Smoking cessation in Sri Lanka: A silver lining in COVID-19 crisis?
Chathurga Karunanayake
As the deadly COVID-19 pandemic threatens
the entire world, claiming thousands of lives and disrupting
economic activities, it
would be wise to look at the role smoking cessation could play in the response.
According to the World Health Organization
(WHO) and the Government Medical
Officers’ Association (GMOA), smokers are at a higher risk during this outbreak, and there
is growing
evidence that confirms COVID-19 and smoking is a noxious combination. Therefore,
giving up smoking can offer protection from coronavirus in the short term, as the
benefits of quitting smoking begin
just one hour later. Given that over a quarter (28.4%) of Sri
Lankan men (15 years and older) smoke, one important intervention that can be taken right now, is utilising
this moment of panic as motivation to stop smoking. Unprecedented
attention being paid to respiratory health at the moment will certainly help in
this regard.
This blog discusses the role of smoking cessation in reducing
the chances of falling victim to the pandemic, which will not only assist in protecting
public health, but will also make
the population less susceptible to COVID-19 and its future recurrences, both
now and in the longer term.
Smoking Epidemic and COVID-19 Pandemic: Now
is the Perfect Time to Quit
According
to the WHO, the link between smoking and COVID-19
is well-established; the
habit harms the body, especially the cardiovascular and respiratory system. Research confirms that smokers are 1.4 times more likely to suffer
the severe symptoms of COVID-19 and approximately 2.4 times more likely to be
admitted to an ICU, need mechanical ventilation, or die, compared to
non-smokers. Given that lung function improves in as little as one month after quitting
smoking, and after nine months’ time, lung function
doubles and the risk of serious infection reduces substantially, giving up
smoking now can help fight COVID-19 or the upcoming waves of it.
According to the WHO
Sri Lanka, over half (51.8%) of the current smokers have
attempted to quit smoking, while 34.4%
of former daily smokers have already quit smoking. As IPS
research shows, cessation support has an important role to play in reducing
smoking prevalence, especially when it is combined with other policy
interventions. As Sri
Lanka continues its strict social distancing measures, closing all
supermarkets, private pharmacies, and groceries, and imposing curfews to
control the spread of COVID-19, the daily routines of smokers are disrupted
already. A majority are off work and confined to their homes, reducing the
opportunities to smoke and to buy tobacco.
In
addition, with many requests made by professional bodies to ban the sale of cigarettes in view of the pandemic,
smokers will be motivated to give up, as the threat to their lives is closer to
home now than ever before.
Therefore,
the current situation in Sri Lanka can drive smokers to quit if they are
approached through proper cessation channels. That said, it is possible that the intensity of smoking may increase, owing to social
isolation (provided they have enough cigarettes for consumption); IPS research suggests that
loneliness could lead to continuation in smoking. The good news is that these
can be controlled through proper cessation channels.
Furthermore,
as this pandemic is already disrupting the economy, smoking will become
relatively more expensive to people, especially for those who rely on daily
wages, as they do not have much of an income right now to purchase cigarettes. This
will be an additional incentive for them to quit. Thus, it is important to use this opportunity wisely,
to help people to finally kick the habit, through properly targeted cessation
channels.
Cessation Programmes in Sri
Lanka and the Country’s Readiness
IPS research shows that Sri Lanka’s current efforts in tobacco cessation focus on
changing the behaviour of people, by conducting diversified programmes that
target different groups. These programmes include educative sessions, trainings,
one to one counselling, a national quit line, and awareness campaigns via
electronic and print media. According to the Strategy for Tobacco Cessation in Sri Lanka 2020-2025, the two
complementary approaches used are community tobacco cessation and clinical
cessation. While community cessation programmes such as ‘tobacco free villages’
are identified as more cost-effective, as they help a large number of people at
once, to quit smoking within a short period of time, persons with the addiction
are required to get support under clinical settings.
However, given that the current situation in the country
encourages self-isolation and social distancing, there are many challenges in delivering
cessation support, and as such, prevailing cessation programmes in the country are
likely to struggle to help smokers to quit in the immediate future.
Quick, Cost-effective Cessation Support during the Pandemic
International evidence suggests that,
during an outbreak, the most successful way of controlling smoking is through
online cessation channels, such as mass-media anti-smoking
campaigns and free smoke-free mobile apps that assist
smokers with personal quit plans. Therefore, it is suggested that more online
support is introduced in Sri Lanka, in addition to raising awareness and
increasing the capacity of the national quit line already in use. For instance,
mobile apps can be used to encourage people to quit smoking through a quit plan
or a schedule that can be used during their stay at homes, while telephone
calls and text messages can be used to deliver programmes remotely to help the smokers
stick to the plan. This support can be introduced quickly and at a relatively
low cost.
Support should be coupled with an awareness campaign, including
using social media to inform people on how smoking could trigger the symptoms
of the outbreak, and traditional media channels can be used to inform the
people about the deadly combination of smoking and COVID-19 as a social message.
While the government has included smoking cessation advice in the health
messages on tackling the spread of COVID-19, it is important that those
messages are extended to the general public through all radio channels,
television programmes, social media, and text messages.
Way Forward: A Start to a
Stop!
As highlighted earlier, smoking
is strongly associated with greater risk of hospitalisation and deaths from COVID-19.
Thus, smokers should seriously consider quitting now. This will improve their immunity,
lung function, respiratory systems, and reduce their risk of serious symptoms
that could later lead to death. As Sri Lanka strives to overcome the deadly
COVID-19 through its health and safety measures, using timely cessation channels
such as social media, online support, mobile apps, radios, text messages, and
telephone calls are very important and come in handy at a time like this, when people
are advised to be in self-isolation and practice social-distancing. Reducing
smoking rates through proper cessation support can help to make the population
more resilient to the pandemic, and as such, should be key in the public health
response. Finally, if Sri Lanka can make this crisis an opportunity to incentivise
smokers to successfully quit, it will be a great win, not only in terms of
curbing the risk of the pandemic but also, in avoiding the burdens that future waves
could bring into the public health system and more generally, in terms of reducing all the
other negative health impacts of smoking in the longer term. Therefore, this is
a window of opportunity to reduce tobacco prevalence for good.
(Chathurga Karunanayake is a Research Assistant at the Institute of
Policy Studies of Sri Lanka (IPS). To talk to the authors, email chathurga@ips.lk. To view this article online and
to share your comments, visit the IPS Blog ‘Talking Economics’ – http://www.ips.lk/talkingeconomics/)