“Smettodifumare”: guided paths tailored for you!| Tabaccologia

In the framework of tobacco control, it is important to develop a culture of prevention through information campaigns and interventions aimed at cessation of tobacco and nicotine dependence. In this context, the National Centre on Addiction and Doping of Istituto Superiore di Sanità has been carrying out studies and research based on scientific evidence for many years, producing and disseminating guidelines and recommendations, promoting surveillance systems, offering training for social-health operators, facilitating the meeting of citizens' demand and the offer of local healthcare services (also through counselling interventions administered via the Tobacco Quitline - 800 554088). In general, to “make healthy choices easy choices” it is necessary to develop communication and information interventions that are able to motivate the individual to change. Thus, by promoting the “empowerment” (self-awareness and control over one's choices) of a person, it is possible to lead the individual to spontaneously adopt healthy lifestyles and attitudes. In particular, in the context of tobacco and nicotine dependence, having knowledge of the characteristics of the product consumed and awareness of the damage it causes is the first step to lead an individual to avoid behaviors that are harmful to health.

The project

Tobacco dependence has a physical, but also a psychological and behavioral component. In fact, smoking is a complex behavior that is ingrained as a daily ritual and accompanies different emotional states (joy, sadness, anger). Smoking therefore becomes an unconscious and automatic habit and quitting does not only involve giving up the cigarette but changing the daily habits associated with smoking.

Facing a path of change is not a simple thing, especially when the habit is consolidated over time.

Many smokers, despite knowing the well-known benefits of quitting smoking, fear facing this important change and may be discouraged by unsuccessful quit attempts.

The National Center for Disease Prevention and Control (CCM) of the Ministry of Health, has funded a project of the National Centre for Addiction and Doping aimed at offering the population awareness and self-help tools that can activate processes of empowerment and learning self-monitoring techniques.

Thus, was born “Smettodifumare” (1), an online platform dedicated mainly to those who have decided to quit smoking. The platform represents a resource for increasing chances of success by providing quality information on all aspects of tobacco dependence and cessation. It allows you to: have support in the cessation process and prevent or cope with a relapse; be guided towards outpatient services that offer paths to quit smoking (Smoking cessation Centres); find information on “tobacco use” and its effects on health, on the benefits of quitting in the short, medium and long- term and on the risks of exposure to second-hand smoke (Figure 1). For smokers, being accompanied step by step in a structured cessation process can make it easier to achieve the goal and its consolidation over time.

On the “Smettodifumare” platform you can find tools that accompany change through food for thought, cessation support, practical tips for managing abstinence and an overview of the benefits that arise from the first hours after the last cigarette.

What the platform offers

The platform is dedicated to smokers who feel ready to quit smoking but also to those who are still thinking about quitting.

In case a smoker is not yet ready to quit, the platform offers a path of information and motivation: to learn more about the ingredients and composition of the cigarette; analyze the reasons for smoking; learn about the harms of smoking and the benefits of quitting; moreover, in the “Find out how much you know about tobacco and nicotine” section, “the smoker” can test himself with informative quizzes on topics such as health, dependence, cessation, environment and legislation.

Finally, to the smoker who still has doubts about taking the path of change, is always offered the opportunity to communicate with a professional on the Tobacco Quitline” by calling 800 554088 or by writing an email in the contact section.

In case the smoker feels ready to quit smoking, the platform offers three paths:

1. contact the Quit Line for a guided path with the help of a professional;
2. go to one of the Smoking cessation centres in the area shown on the Geolocated Map;
3. quit autonomously with Self Help tools.

Contact with the Tobacco Quitline

The Tobacco Quitline is an anonymous and toll-free national service, provided by the National Centre on Addiction and Doping, the importance of which has been confirmed by two legislative (2,3) provisions, which established the toll-free number to appear on cigarettes packs and other tobacco products.

Thanks to the team of experts and psychologists, the service offers the possibility to choose a path that follows the methodology of reactive or proactive telephone counselling, in agreement with the user a calendar of telephone meetings is planned for facilitating the activation of the smoker’s personal, family and social resources. The protocol, which is divided into 5 phone calls on average (with a maximum of 8) over 5 weeks, is an adaptation of the methodology suggested by the World Health Organization (4) and combines elements of problem solving and coping strategies with elements of emotional and motivational support.

The telephone counselling sessions are planned from time to time with the smoker, but while in the reactive mode it is the smoker who calls back according to the shared calendar, maintaining anonymity, in the proactive mode the user will have to leave anonymity to be called back and followed by the same professional throughout the support path.

Smoking Cessation Centres

The Smoking cessation Centres are services that offer specialist support to help smokers to quit. They offer integrated treatments (drug therapies and individual or group counselling) thanks to the work of multidisciplinary teams. The National Centre on Addiction and Doping has been taking a census and updating the network of Smoking Cessation Centres since 2000 to offer citizens updated information on the anagraphic data of the Centres, the assistance offer, and how to access services. All the services on this map belong to the National Health Service (SSN), to the Italian Cancer League (LILT) or to the “private social” sector. Thanks to the new platform, smokers can now use the geo-localized map to identify smoking cessation centre that best meets their needs. The Map is constantly updated and allows you to know the characteristics of the services with respect to their territorial location, the methods of access and the assistance offer. The Quit Line professionals are always available to direct smokers to the Smoking cessation centres.

Quitting autonomously

Following the autonomous path provided on the platform, smokers can use the Smetto di Fumare! Guide, in static (as a document that can be freely downloaded and printed) or dynamic mode. In its dynamic mode, the Smetto di Fumare! Guide is a tool to read, fill in and personalize directly online that provides useful tips and strategies to quit smoking and get over the critical moments. The path is divided into three distinct and consequential phases: preparation, cessation and maintenance.

In the preparation phase, the user is asked to retrace their history as a smoker, to know their level of nicotine dependence and to analyse their motivation to quit smoking. It also offers insights to evaluate the pros and cons of quitting and tips to strengthen the decision of quitting smoking.

Retracing the “history of smoker” is important because it helps to pay attention to the reasons why you smoke and why you want to quit, observing yourself and reflecting on your own smoker behavior.

Among the most important tools offered in this section is the Smoker's Diary. If smoking is often an unconscious and automatic behavior, it becomes important to better control the rituals and moods associated with smoking. Thanks to the Diary it is possible: to write down information that helps to have greater awareness of one’s characteristics as a smoker and to be more aware of certain automatic behaviors; understand how to replace the rituals that induce smoking; identify situations that lead to smoke more; understand how to replace cigarettes with healthier alternatives. The goal is to gradually reduce the number of cigarettes until reaching the cessation phase in which the smoker experiences the first 24 hours without smoking.

The maintenance phase helps to consolidate the choice to stay quit over time and prevent the risk of relapse, always reminding the smoker that he can find support in the Quit Line service for smoking cessation or in the local healthcare Services.

In conclusion, the platform is an agile and modern tool able to meet the different needs of smokers or those who more generally intend to deepen the theme of tobacco and nicotine dependence and the related health risks. It represents the connection point between the needs of the citizen and the local resources able to fulfil these needs. The platform, in its continuous implementation, aims at contributing to the protection of public health by accompanying an ever-increasing number of smokers towards healthy lifestyle choices.

Figures and tables

Figure 1.The homepage of “Smettodifumare” platform of the National Centre on Addiction and Doping of the Istituto Superiore di Sanità.

References

1. Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità (ISS). Smettodifumare.Publisher Full Text
2. Gazzetta Ufficiale della Repubblica italiana. Decreto del 25 ottobre 2012. Recepimento della direttiva 2012/9/UE della Commissione, relativa alle nuove avvertenze sanitarie sui prodotti di tabacco. GU Serie Generale n. 274 del 23-11-2012.
3. Gazzetta Ufficiale della Repubblica italiana. Decreto legislativo n. 6 del 12 gennaio 2016. Recepimento della direttiva 2014/40/UE sul ravvicinamento delle disposizioni legislative, regolamentari e amministrative degli Stati membri relative alla lavorazione, alla presentazione e alla vendita dei prodotti del tabacco e dei prodotti correlati e che abroga la direttiva 2001/37/CE. GU Serie Generale n.13 del 18-01-2016.
4. World Health Organization (WHO). Developing and improving national toll-free tobacco quit line services: a World Health Organization manual. World Health Organization: Geneva; 2011.