World No Tobacco Day 2010
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World No Tobacco Day 2010
- 1. Tobacco epidemic:Problems, conflicts, solutions Rahajeng N. Tunjungputri, MD – June 2010
- 2. 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!
- 3. Outline The problems How big? Pathogenesis of addiction Tobacco related illness Tobacco and cancer Tobacco and TB The conflicts The solutions
- 4. The Problems
- 5. 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?
- 6. What goes through your mind when you see this?
- 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. *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.
- 9. Indonesia
- 10. Indonesia (2)
- 11. Indonesia (3)
- 12. 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.
- 13. WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2009 Implementing smoke-free environments
- 14. Some pathogenic effects of tobacco
- 15. 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/
- 16. Emphysema Osteoporosis Heart and vascular diseases Peptic ulcers http://www.who.int/tobacco/research/smokers_body/en/
- 17. Infertility, impotence Cervical cancers, miscarriages Psoriasis http://www.who.int/tobacco/research/smokers_body/en/
- 18. 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
- 19. TB and Tobacco epidemic
- 20. 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
- 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. 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.
- 22. ?
- 23. The Conflicts
- 24. Tobacco and branding As a consumer, what do you think about this company profile?
- 25. Tobacco and image As a consumer, what do you think about this company profile?
- 27. WHO, 2008
- 29. 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"
- 30. 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.
- 31. The solutions?
- 32. MPOWER: A POLICY PACKAGE TO REVERSE THE TOBACCO EPIDEMIC WHO, 2008
- 33. Indonesia, at the moment
- 38. Counter ads
- 39. TB and Tobacco Patient oriented actions TB Tobacco
- 40. 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
- 41. 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.
- 43. 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?
- 44. 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
Editor's Notes
- Smoking causes about 90% of lung cancers in men and80% in women 5a and according to many studies, the longerone smokes, the greater the risk of developing cancers atseveral sites, including a two-fold risk of developing cancerof the nasal and paranasal cavities 5b; cancer of the oralcavity 5c (4 to 5 times); two-fold risk of developing cancer ofnasopharynx; oro and hypopharynx (4 to 5 times);larynx (10 times); oesophagus (2 to 5 times); stomach 5d(2); pancreas 5e (2 to 4 times) and kidney 5f.Some recent studies have also suggested a linkbetween heavy smoking and breast cancer 5g,
- The FCTC, one of the most quickly ratified treaties in United Nations history,[5] is a supranational agreement that seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke" by enacting a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide.[1][6] To this end, the treaty's provisions include rules that govern the production, sale, distribution, advertisement, and taxation of tobacco. FCTC standards are, however, minimum requirements, and signatories are encouraged to be even more stringent in regulating tobacco than the treaty requires them to be. [7]
- Advertisements falsely link tobacco use with female beauty, empowerment and health. In fact, addiction to tobacco enslaves and disfigures women.Advertisements lure women with such misleading identifiers as "light" or "low-tar". More women than men smoke "light" cigarettes, often in the mistaken belief that "light" means "safer".
- Encourage and support their members to be role models by not using tobacco and by promoting a tobacco-free culture.Assess and address the tobacco consumption patterns and tobacco-control attitudes of their members through surveys and the introduction of appropriate policies.Make their own organizations’ premises and events tobacco-free and encourage their members to do the same.Include tobacco control in the agenda of all relevant health-related congresses and conferences.Advise their members to routinely ask patients and clients about tobacco consumption and exposure to tobacco smoke, using evidence-based approaches and best practices, give advice on how to quit smoking and ensure appropriate follow-up of their cessation goals.Influence health institutions and educational centres to include tobacco control in their health professionals’ curricula, through continued education and other training programmes.Actively participate in World No Tobacco Day every 31 May.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.Ensure that their organization has a stated policy on any commercial or other kind of relationship with partners who interact with or have interests in the tobacco industry through a declaration of interest.Prohibit the sale or promotion of tobacco products on their premises, and encourage their members to do the same.Actively support governments in the process leading to signature, ratification and implementation of the WHO Framework Convention on Tobacco Control.Dedicate financial and/or other resources to tobacco control – including dedicating resources to the implementation of this code of practice.Participate in the tobacco-control activities of health professional networks.Support campaigns for tobacco-free public places.Adopted and signed by the participants of the WHO Informal Meeting on Health Professionals and Tobacco Control; 28-30 January 2004; Geneva, Switzerland.