Cessation

Studies show that quitting tobacco leads to immediate and significant health benefits. But for many, the extremely addictive nature of nicotine makes it difficult to quit unaided. A huge, international body of research shows that tobacco cessation policies and interventions are both effective and cost-effective. Moreover, evidence shows that cessation is the only intervention with the potential to reduce tobacco-related morbidity and mortality in the short- and medium-term.

Article 14 of the WHO Framework Convention on Tobacco Control (WHO FCTC) states that parties to the Convention shall "take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence" and shall "design and implement effective programmes aimed at promoting the cessation of tobacco use". 

Recommended cessation interventions

According to the Guidelines for the implementation of Article 14, the key components of a system to help tobacco users quit include approaches with a wide reach, such as internet support, telephone quit lines and brief advice from health workers, along with more intensive approaches, such as behavioural support delivered by trained specialists. Effective medications also play an important role in tobacco cessation. A substantial body of scientific evidence shows that behavioural support and medications are effective and cost-effective, both separately and combined, but that they are more effective when combined. 

The WHO Report on the Global Tobacco Epidemic, 2015, states that clinical cessation treatment should, at a minimum, include nicotine replacement therapy (NRT), which is available over the counter in most countries. Pharmacological therapy with NRT, alone or in combination with other prescription cessation medications, can double or triple the quit rate. 

The success of cessation interventions also depends on their use in a broader context of comprehensive tobacco control programmes.

Implementation of cessation policies and programmes

In 2014, about 1.1 billion people had access to appropriate cessation support. In the European Region, only seven countries offered cessation programmes. However, the proportion of countries in the WHO European Region offering nicotine replacement therapies and/or some cessation services, where the cost of at least one is covered, is higher than in any other WHO region. Between 2008 and 2010, the coverage of at least one NRT and/or some cessation service increased from 54% to 66%. The WHO European Region also has the highest proportion of countries with a national quit line (62%) compared to any other WHO region (all below 30%).

Challenges to implementing successful cessation programmes

Health professionals are often given the responsibility to deliver successful cessation programmes and offer support. The potential influence of health professionals is tremendous, as they are seen as role models, highly respected and a trusted source of information and advice. Additionally, they are in contact with a high percentage of the population and can be instrumental in helping change health behaviour. Unfortunately, within the WHO European Region, results from the Global Health Professions Student Survey (GHPSS) reveal that approximately 25% of health professional students are formally trained to provide patients with cessation approaches. Meanwhile, eight in ten health professional students believe they should get specific training on cessation techniques to be used in practice.  Providing health professionals with proper training in cessation techniques is critical for countries if they hope to help people quit tobacco use.

WHO support for cessation policies

To help countries meet the goal of providing comprehensive tobacco dependence treatment for all tobacco users, WHO issued in 2013 "Strengthening health systems for treating tobacco dependence in primary care", a training package focused on integration of basic cessation advice into the primary care setting. WHO has also produced several guides, trainings and toolkits on subjects such as improving quit line counseling and delivering successful cessation interventions to TB patients. WHO recommends that countries use these tools to strengthen the delivery of tobacco interventions in primary care as part of their WHO FCTC obligations and implementation of the WHO Global Action Plan for the Prevention and Control of NCDs.