It was in 1950 when Ernst Wynder and Evarts Graham on the one hand and Richard Doll and Bradford Hill on the other first published the evidence of an association between tobacco smoking and lung cancer risk. Over the subsequent 65 years, thousands of studies confirmed this association, and further attributed to tobacco smoking a number of respiratory and cardiovascular diseases. This notwithstanding, the tobacco industry did not discontinue the promotion and sale of their products, and preferred to deny – and even hide – the evidence.
There is today evidence that smoking cessation interventions provided by adequately trained healthcare providers are extremely worthwhile: a brief advice significantly increases the patient’s success in smoking cessation, and again the rate of success is directly related to the time spent with the healthcare provider. Consequently, several national health services or public health organizations worldwide recommend all healthcare providers to promote tobacco cessation to all patients who smoke.
To better understand the current efforts of GPs and dentists in promoting smoking cessation and the potential of these healthcare providers as tobacco control advocates, a recent paper analyzed a representative survey conducted in Italy. In our country tobacco smoking causes 70,000 deaths each year (approximately 12% of total mortality), including 1400 deaths for cancer of the oral cavity and pharynx (about 70% of all deaths from this cancer) (1). Data were collected through a face-to-face survey conducted by DOXA, the Italian branch of the Worldwide Independent Network/Gallup International Association (WIN/GIA). The overall sample consisted of 3052 individuals aged ≥15 years (1464 men and 1588 women), representative of the general Italian population, in terms of sex, age, geographic area and socio-economic characteristics. The results showed that appropriate training is crucial whenever GPs and dentists deliver interventions for smoking cessation to their patients. Unfortunately, several studies highlighted a lack of preparation for delivering effective interventions for smoking cessation to their patients, both in Italy and elsewhere. Moreover, only one hour of training has been shown to significantly increase their involvement in the delivery of smoking cessation advice.
In conclusion, the high proportion of Italian smokers visited by GPs and dentists suggests that these healthcare providers can make a major contribution to the fight against tobacco and they should do more, given that currently only one out of four of them systematically advise their patients to quit smoking. Before acting, however, they should be trained, and before training they should set a good example by refraining from smoking, at least during working hours!
1. Gallus S, Lugo A, Garattini S, Pacifici R, Mastrobattista L, Marzo G, Paglia L. General practitioners and dentists: a call for action against tobacco. Nicotine & Tobacco Research 2016; 18(12)2002-8 1–7.