July 2009, Volume 59, Issue 7
Letter to the Editor
Madam, Perhaps Mark Twain (1835-1910AD) made this comment on the lighter side. However, it aptly describes the serious situation that majority of 1.3 billion current smokers are facing. One in every two of these smokers will succumb to tobacco related causes.1,2sup> The economic toll is equally colossal; estimates for next year are marked at half a trillion dollars.1 Complete cessation is the only way to abate these afflictions in the short- and mid-term.1,2 Quite understandably, emphasis on development of cessation strategies has been immense.
The current state of affairs is that 70-80% of current smokers are willing to quit, a sizeable proportion (26-80%) attempt it but more than 90% of self-quitters relapse within six to twelve months.1-3 Pharmacotherapy and/or behavioural interventions can bring about a statistically significant improvement in these rates. Nonetheless, about 80% of individuals receiving these resource intensive interventions also relapse by six to twelve months.1-4 Increasing duration or intensity of these interventions may delay relapse but makes little difference to long-term abstinence rates.3 Multiple relapses are considered a norm on the way to complete cessation.1,2 But, each of these episodes is a source of attrition to health care resources and even to the perceived ability to quit.5
Long-term maintenance is crucial for the success of a cessation attempt. The key to maintained behaviour change is autonomous motivation that, unlike controlled motivation, is in harmony with an individual's experiences, beliefs and perceptions.5,6 The recognition of smokers as stakeholders in their own health and an understanding of their perspective is a pre-requisite to achieve this end.1,4,6
There is a remarkable dearth of literature pertaining to maintenance, relapse prevention and smokers' heuristics regarding this unhealthy behaviour.2,3,5,6 We urge the scientific community to explore these avenues and to modulate cessation strategies so as to maximize the productivity of tobacco control efforts. Understanding smokers' can be the key to decipher the complex problem of smoking.
Aimon Fatima,1 Abdul Mueed Zafar2
BSc Hons. (Social Sciences), Lahore University of Management Sciences,
Lahore,1 Aga Khan University Medical College, Karachi, Pakistan.2
References
1.World Health Organization. Policy recommendations for smoking cessation and treatment of tobacco dependence. [online] (Cited 2009, Mar 27). Available from URL: http://www.who.int/tobacco/resources/publications/tobacco_dependence/en/index.html.
2.Fiore MC, Jaén CR, Baker TB, Balley WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. U.S. Department of Health and Human Services. Public Health Service. Rockville, MD.
3.Hajek P, Stead LF, West R, Jarvis M, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev. 2009; 1:CD003999.
4.Dijkstra A, Wolde GT. Ongoing interpretations of accomplishments in smoking cessation: positive and negative self-efficacy interpretations. Addict Behav 2005; 30:219-34.
5.Yong HH, Borland R. Functional beliefs about smoking and quitting activity among adult smokers in four countries: findings from the International Tobacco Control Four-Country Survey. Health Psychol 2008; 27:S216-23.
6.Williams GC, Minicucci DS, Kouides RW, Levesque CS, Chirkov VI, Ryan RM, et al. Self-determination, smoking, diet and health. Health Educ Res 2002; 17:512-21.
Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees:
