This chapter presents the rationale for conducting research on barriers to smoking cessation amongst people who should know better. A review of current and relevant literature was done to assess current smoking cessation policies and initiatives, barriers to accessing treatment for nicotine dependence, and barriers to quitting.

Following the studies by Doll and Hill in the mid-twentieth century that suggested the detrimental effects of tobacco smoking(Doll and Hill, 1954), educational and clinical researchers have for decades studied the burden of tobacco smoking and the smoking habit in general. The relationship between tobacco smoking and morbidity/mortality, policy making regarding tobacco smoking regulations and their effectiveness, statistics concerning smoking cessation are amongst topic that have all been studied. This thesis is a study of smoking habits and barriers to smoking cessation amongst people who have an understanding of the health implications of tobacco smoking and also to retrieve a firsthand perspective of the effectiveness of already set down policies and tobacco smoking regulation.

Though smoking rates though reduced in comparison to the mid-twentieth century, there still exists high and alarming incidence and prevalence of tobacco smoking with more young people picking up the habit.

Indeed the view of the individuals primarily involved in tobacco smoking is very important in setting up more effective interventions than are present at the moment. Smoking behaviour differs from class to class and from individual to individual. Several studies have suggested that the strength of the habit is dependent on other influencing factors such as gender, age, employment etc. Because of this, we can find that men have a higher tendency to smoke than women, the less educated and people of low socio-economic status will also be observed to smoke tobacco than the educated and people of a high socio-economic class. Putting into consideration these already set up biases, the author sought to find out barriers to quitting tobacco smoking in an environment that has become anti-smoking.

BURDEN OF TOBACCO SMOKING

Tobacco is a greater cause of death and disability than any single disease (WHO, 1997. WHO fact sheets: fact sheet number 154). It is one of the top causes of preventable death globally and is estimated to kill more than 5 million people every year worldwide, most of which are in between low and middle income countries. It is projected that by the year 2030, this figure will rise to about 8 million people. The burden of tobacco cannot go without mentioning its financial implications and costs to the economy. According to the WHO, tobacco’s cost to governments, employers and to the environment includes social, welfare and health care spending, loss of foreign exchange in importing cigarettes, loss of land that could grow food, cost of fire and damage to buildings caused by careless smoking, environmental costs ranging from deforestation to collection of smokers’ litter, absenteeism, decreased productivity, higher number of accidents and higher insurance premiums. It is said to cost America, Germany, and the UK about $76 billion, $14.7billion and $2.26billion respectively (Mackay and Eriksen, 2002).

Apart from the financial burden of tobacco smoking and related illnesses, the quality of life of the smoker who will be exposed to cancer, organ malfunction and failure, loss of life, is also affected.

AWARENESS AND WHAT HAS BEEN DONE

With the appreciation of death, disability and the financial burden of tobacco smoking, various strategies have been placed by countries to help reduce the trend. Mass awareness campaigns have caused a growing number of people to appreciate the ills of tobacco smoking. Following the scientific reports linking tobacco smoking to ill health in the 1960’s, cigarette packs have been carrying health warnings (Mackay and Eriksen, 2002) such as cigarette smoking causes stroke, tobacco smoking hurts babies, cigarette smokers are liable to die young.

Another major intervention following the scientific reports of the 1960’s, was the introduction of tax on tobacco products. In the UK alone, where tax accounts for about 80% on the price of tobacco, and with a 5% annual increase, about 10billion pounds was generated from excise duty and tax on tobacco products in the year 2009 according to the tobacco manufacturers association. Various studies such by researchers have confirmed an inverse relationship between the price of tobacco and it’s consumption (Chaloupka and Warner, 2000).

EFFECTIVENESS OF ANTI SMOKING INTERVENTIONS

Tobacco use is one of the leading causes of preventable illness and death in the world. Once users become addicted to tobacco, quitting becomes hard. Nicotine dependence resulting from tobacco use hampers efforts to sustain abstinence from tobacco for a prolonged period or a lifetime. Many users make multiple attempts to quit, often without the assistance that could double or even triple their chances of success. Proven individual cessation strategies include counselling and behavioural therapy and, except when contraindicated, first-line and second-line medications.

This section of the literature review will talk about the various smoking cessation policies and treatment for nicotine dependence with a view to analyse them based their effectiveness from previous research.

Smoking cessation interventions include

Individual methods

Cold turkey

Cut down to quit

Self help

Psychosocial and Behavioural therapy

Individual therapy

Group therapy

Self help materials

Aversion therapy

Alternative therapy

Acupuncture

Hypnotherapy