As a recognized global leader in tobacco control, Ireland has worked hard to develop comprehensive treatment for tobacco dependence. The country’s efforts are underpinned by ambitious goals: it aims to be tobacco free by 2025 with a smoking prevalence equal to or lower than 5%. One of Ireland’s keys to success is a rigorous national cessation programme that provides care and support for those struggling with tobacco and nicotine dependence.

As part of the 2021 World No Tobacco Day campaign “Commit to Quit”, we explore Ireland’s world-class stop-smoking services, shining a light on the success of countries working to create a tobacco-free world.

“We now have more quitters than smokers in Ireland,” says Martina Blake, National Lead of the Health Service Executive (HSE) Tobacco Free Ireland Programme. “Unfortunately, as we know from the Healthy Ireland survey, most smokers try to quit alone and don’t use recognized and evidence-based cessation aids. We would like to encourage all smokers to give themselves the best chance of success and use our friendly and supportive services.”

It can be hard to quit smoking, but the chances of succeeding are drastically increased with the right support. Smokers are twice as likely to succeed in ending tobacco addiction with the help of tobacco cessation programmes provided by Ireland’s HSE, and 4 times more likely with a combination of cessation programmes and medication.

Comprehensive cessation programmes

Ireland’s comprehensive cessation services cover a bespoke range of options for tobacco users who want to quit, from a free quitline and live chat on the quit.ie website to “community quitters” Facebook groups and a free online quit plan. The headline service is the structured behavioural support programme.

Implementing comprehensive cessation programmes is important, but can appear daunting or resource-intensive for some countries. A stepwise approach can be helpful for developing support systems in an affordable manner. Ensuring that everyone in society – particularly the most vulnerable – can access cessation services increases the chance of success and boosts progress towards a tobacco-free future.

Tailored support

Ireland is tailoring tobacco-cessation support to specific groups, particularly those in disadvantaged communities, whose unique needs are assessed early in the process.

“Those who have a long smoking history, are heavily addicted or have mental health difficulties often need extra and extended support, particularly in line with other factors like unemployment or concurrent addictions,” Martina says.

“We are beginning to invest in specific services for pregnant smokers and for those in disadvantaged communities. Extra behavioural support sessions are available for people in these groups and can extend beyond the standard 8 sessions over the 12-month period.”

Tobacco advisers for disadvantaged groups are often local peer leaders trained within the community they serve. This improves rates of quitting by increasing engagement and building trust, and places cultural sensitivity at the forefront of the cessation programme.

Affordable support in the right place

Ensuring that smoking cessation services are free to everyone and medication is free to those most in need is key to success. In Ireland, the HSE programme advises all smokers to combine the quit service with stop-smoking medications.

Over 30% of people in Ireland have medical cards, which entitles them to a range of services and medicines free of charge. This means low-income smokers can access stop-smoking medications without denting their wallets.

In addition to affordability, rigorous logistical planning helps ensure that smokers have timely support to quit. “We have a national digital patient-management system, which allows advisers to schedule call-backs,” Martina explains.

“It now also facilitates the electronic referral of smokers from all general practitioners in primary care into a centralized referral processing centre, after which they will be assigned to a stop-smoking adviser and service local to them.”

High uptake of the cessation services has largely been driven by referrals from health professionals and well funded, active mass media campaigns.

The HSE and the National Clinical Effectiveness Committee of the Department of Health have developed best-practice guidelines on diagnosing and treating tobacco addiction, which will be shared with health professionals. This goes hand in hand with investment in people.

“Countries should agree to invest in standardized training for stop-smoking advisers,” says Martina. “This will ensure that a specific role is identified for the treatment of tobacco dependence.”

Impact of COVID-19

Efforts to help people quit have never been more important in light of the coronavirus pandemic. COVID-19 has given many people a strong motivation to quit tobacco use, as smokers have a greater risk of developing a severe case of COVID-19 and dying from the disease.

Although the pandemic has further highlighted the risk of smoking, the picture is not straightforward. In some cases, stress and disruption from the pandemic have caused an increase in tobacco use among current users.

In a survey conducted by Ireland’s HSE in April 2020, 35% of women and 26% of men who were using tobacco noted an increase in usage. As demonstrated by the HSE, redoubling efforts to commit to quit in light of the risks and pressures of COVID-19 is critical.