Quebec: Free smoking cessation services are effective but underused

A survey conducted by the Quebec Institute of Statistics for the Quebec National Institute of Public Health[1], with a representative sample of more than 1300 smokers and former smokers shows that smoking cessation services are known but still little used. Nicotine replacement therapies (NRT) such as gum or patches are also known and considered useful but also remain little used by smokers in their attempts to quit.

Drawing on participants from the 2020-2021 Quebec Population Health Survey (EQSP), the Institut de la Statistique du Québec surveyed a representative panel of 1,336 smokers and former smokers who had quit smoking in the previous year, all aged 18 and over.

According to the most recent edition of the Canadian Community Health Survey (CCHS), the prevalence of cigarette consumption among Quebecers aged 12 and over was 13.1% in 2021.

Well-known services, considered useful but little used by smokers

In Quebec, free quitting assistance services, such as the telephone line I STOP, have been in place for over 20 years and nicotine replacement therapy is fully reimbursed. More recently, a text messaging service to quit smoking (SMAT) was set up. There are also over 150 smoking cessation centres in Quebec offering ongoing advice to people (SAT) and pharmacists are authorised to prescribe pharmacological aids.

The survey results show that the telephone line and the J'ARRÊTE website are known by 81,300 and 61,300 smokers and recent former smokers respectively. Their use by the latter concerns 2,300 and 8,300 respondents respectively. As for certain NRTs, such as nicotine gum or lozenges, they are known by more than 95,300 respondents but used by less than 10,300 of those concerned. The full reimbursement of these treatments by the insurance scheme is known by half of smokers. Among smokers who have attempted to quit, only 20,300 received a prescription for pharmacological assistance but 64,300 found the reimbursement extremely or very useful for quitting smoking or not starting again. Among smokers who were aware of the existence of bupropion (59 %), only 5 % had used it but 80 % of these users had found it extremely or very useful in quitting smoking.

The CATs, which were known by half of the smokers (51 %), had been used by 4 % of them but considered useful by 64% of them. The survey also asked respondents who had tried to quit what other methods they had used, 28% of them answered that they had used the electronic cigarette and 50% of them indicated that they had found it extremely or very useful in their approach. The authors specify however that this method is not recommended in the same way as services and pharmacological aids to quit smoking.

Among smokers who had attempted to quit in the past year and recent former smokers, the most frequently cited reason for not using services or pharmacological aids was the intention to quit smoking on their own. Regarding the use of NRT, particularly bupropion or varenicline, 37% of respondents cited concern about side effects or interactions with other medications.

Health professionals still too reluctant to include smoking cessation in the care pathway

Among the smokers surveyed, who consulted a doctor in the last 12 months preceding the survey, less than half (49 %) were questioned by the practitioner about their intention to consider or stop smoking. Only 15% of pharmacists discussed smoking cessation during the same period while they are authorized to prescribe substitutes. However, a majority of smokers (54%) consider that it is the role of these health professionals to give advice to their patients to stop smoking.

Studies show that a minority of smokers manage to quit without outside help and that the smoker's entourage, particularly health professionals, play a vital role. Indeed, support from a health professional increases by 70% the chances of a smoker successfully quitting.

Keywords: Quebec, smoking cessation, Canada, health professionals, nicotine replacement therapy, smokers

©Tobacco Free Generation

AE

[1] Analysis report, Knowledge, use and usefulness of smoking cessation services and aids among smokers and recent former smokers in Quebec: 2022, National Institute of Public Health of Quebec, consulted on February 23, 2024