Tobacco and Public Health - TCSC Indonesia

In summary, tobacco dependence among lung cancer patients is much higher than
in the general population. Highly dependent smokers are in a high risk group for contracting
lung cancer and other smoking related diseases, and therefore need specific
intervention techniques for treating tobacco dependence.
The clinical evidence of a beneficial effect of chemoprevention in lung cancer is still
limited. Chemopreventive trials have failed or produced unexpected and disappointing
results. It seems therefore that long-term application of Alternative Nicotine Delivery
Systems (ANDS)(NRT) provides a possibility of ‘chemoprevention’ of lung cancer and
other tobacco-related diseases.
As the highly dependent tobacco consumers experience the highest lung cancer risk
and are least likely to stop smoking, alternative strategies (such as ANDS/NRT) are
essential because this concentrates on the high risk group which might contract lung
cancer in the next years (Kunze et al. 1998).
The future of nicotine replacement products
MICHAEL KUNZE AND E. GROMAN 759
The following statements are based on various perspectives, most of them already
established.
◆ NR products have been shown as well in scientific studies as in real life to be effective,
safe, and very well accepted compounds to help people stop smoking.
◆ Using them not only for cessation purposes but also for harm reduction/reduced
smoking or controlled smoking purposes will attract the attention of many tobacco
consumers.
◆ Based on our experiences we want to change the message to the public from ‘You
must stop smoking’ to ‘We want to inform you’.
◆ This new message and other new techniques like craving management need a lot of
communication efforts and additional scientific studies; this does not mean promotion
of these objectives is not yet feasible but additional scientific research is needed.
◆ It will be one of the most important tasks to reach out for those tobacco consumers
who have had experience with NR products but who did not achieve abstinence.
◆ New messages in this respect are the one about underdosing, the message ‘it can be
done if you use enough of NRT, and if you use some of the new NRT-products’.
◆ Among the new messages for smokers and doctors the underdosing problems have
to be addressed and identified as one of the major reasons for not having success.
◆ It might be necessary to be as open as possible and stress the fact: one cannot necessarily
‘cure’ tobacco dependence but it is possible to control it.
◆ Today even extreme forms of tobacco dependence can be treated; this message
should be the basis for a new self confidence among treatment providers and a new
trust into NR products among the consumers.