most promising are bupropion and varenicline. They are both prescription drugs approved by the national authorities of some countries to help patients stop smoking. Bupropion is an anti-depressant drug, that reduces withdrawal symptoms and lessens the urge to smoke. Varenicline, very recently approved both in Europe and the USA, is a partial nicotine agonist that prevents nicotine-withdrawal symptoms, and eliminates the feeling of pleasure that people experience when smoking.

Behavioural treatment can improve the quit rate

Certain moods, times of day, or activities can act as strong triggers for craving a cigarette. Pharmacotherapy is not a cure for these smoking triggers. Furthermore, the motivation to quit smoking determines to a large extent the success rate of smoking cessation. Some studies have found that the integration of behavioural therapy can increase the cessation rate by another 50-100% (Fiore et al., 2000). Psychosocial interventions can be usefully employed at every stage of the tobacco addiction treatment, not only during the first stage(Foulds et al., 2006). There are a wide range of available psychosocial treatment options, including counselling via the internet and the telephone, as well as individual and group counselling.