1.  2012 Johns Hopkins Bloomberg School of Public Health Annette David, MD, MPH, FACOEM Senior Partner for Health Consulting Services at Health Partners, L.L.C. (Guam) Best Practices in International Tobacco Control

2.  2012 Johns Hopkins Bloomberg School of Public Health Learning Objectives Identify key population strategies embodied in the WHO FCTC and MPOWER Delineate actions that health professionals can take to promote tobacco control 2

3.  2012 Johns Hopkins Bloomberg School of Public Health World Cigarette Production 3 Image source: Tobacco Atlas. (2012). www.tobaccoatlas.org

4.  2012 Johns Hopkins Bloomberg School of Public Health A Global Solution to a Global Epidemic 4 Image sources: (left) World Health Organization. (2000). Geneva public hearing; (right) World Health Organization. (2011).

5.  2012 Johns Hopkins Bloomberg School of Public Health MPOWER The six MPOWER measures are:  Monitor tobacco use and prevention policies  Protect people from tobacco use  Offer help to quit tobacco use  Warn about the dangers of tobacco  Enforce bans on tobacco advertising, promotion, and sponsorship  Raise taxes on tobacco Image source: World Health Organization. 5

6.  2012 Johns Hopkins Bloomberg School of Public Health Monitor Tobacco Use and Prevention Policies 6

7.  2012 Johns Hopkins Bloomberg School of Public Health Sources of Data Global Tobacco Surveillance System—GATS, GYTS, GHPSS Other global/regional surveys—WHO Steps, BRFSS, YRBSS National surveys 7

8.  2012 Johns Hopkins Bloomberg School of Public Health Protect from Tobacco Smoke 8

9.  2012 Johns Hopkins Bloomberg School of Public Health Smoke-Free Polices Smoke-free policies decrease exposure to secondhand tobacco smoke by 80-90% in high-exposure settings 9

10.  2012 Johns Hopkins Bloomberg School of Public Health Offer Help to Quit Tobacco Use Three types of treatment should be included in any tobacco prevention effort: 1.Cessation advice in health care 2.Quit lines 3.Pharmacological therapy Tobacco cessation interventions are effective 10

11.  2012 Johns Hopkins Bloomberg School of Public Health Offer Help to Quit Tobacco Use Studies show that even brief advice from health professionals can increase tobacco abstinence rates up to 30% Interventions for smoking cessation led by nurses have shown to increase the chance of successfully quitting smoking by up to 50% There also needs to be a systematic approach for incorporating brief tobacco interventions (the “5 A’s” and “5 R’s”) into primary health care services 11

12.  2012 Johns Hopkins Bloomberg School of Public Health Warn about the Dangers of Tobacco 12

13.  2012 Johns Hopkins Bloomberg School of Public Health Graphic Warnings Increase Smokers’ Intention to Quit 13 Image source: iStockphoto.com

14.  2012 Johns Hopkins Bloomberg School of Public Health Smokeless Tobacco Products and Warning Labels Smokeless tobacco products are less likely to have health warning labels 14 Images source: iStockphoto.com

15.  2012 Johns Hopkins Bloomberg School of Public Health Enforce Bans 15

16.  2012 Johns Hopkins Bloomberg School of Public Health Total Ad Bans Work Image source: Annette David. 16

17.  2012 Johns Hopkins Bloomberg School of Public Health Only 19 Countries Have Total Ad Bans 17

18.  2012 Johns Hopkins Bloomberg School of Public Health Raise Taxes on Tobacco 18

19.  2012 Johns Hopkins Bloomberg School of Public Health Higher Taxes, Lower Consumption 19

20.  2012 Johns Hopkins Bloomberg School of Public Health Optimal Tobacco Tax Rates Less than 10% of middle- and low-income countries have optimal tobacco tax rates 20

21.  2012 Johns Hopkins Bloomberg School of Public Health Average Retail Price and Taxation 21

22.  2012 Johns Hopkins Bloomberg School of Public Health Impact on Consumption 22 Source: Mendez et al. (2013). Tob Control, 22(1): 46-51.

23.  2012 Johns Hopkins Bloomberg School of Public Health Why Health Professionals? Witness to patients’ suffering from tobacco-related illnesses Advocate for patients’ well-being Key opinion leader—credibility Expert—technical knowledge Unique position to influence others Professional and personal role model for the community 23

24.  2012 Johns Hopkins Bloomberg School of Public Health Health Professionals’ Role in Tobacco Control In 2004, a global meeting of medical organizations at the WHO headquarters in Geneva resulted in the publication of a code of practice for health professionals and health organizations Individual actions: 1.Physician, heal thyself—become tobacco-free 2.Patient care—advise all smoking patients to quit 3.Personal policies—tobacco-free clinics/homes 4.Pursue skills and knowledge on tobacco cessation 5.Refuse tobacco industry support of any kind 24

25.  2012 Johns Hopkins Bloomberg School of Public Health Health Professionals’ Role in Tobacco Control Institutional actions: 1.Making all meetings and events tobacco-free 2.Including tobacco issues in conference agendas 3.Assessing and addressing tobacco consumption patterns among members of health associations 4.Refusing tobacco industry support 5.Promoting capacity building for tobacco cessation 25

26.  2012 Johns Hopkins Bloomberg School of Public Health Health Professionals’ Role in Tobacco Control Health system actions: 1.Integrating training on tobacco control and cessation into all health professionals curriculae 2.Incorporating at least brief tobacco cessation advice into primary health care 3.Building a strong cessation infrastructure and instituting cessation programs into all health care settings 4.Promoting tobacco-free policies in all health care settings and supporting all health professionals to become tobacco-free 26

27.  2012 Johns Hopkins Bloomberg School of Public Health Health Professionals’ Role in Tobacco Control National level:  Health professionals should support and advocate for effective tobacco control public policies as embodied by the MPOWER Package and full implementation of the WHO Framework Convention on Tobacco Control  Advise legislators on evidence-based tobacco-control policies and laws As experts we should choose to be tobacco-free, recognize and treat tobacco dependence, advocate for and support tobacco-free policies and programs, and avoid tobacco sponsorship 27

28.  2012 Johns Hopkins Bloomberg School of Public Health 28 Thank You!