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Challenges faced in    implementing tobaccodependence treatment in Jordan        and the EMR                 Feras I. Hawa...
Scenarios: Impact of                                                             Treatment                                ...
WORLD, DEATHS, BY BROAD CAUSE GROUP, 2001           Total deaths: 56,554,000                                         Nonco...
DEATHS, BY BROAD CAUSE GROUP AND WHO              REGION, 2001  Noncommunicable                       Communicable disease...
Noncommunicable Diseases ( 2006 - 2015 )                                 2005                          2006-2015 (cumulati...
Prevalence (%) of tobacco smoking and      overweight/obesity in EMR                                        6
MPOWER Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Wa...
Challenges in TDT Poor implementation of the FCTC agreements: pictorial  warnings, SHS exposure that would drive the inte...
International quit rates                           1
1
 High level of interest in quitting with the   majority of the sample having had a   quitting attempt (60%),  More than ...
MPOWER Monitor tobacco use and prevention policies Protect people from tobacco smoke Of fer help to quit tobacco use W...
Poor implementation of the FCTCagreements: pictorial warnings, SHSexposure that would drive the intention toquit          ...
Prevalence of Lifestyle Health Problems in                              Jordan                               PrevalenceHea...
1
Abughosh, Wu, Hawari et al. Epidemiol 2011, 1:2                                                  1
‫‪ ‬الشكل ٢ - الصورة‬   ‫‪ ‬الشكل ١ - العبارة‬   ‫التحذيرية‬         ‫التحذيرية الصحية‬                                 ...
New Jordanian pictorial warnings                    Hawari , Bader, Beano et                   al. BMC Public Health 2011 ...
Hawari , Bader, Beano et al. BMC Public Health 2011 May 31;11:414.Hawari, Bader, Beano et al. BMC Public Health 2011 May 3...
HawariHawari, Bader, Beano et BMC Public Health 2011 May 31;11:414.      , Bader, Beano et al. al. BMC Public Health 2011 ...
Spread of other forms of tobacco                                   2
 Invented in India by a  physician as a less  harmful way of  smoking (1556-1605) Hakim Abul Fath  suggested that passin...
Dangers of waterpipes Smoke from WP can  cause cancer and  CAD Contains addictive  nicotine Expose smoker to  more smok...
 Social activity People share the WP Of ten mix cigarettes  and WP EMR and SEA have the  highest rates but is  spreadi...
Action needed against WP Research: trends, harms, cessation etc… Subjected to same anti-tobacco regulations Health warn...
Smoking is not considered a diseaseor a substance abuse and high costof TDT when compared to cigarettesprice              ...
Evaluating factors that influence the                ser vice Goal: comprehensive analysis of factors in order  to develo...
Health care system as a barrier for               TDT Smoking is not considered a disease or a  substance abuse:   -No he...
Cost considerations Hypothetical scenarios produce drug  estimates of $280 to $770 for 12 weeks  treatment (not inclusive...
HCP as a barrier to TDT HCP are victims of tobacco  dependence Lack of TDT training and absence of  TDT from medical cur...
HCP as a barrier to TDTHealth professionals 39% of health professionals are current smokers   Male physicians 94.6%   Fem...
Barriers to medication use Patient misperceptions (skepticism  about NRT, over-optimism about not  using aids, mispercept...
THANK YOU!             3
Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eastern Mediterranean Region -- Feras Hawari, M.D.
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Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eastern Mediterranean Region -- Feras Hawari, M.D.

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Presentation by Feras Hawari, M.D., a pulmonologist and the Global Bridges regional director for the Eastern Mediterranean region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

Published in: Health & Medicine
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  • Smoking cessation can have a bigger impact – though a halving of smoking by 2020 is implausible. Smoking cessation directly treats those most at risk and the is a good evidence base to support it.
  • These are projections showing the rapidly rising NCD mortality trend worldwide. They indicate that there will be an overall 17% increase in the number of deaths caused by these conditions over the ten year period up to 2015. However, the greatest increase will be seen in the African region followed by the Eastern Mediterranean region where we will have a 27% and 25% increase respectively.
  • Foulds J, Hughes J, Hyland A, Le Houezec J, McNeill A, Melvin C, Okuyemi K, Shiffman S, Wassum K, Williams L, Zeller M. Barriers to use of FDA-approved smoking cessation medications: implications for policy action. Society for Research on Nicotine and Tobacco. March, 2009.
  • Transcript of "Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eastern Mediterranean Region -- Feras Hawari, M.D."

    1. 1. Challenges faced in implementing tobaccodependence treatment in Jordan and the EMR Feras I. Hawari, M.D Regional Director, Global Bridges EMR Director, Cancer Control Of fice Chief Section, Pulmonar y and Critical Care Director, Respirator y Therapy Ser vice King Hussein Cancer Center
    2. 2. Scenarios: Impact of Treatment   520 500 500 TrendCumulative deaths from tobacco (millions) If smoking 400 uptake halves by 2020 300 340 halves by 2020 220 If adult smoking 200 halves by 2020 190 100 70 0 1950 1975 2000 2025 2050 Year Source: Peto et al
    3. 3. WORLD, DEATHS, BY BROAD CAUSE GROUP, 2001 Total deaths: 56,554,000 Noncommunicable conditions (33.1 million) Communicablediseases, maternal and perinatal conditions and nutritional Injuries deficiencies (5.1 million) (18.4 million) Source: WHR 2002 Vilius GRABAUSKAS
    4. 4. DEATHS, BY BROAD CAUSE GROUP AND WHO REGION, 2001 Noncommunicable Communicable diseases, Injuries conditions maternal and perinatal conditions and nutritional deficiencies 75% 50% 25% AFR AMR EMR EUR SEAR WPR Source: WHR 2002 Vilius GRABAUSKAS
    5. 5. Noncommunicable Diseases ( 2006 - 2015 ) 2005 2006-2015 (cumulative) Geographical Total NCD NCD Trend: Death Trend: Death regions (WHO deaths deaths deaths from infectious from NCD classification) (millions) (millions) (millions) disease Africa 10.8 2.5 28 +6% +27% Americas 6.2 4.8 53 -8% +17% Eastern 4.3 2.2 25 -10% +25% Mediterranean Europe 9.8 8.5 88 +7% +4% South-East Asia 14.7 8.0 89 -16% +21% Western Pacific 12.4 9.7 105 +1 +20% Total 58.2 35.7 388 -3% +17% (WHO, Chronic Disease Report, 2005)
    6. 6. Prevalence (%) of tobacco smoking and overweight/obesity in EMR 6
    7. 7. MPOWER Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco
    8. 8. Challenges in TDT Poor implementation of the FCTC agreements: pictorial warnings, SHS exposure that would drive the intention to quit Spread of other forms of tobacco (waterpipe) Health care system as a barrier for TDT: classification of TD, HCP as barriers , TDT ser vices, access, cost and availability Lack of TDT training and absence of TDT from medical curricula
    9. 9. International quit rates 1
    10. 10. 1
    11. 11.  High level of interest in quitting with the majority of the sample having had a quitting attempt (60%),  More than half of the population considering quitting in the next year (57%)  Smoking < 10 cigarettes/ day were more likely to want to quit than those who smoked >10 cigarettes or more per day. - High addiction: may support the need for good treatment programsAbughosh, Wu, Hawari et al. Epidemiol open access 2011, 1:2 1
    12. 12. MPOWER Monitor tobacco use and prevention policies Protect people from tobacco smoke Of fer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco adver tising, promotion and sponsorship Raise taxes on tobacco 1
    13. 13. Poor implementation of the FCTCagreements: pictorial warnings, SHSexposure that would drive the intention toquit 1
    14. 14. Prevalence of Lifestyle Health Problems in Jordan PrevalenceHealth Morbidity Study (1996) Jordan behavioural risk factorProblems survey (2007) Overall Male Female Overall Male FemaleSmoking (Adult) 27% 48% 10% 29% 50% 6% 25 years and older ( 18 years and above )Smoking GYTS 2000 25% 15%(Adolescent) GYTS 2009 17% 7%Excessive Body 66% 63% 70%Weight ( 18 years and above )(BMI: > 25)Diabetes 7% 16% ( 18 years and above )Inadequate 32%Exercise ( 18 years and above )Smoke WaterPipe 9% Adolescents and Adults
    15. 15. 1
    16. 16. Abughosh, Wu, Hawari et al. Epidemiol 2011, 1:2 1
    17. 17. ‫‪ ‬الشكل ٢ - الصورة‬ ‫‪ ‬الشكل ١ - العبارة‬ ‫التحذيرية‬ ‫التحذيرية الصحية‬ ‫:تحذير‬ ‫احــــــترس، التـــدخيـــن يدمـــــر الصحة‬ ‫ويسبب الوفاة‬ ‫وزارة الصحة‬ ‫1‬
    18. 18. New Jordanian pictorial warnings Hawari , Bader, Beano et al. BMC Public Health 2011 May 31;11:414.Hawari , Bader, Beano et al. BMC Public Health 2011 May 31;11:414. 1
    19. 19. Hawari , Bader, Beano et al. BMC Public Health 2011 May 31;11:414.Hawari, Bader, Beano et al. BMC Public Health 2011 May 31;11:414. 2
    20. 20. HawariHawari, Bader, Beano et BMC Public Health 2011 May 31;11:414. , Bader, Beano et al. al. BMC Public Health 2011 May 31;11:414. 2
    21. 21. Spread of other forms of tobacco 2
    22. 22.  Invented in India by a physician as a less harmful way of smoking (1556-1605) Hakim Abul Fath suggested that passing of smoke through the ball of water will make it harmless 2
    23. 23. Dangers of waterpipes Smoke from WP can cause cancer and CAD Contains addictive nicotine Expose smoker to more smoke over time (0.15-1 .0 liter/session) 2
    24. 24.  Social activity People share the WP Of ten mix cigarettes and WP EMR and SEA have the highest rates but is spreading over the world 2
    25. 25. Action needed against WP Research: trends, harms, cessation etc… Subjected to same anti-tobacco regulations Health warnings Fight false adver tisement about WP safety Cessation inter ventions HCP education about risks to vulnerable groups 2
    26. 26. Smoking is not considered a diseaseor a substance abuse and high costof TDT when compared to cigarettesprice 2
    27. 27. Evaluating factors that influence the ser vice Goal: comprehensive analysis of factors in order to develop a smoking cessation ser vice that is: Accessible Integrates within existing healthcare systems Takes into account unique social, physical and economic environment of target community Operates ef ficiently Measurable and ef fective (positive patient outcomes) Sustainable 2
    28. 28. Health care system as a barrier for TDT Smoking is not considered a disease or a substance abuse: -No health insurance coverage -No clear accessible ser vices -When ser vices exist (like in Jordan) they are not integrated, of ten fragmented with no consistent implementation of clear practice guidelines 2
    29. 29. Cost considerations Hypothetical scenarios produce drug estimates of $280 to $770 for 12 weeks treatment (not inclusive of clinic fees) NRT using gum alone ($275) Varenicline ($336) NRT patches and gum ($492) Countering costs: A pack-a-day smoker spends $42 to $84 per month Savings due to avoiding harmful ef fects of tobacco 3
    30. 30. HCP as a barrier to TDT HCP are victims of tobacco dependence Lack of TDT training and absence of TDT from medical curricula Barriers to the use of medications: training, availability, time to counsel Scarcity of data regarding the tobacco burden Lack of awareness of existing treatment guidelines 3
    31. 31. HCP as a barrier to TDTHealth professionals 39% of health professionals are current smokers Male physicians 94.6% Female physicians 5.4% Male nurses 83.8% Female nurses 16.2% Shishani et. al Eur J card vasc nur 2010 Sep 6 3
    32. 32. Barriers to medication use Patient misperceptions (skepticism about NRT, over-optimism about not using aids, misperceptions of the role of nicotine in causing the dependence or physical harm from smoking) When medication is used, it is under- used (too little for too shor t a time ) Reduced ef fectiveness Availability of drugs 3
    33. 33. THANK YOU! 3

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