- Tobacco deaths can be dramatically reduced in the USA, but only if new regulatory authorities and traditional public health strategies are fully implemented (The Lancet Series 1)
- Asia faces devastating loss of life and illness if tobacco epidemic is not brought under control (The Lancet Series 2)
- "Massive failure" of political and medical leadership on tobacco control has damaged the health and wellbeing of millions of Europeans (The Lancet Series 3)
- Smoking cessation needs to be incorporated into routine health assessment (The Lancet Respiratory Medicine)
- Comment: 'The WHO FCTC: the challenge of implementation', by Dr Alfred Munzer of the Washington Adventist Hospital, Maryland, USA [link only] (The Lancet Respiratory Medicine)
The Lancet Series 1– Tobacco deaths can be dramatically reduced in the USA, but only if new regulatory authorities and traditional public health strategies are fully implemented
The first Series paper focuses on the US, where despite great efforts to reduce the number of deaths and illness due to tobacco use, progress in decreasing the prevalence of tobacco use has slowed. The authors, Corinne Husten of the US Food and Drug Administration (FDA), Rockville, USA, and Lawrence Deyton of George Washington University School of Medicine and Health Sciences, Washington DC, USA, explain how the FDA regulates tobacco use, and showing where control efforts might be improved and challenges persist.
According to Drs Husten and Deyton, "Tobacco product regulation has the potential to be a game-changer for tobacco prevention and control. However, regulation of tobacco products in isolation cannot solve the public health problem caused by tobacco use. It is only with the full implementation of both traditional public health strategies and new regulatory authorities that we will ensure that tobacco-related morbidity and mortality is part of the USA's past, not its future."
The Lancet Series 2 – Asia faces devastating loss of life and illness if tobacco epidemic is not brought under control
In the last four decades, Asia has often led the way in the implementation of public health tobacco control measures, according to the authors of the second Series paper, on tobacco control in Asia. However, despite this long-standing commitment and expertise in controlling tobacco, Asia still has an enormous tobacco problem, with more than half of the world's tobacco consumed in the region. Cigarettes are becoming more affordable in some countries (notably China), while only a handful of governments in the region are increasing taxation on cigarettes. Situations where national monopolies controlling tobacco may come into direct conflict with government public health policies on tobacco, such as in China, are also a particular concern.
According to the paper authors, led by Dr Judith Mackay of World Lung Foundation, Hong Kong, China, "Asia has shown that tobacco control is not the prerogative of high-income countries, and that Asian nations—including low-income and middle-income countries—can grasp the political nettle of tobacco control, and can do so effectively. However, despite these positive developments, Asia as a whole still faces devastating loss of life and illness if the tobacco epidemic is not brought under control. Tobacco use is completely preventable through political will, and proven techniques could reduce this epidemic. The epidemic will not only be solved in the corridors of clinics and hospitals, but also in the corridors of power."
The Lancet Series 3 – "Massive failure" of political and medical leadership on tobacco control has damaged the health and wellbeing of millions of Europeans
While European countries have made substantial progress in implementing some tobacco control measures – such as advertising bans and prioritising smoke-free policies – the third Series paper shows that European tobacco control nonetheless falls short in a number of areas, and implementation of the WHO Framework Convention on Tobacco Control (FCTC) remains patchy, at best, in most European countries. Authors John Britton and Ilze Bogdanovica of the University of Nottingham, UK, point out that many European countries have poor provision of services for smokers trying to quit, and where these services are provided, they are poorly taken up – for example, the UK is described as a "world leader" in providing evidence-based smoking cessation services, yet these services are estimated to be used by fewer than 10% of smokers each year.
With an estimated 120 million smokers in Europe (28% of the total population), and 650 000 entirely preventable deaths from smoking every year, much more needs to be done to address the smoking epidemic in Europe. The authors highlight a number of areas of opportunity for further improvement, including expanding the use of mass-media campaigns – proven to be highly effective ways of promoting smoking cessation to a wide population, yet still largely under-used across Europe; introducing standardised packaging across Europe; reducing the affordability of cigarettes through minimum pricing and pack sizes; realising the potential of the new generation of nicotine-containing products, such as electronic cigarettes, to promote cessation and harm reduction among the millions of smokers who are not ready or able to quit; and investing in new research into tobacco addiction, treatment, and prevention to a degree that is more proportionate to the magnitude of the problems that smoking causes.
According to the authors, "Sustained failure to initiate and support smokers to stop smoking results in a massive toll of avoidable death and disability…The sustained failure of so many governments to introduce simple policies to prevent smoking in so many European countries, to the detriment of the health and wellbeing of millions of people represents a massive failure of political, and medical, leadership. The failure also bodes badly for the likelihood of success in addressing other commercially driven disease epidemics."
The Lancet Respiratory Medicine: Smoking cessation needs to be incorporated into routine health assessment
In The Lancet Respiratory Medicine, the newest Lancet specialty journal, Professsor Nancy Rigotti of Massachusetts General Hospital and Harvard Medical School, in Boston, USA, reviews the evidence for different methods of smoking cessation, with a special focus on patients with respiratory disease, who can find it especially difficult to quit, having usually smoked more frequently and for longer. Evidence suggests that incorporating psychological counselling with a pharmacological treatment, such as nicotine replacement therapy or anti-smoking medication is the most effective way for most smokers to quit. While research is underway into how existing anti-smoking treatments can be improved and take-up of treatment can be increased, Professor Rigotti points out that existing smoking cessation counselling and drugs are among the most cost-effective clinical preventive services available, and incorporating this treatment into routine clinical practice will be essential if treatment uptake is to be increased.
According to Professor Rigotti, "Physicians and the health-care systems in which they work must incorporate tobacco cessation treatment into standard practice. By doing so, they can contribute to a reduction of population smoking rates and the enormous toll of tobacco on health."
Journal
The Lancet