The development of community-based smoking cessation interventions in Hong Kong

Abstract

<p>Tobacco kills up to half of its users[1−3], yet one-fifth of the world's population is currently smoking[4]. The World Health Organization (WHO) has launched the Framework Convention on Tobacco Control (FCTC)[5] and the MPOWER policy package (Monitor, Protect, Offer, Warn, Enforce, Raise)[1] to guide country-level implementation of effective smoking cessation measures. Smoking cessation at any age has significant immediate and long-term health benefits[6], and 'Offer help to quit tobacco use' is one of the key components in MPOWER tobacco control strategy, highlighting the crucial role of primary health services in providing smoking cessation services[7,8].<br>Since 1982, Hong Kong has progressively integrated the legislation and enforcement, taxation, publicity and education, and smoking cessation services as a comprehensive tobacco control strategy[9]. The multi-pronged approach has gradually reduced the smoking prevalence among the population aged 15 or above from 23.3% in 1982 to 10.1% in 2018, and 9.1% in 2023[10]. However, there is still an enormous smoking-related burden given the 637,900 daily cigarette smokers in Hong Kong and accounts for over 7,000 premature deaths per year. In 2018, the Hong Kong Department of Health launched an initiative to prevent and control non-communi-cable diseases 'Towards 2025' and targeted to cut the daily cigarette smoking prevalence from 11.1% in 2010 to 7.8% by 2025[11].<br>Tobacco is highly addictive, and it is difficult for smokers with nicotine dependence to quit without assistance. Approximately two-thirds of adult smokers (68.0%) are willing to quit, but fewer than one-third of smokers who had previous quit attempts ever used evidence-based cessation treatments[12]. Further reduction in smoking prevalence is challenging as many remaining smokers are likely to be more 'hardcore' and thus find it more difficult to quit[13].Our participants of nine territory-wide smoking cessation randomized controlled trials from 2009 to 2018 (except 2011, N = 9,837) also found that cigarette smokers in Hong Kong were having less quit attempts, becoming less motivated to quit, and perceiving lower self-efficacy in quitting in the recent decade[14]. Smoking cessation treatments could substantially increase quit rate but were largely reactive[15]. As few smokers would actively seek help to quit, proactive recruitment is increasingly important to connect smokers to available effective smoking cessation services in the community[15,16]. Our and the research of others have achieved improvements in developing community-based smoking cessation interventions, but most of the current community tobacco control practices remain on preventing smoking initiation through educational programs. Through analyzing the development and effectiveness of community smoking cessation interventions, we aim to provide theoretical and practical references for the implementation of community smoking cessation intervention in the future.<br>Community-based smoking cessation interventions mainly include pharmacological treatments to alleviate nicotine with-drawal symptoms and behavior interventions guided by social psychology models to enhance smoking cessation motivation and support smoking cessation attempts. Pharmacological treatment<br>involves the use of several approved drugs to assist in smoking cessation, mainly provided to smokers who are willing to make a quit attempt. Behavioural interventions vary widely in the content and delivery methods and can be passively (e.g., calling Quitline) or proactively (e.g., advising patients to quit during a visit) provided. They may be delivered to smokers who were unmotivated or not interested in quitting. Pharmacological treatments were usually conducted in conjunction with behavioural interventions (e.g.,<br>counselling) to achieve improved cessation outcomes.</p>