Helping smokers quit needs clinical support, policy support: Experts

Experts at the 9th Summit on Tobacco Harm Reduction stressed stronger clinical support for tobacco dependence, evidence-based policies and greater focus on helping smokers quit

Telling smokers to quit is not enough and greater emphasis needs to be placed on clinical support for tobacco dependence, while public health policies should evolve with emerging scientific evidence, experts said.

The experts spoke at the 9th Summit on Tobacco Harm Reduction, held virtually from September 28 to 30, where clinicians, researchers and policy experts discussed tobacco dependence, smoking cessation, nicotine use among young people and the role of scientific evidence in shaping tobacco-control policies.

Dr Mohsin Wali, Senior Consultant, Internal Medicine, Pacific OneHealth, Delhi, and founding member of Doctors Against Addiction (DaAD), said there was a significant difference between advising a smoker to quit and helping them actually overcome tobacco dependence.

"Every smoker should be encouraged and supported to quit, but after more than four decades in clinical practice, I have seen that telling a smoker to quit and helping that person actually quit are two very different things," Wali said.

He said a large number of his patients who smoke cigarettes or bidis struggle to quit and doctors therefore need to consider the available scientific evidence while supporting them.

"No nicotine product is 100 per cent safe, but different products can carry different levels of risk," Wali said.

"As new evidence emerges, our policies should be reviewed periodically so that public health decisions remain firmly rooted in science," Wali said.

Neal L Benowitz, Professor Emeritus of Medicine, University of California, San Francisco, said nicotine and cigarette smoking should not be treated as synonymous when assessing their health effects.

"Nicotine is not synonymous with cigarette smoking, and understanding its health effects requires us to distinguish the pharmacological effects of nicotine from the much broader harms caused by tobacco burning," Benowitz said.

He said nicotine was addictive and its cardiovascular effects, including effects on heart rate, blood pressure and blood-vessel constriction, could not be ignored.

At the same time, the health risks associated with nicotine products were not necessarily identical to those caused by cigarette smoking, he said, stressing the need for evidence-based assessment of different products.

"Protecting young people from nicotine initiation must remain a priority, while for adults who already smoke, the focus should remain on helping them quit and understanding the relative risks of different nicotine-delivery products," Benowitz said.

The India-focused discussions highlighted the country's tobacco-control framework and continuing challenges related to tobacco dependence, enforcement and informal markets.

Speakers emphasised the need to strengthen prevention and cessation services, protect children and non-smokers, and ensure that public health communication remains transparent and based on credible scientific evidence.

Discussions also examined restrictions on smoke-free nicotine alternatives, with speakers noting that such measures may not by themselves eliminate nicotine demand and could leave some adult smokers continuing to rely on smoked tobacco or turning to illicit alternatives.

Experts said tobacco-control strategies should therefore combine prevention, protection from exposure and stronger cessation support, while remaining responsive to the quality and direction of emerging scientific evidence.