Transcript Special Populations: Update

Special Populations: Update
Stephen A. Tamplin, MSE
Department of Health, Behavior and Society
Institute for Global Tobacco Control
 2011 Johns Hopkins Bloomberg School of Public Health
Objective
To highlight new or recent developments related to tobacco
control in “special populations”
 Tobacco and poverty
 Tobacco and youth
 Women and tobacco
 The role of nurses in tobacco control
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Messages from Previous Lectures—Tobacco and Poverty
84% of smokers live in
developing and transitional
economy countries
The poor smoke the most and
bear most of the economic
and disease burden of tobacco
use
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Smoking prevalence among
men is higher in low- and
middle-income countries
(about 50%)
Tobacco contributes to
poverty at the individual and
household levels:
 Opportunity cost
 Lost earnings due to
higher risk of illness
 Risks of tobacco farming
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Messages from Previous Lectures—Tobacco and Poverty
Tobacco contributes to
poverty at the national level:
 High health care costs
 Lost productivity
 Loss of foreign exchange
 Smuggling
 Environmental
degradation
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Breaking the tobacco-poverty
relationship requires
consideration of:
 The local context
 Relationships and
partnerships
 Local champions
 The need to situate
interventions in the social
development climate
 Timing
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New Knowledge Regarding Tobacco and Poverty
Meta-analysis involved the review of 9,500
references, of which 765 were included
Overall objective was to assess the association
between income level and tobacco consumption,
tobacco expenditures and morbidity, and
mortality attributed to tobacco
Compared high-income groups with low-income
groups on four factors:
 Prevalence of tobacco use
 Quantity of tobacco consumed
 Incidence of disease and death attributed to tobacco
 Household expenditures on tobacco
Source: Ciapponi, A. (2011).
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New Knowledge Regarding Tobacco and Poverty
The major conclusion: there is an inverse relationship between
income level and tobacco use prevalence (particularly in the last
two decades) and its related consequences
 Smoking prevalence: low-income people (both genders)
smoke more than high-income people
 Tobacco-attributable deaths and diseases: “… statistically
significant higher risk at decreasing income strata.”
 Tobacco spending related to total expenditures: “… an
inverse relationship … between income level and the
proportion of tobacco spending related to total expenditures.”
Source: Ciapponi, A. (2011).
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New Knowledge Regarding Tobacco and Poverty
Causes for disparity are “… still under discussion …” but several
factors are alluded to:
 Relative deprivation inside societies
 Tobacco as a marker of social status
 Tobacco price structures
Greater efforts to reduce tobacco use among the poor are needed
The association between tobacco and poverty should be repeatedly
assessed as implementation of the WHO’s FCTC is likely to modify
the current situation
Source: Ciapponi, A. (2011).
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Messages from Previous Lectures—Tobacco and Youth
The majority of all long-term tobacco users start as youth
 Nearly one-fourth have their first cigarette before age 10
There is no single image of youth tobacco use
“Tobacco is a communicated disease … through advertising and
sponsorship ….” (WHO, 2000)
The tobacco industry targets youth by selling “coolness,”
“independence,” and “lifestyle”
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Messages from Previous Lectures—Tobacco and Youth
We know how to reduce youth tobacco use:
 Smoke-free laws
 Increasing taxes and retail prices
 Strong sustained public education campaigns
 Powerful graphic health warnings
 Curtailing tobacco marketing
 Expanding access to cessation
 Involving the community and health care professionals
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New Knowledge Regarding Tobacco and Youth
The Global Tobacco Surveillance System Atlas (2009), Global Youth
Tobacco Survey (GYTS), 1999-2008
 12% of boys and nearly 7% of girls currently smoke cigarettes
 Susceptibility to initiate cigarette smoking is higher than
current smoking rates in most regions
 19% said they were susceptible to start smoking within
the next year
 12% of boys and 8% of girls use other tobacco (e.g., pipes,
water pipes, cigars, smokeless tobacco, and bidis) besides
cigarettes
 In relation to boys, 8 of 165 countries surveyed reported
a prevalence ≥ 30%
 In relation to girls, 6 of the surveyed countries reported a
prevalence ≥ 30%
Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008).
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New Knowledge Regarding Tobacco and Youth
The Global Tobacco Surveillance System Atlas (2009), Global Youth
Tobacco Survey (GYTS), 1999-2008 (surveys of students aged 13-15
years):
 55% of the students surveyed reported exposure to secondhand
smoke in public places during the previous week
 Fewer than 5% of people are protected by comprehensive
smoke-free laws
 4 in 10 youth were exposed to secondhand smoke in their
homes with 43% having at least one smoking parent
 8 in 10 students favor a ban on smoking in public places and
69% of current youth smokers would like to quit
Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008).
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Messages from Previous Lectures—Women and Tobacco
12% of women smoke (22% in high-income countries; 9% in low- and
middle-income countries)
 By 2025, about 20% of women will smoke
Smoking has negative effects on nearly every system of a woman’s
body
Tobacco farming and processing exploit the labor of women and
girls
The tobacco industry targets women by selling “coolness,”
“independence,” “sex appeal,” and “lifestyle”
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Messages from Previous Lectures—Women and Tobacco
Policy recommendations
Ratify and implement the FCTC
Design empowering messages and
ads for improving women’s health
Promote tobacco control policies
that address social and economic
issues
Monitor women’s and men’s
tobacco use rates
Program recommendations
Implement gender- and agespecific tobacco control programs
Provide information on
occupational health and safety for
women and girls
Engage women in designing and
delivering programs
Conduct further research on the
health effects of tobacco use on
women
Build capacity and engage women
and girls in conducting tobacco
control research
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New Knowledge Regarding Women and Tobacco
Women comprise about 20% of the world’s 1+ billion smokers
In half the countries surveyed by the Global Youth Tobacco Survey,
there is no difference in rates of youth smoking based on gender
Smoking is responsible for 12% of male deaths and 6% of female
deaths in the world
In a recent retrospective study (Oberg, M. et. al., 2011) of the
world burden of disease from exposure to secondhand smoke, the
authors concluded that women comprised almost 50% of the deaths
attributable to secondhand smoke in 2004
Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008); Oberg et. al., (2011).
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New Knowledge Regarding Women and Tobacco
Tobacco advertising increasingly
targets women and girls:
 Glamour
 Sophistication and style
 Luxury
 Class and quality
 Romance and sex
 Sociability
 Enjoyment and success
 Health and freshness
 Emancipation
 Being slim
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Specialty Packs Aimed at Women
Specialty packs and formulations (“light,” “slim,” and “superslim”) target the female market
 For example, about 100 special women’s brands have been
introduced to the Russian market where the prevalence of
smoking among women is increasing rapidly
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Specialty Packs Aimed at Women
Source: Institute for Global Tobacco Control. (2011).
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New Knowledge Regarding Women and Tobacco
While policy design may be gender-neutral, the policies may affect
women and men very differently
 It is important that the WHO FCTC be implemented through a
gender perspective as part of a country’s political and
development agenda:
 Monitor tobacco use by gender
 Protect girls and women of all ages from tobacco smoke
 Offer help to assist women in quitting tobacco use
 Warn women and girls about the dangers of tobacco
 Enforce bans on tobacco advertising, promotion, and
sponsorship by empowering women to identify and
counter these influences
 Raise taxes on tobacco, with the active participation of
women leaders
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Messages from Previous Lectures—The Role of Nurses
Over 11 million nurses in the world have the power to make a huge
difference
Nurses enjoy public trust and can be pivotal partners
Barriers to nursing involvement in tobacco control:
 Smoking status of nurses themselves
 Limited tobacco control content in nursing school education
 Not traditionally a part of nursing practice
 Lack of knowledge and fear of causing patient/visitor stress
 Lack of professional leadership
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Messages from Previous Lectures—The Role of Nurses
Opportunities for involvement in tobacco control:
 Nurses need to move beyond bedside care to influence the
policy making process
 Become advocates and get involved—World No Tobacco Day,
supporting smoke-free public places, etc.
 Integrate tobacco control interventions into current practice
 Implement curriculum changes in nursing schools
 Create workplace committees to enhance awareness
 Include “smoking status” as a vital sign on patient records
 Support improving the quality of cessation treatment
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New Knowledge Regarding the Role of Nurses
There are now over 17 million nurses worldwide
Research indicates that tobacco cessation activities can be
effectively provided by nurses (Rice and Stead, 2008)
Continuous declines in smoking rates among nurses have been
documented in countries where regular data has been recorded
over time (e.g., the United States, New Zealand, and Australia)
However, research conducted among nursing students in some
countries has found contemporary tobacco usage rates higher than
that of the general population (Smith and Takahashi, 2008)
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New Knowledge Regarding the Role of Nurses
Challenges (Smith, 2010):
 The rate of smoking among nurses remains unacceptably high
in some countries
 Strategic directions for tobacco control in nursing are needed
 The provision of educational programs in the workplace and
the addition of tobacco control programs to the nursing
education curricula
 Further research is needed to determine the most effective
educational strategies
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Summary
While progress has been made in controlling tobacco use among
special populations, the tobacco industry remains relentless in its
pursuit of new customers among the poor, youth, and women
The overall burden of the tobacco epidemic is increasingly being
borne by the poor
Controlling the tobacco epidemic among special populations
requires a concerted, collaborative effort across sectors
 In this context, the leadership of a fully engaged, nonsmoking, 100% smoke-free health sector is essential
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