1. E Tursan d’Espaignet and S Pujari
Tobacco Control: Monitoring interventions associated with demand measures of the WHO FCTC
E Tursan d’Espaignet and S Pujari
Comprehensive Information Systems for Tobacco Control Tobacco Free Initiative WHO Geneva

2. Types of tobacco Smoking tobacco: Examples include Cigarette Shisha
Bidis (3x more CO and 5x more tar than cigarettes)
Smokeless tobacco:
Snus
Betel
Gutkha

3. A property of tobacco
"… tobacco is the only legal product that maims and kills a large proportion of its users when used exactly as intended by the manufacturer"

5. The Tobacco Epidemic If current trends continue, tobacco will:
Currently estimated at just over five million deaths each year or one death every six seconds
Will cause the death of more than 8 million people in the year 2030 or one death every four seconds
Likely result in more than one billion deaths (1,000,000,000 deaths) during the 21st century
More than three out of every four of these deaths will be in low and middle income countries

6. How does an epidemic spread?
For Influenza: vector is a virus Antidote: vaccination, wash hands, etc
For malaria: vector is a mosquito Antidote: wide variety of anti-mosquito products
Anti-spread strategy: Limit or destroy vector
Common element of the vectors: - We know it exists but unseen - Requires strong population-based national, regional and global surveillance and interventions to reduce effect and impact

7. Spread of tobacco epidemic
The transmission vector is the industry
Secretive and history of hiding the truth
Enormous capacity for marketing and lobbying
Has a history of substantial political support
Claims it is blameless, responsibility rests with the users who have freedom of choice
Requires concerted strong national, regional and global surveillance and interventions antidote

8. The Antidote: The WHO FCTC
Carefully constructed comprehensive antidote across demand and supply and other components
Requires strong coordinated national, regional and global cooperation and action
Convention of Parties Secretariat responsible for providing the political and legislative tools for implementation of all articles
WHO Tobacco Free Initiative provides technical assistance to all Member States 8

9. TFI current focus: Selected Demand Articles of the WHO FCTC
Description 20
Monitoring 8
Protect people from tobacco smoke through smokefree environments 14
Offering help to quit
11 & 12
Warning about dangers of tobacco 13
Enforcing bans on promotion, sponsorship and advertising
6 & 15
Raising taxes on tobacco

10. WHO FCTC Article 20
The Parties shall … initiate and cooperate in the conduct of research and scientific assessments … that addresses the determinants and consequences of tobacco consumption and exposure to tobacco smoke

11. Surveillance
Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health

12. Surveillance and Monitoring
Monitoring effectiveness of policy action - Comprehensive Excel based tool sent to all Member States to elicit details of implementation across each of the items (MPOWER)
Monitoring impact on prevalence and changes at population level through - Global Youth Tobacco Survey - Global Adult Tobacco Survey - WHO STEPwise surveys - National Health Surveys 12

13. Monitoring Tobacco Control Policies
Reports on the Global Tobacco Epidemic
2008 Report
2009 Report

15. Examples of Protection against SHS interventions
Smokefree public places - restaurants, bars, public transport, health care facilities, indoor work places, etc
Examples: Australia: Illegal to smoke in a (private) vehicle with a minor present Mauritius; Illegal to smoke in a (private) vehicle if another person present

16. Evidence on support for protection against SHS
Legislation implemented
Legislation passed

17. Support for smokefree environments

18. Monitoring Protection Against Secondhand smoke
In 2008, only 5% of the world's population is covered by effective implementation of legislation where it exists

19. Offer assistance to those who want to quit tobacco use
Intervention: Reinforce health systems to ensure provision of quit services to assist quitting efforts.
Brief advice within a primary health care setting
Brief advice through telephone (and other electronic services)
Brief advice through other community based services
Pharmacological nicotine replacement therapy treatment

20. Evidence on Offering Assistance to Quit
Increased likelihood(%) of abstinence after 6 months, as compared to no NRT

21. Monitoring Quit Assistance
Only 8% of the world population live in countries with adequate Quit services

22. Warning against dangers of tobacco exposure
Legislate for adequate warnings on packets of cigarettes - both sides covering average of 50% - selected effective fonts and colours and all local languages - rotating images
Latest approaches: Consideration of plain packaging Australia and moves in France for same

23. Attidude towards warnings

25. Database of Images
WHO Tobacco Free Initiative 25

26. Monitoring warnings against the dangers of tobacco
Only 8% of the worlds population live in countries with strong warning labels

27. Enforce legislation prohibiting advertising, promotion and sponsorship
Adopt and apply effective and efficient legislation that prohibits all forms of advertising, promotion, and sponsorship, both Direct, and Indirect forms

28. Examples of bans on advertising
No billboards
No television, radio, internet (difficult)
No print media
In Turkey, not allowed to show cigarette smoking on television - smoking blotted out 28

29. Evidence on Impact of banning advertising

30. Monitoring enforcement of banning ad bans
Only 9% of the worlds population live in countries with strong advertising bans and other forms of promotion and sponsorship

31. Raise taxes: Increase price of tobacco through tax increases
No Convention of Parties guidelines as yet
TFI led initiative: Assist Member States increase the rate of taxation (suggested at 70%+) and adjust periodically relative to inflation such that it increases more than consumer purchasing power
Examples Egypt, Thailand, Australia

32. Evidence of raising taxes on consumption and tax revenues
Consumption of cigarettes
Excise tax rate
Excise tax revenues

33. Tracking Tobacco Taxes
Only 6% of the world population live in countries with taxes account for more than 75% of the retail price

34. 10% or less benefit from effective interventions to reduce use
Proportion of the worlds population covered by selected tobacco control policies
10% or less benefit from effective interventions to reduce use

35. Global Tobacco Surveillance System
Started in 1998 as a collaboration between WHO, CDC, Canadian Public Health Association
Responsible for: - Global Youth Tobacco Survey - Global School Professional Survey - Global Health Professional Student Survey - Global Adult Tobacco Survey

36. survey administration
GTSS Plan
Program
Workshop
Media
SHS
Cessation
School
Access/Availability
Analysis
Workshop
Epi Info Training
Analysis of Data
Report Writing
Survey Workshop
sampling procedures
survey administration
Conduct
Survey
Report Data
Evaluate and
Modify Programs
Best Practices identifies nine components of a comprehensive program
Tobacco Control
Program
Repeat
Every 4 Years
Implement
Programs

37. Surveillance of exposure prevalence
Direct use exposure (both smoking and smokeless):
Current user
Daily user
Occasional user
Former user
Never user
Secondhand exposure (smoking):
In Public places
At work
Other public places (eg restaurants,
At home

38. Characteristics of GTSS surveys
Use standard methods: Questionnaire, Sampling process, Methods of analysis, reporting across all WHO FCTC (MPOWER) articles
GYTS: School based surveys
GATS: Population based surveys of adults (15 years and over) +
WHO STEPwise Surveys and other national health surveys (encouraged to adopt 20 core GATS questions)

39. Status of surveys
Global Youth Tobacco Survey - completed in over 160 countries, some two or three times
Global Adult Tobacco Survey - completed in 14 countries and planning underway in six more countries covering over 80% of current smokers
WHO STEPwise Surveys - completed in over 80 countries

40. GTSS Topics Tobacco Use Knowledge and Attitudes
Secondhand Smoke Exposure
Pro- and Anti-tobacco Media and Advertising Exposure
Cessation
Access and Availability of Tobacco
School Curricula (GYTS and GHPSS)

41. Online Questionnaires and survey tools
GTSS:
WHO STEPwise Survey 41

42. % Smoking any form of tobacco - Adults
Source: Report on the Global Tobacco Epidemic, 2009

43. Countries Completed GYTS 1999-2008
Countries Completed 3rd Round
Countries Completed 2nd Round
Countries Completed

46. Thank you