EDITORIAL Towards the eradication of tobacco addiction in Canada: The role of the physician T wen ty -.,l'Vc'll per ,xnt Llt' the populati<ln ot' Canada aged I 5 years or olde r use tuhacu> prndul·t s. That equates to ovi.:r se ve n million people or who111 t111c in !i v,: wi ll die o r a cigarettc-n:lated di sease. Seventy-liv,' per ce nt or th ese individuals want to quit. :md ri ve out or si x wish they had never .st:1rted. The prl· v,ilcn u: or cigarcllc .smoking has dropped from 50'/r 01· 111 c adult pnpulat ion in the· I 'l)()s .111d continul·d to drup cal'l1 year until i 'Jllc.l . The nulllbcr or t cc: nagcrs smoking in J LJ<)J stood at I Ylc. approx imatc'l y ha lf of' what it was 20 years ago. The initial c.1u scs or tile rl'ductio11 We ' re mul1ir,1ctmial. partly due to increased public awareness o l' tile ri sks and till' be nefit s or cessation. partly due to the reduct ion in advertisi11g. partl y due· to the warnings plac·cd <ll l cig,rn:tte packages ,ind lllO st certai n ly du l· !<> til l· vcl' y si1 ,·a hl i.: inLTc' ,1ses in th i.; pricl' 01· ci garettes . Since February 1 994. with th e· tobacco tax rollback in Canada. 1nore tee na gers and preteens ha ve beg un to sllloke. Previous data !rnm Health ( ·anada have indicated that it is this segment or th e pop ul ation wh ic h is most sensiti ve to the pri cl· or tobacco. 19 94 was 11!c y,·ar ul · th e g reat est in crease 111 toh:1l ·u, consumption in re corded Canadian history. The tobacco tax reduction in I 'Jl>4 may well rank as th e wors t puhlic health fia~ co peq.1ctrated hy any Canadian government. It is also potentially a very expensive blunder ,IS one i11 four 01 · th ,· new smokers will dcv ,· lop a cigare tt e-rdatl'd disease, a nd o ne in five will die becausi.; o r it. Why do 1 c:,· n;1 gl'rs bef!in to smoke'! Initially th e cause is peer press ure ;i nd ciga rette- advert is in g: subsequently nico ti ne add il·tio 11 de ve lops lullowed by psychological conditioning. Why do people L·on1i11uc to srnokc even ii' th ey 1 Nan t to q uir> Primarily. in most ind ivi dual s. ii is because or 11i l'li ti11 c addi,·tio11 and ;1 l'lllllhi11atio11 or c· nvironn1cntal and rn1otional c·ul's as a res ult or psycho logical conditioni ng an d reinforceme nt hy each ciga rc11 c srnoki.:d . Re cent research int o why a person starts smoking an d th ose !'act ors th at mai ntai n the habit have enabled ph ys ic ia n., . psychologis ts :ind pk1nnaco logi s ts to :1pprn.ich a smoking cessa ti on success rate th at has not been possibl e previously. ,\ nu1nbc·1 · or 111odalitic s have been shown to be ci'kcti vc in smoking cessa ti on. The first a nd simplest of these i, phy. ,ician advicc. Finn advice from a dol·tor with cot.mscllin g. prnv isio11 ol litcratu1-c and follo w-up has been shown to resu lt in cessation in a signi ri calll nun1l wr ur smokc·rs. T hi s is particularly tru e: ir the person has a ,1noki11 g-rclatcd di sease. And yet only abo ut 6W!, uf doctors evc ·n as k ,ill their patiL·nts if th ey smoke. If the smoker is detcnnined by the physil·ian tu h,IVL' a sign i fi cant compone nt or nicotine addiction. nicotin i.; replacc1ne n1 therapy is indicated. This can be accomp li sl!ed wit h tl w ni cotine' patch or nicoti11l' gum depending un ind ivi cl 11 al ci rc ums t,1nc es. Ir these agents arc· pr c•s crihL·,I. th e patic' nl should be rully acq11ai11tc-d with the cor rect usage and potential si de effects. For example. ii' the pe rs on continu,·s smok in g while using the nicotine patch c·s . the ni cotine in 11!,· blnod n1;1y rise to le vels th at are potrntiall y h,t la rdous to palil'tlls with u11stabk heart disease. Behaviour mocl iricatinn is an essential component ol tli c· sm ok in g cessation process. All smokers trying 10 quit should be rdc rre cl to th e 1.ung Associat ion or equiva le nt program for instruc ti on in those aspec ts or behaviour modi rication most app li cab le to him or her. These t,'chniq11e, address th e c'nvironmcntal ,ind ,·nwtional CUl 'S su important in sus ta ining th e habit in most sm oki.:rs. T he combination or ph ys ician ;1d vic e. 11i co ti11 l' replaceme nt and behaviour mod iri ca ti on. w ith fo ll ow-up by till' phys ician or ,1 t'orn1,il smoking cessation program. h,1s hl'l:n show 11 to res ult in documented quit rates of 25 lO 30 '7r verifi ed bi oche mi cally. The other facto rs shown to Ix· r,: lc van l in cessation arc social. Ir th e spouse mid rriends don 't smoke and th e cnviro 11111l·nt at work is 1wm 111oking. thcre is a g rc ,1 ter likelihood or th e· s1nok cr quilling. Unfortunately. howev er . th e rc•vnse is true ii' thl· spm!Sl'. fri,·11ds ,111d work assoc iat es do smoke. th e' likelihood or succcss is significantly diminished. As important as the acc umplisl1111rnt or cessation by current smokers is tir e prevention or initiation or th e tobacco habit in 1,·c11 age rs . ;\ 1o t,il of' 40.000 Canadia ns die eac h yea r ur cigarette-related diseases. approximately 11 0 deaths daily. Thus. the tob;K'l'v industry needs w indu ce' addicti on i11 110 Canadian 1cenagers ea ch d,1y iusl Ill reta in th e ma rkl'l . It behooves every physician to l'X C rt an y influence hi.: or she may ha l'l' upon the ir clcc tecl o ffie·ials to reinstitute tobacco taxes in those pro vi nces where they have been reduced. ban ,di cigarette .idv c' rtising. initiate th e use or plain (gene ri c) packag in g and remo ve cigare tt e machines from areas accessihle to teenagers. The orga ni1;11io11 ·Ph ys ic ians !' or a Smoke Free Canada· wo rk s actively towards th ese object iv es. an d they should he supported in th e ir e fforts. With the· improved u11d e rst.111di11g or th e development or addict inn ,lllcl main tena nc e or th e habit and the new the ra pe ut ic mod al iti es . we· ar,: closer than 1w have ever been to eliminating eventually the curse of tobacco smoking. the major cause uf prevcntibk dc,1th in our socic'ly tuday. Can Respir J Vol 2 No 3 Fall 1995 1vlorlc_1 Lcr1:1 11!111 J//) IRCf'C Pr, ifc'.l' .\(I/' o/Mcdi,'i11c. U11i\'Cl'S i/_\' o/Ma11ituho /f eud. Sc ,·1io11 n/Nnpll'!l/01'_1' Mcdici111' s, J/m1i/i1< c ( :c11aa/ llos11iral \\iin11 1j>cg, Mu11i1ohu 149