Tobacco and Public Health - TCSC Indonesia

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EFFECTIVE INTERVENTIONS TO REDUCE SMOKING
Besides price, limits on smoking at home and at school that are relatively strong and
are enforced can slow down smoking uptake (Pierce and Gilpin 2001). Restriction on
smoking at workplaces and at home can also increase cessation attempts and lower rates
of relapse among smokers who attempt to quit (Wakefield et al. 2000; Levy and Romano
2002). Smoking restrictions are often a reflection of antismoking social norms that make
smoking behavior less attractive, thus reducing the motivation for smoking initiation
and increasing the probability of smoking cessation (Nyborg and Rege 2000).
Tobacco advertising and marketing is linked to higher rate of smoking experimentation
(Pierce et al. 1998). In addition, comprehensive antismoking media campaigns
(Pierce and Gilpin 2001; Levy and Romano 2002) and long-term community-wide
programs (Korhonena et al. 1999; Farrelly et al. 2002) lead to more quit attempts and
higher smoking abstinence rates.
Along with population-based cigarette demand interventions, there are individuallevel
efforts relying on behavioral treatments of smoking cessation. They range from
self-help manuals and on-line quit guides to clinical interventions (USDHHS 2000).
Recently, pharmacological treatments, including nicotine replacement therapies
(NRTs) and antidepressants such as bupropion, have become widely available in highincome
countries (Novotny et al. 2000; USDHHS 2000). There is mixed evidence on
the impact of behavioral therapies on successful smoking cessation (Novotny et al.
2000; USDHHS 2000). Nevertheless, pharmacological treatment is linked to greater
likelihood of quitting, with success rates two times those when this aid is not employed
(Raw et al. 1999; Novotny et al. 2000; USDHHS 2000). The demand for NRT and other
pharmacological therapies is related to economic factors, including their price (Tauras
and Chaloupka 2001). Policies that decrease the cost of NRT and increase its availability
would likely lead to substantial increases in the use of these products. The evidence
from the US suggests that full coverage of a tobacco-dependence treatment benefit
and/or their sale over-the-counter (OTC) are effective and relatively low-cost strategies
for significantly increasing quit rates and quit attempts among adult smokers (Keeler
et al. 2002). The net impact of NRT in low- or middle-income countries has been less
well studied.
Table 42. 2 summarizes the current knowledge about the efficacy of various public
health measures with respect to smoking initiation and smoking cessation.
Even though the recent attention to smoking uptake and cessation begins to fill in
the knowledge gap, there are still many aspects of this complex behavioral change that
need to be investigated in order to design more effective public policies encouraging
smoking cessation and preventing smoking initiation.
Effectiveness of demand side interventions
Research has demonstrated that demand side interventions are highly effective in
reducing the demand for tobacco products and that their widespread adoption would
generate substantial reductions in the public health toll from tobacco.