1 NATIONAL AND INTERNATIONAL ASPECTS OF TOBACCO CONTROL Szeged, június 18. Priority aspects of the program: Increasing Capacity of Tobacco Reasearch in Hungary Dr. Balázs Péter Semmelweis Egyetem Budapest Általános Orvostudományi Kar Népegészségtani Intézet Kristie L. Foley, PhD Associate Director Medical Humanities Program Davidson College North Carolina, USA

Sponsored by Fogarty International Center Sponsored by Fogarty International Center (established on 1st of July 1968) National Cancer Institute, and National Institute on Drug Abuse International Tobacco and Health Research and Capacity Building Program (RFA-TW ) 1.pursue observational, intervention and policy research 2.build capacity in epidemiological and behavioral research, prevention, treatment, communications, health services and policy research. 3.promote international collaboration John Edward Fogarty

International Tobacco and Health Research and Capacity Building Program (RFA-TW ) Provided exceptional possibility to design a comprehensive and long-term funded program focused on the most exciting problems: - gaining reliable data about tobacco epidemic - concerning relevant financial and economic and socio-cultural questions - nationwide overview of local legislation - targeting most urgent public health problems - supporting anti-tobacco activities Communicating domestic problems to the international community

From biomedical to the social approach Lung cancer + COPD and screening programs Children’s otitis media and ETS Smoking and pregnancy, LBW and PTBSmoking and pregnancy, LBW and PTB Epidemiology of tobacco smoking among school children, body image and weight control Epidemiology of young adults’ smoking Social and health related predictors of smoking and quitting The role of dentistry in cessation programs Health economy impact of tobacco smokingHealth economy impact of tobacco smoking Tobacco legislation (litigation, law enforcement)Tobacco legislation (litigation, law enforcement)

Priorities in Metodology No invasive biomedical methods (IRB approved human research program)No invasive biomedical methods (IRB approved human research program) Questionnaire based smoking habit inquiryQuestionnaire based smoking habit inquiry Statistical (descriptive and analytic) evaluation of health related dataStatistical (descriptive and analytic) evaluation of health related data Health economy impact of tobacco smoking related diseases, based on clinical costs of treatmentHealth economy impact of tobacco smoking related diseases, based on clinical costs of treatment Analysis of health legislation at national and local levelsAnalysis of health legislation at national and local levels

Ethnicity concerns in our researh... Smoking is a complex socio-cultural phenomenon responsible for a considerable part of disease burden According to the classic Canadian Health Report (Marc Lalonde 1974) one of the 4 determinants of health is of genetic nature Is there a specific minority/ethnicity relevant as a socio-cultural and/or genetic factor responsible for tobacco smoking related diseases in Hungary? Yes, Roma people based on empiric knowledge in obstetrics, pulmomology and smoking habits

7 Roma ethnicity is a sensitive but legitimate issue in Hungary 46/2003. (IV. 16.) House resolution about the Decade of Health, a Public Health Program „We do not know exactly the relationship between Roma and different health services (GPs, outpatient care, etc.), We do not have exact knowledge of the prejudice of health care workers towards Roma and vice and verse, nor which type of prejudice. Based on evidence, there are apparent problems of communication in the doctor-patient relationship with obvious impact on understanding the Roma health behaviour. There is a more serious problem with GPs because they do not have any scientifically-based evidence about the health and mortality of their Roma patients wich is more serious related to the non-Roma population, consequently, in all probability, they do not have an increased interest for Roma patients.”

8 Ethnicity was inevitable in our smoking and pregnancy research… There are basic demographic data about - newborns’ biometric parameters - PTB and LBW (weeks and weights) Roma versus non-Roma comparison of biological determinanats (if any) may be verified By addtitional socio-economic questions, we may understand the interrelation between deep poverty, Roma ethnicity, and birth outcomes while controlling for biologic determinants.

In the United Kingdom, the first census concerning ethnicity by individuals' self-definition occurred in Office for National Statistics: Membership of an ethnic group is something that is subjectively meaningful to the person concerned, and this is the principal basis for ethnic categorisation in the United Kingdom. So, in ethnic group questions, we are unable to base ethnic identifi- cation upon objective, quantifiable information as we would, say, for age or gender. And this means that we should rather ask people which group they see themselves as belonging to.

How do you define ethnicity? How do you define ethnicity? Office for National Statistics. 4 November The ethnicity data used in UK national statistics relies on the individuals' self-definition. Factors contributing to this classification are as follows: - country where the individual was born - national identity - language spoken in the family - country where the parents were born - skin colour - country or geographic region of origin - specific race - religion

Roma population in Hungary… Legitimate ethnic minority according to the Act LXXVII. (13 minorities – 1 century – nationality/ethnicity) Anthropological characteristics (hidden v. obvious status) In social terms, anthropologic characteristics are irrelevant There is no regulation in Hungary prohibiting to ask questions about ethnicity of individuals, and it is his/her decision to answer this question What is the reason (if any) behind the prevalent situation in registered health data without self-determined ethnicity?

Act 1997.C. about the election procedures: 115 /E. (4) Application for enlisting in the voting list of minority elections must comprise the individual’s a) actual first and second name, b) his/her name at birth, c) habitat, d) identity number, e) declaration about affiliation with a specific national or ethnic minority, further f) the signature. 115/G.§ (4) Voting lists of the minority elections must be deleted immediately after the official declaration of the final results, inclusive the legal deadline of appeal to the relevant courts. Act LXXVII. 5§ (2): voting lists in the minority elections Fear of beingregistered… Fear of being registered…

13 Why just Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg Counties?

Specific County CSO data VariablesBAZSzabolcs-Sz-B Population ,497589,989 Population ,771 (-60,726) 560,429 (-29,560) Live births7,142 (6,927)5,944 (5,805) Live birth proportion (9.6 ‰ )10.2 ‰ (3.)10.6 ‰ (1.) Reproductivity (1.33)1.55 (1.)1.50 (2.) Infant death proportion ( )9.0 ‰ (1.)5 ‰ (15.) 0-14 years group16.4 % (3.)17.6 % (1.) Roma population ,525 (1.) = 6.4% 25,612 (3.) = 4.34% Nr. of Roma Self-governments173 (1.) (358)133 (3.) (229) Net average income/month108,264 HUF. (9.)95,950 HUF (1.)

Our results to be presented in the afternoon program Grenczer A., Rákóczi I., Balázs P.: Interrelations of live birth cases with socio-economic situation in Borsod-Abaúj-Zemplén County in Rákóczi I., Grenczer A., Balázs P.: Population dynamism related to socio-economic factors in Szabolcs-Szatmár-Bereg County in 2009.

Thank you for attention