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Tobacco

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geraldine mcdarby

on 2 February 2016

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Transcript of Tobacco

To
bacco

Dr. Geraldine McDarby
History
Prevalence
Burden
Approaches
2003 WHO FCTC
Birth of the modern cigarette 1913
1500
1600
1700
1800
1900
2000
Cigarette price wars begin
1939-45
Advertising focuses on War
Marlboro Cowboy created 1954
1960 Tax & Advertising Restrictions (US)
1964 Smoking and Health
1971 Advertising ban (Ireland/US)
1981 "The Changing Cigarette"
1984 Surgeon General Warnings (US)
"Cigarette Advertising Code"
US/Ireland
Joe Camel 1987
1930 Link to cancer (Germany)
1938 Link to premature death (US)
1944 American Cancer Society warning
1956 Doll & Hill
1952 Readers Digest article
"Lights" low tar/low nicotine 1972
1st cellulose filter
1991 JAMA 91% 6yr olds can match Joe Camel to his product and is as recognisable to preschoolers as Mickey Mouse
2004 Public Health Act (Tobacco)
2009 Public Health Act (Tobacco)
1978 TPCASSP Act (Ireland)
2000 Content disclosure laws (EU)
"from mild as May to tough as nails" ......
British Doctors Study 1951-1956 (2001)
Prospective
General Register of Medical Practitioners (cohort)
Cause specific mortality
Conclusively linked smoking with Lung Cancer, IHD and Respiratory disease
Report of the Advisory Committee to the Surgeon General of the United States
Analyzed >7,000 studies
70% increase in age-adjusted mortality
Correlation between bronchitis, emphysema and heart disease and low birth weight
Tobacco Products Control of Advertising,
Sponsorship and Sales Promotion Act
'Youth Cigarettes-New Concepts"
Framework Convention on Tobacco Control
1st country to introduce fully smoke-free workplaces
2002 Legal age for sale of tobacco products 18 (Ireland)
2007
no point of sale display
vending machine restrictions
pictoral warnings to came into effect Feb 1, 2013
First global public health treaty
April 1948
Mandate "to work for the attainment of all peoples of the highest levels of health"
Powers vested in the World Health Assembly to protect and promote international public health
WHO Constitution
176 member states-90% of worlds population (2010)
Specific steps to control tobacco
focus on protection
32%
National Tobacco Control Office 2014
19.5% IRISH ADULTS
Gender
Socioeconomic Class
Age
12% Irish Children
and Adolescents
HBSC 2010
References & Reading:

Office of Tobacco Control-www.otc.ie
SLAN 2007
Health and Behaviour in School Children 2010
HSE Transformation Programme: The Health Service Executive; Tobacco Control Framework. February 2010. www.hse.ie
Global Health Risks: Mortality and burden of disease attributable to selected major risks. www.who.int
WHO Global Report. Mortality attributable to tobacco 2012
Cigarette Smoking-Attributable Morbidity. United States, 2000MMWR weekly. September 5, 2003 / 52(35);842-844
Systematic review of link between smoking and poverty. WHO 2011
Low birthweight: Country, regional and global estimates. UNICEF 2004
The Oxford Medical Companion 1994
www.thetruth.com
WHO report on the Global Tobacco Epidemic 2008
www.tobaccodocuments.org
The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths in Ireland using the IrelandSS simulation model. Laura M Currie et al. tobaccocontrol.bmj.com
The Federal Tobacco Control Strategy (Canada)
http://www.hse.ie/eng/about/Who/TobaccoControl/Research/smokinginireland2014.pdf
Morbidity
Gender
Age & Socioeconomic Class
12%
Kills >
5million
people annually

estimated-8 million annually by 2030
The leading preventable cause of death worldwide
1/10 adult deaths worldwide
1492 Columbus
P. Lorrilard established 1760
boys
girls
2008 WHO FCTC MPOWER
Women
Emerging Markets
Hollywood
Financial implications of ill-health
>6,000/yr. Ireland
1 death = 20 serious chronic illness CDC
Mortality
&
Lung Cancer
8.1
/
6.0
IHD (30-44yrs.)
5.5
/
2.3
COPD
10.8
/
12.3
42%
70-90%
38%
Relative Risk
Attributable Risk

1000 20-year-olds who smoke cigarettes regularly:
about 1 will die from homicide
about 6 will die from motor vehicles
about 250 will be killed by smoking in MIDDLE age alone
250 more will be killed by tobacco in OLD age
Perspective
approximately 600,000 of these deaths are attributable to second hand exposure with children accounting for approximately 30% of these
1 death every 6 seconds
smoking attributable morbidity
Smoking and Poverty
1-
Low birth weight
2-Coronary Heart Disease
3-Peridontitis/tooth loss
4-COPD
5-Lung cancer
6-Stroke
WHO
morbidity attributable to second hand exposure
Infancy
low birth weight,
premature birth, cot death/SIDS
Childhood middle ear infection, respiratory infections, asthma
Adults heart disease, lung cancer, stroke, nasal cancer, asthma attacks
General SOB, airway irritation, coughing, nausea, headache, eye irritation
CDC
2000
@ least 30% increased risk:
20x's higher mortality and morbidity than child with normal birth weight
& is associated with Chronic diseases in later life
Inverse relationship between income level and prevalence of tobacco use
82% of the worlds 1.1 billion smokers live in low and middle income countries
% income spent on cigarettes increases as income level decreases
low middle high
10.7% 3.7% 1.8%
Socioeconomic gradient
interaction of social/environmental
percieved demands vs abilities
self efficacy and self care
locus of control
Prevalence of smoking higher in those on lower incomes
Smoking leads to poverty
cost
Lifecourse approach
Commodity
or
Drug
The Law of Supply and Demand
Reduce or restrict supply
Reduce or restrict demand
?
"Global ag
ent of death"

a marketable good that satisfies a 'want'
Ban/Prohibition
Sale restrictions*
Crop Substitution/incentives
Trade Restrictions
Control of ilicit trade*
Increase price*
Increase knowledge of associated risks*
Countermarketing*
Restrict advertisement*
Public bans (workplace/public areas)*
Support efforts to quit*
Labelling* (warnings/pictoral)
Regulation (content/quality?)
Strict Labelling (light/low tar)*
Reduce Harm*
MPOWER
The only legal drug that, if used as directed, will kill up to half of its users
P
O
W
E
R
M
Monitor
tobacco use
Cross- cutting
activity
Obtain nationally representative and population based periodic data on key indicators of tobacco use for youth and adults
Protect people from tobacco smoke
Intervention P1
Enact and enforce completely smoke-free environments in health-care and educational facilities and in all indoor public places including workplaces, restaurants and bars
Offer help to quit tobacco use
Intervention O1
Strengthen health systems so they can make tobacco cessation advice available as part of
primary health care
. Support
quit lines
and other community initiatives in conjunction with easily accessible, low-cost
pharmacological treatment
where appropriate.
Warn about the dangers of tobacco
Intervention W1
Intervention W2
Intervention W3
Require effective package warning labels
Implement counter-tobacco advertising
Obtain free media coverage of anti-tobacco activities
Enforce bans on tobacco advertising, promotion and sponsorship
Intervention E1
Intervention E2
Enact and enforce effective legislation that comprehensively bans any form of direct tobacco advertising, promotion and sponsorship
Enact and enforce effective legislation to ban indirect tobacco advertising, promotion and sponsorship
Raise taxes on tobacco products
Intervention R1
Intervention R2
Increase tax rates for tobacco products and ensure that they are adjusted periodically to keep pace with inflation and rise faster than consumer purchasing power
Strengthen tax administration to reduce the illicit trade in tobacco products
Total ban in public places
reduce exposure to 2nd hand smoke (@ least 30% risk)
work place bans can cut absolute smoking prevalence by 4%
encourage smoke-free homes
“Total prohibition of smoking in the workplace strongly affects industry volume. ... Milder workplace restrictions, such as smoking only in designated areas, have much less impact on quitting rates and very little effect on consumption.”
1992

Phillip Morris internal document
"Today’s teenager is tomorrow’s potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens." Philip Morris internal document 1981
SLAN/HBSC-4yrly
OTC monthly
Revenue
Smoking Prevalence
Policy Effectiveness
OTC
Monitoring Industry
OTC
Workplace Smoking Ban
2004
Compliance 97% in 2008
National Smokers Quitline 2003
NRT free on GMS
Social Marketing
Health Warnings
NICO
Every cigarette is doing you damage
The Beauty of Quitting
1 out of 2
Quitline
No advertising or display from July 1, 2009
10% increase leads to 4% reduction
Highest tax takes on cigarettes in EU
preferentially targets young people, minority groups and low income smokers
low level
30-40% front and back, not pictoral or graphic
high
high
2013
+1% reduction in smoking prevalence
Partial Cessation Coverage since 2001
Low levels
of
brief interventions
strong evidence of the effectiveness of Brief Opportunistic Interventions in promoting quit attempts
if 20% of a population of smokers attempt quit post GP visit
BOI increases to 25% (21 +1)
BOI + assistance 35% (7 +1)
Marketing Innovations Suggestions:
Cola Flavor-while the government would not permit us to add caffeine to a cigarette, it may be possible to use artificial ingredients to obtain a cola taste and aroma
Apple Flavor-apples connote goodness and freshness and we see many possibilities for our youth oriented cigarette with this flavor. Apple cider is also a possibility
Sweet Flavor Cigarette-we believe there are pipe tobaccos that have a sweet aromatic taste. It's a well known fact that teenagers like sweet products. Honey might be considered.
legal basis
for international public health treaties
"Our philosophy isn’t anti-smoker or pro-smoker. It’s not even about smoking. It’s about the tobacco industry manipulating their products, research and advertising to secure replacements for the 1,200 customers they “lose” every day in America. You know, because they die."
www.the truth.com
Effectiveness
WHO
Disease
Smoking
Intrauterine environment
Low birth weight
Second hand smoke
Poor nutrition
Poor living conditions
Childhood ill health
Educational opportunities
and on and on.....
to Control
of Interventions
21.8% reduction in prevalence 1998-2010
The savings to the economy in avoiding Healthcare costs and premature death for the
average quitter
was $421,533
Federal Tobacco Control Strategy-Canada 2011
Price Increase
Smoke Free
Legislation
Advertising
Restrictions
Framework for
Tobacco Control
>5 million deaths annually worldwide
>6,000 deaths in Ireland annually
from 1% of market share to a 10% annual increase
US Surgeon General
legal obligations including regulation, taxation, protection, etc
Division of Population Health Science RCSI 2010
21.6%
17.6%
Full transcript