Tobacco and Public Health - TCSC Indonesia

MICHAEL KUNZE AND E. GROMAN 755
tobacco dependence treatments, choosing a blend of options relevant to local circumstances
but emphasizing those interventions which have the strongest evidence base.
Because tobacco dependence treatment is so cost effective, it should be provided by
public and private health care systems. Access to both behavioural and pharmaceutical
treatments should be as wide as possible with due regard to local regulatory frameworks
and other circumstances. It is important to increase the availability or treatment
to low income smokers, including at a reduced cost or free of charge.
Health professionals should be trained to advise and help smokers stop smoking,
and health care purchasers should ensure the provision of adequate training budgets
and training programmes. Education and training for the different types of interventions
should be provided not only at the postgraduate and clinical level, but should
start at undergraduate and basic level, in medical and nursing schools and other relevant
training institutions.
Telephone helplines can be effective and are very popular with smokers. Although
more research is needed on their effectiveness, they seem likely to provide a valuable
service to smokers and should be made available where possible.
A second important review is the US consensus statement: A Clinical Practice
Guideline for Treating Tobacco Use and Dependence (Fiore 2000).
The panel, which compiled the consensus statement included 18 scientists, clinicians,
consumsers, and methodologists selected by the US Agency for Healthcare
Research and Quality. A consortium of seven governmental and non-profit organizations
sponsored the update.
Approximately 6000 english-language, peer-reviewed articles and abstracts,
published between 1975 and 1999, were reviewed for data that addressed assessment
and treatment of tobacco dependence. This literature serviced as the basis for more
than 50 meta-analysis.
Major conclusions and recommendations include:
◆ Tobacco dependence is a chronic condition that warrants repeated treatment until
long-term or permanent abstinence is achieved.
◆ Effective treatments for tobacco dependence exist and all tobacco users should be
offered those treatments.
◆ Clinicians and health care delivery systems must institutionalize the consistent
identification, documentation, and treatment of every tobacco user at every visit.
◆ Brief tobacco dependence treatment is effective, and every tobacco user should be
offered at least brief treatment.
◆ There is a strong dose–response relationship between the intensity of tobacco
dependence counselling and its effectiveness.
◆ Three types of counselling were found to be especially effective—practical counselling,
social suppport as part of treatment, and social support arranged outside of
treatment.