Smoking: A global health issue 

Tobacco smoking is estimated to lead to the premature death of 96,000 people in the UK every year,¹ making it the number one preventable cause of death.² However, stopping smoking is not as easy as just quitting, as tobacco is highly addictive. This means that encouraging cessation and preventing people from smoking to begin with is extremely important. It is also instrumental that various approaches to cessation and prevention can be useful to different demographics.

Traditional approaches to smoking cessation

Nicotine replacement therapy (NRT)

Nicotine is the main active ingredient in tobacco, and it is the pharmacological effects of nicotine that cause smoking addiction. This occurs by nicotine-stimulating receptors in the brain, leading to dopamine release. The release of dopamine can eventually lead to changes in the brain which strengthen substance-seeking and substance-taking habits as addiction progresses, which ultimately leads to the compulsive use of cigarettes.³ NRT is the most widely used tool to manage nicotine dependence and withdrawal. It works by providing relief through the immediate release of nicotine via transdermal patches, gum, nasal spray, oral inhaler and tablet. The first NRT that was made available was nicotine gum, also known as transmucosally delivered nicotine polacrilex, which is intermittently chewed and held within the mouth for 30 minutes for the nicotine to be released in doses of 2mg and 4mg.¹ Both gum and patches could enable about 15% of smokers to quit their habit.⁵

Prescription medications

There are also available prescription drugs which aid smoking cessation.

Bupropion is a dopamine reuptake inhibitor, meaning it prevents dopamine from being broken down. This reduces the dopamine deficiency that is experienced when someone stops smoking, effectively attenuating nicotine withdrawal symptoms. Bupropion has also been shown to block the pharmacological effects of nicotine in vivo, preventing it from becoming addictive. Approximately 1 in 5 smokers are successful in quitting and remain non-smoking for up to a year when they are administering bupropion therapy.⁶ Bupropion is available as an oral prolonged-release tablet and as a salt.⁷

Cytisine is a drug that binds to the main receptor responsible for the central effects of nicotine, preventing nicotine itself from binding.⁸ Cytsine increased the chances of successful smoking cessation by more than twofold compared with a placebo.⁹

Behavioural therapy and counselling

Some smokers may prefer a less medicalised intervention as a way to aid them in quitting smoking. Psychological interventions can also be extremely effective, including behavioural therapy, which aims to help smokers set specific goals by focusing on their current situation. There are also group therapy options which allow participants to receive feedback and encouragement from peers.¹⁰

Innovative cessation strategies

Digital health interventions 

Shortages of trained counsellors create a barrier for many people to obtain routine behavioural therapy and counselling in the pursuit of smoking cessation. Digital health interventions provide a cost-effective and automatic platform for smokers to receive professional and personal guidance. Intervention content may include games and virtual reality, which are influenced by different psychological behavioural theories like the theory of planned behaviour.¹¹ Mobile applications are available for free and provide motivation and insight into how to stop smoking.

There are also online forums available that provide community-based smoking cessation programmes and aids.

Vaping

Many tobacco smokers will take to electronic cigarettes, also known as vapes, as an alternative to cigarettes in an attempt to curb their habit. Electronic cigarettes are considered a healthier alternative to cigarette smoking, as any means of administering nicotine without the over 4,000 toxic substances that are also in cigarettes can be considered preferable, but the long-term health effects of vaping are unknown; although the heating process that is necessary to create a vapour that occurs inside electronic cigarettes is believed to cause the formation of toxic compounds.¹² There are also concerns that vaping encourages cigarette smoking in younger generations.¹³

Comprehensive prevention programs

Prevention is better than cure, so having robust measures in place that dissuade people from ever taking up smoking as a habit is necessary.

School-based prevention programs

Discouraging the youngest generations from smoking could prevent them from wanting to become smokers later in life, so school-based programs can act as a strong deterrent to becoming a smoker. ‘A Stop Smoking In Schools Trial’ (ASSIST) is a peer-led, school-based smoking prevention programme for students aged 12-13. Students are nominated to become peer supporters, where they are trained to talk about the risks of smoking and the benefits of not smoking with their peers.¹⁴ In schools that took part in this programme, 0.9% of the participants were regular smokers, nine out of ten students said they never smoked,¹⁵ and they claim to reduce smoking uptake by up to 22%.

Policies and regulations

The government also plays a massive role in preventing its citizens from smoking. Cigarette packets must feature a text warning and image to discourage their purchase.¹⁶ These warnings are effective in increasing people’s intention to quit smoking as well as encouraging people to forgo cigarettes.¹⁷

Direct marketing and promotion of tobacco were also banned in 2002 in the UK.¹⁷

UK lawmakers are also enforcing a new law that plans to create a smoke-free generation by 2040 by banning the sale of tobacco to any person born in or after 2009, preventing anyone who turns 15 or younger in 2024 from ever legally purchasing cigarettes.¹⁸ This drastic measure seeks to completely eradicate this deadly habit from the next generations.

Public education and awareness campaigns

As well as legislation and policy, it is important for the public to be educated on the fatal consequences of smoking for them to understand why it should be avoided. Public Health England has run anti-smoking ad campaigns that depict the serious health consequences that come with a smoking habit. These campaigns provide visual stimuli that can communicate the urgency to avoid smoking.

Community outreach and engagement

Smoking behaviour is often influenced by a person’s social context, and so community-based prevention programmes can be an effective means of changing social norms and encouraging a smoke-free lifestyle in many people. This can involve counselling, support groups, provision of self-help materials like quit kits, access to health professionals and public events such as lectures.¹⁹ Altering a whole community’s view on smoking can be essential in providing ex-smokers with the support and affirmation they need to quit permanently.

Smoke-free environments

Prohibiting smoking in specific areas is another tactic that has been employed to both protect non-smokers from second-hand smoke and also make smoking less acceptable and harder to carry out. It is illegal to smoke in all public enclosed or substantially enclosed areas and workplaces.²⁰

Summary

Smoking is a deadly habit that leads to many health complications and early death. However, due to the addictive nature of nicotine in cigarettes, it takes more than just the willpower to quit and kick this habit to the curb. Smoking cessation may require nicotine replacement therapy, prescription medication, counselling, digital health interventions, and alternative smoking methods. Preventing people from smoking in the first place is crucial, and this can be achieved through school-based prevention programmes, policy and regulation, community outreach and engagement, smoke-free spaces, and public education.

FAQ’s

What is the most effective smoking cessation method?

Studies have found that a combination of nicotine agonists and replacement therapy is the most effective method to quit smoking and that combining 2 or more therapies yields the best success rates.²¹

Is it better to quit smoking gradually or suddenly?

Smoking abstinence appears to be higher in smokers who quit abruptly compared to those who quit gradually. This is because the body can adjust to the absence of nicotine more quickly, and you begin experiencing the benefits of a smoke-free life sooner, e.g. less money spent on cigarettes and increased capacity for exercise.²² This can serve as an instant encouragement for an individual, leading them to stop smoking.

What happens to your body after you stop smoking?

Within 24 hours of smoking cessation, there are marked improvements in blood pressure and heart rate. Within a year of abstinence, the risk of cardiovascular events like stroke is cut in half. Between 5 to 15 years after quitting smoking, the risk of stroke or coronary heart disease decreases to that of someone who has never smoked. The risk of lung cancer also decreases by between 30-50% after 10 years of smoking cessation.¹

Is any damage from smoking permanent?

Long-term cigarette smoking causes the airways to become narrow and impairs the ability of the lungs to absorb oxygen. This damage is not fully reversed by smoking cessation and can lead to conditions like chronic obstructive pulmonary disease.²³