WHO FCTC AND MPOWER STRATEGY

Module O
DR FLORANTE E TRINIDAD
Technical Officer – Tobacco Free Initiative

1
 MPOWER Strategy - O
Offer help to quit smoking
Why need to Offer Help
to Quit Tobacco Use?
• In order to protect the lives and health of
the smokers who are victims of this
epidemic & disease
– As victims, it is hard for them to quit on their
own, hence, they need all the help they can
get

Basic premise:
• smoking is a deadly epidemic  it kills!
Why need to Offer Help
to Quit Tobacco Use?
• Because, even if other tobacco control
measures in place, current smokers will
still find it hard to quit due to nicotine
dependence
Basic premise:
• Smoking behavior is NOT solely a personal
choice but often a DISEASE with NICOTINE
DEPENDENCE as the disease agent 
smokers find it hard to quit on their own
Low Success rate of quitting smoking is
evidence of power of nicotine addiction
Only ~2–3%
Succeed in
Stopping
Each Year3

All Smokers
100% Try to Quit
~30%

Want to Quit
~70%

Smoking Quit Percentages Per Year

1. Bridgwood et al. Living in Britain: Results for the 1998 General Household Survey 1998.
2. West. Getting serious about stopping smoking – a review of products, services, and techniques. No Smoking Day 1997.
3. Arnsten JH. Prim Psychiatry. 1996;3:27-30.
Reasons for Starting and Continuing
Smoking among Filipinos

Reasons for Reasons for

initial intake continuing intake

peer pressure 97% feel relaxed/cool 92%

family influence 94% helpful in
curiosity 89% concentrating 87%
lonely/feel relaxed 54% peer pressure 85%
other people as 46% family influence 85%
model

Ramiro, L. An ethnographic study

of smoking among urban Filipinos. 1999
DESIRE & ATTEMPT TO QUIT
AMONG FILIPINO SMOKERS

 65% wanted to stop/decrease smoking

 100% among those who wanted to quit
failed within 1 mo of attempt

100% relapse rate !

N = 400 smokers
Ramiro et al. An ethnographic study of
Smoking among urban Filipinos. 1999.
QUITTING PERCEPTION AND EXPERIENCE of
> 1 PACK/DAY FILIPINO SMOKER

 Smokers are fully aware of very harmful effects of cigarette smoking.

They also agree that smoking is an “addiction,” but they do not
perceive it as a medical condition.

 9/10 smokers confident about their quitting ability, strongly believing

that cessation is just a matter of willpower and that they can quit when
they want to.

 But based on actual experiences of those who have tried to quit,

cessation is a lot harder than expected. Only 1/2 of hard core smokers
have actually tried to quit. Even with the desire to stop and multiple
attempts, only 40% have succeeded, among which well over the
majority relapsed < 6 months.

 Smokers identify withdrawal symptoms and being around other

smokers as the most difficult barriers to hurdle when quitting.
Project Cold- Turkey by Pfizer Inc.
Why is it difficult to stop smoking?

Habit

Smoker
Psychosocial
Victim

Nicotine
addiction
How is dependence developed

• Smoking is dependence-
producing:
– Physical: Nicotine
dependence, withdrawal
symptoms

– Behavioral: linked to certain

activities (drinking coffee, beer)
and situations (stress), habitual

– Psychological: can’t do
without it
 “Among All Who Have Ever Tried a Single
Cigarette, Almost 1/3 Would Develop
Nicotine Dependence”

Source: J. Henningfield
NICOTINE LEVELS
Nicotine changes the brain chemistry

• Nicotine increases the number of nicotinic

receptors in the brain
• Nicotine receptors are triggered by cues to
desire smoking
Nicotine changes the brain chemistry
• When the receptors are empty, cravings and
urges arise
• With 1-2 puffs of a cigarette, 50% occupancy of
the nicotinic receptors in the brain that may last
for 3 hours after smoking
• One cigarette may fill 88% receptor and
reduces the craving
 WITHDRAWAL SYMPTOMS

Anxiety 87%
Irritability, Frustration, Anger 87%
 Heart Rate 80%
Difficulty Concentrating 73%
 Appetite and Weight Gain 73%
Restlessness 71%
Craving for Cigarettes 62%
Depression , Dysphoria 31%
(Lilington, Clinics in Chest Medicine, 2000)
Whose Responsibility is it to Help Smokers
Stop Smoking?
Whose responsibility is it to
Offer Help to Quit Tobacco Use?

Managing tobacco dependence is primarily

the responsibility of a country’s
healthcare system:
• Government
• social security
• NGOs
• private clinical services

MPOWER WHO document

Why quit? The effects are immediate!

• 20 minutes after quitting: Heart rate and blood

pressure drops.
• 12 hours after quitting: Carbon monoxide level in
your blood drops to normal.
• 2 weeks to 3 months after quitting: Circulation
improves and your lung function increases.
• 1 to 9 months after quitting: Coughing and
shortness of breath decrease; lungs regain normal
function
• 1 year after quitting: The excess risk of coronary
heart disease is half that of a smoker's.
• 5 years after quitting: Your stroke risk is reduced to
that of a nonsmoker 5 to 15 years after quitting.
• 10 years after quitting: The lung cancer death rate is
about half that of a continuing smoker's.
• 15 years after quitting: The risk of coronary heart
disease is that of a nonsmoker's.
 Approaches

• High risk individual approach - provide

information and services directly to
individuals (brief advice, quit lines,
counselling and treatment)
• Population level measures - discourage
smoking through prices and taxes, bans
on indoor smoking, stiff penalties for
smoking in public, graphic health
warnings, bans on advertising,
promotion and sponsorship
GO! On the day that you quit
• Get rid of all your cigarettes. Put away your ashtrays & lighter.

• Change your morning routine. Stay busy.

• When you get the urge to smoke, do something else instead.

• Carry other things to put in your mouth, such as gum, hard candy, or a
toothpick.

• Reward yourself at the end of the day for not smoking. See a movie or go out
and enjoy your favourite meal.
Staying off cigarettes
• Don't worry if you are sleepier or
more short-tempered than usual;
these feelings will pass.
• Exercise! Jog, go to the gym.
• A positive attitude will help you
through tough times.
• When you feel tense, try to keep
busy, tell yourself that smoking won't
make it any better, and go do
something else.
 Staying off cigarettes
• Eat regular meals. Feeling hungry is
sometimes mistaken for the desire to smoke.

• Start a money jar with the money you save

by not buying cigarettes.

• Let others know that you have quit smoking -

most people will support you. Many of your
smoking friends may want to know how you
quit.

• If you slip and smoke, don't be discouraged.

Many former smokers tried to stop several
times before they finally succeeded. Quit
again.
DOH Dept Memo No. 2010-0191

• Health Advisory on Electronic Nicotine Delivery

Systems (ENDS)/E-Cigarettes
• DOH warns the public on the use of these
products. There is insufficient evidence that
ENDS are safe for human consumption.
Rechargeable battery tip
Atomizer

Indicator light Vaporizing chamber Replaceable ingredients cartridge

Industry Programs
Let us
move
forward.
Thank you!