Tobacco and Public Health - TCSC Indonesia

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TREATMENT OF TOBACCO DEPENDENCE
(the major metablite of nicotine, with a much longer half-life) levels could also be used
but these more complicated methods cannot distinguish between nicotine taken from
tobacco smoking or nicotine replacement.
Smokers should be fully informed about reduced smoking, and the end goals—
complete cessation for those wishing to quit and a significant reduction in the number
of cigarettes/day for those not yet ready or motivated to quit—should be discussed.
A common goal for both groups could be a 50% reduction in the number of cigarettes/
day within a few weeks of commencement. Smokers need time to adjust to their nicotine
replacement medications and it is important that full information is provided on
the use of the various preparations available. It is preferable to allow smokers to try
different nicotine preparations and select the one they feel to be most helpful on an
individual basis. Although none of the existing nicotine replacement medications is
more effective than the others, the utility of different preparations may vary across
smokers. In addition, long-term compliance is likely to be better if individuals feel
comfortable with their chosen preparation (Kunze 1997).
With other drug dependences harm reduction has been controversial and it is possible
that reduced smoking also will be subject to similar debate within the public health
community and the society at large.
Another caveat for reduced smoking is the possible impact on attitudes of people
considering quitting tobacco consumption and who might prefer reduced smoking to
complete abstinence. Whether there is such a sub-sample of smokers and how big it is,
further research will have to address. Further careful monitoring of smoking patterns
will show whether this development is to be observed or not (Kunze 1997).
Tobacco dependence and lung cancer
Nicotine is addictive, but not a carcinogen. Nicotine is the substance which maintains
tobacco consumption. It is necessary to deal with the issue of tobacco dependence
when dealing with preventive medicine in general and preventive oncology in
particular.
Lung cancer is a tumour very suitable for preventive programmes. Lung cancer risk is
very much related to tar exposure. There is a clear dose–response relationship between
tar exposure and lung cancer risk. If people highly addicted to nicotine are also experiencing
a comparatively high tar exposure, then self-help alone is most probably not
sufficient to provide preventive oncology.
Those people who can stop on their own or by minimal intervention are most probably
not the ones who suffer from the highest tar exposure and are therefore not in the
highest risk group for contracting lung cancer. This is especially the case if other risk
factors than tar exposure are present. Clustering of risk factors (including occupational
exposure, poor nutritional status, tar exposure, and nicotine addiction), has to be taken
into account.