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World No Tobacco Day 2010

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World No Tobacco Day 2010

  1. 1. Tobacco epidemic:Problems, conflicts, solutions<br />Rahajeng N. Tunjungputri, MD – June 2010<br />
  2. 2. RULES!!!<br />I’m interested in what you think!<br />We are learning together<br />Please be active!<br />Please express your opinions!<br />Please feel free to ask questions!<br />
  3. 3. Outline<br />The problems<br />How big?<br />Pathogenesis of addiction<br />Tobacco related illness<br />Tobacco and cancer<br />Tobacco and TB<br />The conflicts<br />The solutions<br />
  4. 4. The Problems<br />
  5. 5. Questions<br />Smoking is bad, but why do people still smoke?<br />What is the situation of tobacco and anti-tobacco campaign in Indonesia?<br />What does it take to successfully overcome the tobacco epidemic?<br />What can you contribute as health professionals in reducing tobacco epidemic?<br />
  6. 6. What goes through your mind when you see this?<br />
  7. 7.
  8. 8. 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.<br />*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.<br />
  9. 9. Indonesia<br />
  10. 10. Indonesia (2)<br />
  11. 11. Indonesia (3)<br />
  12. 12. Pathogenesis of addiction<br />Mesolimbic dopamine system, stretches from the ventral tegmental area to the basal forebrain. <br />The nucleus accumbens, a dopamine-rich area, is an intersection where all addictive behaviors meet. <br />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. <br />
  13. 13. WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2009<br /> Implementing smoke-free environments<br />
  14. 14. Some pathogenic effects of tobacco<br />
  15. 15. Tobacco related illness<br />Reduction of blood flow<br />Cataract, macular degeneration<br />Reduction of elastic tissue, depletion of vitamin A<br />Vulnerability to infection<br />Cancer: lung (80-90%) nasal, paranasal, oral, nasopharynkx, larynx, esophagus, stomach, pancreas, breast.<br />http://www.who.int/tobacco/research/smokers_body/en/<br />
  16. 16. Emphysema<br />Osteoporosis<br />Heart and vascular diseases<br />Peptic ulcers<br />http://www.who.int/tobacco/research/smokers_body/en/<br />
  17. 17. Infertility, impotence<br />Cervical cancers, miscarriages<br />Psoriasis<br />http://www.who.int/tobacco/research/smokers_body/en/<br />
  18. 18. Tobacco and cancer<br />Tobacco smoke depositshundreds of chemicals in the airways and lungs<br />Tobacco smoke contains more than 60 mutagens that bind and chemically modify DNA<br />Different mutations between smokers and non-smokers<br />Several tumour suppressor genes are inactivated, including TP53 (80–90%), RB1 (60–90%) and PTEN (13%)<br />One mutation for every 15 cigarettes smoked<br />
  19. 19. TB and Tobacco epidemic<br />
  20. 20. WHO systematic review of Tobacco and TB<br />Passive or active exposure to tobacco smoke is significantly associated with tuberculous infection and tuberculosis disease. <br />Active smoking is significantly associated with recurrent tuberculosis and tuberculosis mortality, independent of the effects of alcohol use, socioeconomic status and other potential confounders. <br />Excess risk of tuberculosis outcomes was found:<br />tuberculosis disease<br />recurrent disease<br />smear conversion<br />death during or after treatment<br />
  21. 21. 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.<br />The cost of inaction on tobacco is high. Perhaps it is time for the Marlboro man to ride off into the sunset.<br />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.<br />
  22. 22. ?<br />
  23. 23. The Conflicts<br />
  24. 24. Tobacco and branding<br />As a consumer, what do you think about this company profile?<br />
  25. 25. Tobacco and image<br />As a consumer, what do you think about this company profile?<br />
  26. 26.
  27. 27. WHO, 2008<br />
  28. 28.
  29. 29. Tobacco industry marketing endangers women<br />Advertisements falsely link tobacco use with female beauty, empowerment and health.<br />Addiction to tobacco enslaves<br />Addiction disfigures women<br />Advertisements lure women with such misleading identifiers <br />"light“<br />"low-tar“<br />Women often mistakenly believe that "light" means "safer"<br />
  30. 30. Second-hand smoke is particularly worrisome for women<br />In many countries, vastly more men smoke than women, and many of those countries fail to protect nonsmokers adequately.<br />In many countries, women are powerless to protect themselves, and their children, from second-hand smoke.<br />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.<br />
  31. 31. The solutions?<br />
  32. 32. MPOWER: A POLICY PACKAGE TO REVERSE THE TOBACCO EPIDEMIC<br />WHO, 2008<br />
  33. 33. Indonesia, at the moment<br />
  34. 34.
  35. 35.
  36. 36.
  37. 37.
  38. 38. Counter ads<br />
  39. 39. TB and Tobacco Patient oriented actions<br />TB <br />Tobacco<br />
  40. 40. Health professionals and tobacco control<br />Be role models<br />By not using tobacco <br />By promoting a tobacco-free culture<br />Get educated!<br />Make premises and events tobacco-free<br />Ask YOUR patients: <br />tobacco consumption <br />exposure to tobacco smoke (using evidence-based approaches and best practices) <br />give advice on how to quit smoking<br />ensure appropriate follow-up of their cessation goals<br />
  41. 41. Health professionals and tobacco control<br />Include tobacco control in the health professionals’ curricula<br />Actively participate in World No Tobacco Day<br />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.<br />Adopted and signed by the participants of the WHO Informal Meeting on Health Professionals and Tobacco Control; 28-30 January 2004; Geneva, Switzerland.<br />
  42. 42. Take home message<br />Educate ourselves about the danger of tobacco<br />Encourage and help patients to stop smoking<br /><ul><li>If you don’t understand, you can’t help!</li></ul>Health policies are essential, but complicated<br />See “what is really going on”<br />
  43. 43. Questions<br />Smoking is bad, but why do people still smoke?<br />What is the situation of tobacco and anti-tobacco campaign in Indonesia?<br />What does it take to successfully overcome the tobacco epidemic in Indonesia?<br />What can you contribute as health professionals in reducing tobacco epidemic?<br />
  44. 44. Further reading<br />http://emedicine.medscape.com/article/287555-overview<br />http://www.nature.com/onc/journal/v21/n48/pdf/1205807a.pdf<br />http://www.nature.com/nature/journal/v463/n7278/pdf/nature08629.pdf<br />http://www.cdc.gov/tobacco/basic_information/health_effects/index.htm<br />http://www.drugabuse.gov/nidamed/<br />http://www.medscape.com/resource/substance-abuse<br />http://www.who.int/tobacco/en<br />

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