Tobacco and Public Health - TCSC Indonesia

Fifteen different products were identified most on sites not updated since 1997. Eight
out of the 14 products could be ordered by internet, six are described in detail in the
internet, but could only be obtained in the pharmacy. Two-third of the products, however,
do not have any scientific background: Two products were filters (1+2) to reduce
the nicotine supply. Other products were a CD ROM (3) with relaxing products and a
pocket-safe for cigarettes. The main ingredients in five products were herbal extracts
(5–9), that have no proven effect on nicotine addiction. Consumption of herbal cigarettes
resulted in high carbon monoxide values (Groman et al. 1999a).
Just five products were based on a scientific findings (published in peer reviewed
journals). These were the nicotine replacement products: patch, gum, inhaler, nasal
spray, and bupropion (Groman et al. 2000b).
The results show that most of the products lack a scientific background. Adverse
health effects after consumption of herbal cigarettes, which are sold for smoking cessation
cannot be excluded. This example shows the necessity of continuous assessment
and observation of the market, and the need for scientific studies on smoking cessation
products. An international body to examine the sites would be useful (Eckl-Dorna and
Groman 1999).
Reduced smoking
MICHAEL KUNZE AND E. GROMAN 757
As far as the management of smoking behaviour is concerned, complete abstinence
remains the best option. Nevertheless one has to take into account that many tobacco
consumers want to reduce their consumption, either as a first step towards abstinence
or as a strategy of its own to reduce their health risk (Jiménez-Ruiz et al. 1998). At this
time 37% of the Austrian smokers want to reduce and only 18% want to stop smoking.
The concept of reduced or controlled smoking will become more important in
future. Reduced smoking means smoking fewer cigarettes on individual level. Nicotine
replacement is the best medication to reduce smoking. Most smokers need the nicotine
and not the tar or carbon monoxide or any other toxic substances contained in cigarettes
(Jiménez-Ruiz et al. 1998).
Reduced smoking in combination with nicotine replacement therapy may be indicated
for those who are failing in cessation attempts, who would like to give up smoking
but are not able to quit. The second group which wants to reduce cigarette consumption
may be smokers who do not want to quit but only reduce (Kunze et al. 1998). The
new experience of smoking fewer cigarettes without withdrawal symptoms may also
lead to a higher quitting rate.
With respect to the practical management of reduced smoking, baseline smoking
parameters must by ascertained, preferably using exhaled CO or plasma COHb levels.
Measuring CO in the expired air is a very simple way to assess the actual smoking
behaviour of a tobacco consumer and provides also a measurement which usually is
very impressive for the patient/client. Alternatively, plasma nicotine and/or cotinine