Towards tobacco cessation: Now more than ever

by | Aug 16, 2021 | Tobacco control

Tobacco use is a major cause of mortality and accounts for more than 8 million deaths annually. It significantly increases the risk of cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.1,2 The smoking-related mortality, potential life years lost and decreases in productivity cause losses at both the individual and the macro level.  Yearly, an estimated US$1.4 trillion in healthcare costs and lost productivity is attributed to tobacco use.  With those facts in mind, it is highly discouraging that tobacco use is on the rise.3 To reverse this trend, nations ought to provide tobacco cessation services to all citizens: such as quit lines, text message or app-supported programs, web-based support or nicotine replacement therapies, counselling or treatment options.

Recently, as with other healthcare priorities, tobacco cessation efforts were severely impacted by the COVID-19 pandemic.4 As both attention and funding shifted towards different areas, the impact on tobacco control policies has varied, however, tobacco cessation efforts were already lagging pre-pandemic, worsening their situation further. What is more, the very data we base our understanding of the problem on primarily reflects the pre-pandemic situation and less is known on how the actual numbers have changed since. Similarly, no concrete evidence exists on the effect of smoking status on COVID severity, but evidence from other respiratory infections suggests increased risk for severe disease and death among smokers.5,6

The path towards successful tobacco cessation progress follows a number of population-wide interventions and policies, which engage a vast array of stakeholders. Interaction among the latter is key for the success of tobacco cessation efforts, but engaging all stakeholders is a complex task, which requires a systematic approach. Our experts have established a framework that analyses the tools available for a systematic development of tobacco cessation policies and interventions with the greatest impact.

The framework consists of 5 components, which are essential throughout the work from building the investment cases through policy formulation, implementation, and enforcement. A key first step is context analysis, whereby a comprehensive overview of an issue in a country needs to precede any further work. Important steps such as identification of relevant issues and the identification of stakeholders happen during context analysis. This is followed by stakeholder consultation, i.e. a deeper examination of the power structures, incentives, beliefs, motivations, and behaviours of the relevant stakeholders and stakeholder involvement – the establishment of mechanisms for stakeholders to raise questions and concerns throughout the life cycle of the relationship. While the former aims to collect more detailed information, the latter is intended to be multi-directional, interactive group stakeholder discussions to analyse complex problems. Cognitive mapping and options analysis are appropriate tools for stakeholder involvement.

The fourth and fifth components are stakeholder communication and stakeholder management. A communications plan based on the findings of the previous steps is important for prioritising and planning of communications with stakeholders. Effective communication is in turn essential in order to prevent a unidirectional information flow, but rather create a feedback loop. Finally, stakeholder management reflects the organisation’s engagement capacity to manage stakeholder relationship building, involvement, communications, intervention implementation, monitoring and reporting, and conflict resolution. An important aspect is fair decision-making, which should be evidence-based, equitable among stakeholders, transparent, and during which the enforcement management and leadership put relevant decision in place via the appropriate processes, which ensures that the other conditions are met. Following the components of this framework ensures effective, evidence-based, fair stakeholder engagement and accordingly, more successful tobacco cessation policy and intervention implementation.