Ali Tobacco Ncd Presentation 9 Oct

TOBACCO RELATED DISEASES Dr. Mohammad Ali Raja Roll No. 13 MSPH – 2009 HSA - ISLAMABAD

INTRODUCTION TO TOBACCO

A

South American herb, formally known as Nicotiana tabacum, whose leaves contain 28% nicotine and serve as the source of smoking and smokeless tobacco  Tobacco is still widely consumed in a variety of different ways, mainly as smokeless tobacco and cigarette smoking

. . .Introduction cont

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Children are the most vulnerable population particularly during the first years of life Passive smoking increases risks for higher and lower respiratory tract illness but a smoke-free environment improves all these disorders Ischemic heart diseases and lung cancer are the main risks for non smoking adults exposed to cigarette smoke Tobacco use and exposure is the single most important source of preventable morbidity, disability and premature mortality

GLOBAL SITUATION

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Across the globe, nearly 5 million people died of tobacco-related diseases in 2008, which is more than tuberculosis, HIV/AIDS and malaria combined The usage of tobacco worldwide killed around 100 million people in the 20th century and if the current trend continues, there will be up to one billion deaths in the 21st century The current global death toll of 5 million per year from tobacco use will increase to 10 million per year by 2025

Tobacco Kills More Americans Each Year Than Alcohol, Cocaine, Crack, Heroin, Homicide, :Suicide, Car Accidents, Fires & AIDS combined

(Chart of health effects- to be scanned in)

Consequences of Tobacco-Use: Preventable Causes of Death

Smoking 400,000 Accidents 94,000 Passive Smoking 38,000 Alcohol 45,000 HIV/AIDS 32,600 Suicide 31,000 Homicide 21,000 Drugs 14,200

WORLD BANK 2002

SMOKING PREVALENCE IN SELECTED EMRO REGION SMOKING ANY TOBACCO PRODUCT Country

%Male

%Female

Iran (Islamic Republic of)

26.2

4.5

Egypt

26.0

4.1

Pakistan

31.7

5.2

Saudi Arabia

25.6

3.2

Jordan

61.7

7.9

Tunisia

51.0

1.7

United Arab Emirates

27.2

2.4

WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2008

SITUATION IN PAKISTAN  Tobacco

use claimed around 100,000 deaths annually in Pakistan and over half of the adult population are addicted in one form or the other  In Pakistan, estimated 100,000 people die every year from Tobacco related diseases

ADULT TOBACCO SURVEYS IN WHO MEMBER STATES )EASTERN MEDITERRANEAN( Country

Reference

Pakistan World Health Survey, 2003

Year of Representati (Definition (1 veness survey

-2002 2003

National

Daily tobacco smoking

Age

Male

Female

Both sexes

+ 18

27.3

4.4

15.9

WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2008

SMOKING IN PAKISTAN URBAN (HEARTFILE (2006 Prervalence of smoking - by place of residence and gender (URB AN(

Percentage

120 100 80

never s m oked

60 40

past smoker sm oker

20 0 m ale

fem ale Se x

SMOKING IN PAKISTAN RURAL (HEARTFILE (2006

percentage

Prervalence of smoking - by place of residence and gender (RURAL( 150 100 50 0 male

female Sex

smoker

past smoker

never smoked

Prevalence of smokeless tobacco use URBAN 120

percentage

100 80

never us ed

60

pas t us er us er

40 20 0 m ale

fem ale

Prevalence of smokeless tobacco use RURAL 120 100

percentage

80

n e ve r u s e d

60

pas t us er us er

40 20 0 m a le

fe m a le

Prevalence of passive smoking - Urban 120 100

percentage

80

n e ve r e xp o s e d e xp o s e d o n ce a w e e k

60

e xp o s e d s e ve ra l tim e s a w e e k

40

e xp o s e d d a ily

20 0 m a le

fe m a le

Prevalence of passive smoking - Rural 120 100

percentage

80

n e ve r e xp o s e d e xp o s e d o n c e a w e e k

60

e xp o s e d s e ve ra l tim e s a w e e k

40

e xp o s e d d a ily

20 0 m a le

fe m a le

GYTS (2004-05( – Islamabad / Lahore NACP    

A recent surveillance in Pakistan is GYTS )global youth tobacco survey( Focused on adolescence 13 -15 yrs School-based survey Smoking prevalence: Overall 1.7% –

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Girls)0.5%( - - - Islamabad

Other tobacco products prevalence: – –

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Boys)2.5%( Overall = 10.3% Boys )11%(

Girls )8%(

Passive smoking exposure: – –

3 in 10 students at home 4 in 10 outside home

What are the tobaccorelated diseases that are contributing to all these deaths?

:Arteriosclerosis & Atherosclerosis

Healthy

Damaged

:Heart Attack

Smokers are twice as likely as Nonsmokers to have a heart attack

Torn heart wall: Result of over-worked heart muscle

Quitting smoking rapidly reduces the risk of coronary heart disease

Peripheral Vascular Disease

:Stroke This brain shows stroke damage, which can cause death or severe mental or physical disability

:Emphysema

Emphysemati c lung

Healthy lung

Symptoms Include Shortness of breath Chronic cough Wheezing Anxiety Weight loss Ankle, feet and leg swelling fatigue

Lung Cancer:

The uncontrolled growth of abnormal cells in one or both lungs

Lung cancer kills more people than any other type of cancer

:Fetal Damage Fetal Smoking Syndrome: •Birth defects •Premature stillbirth •Low birthweight •Prone to Sudden Infant Death Syndrome •Lowered immune

Laryngeal Cancer Symptoms: •Persistent hoarseness

•Chronic sore throat •Painful swallowing •Pain in the ear Lump infrom the neck Over 80% of •deaths laryngeal cancer are linked to smoking

: Dental Problems Common Consequences : •Stained teeth Above:

•Gum inflammation

Cavities Below:

Gingivitis

Overall poor oral health

•Black hairy tongue •Oral cancer •Delayed

:Consequences of chewing tobacco

Leukoplaki a

Oral cancer

Predictive Factors of Youth Tobacco Use Onset Socio-Demographic

Environmental

Low SES Developmental stage

Access to tobacco Exposure to marketing Peer use and support Sibling use and support Parental support Normative expectations

Intra-Personal Functional meanings of tobacco-use Low self-image Self-efficacy to refuse offers Personality factors

Behavioral Academic achievement Behavioral skills Prior use of tobacco Other problem behaviors

Flow of Tobacco to Youth Illegal sales to < 18 youth

Commercial outlets

Legal sales to 18+ adults

Provision Acquisition

Youth Tobacco Users

Theft by < 18 youth Source: Forster et al, 1999

 AIM:  Reduction

in mortality and morbidity among youth due to tobacco related diseases.  OBJECTIVE:  To increase awareness in 100% young population )13 – 35 yrs( of Pakistan regarding illhealth effects of tobacco use within two years.  To reduce tobacco use by 50% among youth in Pakistan within three years.

EXISTING GLOBAL POLICY WHO FCTC FCTC treaty was signed by the 142 members of WHO & it came into effect on 29th June 2004. The core demand reduction provisions in FCTC are contained in articles 6-14:  Price and tax measures to reduce the demand for tobacco, and  Non-price measures to reduce the demand for tobacco, namely:  Protection from exposure to tobacco smoke;  Regulation of the contents of tobacco products;  Regulation of tobacco product disclosures;  Packaging and labelling of tobacco products;  Education, communication, training and public awareness;  Tobacco advertising, promotion and sponsorship; and,  Demand reduction measures concerning tobacco dependence & cessation. The core supply reduction provisions in the FCTC are contained in articles 15-17:  Illicit trade in tobacco products;  Sales to and by minors; and,  Provision of support for economically viable alternative activities

Existing National Policy 1959 the government promulgated the West Pakistan Juvenile Smoking Ordinance; this superseded all the previous Acts about smoking. This ordinance was in effect and practice till 2002.In 2002 a new Ordinance viz.Prohibition of Smoking Ordinance 2002 was promulgated In Pakistan, the Prohibition of Smoking Ordinance 2002, which bans tobacco use in all public places, transport and indoor workplaces, was promulgated after a time lapse of four decades since the earlier enactment of the 1959 Ordinance. This Ordinance came into effect on the 30th of June, 2003. If enforced in its true spirit, this legislative measure has the potential to reduce tobacco consumption to some extent and decrease exposure to second-hand smoke in public places The Ministry has since taken a number of tangible steps aimed at enforcing this Ordinance; as an initial step, an implementation committee has been set up with broad-based representation; based upon the recommendations of this committee, several steps have been taken to-date. These include issuance of official orders & dissemination of the Ordinance to all institutes within the federal, provincial and private sector domains; information & transport-related institutions inclusive of the PIA, Pakistan Railways & local government

Flaws / weakness  Policy

do exist but there is no implementation  No restriction on sale of tobacco to under 18 youth  No restriction on sale of tobacco by the youth  Huge amount of tax being paid by the tobacco industry, so no action taken against the tobacco industry

PROJECT TARGET GROUP YOUNG ADULTS  Young

adults are an important opportunity  Develop programs for lifestyle/attitude groups  Reflect THEIR values, not ours  Don’t expect them to come to us  Environmental restrictions important  Include non-tobacco users in the campaign  Social acceptability is a key issue

A Comprehensive Approach / Strategies To Reduce Tobacco Use in Youth 

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Adopt and enforce local and state wide policies – School policies – Tobacco tax increases – Restrictions on commercial access to tobacco by youth – Smoke-free public places Strict Legislation Use evidence-based anti-tobacco curricula in all academic grades Counter pro-tobacco norms through a high-quality media campaign Encourage parents to establish no-smoking expectations and home policies

MASS MEDIA CAMPAIGN FOR BEHAVIOR CHANGE Consequences of Smoking

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Short-term – Long-term – Family-related – Addiction Social Norms and Imagery – De-glamorization of tobacco – Tobacco use not normal behaviour Role Models – Tobacco user is negative role model – Celebrities promote non-tobacco use Industry and Product Focus – Tobacco industry documents – Chemicals in tobacco smoke –

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IMPLEMENTATION ACTION OF PLAN ON CONTROL OF TOBACCO RELATED DISEASES

 There

will be a National vertical programme exclusively working for tobacco – – –

Will have its own budget and objectives Will have its own screening & surveillance system Will work in collaboration with Ministry of Health, Ministry of Education, Minisrtry of Commerse, Ministry of Agritulture, Pakistan customs

Resources required for the project  Human

resources  Financial resources  Infrastructure  Legislations  Power )political / economical(  Strong Commitment

Functions to be performed       

to regulate the production, manufacture and marketing of tobacco. to advise government on the sale and export of tobacco to collate statistics on tobacco and diseases related to it to carry out tobacco related diseases research to distribute and disseminate information relating to tobacco to control and regulate the sale of tobacco to register and license tobacco growers and sellers

BIGGEST LIMITATION Reliance on revenue generated from tobacco is one of the fundamental barriers to effective tobacco control in Pakistan. This will continue to remain a hurdle, undermining any strategy that aims to address tobacco control in a comprehensive manner

BUDGET & GANTT CHART  Calculations

will be done on annual basis  Changes will be made accordingly at the start of next year after evaluation

GANTT CHART

1st YEAR WBS

Start

Tasks

End

Duration % (Day Co (s mp let e

1

PLANNING

3

2

BUDGET ALLOCATION

2

3

MEETING WITH HEALTH STAFF

3

4

MEETING WITH OTHER DEPT

4

5

MOU

2

6

POSTS ADVERTISEMENT

10

7

RENOVATION OF BUILDINGS

10

8

RECRUITMENTOF STAFF

10

9

PURCHASING

10

10

PRINTING / TRAINING MANNUALS

12

st quarter!

2nd quarter

3rd quarter

4th quarter

GANTT CHART 11

( TRAINING (PHASE1

5

12

( TRAINING (PHASE 2

10

13

( TRAINING (PHASE 3

10

14

EVALUATION

5

15

PILOT TESTING

5

16

PROJECT LAUNCHING CEREMONY

5

17

REGISTRATION OF CSW

12

18

REGISTRATION COMPLETES

12

19

HE SESSIONS START

20

HANDING OVER TO LOCAL CLINCS

21

MASS MEDIA COMPAIGN STARTS

22

FACILITIES SERVICES START

23

DISTRIBUTION OF MEDICINES

24

ACTIVE MONITORING

25

PASSIVE MONITORING

26

(REFRESHER COURSES (2 DAYS

27

END YEAR EVALUATION

28

PROJECT 1 YEAR COMPLETION CEREMONY

29

REPLANNING FOR NEXT YEAR

7

EVALUATION  Process – – – –

Indicators

# of education sessions held # of anti tobacco walks held # of media compaigns done etc

 Outcome – –

indicators

% of boys using tobacco % of girls using tobacco

THANK YOU