 2012 Johns Hopkins Bloomberg School of Public Health Prof. Javaid Khan FRCP (Edin) Head Section of Pulmonary and Critical Care Medicine The Aga Khan University, Karachi, Pakistan Involving Health Professionals in Tobacco Control

 2012 Johns Hopkins Bloomberg School of Public Health Involving Health Professionals in Tobacco Control Why involve health professionals in tobacco control? What are the barriers to involving health professionals in tobacco control? What are practical examples of the ways in which health professionals can contribute in tobacco control? 2

 2012 Johns Hopkins Bloomberg School of Public Health Which Health Professionals? Medical, nursing, dental, and pharmacy students Deans, principals, and professors of these schools Midwives Hospital employees Clinic employees 3

 2012 Johns Hopkins Bloomberg School of Public Health Doctors and the Tobacco Industry Doctors have a very important marketing value Tobacco industry used doctors for promoting tobacco in 1950s 4 Image source:

 2012 Johns Hopkins Bloomberg School of Public Health Video: What Cigarette Do You Smoke, Doctor? 1.Click this link to view the video: After viewing the video, return to this slide, and click Play to continue the lecture presentation. 5 At this point in the presentation, you will view an online video that will appear in another browser window. Follow these steps to view the video and then return to this lecture.

 2012 Johns Hopkins Bloomberg School of Public Health Video: What Cigarette Do You Smoke, Doctor? 6

 2012 Johns Hopkins Bloomberg School of Public Health The Potential of Doctors to Change Patient Behavior Doctors have probably the greatest potential of any group in society to promote reduction in tobacco use, and thus cause a reduction in tobacco-induced morbidity and mortality 7 Source: Simpson. (2000). Doctors and tobacco: Medicine’s big challenge.

 2012 Johns Hopkins Bloomberg School of Public Health Health Professionals Are in a Powerful Position Respected position in society In the front line in dealing with health consequences of tobacco use Unique opportunities to give advice to patients Considered “expert” on health-related issues Lines of access to decision makers 8

 2012 Johns Hopkins Bloomberg School of Public Health Barriers to Involving Health Professionals Barriers to involving health professionals in tobacco control  Health professionals extremely busy in their clinical work  Tobacco use is not considered as a serious public health issue in the country  High smoking rates in health professionals  Low perception of risk among the public  Most health professionals do not receive any training on tobacco control/smoking cessation in their medical schools  Many health professionals are not aware of how certain policies/legislation affect their ability to help patients quit tobacco  Poor health care infrastructure in many low-income countries 9

 2012 Johns Hopkins Bloomberg School of Public Health Health Professionals and Smoking Credibility of anti-smoking message is lost if public see health professionals smoking Overall the current smoking prevalence among Chinese physicians differed significantly by gender  Men: 26% to 61%  Women: 0% to 19% In countries with the highest smoking rates, doctors smoke even more than the general public and, as a result, serve as negative role models 10 Text source: Abdullah et al. (2011). Tob Control, 22(1): Image source: Javaid Kahn.

 2012 Johns Hopkins Bloomberg School of Public Health Global Health Professionals Survey Pilot Study, 2005 Surveys conducted in ten countries among third-year students in four health-professional disciplines (dentistry, medicine, nursing, and pharmacy) Results indicated that current cigarette smoking among these students was higher than 20% in seven of the ten countries surveyed 87%-99% of the students surveyed believed they should have a role in counseling patients to quit smoking Only 5%-37% of students had actually received formal training in how to conduct such counseling 11 Source: Centers for Disease Control and Prevention (2005). Tobacco use and cessation counseling—Global health professionals survey pilot study, 10 countries, MMWR, 54(20):

 2012 Johns Hopkins Bloomberg School of Public Health Health Professionals Must Not Forget Other Measures Prevention of smoking-related diseases in society demands more than just smoking cessation  Comprehensive ban on tobacco advertising and promotion  Mass media campaign  Powerful pictorial health warnings  Implementation of clean air laws  Increase taxation on tobacco  Preventing the youth from tobacco experimentation 12

 2012 Johns Hopkins Bloomberg School of Public Health Why Doctors Don’t Discuss Tobacco with Patients Too time-consuming Advice is ineffective Lacking confidence Discussions are unpleasant Knowledge is deficient Discussing smoking is outside of their professional duty Intrudes upon patients’ privacy Discussions are inappropriate 13 Source: Vogt. (2005). Addiction, 100(10):

 2012 Johns Hopkins Bloomberg School of Public Health How Can Health Professionals Contribute? Acting as a role model by not smoking, or by quitting smoking Counseling patients not to smoke Providing smoking cessation treatment Speaking out publicly and lobbying for comprehensive public policies to control tobacco use Using professional societies and medical associations as pressure groups for implementation of tobacco control laws Doing research related to tobacco control in the country 14 Source: American Cancer Society. (2003). Engaging doctors in tobacco control: Volume 2 of tobacco control strategy planning, companion guide.

 2012 Johns Hopkins Bloomberg School of Public Health What Can Clinicians Do? Do not smoke or use other forms of tobacco Take a smoking history from every patient Give firm advice to patients on quitting smoking Learn “how to counsel patients” in order to make them quit smoking Educate the public regarding the hazards of active and passive smoking 15

 2012 Johns Hopkins Bloomberg School of Public Health Future Professionals Medical, nursing, pharmacy, and dental students must be taught about tobacco control and smoking cessation Smoking rates in medical students is very high in many countries of the world Curriculum is deficient in tobacco control and smoking cessation 16 Text source: Richmond. (1999). Thorax, 54(1): 70-78; Image source: Javaid Kahn.

 2012 Johns Hopkins Bloomberg School of Public Health Does Advice from Doctors Encourage Smokers to Quit? Advice from doctors helps people to quit Even brief advice of 2-3 minutes about quitting smoking works More intensive advice results in slightly higher rates of quitting Providing follow-up support after offering the advice may increase quit rates 17 Source: Stead et al. (2008). Cochrane Database of Syst Rev (2): CD

 2012 Johns Hopkins Bloomberg School of Public Health The 5 A’s of Tobacco Cessation Ask about tobacco use Advise all users to quit Assess willingness to make a quit attempt Assist in quit attempt Arrange for follow-up 18

 2012 Johns Hopkins Bloomberg School of Public Health Health Professionals Lobbying for Tobacco Control 19 Image source: Javaid Khan.

 2012 Johns Hopkins Bloomberg School of Public Health Lobby to Make Your Hospital and Clinics Smoke-Free 20 Image source: Javaid Khan.

 2012 Johns Hopkins Bloomberg School of Public Health Let’s Get Our Own House in Order 21 Image source: Javaid Khan.

 2012 Johns Hopkins Bloomberg School of Public Health 22 Raising Voice on Non-Implementation of Clean Air Laws

 2012 Johns Hopkins Bloomberg School of Public Health Educating Public Using Print Media 23 Image source:

 2012 Johns Hopkins Bloomberg School of Public Health Educating Public Using Print Media 24 Image source:

 2012 Johns Hopkins Bloomberg School of Public Health Writing Letters to Editors and Appearing on Television 25 Image sources: (left) Javaid Kahn, (right) courtesy of Health TV Pakistan.

 2012 Johns Hopkins Bloomberg School of Public Health Health Professionals With Politicians at Press Club 26 Image source: Javaid Khan.

 2012 Johns Hopkins Bloomberg School of Public Health Role of Medical Professional Societies Train members as tobacco control advocates Include tobacco as an issue in conferences Exert pressure on decision makers for tobacco control measures in the country Ensure that all conferences are smoke-free Create public awareness of tobacco industry tactics 27

 2012 Johns Hopkins Bloomberg School of Public Health Role of Medical Professional Societies Issue brochures and guidelines on smoking cessation in local languages Hold workshops for doctors on tobacco control and smoking cessation Help organize talk shows on the tobacco epidemic Encourage medical leaders to write letters and articles to newspapers 28

 2012 Johns Hopkins Bloomberg School of Public Health Local Research Health professionals must do local research to seek public attention 29

 2012 Johns Hopkins Bloomberg School of Public Health At Medical School Level Introduce tobacco control and smoking cessation in medical curriculum Professors can use their status to speak out about the importance of tobacco control Do research related to tobacco control Raise issue of tobacco on World No Tobacco Day, World Cancer Day, etc. Run smoke-free doctors and medical school campaign 30

 2012 Johns Hopkins Bloomberg School of Public Health Training Future Health Professionals 31

 2012 Johns Hopkins Bloomberg School of Public Health Quit Smoking! 32

 2012 Johns Hopkins Bloomberg School of Public Health Thank You! 33