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Evidence-based/Best Practices Tobacco Control Hadii Mamudu, PhD, MPA COPH-China Institute November 17, 2011
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Outline of Presentation Types of tobacco products Scientific bases for tobacco control Health and Economic Consequences of Tobacco Use (Smoke and Smokeless) Approaches to tobacco control ◦ Demand-side ◦ Supply-side ◦ Production-side ◦ Addressing tobacco industry interference in policy ◦ Building capacity Effects of tobacco control
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Scientific Bases for Tobacco Control Biomedical research Epidemiology Policy Analysis Documents research
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Scientific Bases for Tobacco Control U.S. Surgeon General since 1964 UK Royal College of Physicians since 1962 World Health Organization since 1970 International Agency for Research on Cancer World Bank
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Tobacco Products
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Smoke Contains 400-500 known carcinogens Cigarette Cigar Kretek Hooka/Waterpipe
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Smoke The future of many kids is at stake From Indonesia
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Smokeless Chewing Snuff Snus Dip
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Emerging Tobacco Products E-cigarettes Herbal Cigarettes
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Tobacco Use as a Global Problem Smoking prevalence The United States: 46+ million China: 350+ million Globally: 1.35+ billion
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Consequences of Tobacco Use Leading Cause of Preventable Diseases and Deaths
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Health Consequences Direct tobacco use Death ◦ United States: 443,000 ◦ Globally: 5.4 million Increased health risks Cardiovascular Diseases Respiratory Diseases Cancer Adverse Reproductive Effects Adverse Early Childhood Effects NB: Tobacco kills half of its users
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Health Consequences Secondhand smoke (SHS) /environmental tobacco (ETS)/Involuntary or Passive Smoking Heart Disease ◦ United States: 46, 000 deaths among nonsmokers ◦ Globally: 600,000 deaths among nonsmokers Lung Cancer Sudden Infant Death Syndrome (SID) Adverse effects for children ◦ Bronchitis and pneumonia ◦ Cough ◦ Asthma attacks ◦ Ear infections
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Health Consequences Tobacco Addiction ◦ Nicotine is a drug U.S. Surgeon General Report, 1988 UK Royal College of Physicians Tobacco is addictive more than banned substances
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Health Consequences Source: U.S. Surgeon General Report, 2010
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Economic Consequences Direct Medical Costs + Lost Productivity ◦ United States: $193 billion ◦ Globally: $500+ billion Household expenditure ◦ Crowd out expenditure on essential needs ◦ Increases poverty Environmental damage ◦ Deforestation ◦ Toxic chemicals
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Approaches to Tobacco Control
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Prohibition vs. Control Prohibition Late 19 th and early 20 th Century: Cigarettes Prohibition in the U.S. ◦ Failed Country with prohibition: Bhutan ◦ Illicit trade: smuggling, counterfeiting, bootlegging Control ◦ Since the mid-20 th Century ◦ Has been successful Cut smoking rates in the U.S. and Europe by more than a half.
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CDC Best Practices for Tobacco Control, 1999, 2007
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World Bank Curbing the Epidemic, 1999
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World Health Organization The WHO Framework Convention on Tobacco Control (FCTC) International tobacco control treaty 174 Members ◦ Not including United States
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World Health Organization The MPOWER Reports, 2008, 2009, 2011
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Experts/Scientists
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Individual vs. Population-Based Individual-base: Cessation and treatment for tobacco dependence ◦ Clinical interventions ◦ Therapies ◦ Counseling ◦ Nicotine Replacement (e.g., patches, gum, inhalers, drugs) Note ◦ Majority of smokers quit without cessation treatments ◦ Most ex-smokers try several times before quitting ≈5-7 times
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Individual vs. Population-Based Population-based Tax increases Ban on advertising and promotions Preventions Anti-tobacco campaign Smoke-free environments Quitlines Monitoring Advocacy
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Individual vs. Population-Based
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Demand-side policies Tax increases (70% of Retail Price) ◦ Reduce consumption ◦ Encourage cessation Health Warnings (45 countries with Pictograms)
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Supply-side policies Ban on sale to minors ◦ Youth access laws ◦ Restricting tobacco industry promotions Control illicit trade in tobacco products ◦ Smuggling ◦ Counterfeiting ◦ Bootlegging Tracing and Tracing
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Production-side policies Tobacco and Poverty Alternative sources of livelihoods ◦ Switching from tobacco production
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Capacity Building for Tobacco Control Institutions Education Advocacy ◦ Encouraging civil society groups ◦ Liaising with the international community Scientific research ◦ Country-specific data Understand the Tobacco Industry’s Role(s) in Policy ◦ The tobacco industry documents The tobacco industry documents
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The Tobacco Industry The Global Industry: Market Share
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The Tobacco Industry Promote tobacco use Undermine policy ◦ Lobbying ◦ Corrupting the policy process ◦ Focus attention on economics; not health ◦ Divert attention from the effects of tobacco use ◦ Etc.
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Effects of Tobacco Control
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Smoking Prevalence Prevent smoking initiation Reduce tobacco use
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Health Improves health Reduces health risks Helps with cessation
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Economic benefits Does not harm economy ◦ See the World Bank’s Cubing the Epidemic Saves medical costs ◦ $80+ billion saved by the California Tobacco Control Program Generates revenue through higher taxes (“sin tax”) Makes more money available to households
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The Scientific Consensus Mamudu et al., 2011
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Thank you!!
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