Transcript Effective tobacco control strategies and their evaluation

SELLING DEATH NICELY PACKAGED
Rima Nakkash, DrPH
Faculty of Health Sciences
American University of Beirut
Spread of the epidemic
In the 20th century, the tobacco epidemic
killed 100 million people worldwide.
During the 21st century, it could kill
one billion.
WHO, MPOWER 2008
…Tobacco use is unlike other threats to global health.
Infectious diseases do not employ multinational public
relations firms. There are no front groups to promote
the spread of cholera. Mosquitoes have no lobbyists.
—Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny,PhD, Fazel
Randera, MD1
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The Dwarves-video
“Nicotine is addictive. We are, then, in the business of selling
nicotine…”
(Addison Yeaman from Brown & Williamson, 17 July 1963)
Tobacco company CEOs declare, under oath, that nicotine is not addictive
(1994)
Lots of toxic chemicals!
What is in tobacco and cigarettes?
Carbon Monoxide-auto exhaust, gas
chambers
Carbon Dioxide
Carbonyl Sulfide
Benzene (1)
Toluene-industrial solvent, in explosives
Formaldehyde (2)- body tissue
preserver
Acrolein-aquatic herbicide=burned
glycerol
Acetone-poisonous solvent, nail polish
remover
Pyridine-poisonous solvent
Methylpyridine-insecticide solvent
Vinylpyridine
Hyrogen Cyanide-rat poison, gas
chambers
Hydrazine-rocket fuel chemical
Ammonia-poisonous, cleaning agent for
toilets and floors
Methylamine-tanning agent
Dimethylamine-tanning accelerator
Nitrogen Oxides
Nitrosodimethylamine
Nitrosodiethylamine
Nitrosopyrrolidine
Formic Acid-caustic solvent
Acetic Acid-caustic solvent
Methyl Chloride-poisonous refrigerant
Butadiene
Particulate Matter-animal
carcinogen
Nicotine-insecticide, cockroach
killer
Anatabine
Phenol-toilet bowl disinfectant
Catechol-tanning, dyeing agent
Hydroquinone-photographic developing
agent
Aniline-industrial solvent
Toluidine-agent in dye manufacture
Napthalamine-mothballs
Aminobiphenyl
Benz(a)anthracene
Benzo(a)pyrene
Cholesterol
Butyrolactone
Quinoline-specimen preservative
Harman
Nitrosonornicotine
NNH
Nitrodiethanolamine
Cadmium
Nickel
Zinc-anti-corrosion coating for metals
Aluminum-metal
Titanium-metal
Copper-metal
Mercury-metal
Silicon-metal
Silver-metal
Gold-metal
Polonium-210-radioactive element
Benzoic Acid-tobacco curing agent
Lactic Acid-caustic solvent
Glycolic Acid-metal cleaning agent
Succinic Acid-agent in Lacquer
manufacture
PCDDs and PCDFs –dioxins,
dibenzofurans Hexamine-barbecue
lighter
Stearic Acid-candle wax
Cadmium-rechargeable batteries
Arsenic-poison
Butane-cigarette lighter fluid
Propylene Glycol-antifreeze
What’s in a cigarette
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Video
SPIKE MY CIGARETTE
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VIDEO, Is big tobacco evil ?
Tobacco Industry uses a variety
of tactics
•They target youth and special populations such as women, different cultural groups
and low income people.
•They reassure concerned smokers by linking tobacco with healthy images.
•They use advertising and promotion to publicize their product.
•They launch “prevention” campaigns that have been shown to actually encourage
youth to smoke.
•They pretend to be concerned “corporate citizens” by donating money to various
causes.
•They challenge the decisions of governments to control tobacco.
•They use their networks to influence politicians.
•They create “front groups” to express their opinions.
•They create controversy about the health effects of smoking.
•They deny scientific evidence.
•They deny that second-hand smoke is dangerous, even though it has been proven
to be harmful.
Other tactics
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Flavored products: Cigarettes, smokeless tobacco, and so-called “little cigars” have
been introduced in many candy, fruit, and alcohol flavors that mask the harshness of
the products and make them appealing to children.
Novel smokeless products: New smokeless tobacco products, some in teabag-like
pouches and even in dissolvable, candy-like tablets, have been marketed as ways to
help smokers sustain their addiction where they cannot smoke.
Targeted products and marketing: New products and marketing, such as R.J.
Reynolds’ Camel No. 9, are aimed at women, girls and other populations.
Unproven health claims: To discourage smokers from quitting, and possibly entice
new or former smokers, increasing numbers of products have been marketed with
unproven and misleading claims that they are less harmful than traditional
cigarettes.
Undisclosed product designs: The report also details how tobacco manufacturers
control nicotine delivery to maximize addiction, while using flavorings and other
additives to make their products milder,
• Are you really more of a
man if you smoke? What
girl is going to kiss you
with that stinky breath?
The tobacco industry as disease vector
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The tobacco industry plays a key role in the
tobacco epidemic.
Industry voluntary or self-regulatory measures have
not been proven to be effective.
Release of internal tobacco industry documents
(TIDs).
Framework Convention on Tobacco Control
Adopted in May 2003 by the World Health
Assembly (WHA).
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Ninety days after the 40th country ratified the
treaty, the FCTC became legally binding in February
2005
.
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Anti smoking media campaigns
Non price measures
Ban tobacco advertising in all its forms
Advertising to women ……
….and youth
Faraya Skiing Event
Mika concert downtown Beirut
Tobacco advertising increases consumption:
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Encourages children to experiment
Encourages smokers to smoke more
Reduces motivation to quit
Encourages former smokers to resume
Discourages full and open discussion of the hazards of smoking
as a result of media dependence on advertising revenues …
dependence of organisations receiving sponsorship from
tobacco companies
Creates through in which tobacco use is seen as familiar and
acceptable .
Tobacco Industry Resistance
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Voluntary codes in existence for decades, but consumption is
growing
A 1989 Philip Morris International Memorandum states that:
“The general argumentation used by the industry is beginning
to look extremely weak… This is best illustrated in the
advertising bans and consumption argument, where the
industry argues that ‘advertising does not increase total market
size’, yet we are presented with a dilemma in developing
markets where the total market is growing and advertising
expenditure is rising accordingly. How can we reconcile this?...”
Branding
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Marlboro Classics clothing, camel boots and
accessories, Gauloise cars
Sports Sponsorship
Music Sponsorship
Health
Warning
Labels
Iran
Brazil
Jordan: Courtesy of Dr. Hiba Ayoub
‫التحذيرات الصحية على علب السجائر‬
‫في جمهورية مصر العربية‬
Graphic labels on tobacco products
Graphic Warnings
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“Large, graphic warnings on cigarette packages are an
effective means of increasing health knowledge among smokers
[and] may also help to reduce the disparities in health
knowledge by providing low-income smokers with regular
access to health information.”
Hammond and colleagues also found that smokers in countries
where a warning depicts a particular health hazard of smoking
are much more likely to know about that hazard and smokers
who reported noticing warnings were 1.5 to 3 times more likely
to believe in each health hazard.
Hammond et al.,2001
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73 percent of smokers
approved of them
54 percent had
changed their opinion on
the health consequences
of smoking
67 percent said the new
warnings made them
want to quit.
The impact was
particularly strong
among less educated,
lower income people.
Industry Arguments and Rebuttals
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Expensive and technically difficult
Larger warnings or the use of pictures will not be more
effective than existing warnings.
Smokers already know the health effects of smoking.
Mandatory health warnings constitute an expropriation of the
tobacco industry's
Packages and trademarks spoiled
The warnings ‘demonize’ smokers and make them feel like
outcasts.
If the government wants to put out those messages, it should
use billboards or TV commercials.
Dangers of second hand smoke
The debate is over!
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The Surgeon General’s 2006 Report on The Health
Consequences of Involuntary Exposure to Tobacco
Smoke
 secondhand
smoke causes cancer, heart disease and
serious lung ailments.
 Former Surgeon General Richard Carmona stated when
releasing the report, "The debate is over. The science is
clear. Secondhand smoke is not a mere annoyance but a
serious health hazard."
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Secondhand smoke contains over 4,000 chemicals,
including at least 69 that cause cancer, including
arsenic, ammonia, formaldehyde, and polonium 210.
Studies show that children, the elderly, and people
with respiratory illnesses are especially vulnerable to
secondhand smoke.
For example, children exposed to secondhand smoke
are more susceptible to bronchitis, asthma, eye and
ear problems, and other ailments.
Bans on Smoking in the Workplace
and Public Places
Previously “SECRET” Tobacco Industry Documents:
 “Total prohibition of smoking in the workplace strongly affects
industry volume. Smokers facing these restrictions consume
11%-15% less than average and quit at a rate that is 84%
higher than average…If smoking were banned in all
workplaces, the industry’s average consumption would decline
8.7%-10.1% from 1991 levels and the quitting rate would
increase 74% (e.g. from 2.5% to 4.4%).”
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Such measures need to be strictly enforced in order to be
effective.