1. Using Data to Inform and Evaluate Tobacco Control Measures
April 22, 2015
Yogyakarta, Indonesia
Kalina Duncan, MPH Public Health Advisor Center for Global Health
@NCIGlobalHealth

2. Overview Definition of surveillance
Tobacco control surveillance systems
CDC Global tobacco surveillance systems (GTSS) framework and components
Accessing and using GTSS data
MPOWER examples
Case studies and examples

3. Surveillance
Ongoing, systematic collection, analysis, & interpretation of data essential to planning, implementation, & evaluation of public health practice, integrated with timely dissemination to those responsible for prevention & control.
- US CDC
Timely, useful evidence to empower public & policy makers to lead & manage effectively. That’s where public health begins.

4. WHO FCTC Monitoring Protocol 20.2
“…integrate tobacco surveillance programs into national, regional, and global health surveillance programs so that data are comparable and can be analyzed at the regional and international levels, as appropriate.”

5. Purpose of a Tobacco-Related Surveillance System
To provide timely information from populations on:
Prevalence of use of tobacco-related products
Factors that influence their use
Incidence, prevalence, and mortality from tobacco-attributable diseases
Impact of tobacco control programs and policies on relevant outcomes

6. Uses of Tobacco Surveillance Data
Understand the natural history and trends of tobacco use and consequences of use
Identify emerging issues and research needs (e.g. tobacco harm reduction, SHS exposure)
Evaluate tobacco use prevention and control programs, policies, and legislation

7. Using Existing Tobacco Control Data
CDC Global Tobacco Surveillance Data
GATS, GYTS
National Datasets
RISKESDAS/Basic Health Survey/ Indonesia Demographic and Health Survey (IDHS)
National Health Information System (HIS)
Disease registries
Posbindo NCD Risk Factor Screening Program (Ministry of Health)
Others

8. CDC Global Tobacco Surveillance System
GLOBAL YOUTH TOBACCO SURVEY
GLOBAL ADULT TOBACCO SURVEY
TOBACCO QUESTIONS FOR SURVEYS
Features:
Standardized, systematic & scientific surveys
Standard protocol, country adaptations & expert reviews
Systematic training & technical exchange
Repeats 4-5 years
Data Coordinating Center (data bank, quality assurance, data release)
Sustainable & efficient
Country commitment & partnerships
Strengths:
Template focused on statistically efficient probability sampling
Priority to design comparability
Series of manuals & guidelines
Training sessions offered to in-country technical/field staff
External review of key design components
Wide use of handheld technology
Commitment to in-country capacity-building
Weighted estimates accounting for design complexity

9. GYTS: Global Youth Tobacco Survey
Global Youth Tobacco Survey (GYTS)
Global standard for systematically monitoring youth tobacco use & key tobacco control indicators (WHO FCTC & MPOWER).

10. GYTS Methodology School-based survey of students aged 13-15
Anonymous and confidential self-administered data collection
Core questionnaire with optional questions
Option for countries to add additional questions
Use of answer sheets that can
be optically scanned

11. GYTS in Indonesia 2006, 2009, in the field now
Dataset available at: (select Indonesia)
Highlights:
22.5% of students use tobacco
2/3 of students live in homes where others smoke
8/10 of students who smoke want to quit

12. GATS: Global Adult Tobacco Survey
Global Adult Tobacco Survey (GATS)
Household-based survey of adults that aims to collect data on adult tobacco use and key tobacco control measures by using a standard global protocol.
Methodology
Nationally representative household survey of persons aged 15 years and older
Cross sectional estimates by gender and urban/rural
Core questionnaire with optional questions
Options for countries to add additional questions
Face-to-face personal interview survey
Electronic data collection using handheld devices

13. GATS in Indonesia
2011

14. Tobacco Use in Indonesia
Source: Campaign for Tobacco Free Kids

15. Tobacco Questions for Surveys (TQS)
22 Survey questions to collect data on tobacco use prevalence that can be used in national surveys.
Currently TQS is integrated into:
World Bank Living Standards
WHO Stepwise
UNICEF National Surveys
USAID Demographic and Health Survey
Available at:
Features:
Standardized, systematic & scientific surveys
Standard protocol, country adaptations & expert reviews
Systematic training & technical exchange
Repeats 4-5 years
Data Coordinating Center (data bank, quality assurance, data release)
Sustainable & efficient
Country commitment & partnerships
Strengths:
Template focused on statistically efficient probability sampling
Priority to design comparability
Series of manuals & guidelines
Training sessions offered to in-country technical/field staff
External review of key design components
Wide use of handheld technology
Commitment to in-country capacity-building
Weighted estimates accounting for design complexity

16. Accessing GTSS Data Access GTSSData at www.cdc.gov/tobacco/global
Click the GTSSData icon

17. GTSSData: Home Page Edward

18. GTSS Data: Indicators by Tobacco Topic or MPOWER Objective
View one indicator for all locations
View one indicator for all locations
View results for one indicator for all countries and regions which have data available. Indicators are organized by tobacco topic or MPOWER objectives.
View results for one indicator for all countries and regions which have data available. Indicators are organized by tobacco topic or MPOWER objectives.

19. Data Sharing & Dissemination
Source data files
Publications
Public use datasets
Key Products
Fact Sheets
Country Reports

20. Country Fact Sheets and Reports

21. MPOWER: M - Monitor Monitor tobacco use and prevention policies
Obtain nationally representative data on youth and adults
Critical to understanding and reversing the epidemic and ensuring success of the other five MPOWER measures

22. MONITOR: Tobacco Use by Gender
Prevalence (%)
Male
Female
Global Adult Tobacco Survey, 22

23. MPOWER: P Protect People from Tobacco Smoke
Exposure to smoke at work (for people who work outside the home)
Exposure to smoke in the home
Source: Giovino

24. PROTECT: SHS Exposure at Workplace
* In the past 30 days preceding the survey
Global Adult Tobacco Survey,

25. MPOWER: O Offer Help with Quitting
Quit attempts during the previous 12 months
Receipt of advice to quit from a doctor or other health care provides

26. OFFER: Advised to Quit by a Health Care Professional
* Among those who visited a Health Care Provider (HCP) in the last 12 months
Global Adult Tobacco Survey,

27. MPOWER: W Warn About the Dangers of Tobacco
Noticing anti-cigarette information:
In newspapers/magazines
On television
On cigarette packs
Both noticing and thinking about quitting

28. WARN: Thoughts About Quitting Smoking Because of Warning Labels on Cigarette Packages
* Among those who noticed health warning label (WL) on cigarette packages in the past 30 days preceding the survey
Global Adult Tobacco Survey,

29. MPOWER: E Enforce Bans on Tobacco Marketing
Noticing cigarette advertising in stores
Noticing cigarette promotions:
Free samples
Sale prices
Coupons
Free gifts or discounts with purchase
Clothing or other items
Promotions in the mail
Source: Giovino

30. ENFORCE: Percent Who Noticed Cigarette Marketing in Stores
* In the past 30 days preceding the survey
Global Adult Tobacco Survey,

31. MPOWER: R Raise Taxes on Tobacco
Purchasing patterns
Amount paid for cigarettes

32. RAISE: Cigarette Affordability
* Affordability as the relative income price - median price paid per 2000 sticks as % of per capita GDP
Global Adult Tobacco Survey,

33. Using Data to Inform and Evaluate Tobacco Control Policies
Examples from the field…

34. International Tobacco Control Policy Evaluation Project (ITC)
The ITC Project has established a research platform to guide strong, evidence-based implementation of FCTC policies to:
Evaluate FCTC policies at the level of the individual smoker
Identify the determinants of effective tobacco control policies
Disseminate research findings to the global tobacco control community, including researchers, policy makers, and advocates.
The International Tobacco Control Policy Evaluation Project (the ITC Project) is the first-ever international cohort study of tobacco use. Its overall objective is to measure the psychosocial and behavioral impact of key national level policies of the WHO Framework Convention on Tobacco Control (FCTC). The ITC Project is a collaborative effort with international health organizations and policymakers in more than 20 countries so far, inhabited by more than 50% of the world's population, 60% of the world's smokers, and 70% of the world's tobacco users. In each country, the ITC Project is conducting prospective cohort surveys to assess the impact and identify the determinants of effective tobacco control policies in each of the following areas:
Health warning labels and package descriptors
Smoke-free legislation
Pricing and taxation of tobacco products
Communication and education
Cessation
Tobacco advertising and promotion
Source:

35. International Tobacco Control Policy Evaluation Project (ITC)
The ITC measures the psychosocial and behavioral impact of national level policies of the FCTC, studying:
Health warning labels and package descriptors
Smoke-free legislation
Pricing and taxation of tobacco products
Communication and education
Cessation
Tobacco advertising and promotion
The International Tobacco Control Policy Evaluation Project (the ITC Project) is the first-ever international cohort study of tobacco use. Its overall objective is to measure the psychosocial and behavioral impact of key national level policies of the WHO Framework Convention on Tobacco Control (FCTC). The ITC Project is a collaborative effort with international health organizations and policymakers in more than 20 countries so far, inhabited by more than 50% of the world's population, 60% of the world's smokers, and 70% of the world's tobacco users. In each country, the ITC Project is conducting prospective cohort surveys to assess the impact and identify the determinants of effective tobacco control policies in each of the following areas:
Health warning labels and package descriptors
Smoke-free legislation
Pricing and taxation of tobacco products
Communication and education
Cessation
Tobacco advertising and promotion
Source:

36. Global Adult Tobacco Survey Data as a Tool to Monitor the WHO Framework Convention on Tobacco Control (WHO FCTC) Implementation: The Brazilian Case
The Global Adult Tobacco Survey (GATS) was conducted in Brazil to provide data on tobacco use in order to monitor the WHO FCTC implementation in the country.
Data in this report can be used as baseline for evaluation of new tobacco control approaches in Brazil, vis-à-vis WHO FCTC demand reduction measures.
Available at:

37. Using Data to Inform and Evaluate Tobacco Control Policies
Examples from Indonesia…

38. Using Data to Inform and Evaluate Tobacco Control Policies
Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control: the case for Indonesia.
Aditama TY1, Pradono J, Rahman K, Warren CW, Jones NR, Asma S, Lee J.
RESULTS:
This report shows that more than 1 in 10 students (12.6%) currently smoked cigarettes, with the prevalence among boys (24.5%) significantly higher than among girls (2.3%). Of the students who currently smoked, more than 7 in 10 (75.9%) reported that they desired to stop smoking now….
CONCLUSIONS:
Tobacco control in Indonesia will likely not move forward until the government evaluates and strengthens existing laws, considers passing new strong laws, and develops protocols for enforcing all laws…
Available at:

39. Using Data to Inform Tobacco Control Policies
Examples from Indonesia… Susi Ari Kristina, MPH, PhD