Clinical Review ABC of smoking cessation

Policy priorities for tobacco control

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7446.1007 (Published 22 April 2004) Cite this as: BMJ 2004;328:1007
  1. Konrad Jamrozik
  1. professor of primary care epidemiology, Imperial College, London, and visiting professor in public health, School of Population Health, University of Western Australia, Perth

    Introduction

    Although many countries have implemented strategies for reducing tobacco use at individual and population level, no country to date has adopted a truly comprehensive control programme. In addition, the tobacco industry and the strategies it uses to counteract policies on tobacco control and thereby maintain and develop its commercial markets have both continued to evolve. All communities therefore face at least some “unfinished business” in relation to tobacco control, and those working in smoking cessation need to be familiar with the necessary policy responses.

    The healthcare industry

    Individuals and institutions in the healthcare industry have an important exemplar role. In many countries the prevalence of smoking among doctors differs little from that in the wider community. This considerably undermines individual practitioners' credibility in advising patients not to smoke and denies the profession as a whole the influence it might wield on public and political opinion and policy on tobacco.

    Prevalence of smoking among doctors around the world, according to data collected from 493 medical schools in 93 countries (36% response rate) in 1995. Data from Mackay et al(The tobacco atlas. Geneva: World Health Organization, 2002)

    Institutions that train health professionals need to make more time available in both undergraduate and postgraduate curriculums for teaching about smoking and especially about effective cessation interventions. Coverage of these topics is currently, for the most part, inadequate. As assessment shapes learning, these topics also need to feature prominently and regularly in major examinations.

    All healthcare facilities, including schools of medicine, nursing, and dentistry, should adopt and enforce comprehensive smoke-free policies across their entire campuses and not just in buildings. Where smoking rooms are provided for inpatients, these should have separate, externally ventilated air conditioning systems so that tobacco smoke is not recirculated into the rest of the building.

    Policies on smoke-free places

    The smoking of tobacco should eventually become …

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