Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.
KeywordsTobacco AddictionSmoking CessationSmoking Cessation InterventionsHealthcare PracticeTobacco Control
Bunn, W.B., Stave, G.M., et al. (2006) Effect of smoking status on productivity loss. Journal of Occupational and Environmental Medicine, 48(10), 1099-1108.
Jacobs-van der Bruggen, M.A.M., Welte, R.A., et al. (2002) Aan roken toe te schrijven productiviteitskosten voor Nederlandse werkgevers in 1999 [Costs of smoking related productivity loss for Dutch employers in 1999]. RIVM, the Netherlands.
Droomers, M., Schrijvers, C.T. and Mackenbach, J.P. (2002) Why do lower educated people continue smoking? Explanations from the longitudinal GLOBE study. Heal- th Psychology, 21(3), 263-272.
Janson, C., et al. (2006) Changes in active and passive smoking in the European Community Respiratory Health Survey. European Respiratory Journal, 27(3), 517-524.
STIVORO (2008) Roken, de harde feiten: volwassenen 2007 [Facts of smoking: adults 2007]. STIVORO - for a smokefree future, the Hague, the Netherlands.
Hughes, J.R., Keely, J. and Naud, S. (2004) Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction, 99(1), 29-38.
Willemsen, M.C., Wagena, E.J. and van Schayck, C.P. (2003) De effectiviteit van stoppen-met-rokenmethoden die in Nederland beschikbaar zijn: een systematische review op basis van Cochrane-gegevens. [The efficacy of smoking cessation methods available in the Netherlands: a systematic review based on Cochrane data]. Nederlands Tijdschrift voor Geneeskunde, 147(19), 922-927.
Collins, J.A. and Fauser, B.C.J.M. (2005) Balancing the strengths of systematic and narrative reviews. Human Reproduction Update, 11(2), 103-104.
Tromp-Beelen, P.G. and Weijers-Everhard, J.P. (2005) Verslaving [Addiction]. In: Knol, K., et al. Eds., Tabaksgebruik: Gevolgen en bestrijding [Tobacco Use: Results and Control], Lemma B.V., Utrecht, 265-282.
TNS Opinion & Social (2007) Special Eurobarometer. Attitudes of the Europeans towards tobacco. TNS Opinion & Social.
Hughes, J.R., Marcy, T.W. and Naud, S. (2009) Interest in treatments to stop smoking. Journal of Substance Abuse Treatment, 36(1), 18-24.
Hammond, D., et al. (2004) Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behavior. Addiction, 99(8), 1042-1048.
Gross, B., et al. (2008) Reasons for not using smoking cessation aids. BMC Public Health, 8, 129.
Bansal, M.A., et al. (2004) Stop-smoking medications: who uses them, who misuses them, and who is misinformed about them? Nicotine & Tobacco Research, 6 (Suppl 3), S303-10.
Kaper, J., et al. (2006) A randomized controlled trial to assess the effects of reimbursing the costs of smoking cessation therapy on sustained abstinence. Addiction, 101 (11), 1656-1661.
Stead, L.F., Bergson, G. and Lancaster, T. (2008) Physician advice for smoking cessation. Cochrane Database of Systematic Reviews, 2, Article No. CD000165.
Stead, L.F., Perera, R. and Lancaster, T. (2006) Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, 3, Article No. CD002850.
Lancaster, T. and Stead, L.F. (2005) Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews, 3, Article No. CD001292.
Stead, L.F. and Lancaster, T. (2005) Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews, 4, Article No. CD001007.
Stead, L.F., et al. (2008) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 1, Article No. CD000146.
Hughes, J.R., Stead, L.F. and Lancaster, T. (2007) Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews, 1, Article No. CD000031.
Cahill, K., Stead, L.F. and Lancaster, T. (2008) Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 3, Article No. CD006103.
Feenstra, T.L., et al. (2005) Cost-effectiveness of face-to- face smoking cessation interventions: A dynamic modeling study. Value in Health, 8(3), 178-190.
Hoogendoorn, M., Welsing, P. and Rutten van Molken, M.P. (2008) Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands. Current Medical Research & Opinion, 24(1), 51-61.
van Baal, P.H., et al. (2007) Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a “perfect” cost-utility ratio. Health Economics, 16(4), 421-433.
Fiore, M.C., et al. (2000) Clinical practice guidelines: treating tobacco use and dependence. Public Health Service, U.S.
CBO (2004) Richtlijn “Behandeling van tabaksverslaving” [Guideline “Treatment of tobacco addiction”]. Kwaliteit- sinstituut voor de Gezondheidszorg, Utrecht, the Nether- lands.
Willemsen, M.C., Hoogenveen, R.T. and Van Der Lucht, F. (2002) New smokers and quitters. Transitions in smo- king status in a national population. European Journal of Public Health, 12(2), 136-138.
Chavannes, N.H., et al. (2007) NHG-Standaard Stoppen met roken [General Practice Protocol Smoking cessation]. Huisarts & Wetenschap, 50(7), 306-314.
IPCRG (2007) International guidance on smoking cessation in primary care. International Primary Care Respiratory Group.
Kotz, D., Wagena, E.J. and Wesseling, G. (2007) Smoking cessation practices of Dutch general practitioners, cardiologists, and lung physicians. Respiratory Medicine, 101(3), 568-573.
Pieterse, M.E., et al. (2001) Effectiveness of a minimal contact smoking cessation program for Dutch general practitioners: A randomized controlled trial. Preventive Medicine, 32(2), 182-190.
Gordon, J.S. and Severson, H.H. (2001) Tobacco cessation through dental office settings. Journal of Dental Edu- cation, 65(4), 354-363.
Kotz, D. and Wagena, E.J. (2003) Roken en stoppen- met-roken in de eerste en tweede lijn van de gezondheidszorg. Attitudes, gedrag en eigen effectiviteit van huisartsen, longartsen en cardiologen. Deel 1: de huisarts [Smoking and smoking cessation in primary and secondary health care. Attitudes, behaviour an self-efficacy of general practitioners, lung physicians and cardiologists. Part 1: the general practitioner], Maastricht University.
Kotz, D. and Wagena, E.J. (2003) Roken en stoppen- met-roken in de eerste en tweede lijn van de gezondheidszorg. Attitudes, gedrag en eigen effectiviteit van huisartsen, longartsen en cardiologen. Deel 2: de longarts [Smoking and smoking cessation in primary and secondary health care. Attitudes, behaviour an self-efficacy of general practitioners, lung physicians and cardiologists. Part 1: the general practitioner], Maastricht University.
Kotz, D. and Wagena, E.J. (2003) Roken en stoppen- met-roken in de eerste en tweede lijn van de gezondheidszorg. Attitudes, gedrag en eigen effectiviteit van huisartsen, longartsen en cardiologen. Deel 3: de cardioloog [Smoking and smoking cessation in primary and secondary health care. Attitudes, behaviour an self-efficacy of general practitioners, lung physicians and cardiologists. Part 3: the cardiologist], Maastricht University.