The Application of Tobacco Cessation as a Tobacco Use Intervention in the UAE

The Application of Tobacco Cessation as a Tobacco Use Intervention in the UAE

The Application of Tobacco Cessation as a Tobacco Use Intervention in the UAE

Introduction

Tobacco use has remained one of the greatest concerns bedeviling the United Arab Emirates (UAE) due to the serious impacts it causes to its users, their families, the wider public and the government. It causes hundreds of deaths and other complications each year and has cost the country millions of dollars in treating the conditions associated with its use. Tobacco smoking heightens the risk of cancer among its users and is the second leading root of cardiovascular diseases, the main cause of deaths in the UAE. Also, the use of this substance is a direct cause of lung diseases and respiratory failure. In 2016, the Tobacco Atlas reported that the country lost the lives of more than 2,900 of its citizens due to tobacco smoking complications and spent more than $569 million in health care costs and lost productivity (Webster & Gornall, 2018). About 2,718 of the casualties were of men whereas 265 were women. Studies show that tobacco use can produce an opening for other substance abuse. Also, managing and preventing tobacco use is a costly affair as it entails the use of funds to create awareness among the substance users and the wider public in regards to the harmful effects it causes. However, all tobacco-related deaths and consequences are preventable, and every government has the capacity to minimize the human and economic costs of the tobacco epidemic.

In recent years, the UAE has made considerable efforts to combat tobacco use within its boundaries. Nevertheless, people continue to use the substance, fall sick needlessly, and die. Also, the costs to the country from this abuse continue to rise and the number of its users seems to increase. In the country, about 24 per cent of men and 0.8 per cent of women are tobacco users (Al-Houqani et al., 2018). The use of this substance in the country is highest among young men of ages between 30–39 years, resulting in the falling ill and deaths among the most productive age group in the UAE (Al-Houqani et al., 2018). Among its nationals, the rate of smoking among men was highest among people of 20–29 years accounting for 29 percent while men of ages between 30 and 39 accounting for 32 percent (Al-Houqani et al., 2018). The seriousness of tobacco use has forced different stakeholders such as the government in the UAE to initiate programs to curb this menace. In the country, tobacco control legalization began after the inauguration of an anti-tobacco federal law in 2009 (Obaid et al., 2014). The law imposed a smoking ban in all public areas such as schools and universities. Also, it made it illegal for anyone to sell cigarettes to any person under 18 years or to smoke in transport vessels such as cars transporting children below 12 years (Obaid et al., 2014). Despite these efforts, there is an increasing magnitude of tobacco smoking among adolescents and young adults in the country.

Intervention and the Problem It Addresses Restated

Since the UAE is suffering unnecessarily from this challenge, there is a need for the adoption of effective tobacco use management strategies that can enable its users to abandon the substance. Tobacco cessation is one of the effective interventions that can result in positive outcomes in the management of the use of this substance. However, there is limited knowledge among the UAE public about tobacco cessation as an intervention despite study findings confirming that this strategy is effective. As a result, there is a need for studies that highlight this intervention in the UAE to increase its use, thereby relieving the public and the economy from suffering the costs of tobacco use.

Background Literature  

Tobacco cessation is an appropriate strategy of encouraging the abandonment of tobacco use among its users. Different behavioral therapies are efficacious for many smokers. The therapies range in complexity from simple advice provided to smokers by a physician or other health care professionals to more extensive therapy offered by counsellors or specialized smoking cessation clinics. Simple advice from health care professionals has increased abstinence rates by about 30 per cent compared to no advice. According to Nisaa, Zafar, and Zafar (2018), smoking cessation extensively reduces premature deaths and increases the quality of life of the patients. This strategy decreases the chance of cardiovascular diseases, lung cancer, stroke, respiratory complications. In Baumeister’ (2017) view, smoking is an addictive habit to abandon and many smokers find it hard to quit on their own. Nisaa, Zafar, and Zafar (2018) argue that many smokers require support in quitting smoking. There are numerous cessation strategies comprising pharmacological therapies, behavioral therapies, and natural agents (Nisaa, Zafar, & Zafar, 2018). Every smoker has unique characteristics that can be managed by a specific cessation strategy. As a result, smoking cessation is effective in reducing smoking habits as it can be applied to all smokers. Verbal persuasion is effective in promoting recovery from chronic conditions, facilitating health promotion, and promoting change in people’s adverse conducts, especially for high risk problems relating to health such as tobacco addiction (Elshatarat, Yacoub, Khraim, Saleh, & Afaneh, 2016). The use of persuasion by health care practitioners has a significant impact on the self-efficacy expectations of smokers on quitting smoking.

The Intervention and its Relevance to the UAE

Tobacco cessation occurs in five stages. All tobacco smokers have to undergo these stages to fully abandon the substance.

1. Pre-contemplation Stage

This is the stage when a smoker does not think about quitting tobacco use. In this phase, they strongly defend their smoking and may resist any convincing to abandon the habit (Government of Canada, 2009). This is the critical stage when the facilitators in this program will exert a lot of effort to convince the smokers to quit their lifestyle.

• Contemplation

During this stage, smokers are thinking about quitting smoking, sometime in the near future, such as in the next six months or less. They have some knowledge regarding the consequences of the habit and believe that smoking is a problem that needs solutions (Swedish, 2019). As a result, they are welcome to information that can help them overcome smoking and the hindrances to quitting the habit. The facilitators of this program will guide them to understand how they can progressively abandon smoking and overcome challenges hindering behavior change.

• Preparation to Quit

At this stage, the smokers decided to abandon smoking and are preparing themselves to stop it. They believe that not smoking is more beneficial compared to smoking; therefore, they are committed to stopping (Mallin, 2002). The facilitators of the cessation program will have a duty to highlight the best and necessary steps the patients should take to change their behavior.

• Action

In this stage, the patients are actively attempting to end their smoking habit. They use short-term rewards to gain motivation and consistently turn to their close ones such as family, friends and others for support. This stage usually lasts for about six months and the smokers mostly need help and support. The facilitators of this program will provide maximum support to the patients and seek external support for them.

5. Maintenance Non-smoking

This is the final stage where the former smokers anticipate and handle temptations to revert to smoking. They adopt numerous coping tactics to resist the temptation to smoke and develop new ways of managing stress, social pressures, and boredom of being nonsmokers. At this stage, this program will concentrate on supporting the reformed individuals counter the temptations to revert to smoking.

The ever-increasing level of tobacco smoking in the UAE is a clear indication that the various tobacco use prevention measures have been ineffective. The UAE has used numerous strategies such as the enactment of law restricting tobacco use, public awareness programs, publication of warning contents, and social initiatives facilitated by the government and private entities. However, it is essential to adopt programs that can result in mass abandonment of tobacco, thereby saving the country from the burden of medication costs and deaths, especially the young adults who are the most productive group in the country.

How The Intervention Will Be Performed

Tobacco cessation is one of the best strategies that can enable the UAE to drastically reduce the number of smokers. This intervention will be implemented in the employment sector. All people in employment and those seeking employment will be subjected to tobacco use tests to determine whether they are using the substance. For the people in employment, if the results are positive for the use of tobacco, he or she will be enrolled in a cessation program. On the other hand, employment seekers will be denied job vacancies if the results are positive. All the smokers, whether in employment or seeking employment will undergo tobacco cessation. Those in employment will be required to provide a plan on how to undergo the cessation program after consulting with their employers so that they do not interrupt their work schedules and roles. The patients will be evaluated as they continue with the program to determine whether they are reducing their tobacco use. Employee participants who fail to minimize the use of tobacco will experience progressive monthly pay cuts. Those seeking employment will not be employed unless they abandon tobacco use. The participants in this intervention program will include healthcare professionals such as physicians, psychologists, and social workers, employers, and the patients themselves (smokers). The program will adopt the models of addiction 1st disease concept which consider the cause, the substance is the problem that is addictive, the individual is not to blame, treatment through cessation program, the substance should be banned, and the individual should be helped.

Use of the Intervention in UAE Context

This intervention is effective if applied to the working class in the UAE. It is good for the UAE context because most of the smokers in the country are young people. It will help the country to reduce the frequencies of diseases associated with tobacco use, the high cost of medication, and deaths associated with the substance. Also, it will help the country to benefit from the productivity of its youth and young adults because, by saving them from smoking, they will revert to productive activities for the benefit of their country’s economy. The participants will benefit from the counselling provided to them throughout the program and it will enrich their knowledge. Also, it will guide them from smoking.

The Program’s Success

Different studies have confirmed that smoking cessation is effective in reducing tobacco use, depending on the way the program is implemented. For instance, this strategy gives positive results if nicotine replacement therapy (NRT) and behavioral support (Thurgood, McNeill, Clark-Carter, & Brose, 2016). The combination of these processes increases smoking abstinence, especially among people treated for substance use disorders (Thurgood et al., 2016). Also, the use of these methods is appropriate since it does not affect other substance use treatment outcomes. This program will involve weekly individualized bupropion and counseling, which will enable the program’s facilitators to evaluate the patients’ conduct and Listen to them. As a result, the healthcare professionals will determine the necessary steps at each moment to enhance patient’s abandonment of tobacco. Also, the effectiveness of this program will be augmented by subjecting health professionals to training, which is a critical part of a cost-effective and evidence-based strategy of improving the effectiveness of treatment of tobacco dependence and smoking cessation. There is a great likelihood of the success of this program since the fear of pay cuts, dismissal, and rejection of job applications will encourage the patients to quit tobacco use.

Methods of Assessing the Efficacy/Effectiveness of The Intervention

The success of this program will be based on the number of tobacco smokers who will enroll for support to abandon the use of this substance. A large number of enrolment will act as an indication of tobacco users’ desire to abandon smoking and their trust in the effectiveness of this strategy. Tobacco use prevention strategy should be convincing and not appear to be burdensome to its users. Costly and time-consuming programs may deter enrolment and increase withdrawal (Turan & Turan, 2016). The effectiveness of the program will also be gauged based on the rate of the patients’ use of tobacco. The facilitators should record a continued reduction in the number of tobacco cigarettes used by each of the patients registered for this intervention. If the patients do not display a reduced rate of tobacco use, then the program will be considered ineffective. The effectiveness will also be gauged based on the continued participation of the patients. If the number of patients reduces with time due to withdrawals before the planned completion date, the program facilitators will understand that the program is ineffective. Also, the program will be confirmed to be effective, if by its end, the participants will have fully stopped using tobacco use.  

The Strengths of intervention and its Implications of the for the UAE

This intervention is effective in reducing smoking among youth and young adults because these individuals are the working group. Threatening working individuals with salary cuts or dismissal for tobacco use will motivate them to abandon the substance. Similarly, job seekers will realize that tobacco use would render them jobless and poor since no employer would accept smokers.

The Limitations of this Intervention

This intervention may not lead to the intended outcomes. The intervention does not provide ways of preventing smokers from reverting to smoking after the intervention. This program may not cause a substantial impact in the UAE because it is designed for people in employment and those seeking employment. It will not benefit the people who are jobless in the country, the group which forms the majority in the population. Also, it may not affect teenagers and youth who are schooling or looking for employment. Research findings indicate that 20-year-olds, most of whom are still schooling are smoking. This program may not be supported by employers who use tobacco. This intervention is costly, thus, it might be hampered by financial challenges. Also, it may be challenged in the courts because there is no law prohibiting tobacco use, especially among adults.   

Implications of the Intervention for the UAE

This intervention has numerous implications for the UAE. It will help the country to reduce the number of smokers, especially among the working class which is made up of young adults and the youth. It will reduce the frequencies of tobacco-related diseases and the cost of medication. Also, it will reduce the number of deaths associated with the substance. The intervention will enable UAE to increase the productivity of its youth and young adults by keeping them healthy and safeguard them from complications linked to tobacco use. Thus, the UAE’s economy would improve from the productivity of the youth and reduced costs in tobacco use and related diseases.

References

Al-Houqani, M., Jabari, A. L., Naeemi, A. A., Junaibi, A. A., Zaabi, E. A., Oumeziane, N., Kazim, M., Maskari, F. A., …… (2018). Patterns of tobacco use in the United Arab Emirates Healthy Future (UAEHFS) pilot study. PLoS One, 13(5). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976156/

Baumeister, R. F. (2017). Addiction, cigarette smoking, and voluntary control of action: Do cigarette smokers lose their free will? Addict Behav Rep. 5: 67–84. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800589/

Elshatarat, R. A., Yacoub, Khraim, M. I., Khraim, M. M., Saleh, Z. T., & Afaneh, T. R. (2016). Self-efficacy in treating tobacco use: A review article. Proceedings of Singapore Healthcare, 25(4): 243 –248. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/2010105816667137

Government of Canada (2009). 5 Stages to quitting. Date modified: 2009-02-16. Accessed on April 17, 2019 at https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/quit-smoking/faqs-facts/five-stages-quitting.html

Mallin, R. (2002). Smoking Cessation: Integration of Behavioral and Drug Therapies. Am Fam Physician, 65(6):1107-1115. Retrieved from https://www.aafp.org/afp/2002/0315/p1107.html

Nisaa, Z. U., Zafar, A., & Zafar, F. (2018). Efficacy of a smoking cessation intervention using thenatural agents. International Journal of Collaborative Research on Internal Medicine & Public Health, 10(2): 809-815. Retrieved from http://internalmedicine.imedpub.com/efficacy-of-a-smoking-cessation-intervention-using-the-natural-agents.pdf

Obaid, H.A., Hassan, M.A., Mahdy, N.H., ElDisouky, M.I., Alzarba, F.E., Alnayeemi, S.R., Rillera, M.C., & AlMazrooei, B.S. (2014). Tobacco use and associated factors among school students in Dubai, 2010: intervention study. Eastern Mediterranean Health Journal, 20(11): 765-773. Retrieved from http://applications.emro.who.int/emhj/v20/12/EMHJ_2014_20_12_765_773.pdf

Swedish (2019). Quitting smoking: The stages. Accessed on April 17, 2019 at https://www.swedish.org/classes-and-resources/smoking-cessation/stages-of-quitting-smoking

Thurgood, S. L., McNeill, A., Clark-Carter, D., & Brose, L. S. (2016). A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Oxford Journals: Nicotine and Tobacco Research, 18(5): 993–1001. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826485/

Turan, O. & Turan, P. A. (2016). Smoking-related behaviors and effectiveness of smoking cessation therapy among prisoners and prison staff. Respiratory Care, 61(4): 434-438. Retrieved from http://rc.rcjournal.com/content/respcare/61/4/434.full.pdf

Webster, N. & Gornall, J (2018). Almost 3,000 smoking-related deaths a year in UAE, report shows. The National. Updated on March 8, 2018. Accessed on April 15, 2019 at https://www.thenational.ae/uae/almost-3-000-smoking-related-deaths-a-year-in-uae-report-shows-1.711425

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