World No Tobacco Day 2010

Tobacco epidemic:Problems, conflicts, solutions
Rahajeng N. Tunjungputri, MD – June 2010

RULES!!!
I’m interested in what you think!
We are learning together
Please be active!
Please express your opinions!
Please feel free to ask questions!

Outline
The problems
How big?
Pathogenesis of addiction
Tobacco related illness
Tobacco and cancer
Tobacco and TB
The conflicts
The solutions

The Problems

Questions
Smoking is bad, but why do people still smoke?
What is the situation of tobacco and anti-tobacco campaign in Indonesia?
What does it take to successfully overcome the tobacco epidemic?
What can you contribute as health professionals in reducing tobacco epidemic?

What goes through your mind when you see this?

Hatched areas indicate proportions of deaths that are related to tobacco use and are coloured according to the column of the respective cause of death.
*Includes mouth and oropharyngeal cancers, oesophageal cancer, stomach cancer, liver cancer, other cancers, as well as cardiovascular diseases other than ischaemic heart disease and cerebrovascular disease.

Indonesia

Indonesia (2)

Indonesia (3)

Pathogenesis of addiction
Mesolimbic dopamine system, stretches from the ventral tegmental area to the basal forebrain.
The nucleus accumbens, a dopamine-rich area, is an intersection where all addictive behaviors meet.
The release of dopamine at this site promotes pleasure and reinforces the associated behaviors, such as the use of alcohol, drugs, and sex to replicate the positive experience.

WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2009
Implementing smoke-free environments

Some pathogenic effects of tobacco

Tobacco related illness
Reduction of blood flow
Cataract, macular degeneration
Reduction of elastic tissue, depletion of vitamin A
Vulnerability to infection
Cancer: lung (80-90%) nasal, paranasal, oral, nasopharynkx, larynx, esophagus, stomach, pancreas, breast.
http://www.who.int/tobacco/research/smokers_body/en/

Emphysema
Osteoporosis
Heart and vascular diseases
Peptic ulcers

Infertility, impotence
Cervical cancers, miscarriages
Psoriasis

Tobacco and cancer
Tobacco smoke depositshundreds of chemicals in the airways and lungs
Tobacco smoke contains more than 60 mutagens that bind and chemically modify DNA
Different mutations between smokers and non-smokers
Several tumour suppressor genes are inactivated, including TP53 (80–90%), RB1 (60–90%) and PTEN (13%)
One mutation for every 15 cigarettes smoked

TB and Tobacco epidemic

WHO systematic review of Tobacco and TB
Passive or active exposure to tobacco smoke is significantly associated with tuberculous infection and tuberculosis disease.
Active smoking is significantly associated with recurrent tuberculosis and tuberculosis mortality, independent of the effects of alcohol use, socioeconomic status and other potential confounders.
Excess risk of tuberculosis outcomes was found:
tuberculosis disease
recurrent disease
smear conversion
death during or after treatment

Obviously, I thought during my trip, Indonesia is not a signatory of the Framework Convention for Tobacco Control. However, a little research at my favorite anti-smoking site, the Tobacco Free Centre (http://tobaccofreecentre.org) taught me that Indonesia is the ONLY country in South East Asia to not ratify the FCTC.
The cost of inaction on tobacco is high. Perhaps it is time for the Marlboro man to ride off into the sunset.
Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University.

The Conflicts

Tobacco and branding
As a consumer, what do you think about this company profile?

Tobacco and image
As a consumer, what do you think about this company profile?

WHO, 2008

Tobacco industry marketing endangers women
Advertisements falsely link tobacco use with female beauty, empowerment and health.
Addiction to tobacco enslaves
Addiction disfigures women
Advertisements lure women with such misleading identifiers
"light“
"low-tar“
Women often mistakenly believe that "light" means "safer"

Second-hand smoke is particularly worrisome for women
In many countries, vastly more men smoke than women, and many of those countries fail to protect nonsmokers adequately.
In many countries, women are powerless to protect themselves, and their children, from second-hand smoke.
In China – where the vast majority of adult smokers are men – more than half of women of reproductive age are regularly exposed to second-hand smoke, which puts themselves and their unborn babies at risk.

The solutions?

MPOWER: A POLICY PACKAGE TO REVERSE THE TOBACCO EPIDEMIC
WHO, 2008

Indonesia, at the moment

Counter ads

TB and Tobacco Patient oriented actions
TB
Tobacco

Health professionals and tobacco control
Be role models
By not using tobacco
By promoting a tobacco-free culture
Get educated!
Make premises and events tobacco-free
Ask YOUR patients:
tobacco consumption
exposure to tobacco smoke (using evidence-based approaches and best practices)
give advice on how to quit smoking
ensure appropriate follow-up of their cessation goals

Health professionals and tobacco control
Include tobacco control in the health professionals’ curricula
Actively participate in World No Tobacco Day
Refrain from accepting any kind of tobacco industry support – financial or otherwise – and from investing in the tobacco industry, and encourage their members to do the same.
Adopted and signed by the participants of the WHO Informal Meeting on Health Professionals and Tobacco Control; 28-30 January 2004; Geneva, Switzerland.

Take home message
Educate ourselves about the danger of tobacco
Encourage and help patients to stop smoking
If you don’t understand, you can’t help!
Health policies are essential, but complicated
See “what is really going on”

Questions
Smoking is bad, but why do people still smoke?
What is the situation of tobacco and anti-tobacco campaign in Indonesia?
What does it take to successfully overcome the tobacco epidemic in Indonesia?
What can you contribute as health professionals in reducing tobacco epidemic?

Further reading
http://emedicine.medscape.com/article/287555-overview
http://www.nature.com/onc/journal/v21/n48/pdf/1205807a.pdf
http://www.nature.com/nature/journal/v463/n7278/pdf/nature08629.pdf
http://www.cdc.gov/tobacco/basic_information/health_effects/index.htm
http://www.drugabuse.gov/nidamed/
http://www.medscape.com/resource/substance-abuse
http://www.who.int/tobacco/en

World No Tobacco Day 2010

by Rahajeng Tunjungputri on Jun 23, 2010

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