The Potential Effectiveness of Stop Smoking Interventions in the Philippines

Jenni Greaves

A survey of smoking habits in the Philippines1, the results of which were published in this journal in 2013, revealed that 31% of the population smokes. While smoking rates remain far lower among women – the study showed that more than four times as many men as women smoke – rates are still high among women over the age of 70, while men in their twenties smoke in greatest numbers. This highlights the need for smoking cessation interventions in the Philippines across the age range, targeting both men and women.

Health impacts of smoking

A recent piece of research published in The Lancet2, considering the cases of lung cancer attributable to smoking, provides further evidence for the need to both prevent people taking up smoking and to help those already smoking to quit. The research into lung cancer cases associated with smoking indicated that of the 10,871 cases of lung cancer diagnosed in 2008, 62% of these cases were attributable to smoking. What is more, there was the loss of 64,913 disability adjusted life years as a consequence of smoking, with 99% of these related to loss of life as a result of early mortality. With smoking contributing significantly to cases of oral cancers, circulatory disease and COPD, the impact of smoking on health outcomes is serious.

Efforts to reduce smoking levels

The World Health Organization advises that there are four key areas to prevent smoking uptake and aid smoking cessation3. Firstly, it is essential that current smokers receive help, both in terms of counselling and stop smoking medication to support their quit attempts. Hard-hitting images of the damage caused by smoking also serve as a helpful deterrent and it is crucial to ban all cigarette advertising. Finally, the World Health Organization also highlights the positive impact that higher taxes have on smoking rates.

Help to quit

Smoking cessation counseling forms part of the quit smoking program offered by the Department of Health in the Philippines4, helping smokers to identify triggers, cope with withdrawal symptoms and manage cravings. Although limited information is available about the effectiveness of this smoking cessation counseling, data from the Global Adults Tobacco Survey in the Philippines indicated that of those who smoked in the last 12 months, 12.3% reported receiving counselling, though only 4.5% managed to quit. However, in addition to counselling, the Department of Health also advocates nicotine replacement therapy. While this form of therapy can help with nicotine cravings, a more successful approach is using the stop smoking medication varenicline, sold under the brand names of Champix and Chantix. In a study published in the International Journal of Clinical Practice5, looking at the success of smoking cessation drugs in Asia, of smokers from the Philippines who took varenicline for 12 weeks, 51% successfully quit. This piece of research also found the drug was safe, though as reported by KwikMed6, nausea was a common side effect; others include headaches, low mood and sleep disturbances. Where appropriate, smokers should have access to varenicline.

Pictorial warnings

Although there are a variety of ways to get anti-smoking messages across to people, pictorial warnings are most effective. This was demonstrated in a piece of work published in Social Science and Medicine7, which investigated the impact of anti-smoking adverts in countries with low and middle-income, including the Philippines. Adverts illustrating the health effects of smoking had greatest impact and their influence was most consistent across the countries and different sectors of the population within countries. However, other forms of advertising that emphasise the negative health impacts of smoking were also shown to be effective, though to a lesser degree. Pictorial warnings should therefore feature on tobacco products and be used alongside messages to dissuade smoking.

Advertising bans

According to Tobacco Control Laws, advertising tobacco products through media sources is now banned in the Philippines8. However, tobacco companies may still advertise where their products are sold and offer promotions. Research shows though that young people in the Philippines are still being exposed to other forms of advertising; the results of a survey published in Tobacco Induced Diseases9, show 91% reported exposure through television programmes and 79% through outdoor community events. Further work is therefore needed to reduce indirect advertising of tobacco products.

Higher taxes

As reported in the New England Journal of Medicine, a 50% rise in the cost of tobacco products reduces their consumption by around 20%10. Higher taxes are therefore an effective means to cut tobacco use. While cigarettes are not uniformly taxed in the Philippines at present, according to an article in the Philippine Star, unitary taxation of tobacco will take effect in 201711. One of the hoped effects of this is reduced usage of tobacco products.
Although interventions are in place in the Philippines to reduce tobacco consumption, further efforts are needed to cut smoking rates, benefiting the health of both smokers and those exposed to their second-hand smoke. Research looking at the effectiveness of stop smoking interventions for people in the Philippines will help to guide the help offered to smokers.

References:

  1. Punzalan FER et al (2013) Smoking burden in the Philippines. Acta Medica Philippina. 47(3): 28-31
  2. Bilano VLF (2013) Smoking attributable burden of lung cancer in the Philippines: a comparative risk assessment. The Lancet. 381: S15
  3. World Health Organization (2013) Tobacco
  4. Department of Health (no date) Smoking cessation program
  5. Wang C et al (2013) Effectiveness and safety of varenicline as an aid to smoking cessation: results of an inter-Asian observational study in real world clinical practice. The International Journal of Clinical Practice. 67(5): 469-76
  6. KwikMed (no date) What to expect while on chantix
  7. Durkin S et al (2013) Potential effectiveness of anti-smoking advertisement types in ten low and middle-income countries: Do demographics, smoking characteristics and cultural differences matter? Social Science and Medicine. 98: 204-13
  8. Tobacco Control Laws (2013) Country details for Philippines
  9. Agaku IT et al (2013) A cross-country comparison of the prevalence to exposure of tobacco advertisements among adolescents aged 13-15 in 20 low and middle-income countries. Tobacco Induced Diseases. 11: 11
  10. Jha P & Peto R (2014) Global effects of smoking, of quitting and, of taxing tobacco. New England Journal of Medicine. 370: 360-68
  11. Dela Pena ZB (2013) Cigarette, alcohol taxes up 81.5%. The Philippine Star, 21 December