Expanding the digital arsenal of smoking cessation tools during COVID-19

Every year, tobacco kills 8 million people, predominantly caused by non-communicable diseases such a

s cardiovascular diseases, lung disorders, cancers, and hypertension. As a result, the economic burden of tobacco use amount to more than $1 trillion USD in healthcare expenditures and lost productivity annually. This year-long campaign for World No Tobacco Day — “Commit to Quit” — aims to support 100 million tobacco users with the tools they need to quit smoking. With the right support, tobacco users may double their chances of quitting successfully.

Despite notable progress since the adoption of the WHO Framework Convention for Tobacco Control (FCTC), a major challenge for strained health systems is the provision of cessation services suitable to peoples’ needs and circumstances. Data from WHO’s Report on the Global Tobacco Epidemic (2019) indicates that about 60% of the world’s 1.3 billion tobacco users want to quit tobacco, but less than half of them have access to these services. Ideally, countries should offer a complete set of proven interventions including brief advice, national toll-free quit lines, cost-covered nicotine replacement therapies, and digital and mobile technologies to empower those who want to quit.

The COVID-19 pandemic offers new incentives to scale up cessation support as evidence suggests that tobacco users are at higher risk of severe outcomes of coronavirus infection. This is mainly due to the added risk of co-morbidities and underlying health concerns comparative to non-smokers. Research shows that ICU admissions and mortality rates are higher among tobacco users, especially among women.

Yet, with the added stress of lockdown measures and isolation, many tobacco users have struggled to find the motivation to quit smoking. In Italy, the first lockdown led to a 9.1% increase in smoking consumption mainly due to mental distress. Despite a 6.2% relative reduction in smoking prevalence, there was an observed increase in intensity among current smokers. At the same time, the use of e-cigarettes and vapes continue to rise among youth, reaching up to 20% prevalence in some countries. This is attributable to the tobacco industry’s heavy investments in promoting these products as healthier substitutes to conventional cigarettes. Last week, WHO released new information warning against switching to e-cigarettes as these products are harmful, highly addictive and particularly dangerous among youth as the long-term health impacts remain relatively unknown.

Fortunately, a wave of digital health technologies is emerging as a result of the pandemic enabling countries to offer innovative and cost-effective tobacco cessation support. A recent report measuring the effectiveness of COVID-19-risk related text messages indicated promising results in encouraging quit attempts and information-seeking behaviour among tobacco users. A text-messaging program for vaping cessation providing tailored advice, coping strategies and social support resulted in nearly 40% quit rates among young adults. Interactive mobile programmes offering motivational, informative and targeted advice that resonate with tobacco users may reduce stress levels and provide the right motivation to quit.

In collaboration with WHO over the past year, tech companies have launched quit apps, text-messaging support and tools based on artificial intelligence, including the WhatsApp chatbot and the digital health worker Florence. These tools contribute to educate tobacco users, build personalized plans to quit while dispelling misconceptions about COVID-19, tobacco products- and use. In countries overburdened with the COVID-19 pandemic, digital health tools present promising and scalable solutions for behavioural support to deal with tobacco dependence, mental distress, and improve the reach of tobacco cessation services.