Anti – smoking policies in

         Ireland


        Dr Siobhan Jennings,

  Consultant in Public Health Medicine


      Health Service Executive and

 representative for Irish Cardiac Society
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TOBACCO USE IS A RISK FACTOR FOR SIX OF THE EIGHT LEADING 

            CAUSES OF DEATH IN THE WORLD





Source:   MPOWER: a Policy Package to Reverse the Tobacco Epidemic
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Monitoring tobacco use and prevention

               in Ireland


                     1.	 SLAN survey 1998,
                         2002 and 2006

                     2.	 HBSC survey in
                         children 2002 and
                         2006

                     3.	 Office for Tobacco
                         Control (OTC)
                         monthly telephone
                               survey
SLAN 07         Smoking rates




Overall smoking prevalence 29% in SLAN 07
      male (31%), female (27%)
Health Behaviour in School-aged Children
            Study (BOYS)
Health Behaviour in School-aged Children
          Study (GIRLS)
Protect people from tobacco smoke
Milestones in tobacco control in Ireland

• 1964	    Voluntary Advertising Ban
• 1988	    Ban on sale to < 16yr olds, raised to < 18 yrs in 2001

•	 1990s   Health strategy (also CHD strategy), Quitline, health
           warning on tobacco products, restrictions on
           advertising

•	 2000    ‘Towards a Tobacco Free Society’ , Ban on all print
           advertising, end of sponsorship, OTC and
           RIFTFS
•	 2003    Report on health effects of environmental tobacco
           smoke
• 2004	    Legislation ‘Smoking ban’

• 2006	    Packets of cigs < 20 banned.

•	 2009    Point of sale ban on display of cigs and advertising
           Two hospitals banned smoking on campus
Protect people from tobacco smoke

March 2004
Legislation prohibiting smoking in workplaces ‘Smoking Ban’

Evaluation	 (Office for Tobacco Control)
High compliance
       2005           93% in hotels, 99% in restaurants,
                      90% in licensed premises / pubs

      2008          97% workplaces compliant
Hugh public support
      96%	          believed smoking ban ‘was successful’
                    (89% of smokers)
       98%	           believed that workplaces were more
                      healthy (94% of smokers)
SLAN 07
Office of Tobacco Control, Monthly telephone survey
of trend in prevalence in smoking in Ireland, 2003 - 2008
Impact of a national smoking ban on the rate of admissions to hospital
with acute coronary syndromes – CHAIR Registry, Ireland (population
~550,000)
                                             Smoking ban in
                                             2004… 11% decrease
                                             in following year

                               1400
      1215

                               1200
                       1079                1072

         No. of ACS patients




                               1000

                                800

                                600

                                400

                                200

                                  0
                                       29.03.03-       29.03.04-          29.03.05­
                                       28.03.04        28.03.05           28.03.06


Acknowledgement            Edmond Cronin 1, Patricia Kearney 2, Peter Kearney 1, Pat Sullivan 3

1 Cork University Hospital, 2 University College Cork, and 3 Mallow General Hospital, Ireland
Ban on smoking in public places, 2008




                   Malta
Offer help to quit tobacco use

                     Benefits for those who quit smoking

•    Within 20 minutes	                        Blood pressure and pulse drop

•    Within 8 hours	                           Carbon monoxide levels return to normal

•    Within 24 hours	                          Risk of heart attack decreases

•    Within 72 hours	                          Lung capacity increases

•	 After 1 year                                Risk of sudden death from heart attack is almost cut
                                               in half

•	 After 5 years                               Lung cancer death rate for the average smoker
                                               decreases

•	 Within 10 years                             Risk of sudden heart attack and strokes becomes
                                               almost the same as a non smoker, risk of cancer
                                               drops significantly
Source: Burnside, G., Spiers, A., Winckles, W. Help Smokers Quit Kit. Ulster Cancer Foundation,
Northern Ireland.
Offer help to quit tobacco use

                     1. National telephone
                         Quitline (trained
                        counsellors)

                     2.www.giveupsmoking.ie
                       launched May 2009
                        information,
                        personal quit plan

                     3. Smoking cessation
                          services

                     4. NRT therapies
Offer help to quit tobacco use

                     1. National telephone
                         Quitline (trained
                        counsellors)

                     2.www.giveupsmoking.ie
                       launched May 2009
                        information,
                        personal quit plan

                     3. Smoking cessation
                          services

                     4. NRT therapies
Warn about dangers of tobacco

Social marketing campaigns
  – ‘Break the habit for good: NICO’ – targeting youth in
    2000
  – Dangers of Second Hand Smoke in 2004
  – ‘Every cigarette is doing you damage’ in 2003/04
  – ‘Beauty of Quitting’ in 2007 - targeting young
    women
  – Promotion of Quitline
  – Campaigns targeting parents
  – EU campaigns - ‘Feel free to say No’
Expenditure on social marketing campaigns warning of
            dangers of tobacco


            HSE Expenditure on Anti-smoking
                    campaigns (€ )


    1,200,000
    1,000,000
     800,000
     600,000
                                                    Expenditure
     400,000
     200,000
           0
                2006   2007   2008    2009


                              € 625k in 2009 = € 0.15c per head
                               (Recommended € 2 - 3 per head)
Consideration being given to photo warning on cigarette
                  packs in Ireland
Enforce advertising and sponsorship
                bans
Tobacco product display prior to Ban in 2009
Tobacco product display in back lit panels
               in stores
Display Till Covers
Advertising on beer mats
Enforce bans on advertising, promotion and

              sponsorship


• From July 2009    New Legislation to protect minors

  – Point of sale ban on advertising or display of tobacco
    products

  – Introduction of closed container/dispensers to store
    tobacco products

  – Tighter control on location and operation of vending
    machines

  – Register of retailers who sell tobacco
Raise taxes on tobacco
Trend in the price of a pack of 20 cigarettes, the Tax

      Take and Tax Exclusive Price in Ireland





   Ireland has the highest tax take on cigarettes in EU (tax = >70% )
2009
•	 € 95.8m smuggled tobacco seized in 2009 ($50m from single seizure in
    October)   - 70% increase on 2008 seizures

•	 Finance Bill in 2010 - increase in fines by a factor of 10
Summary
• Ireland
  –   2nd on WHO Tobacco Control Scales
  –   Many elements of MPOWER
  –   Became complacent??
  –   Point of sale advertising ban in 2009 (expected to
      pay dividends in medium term)

• Reflections
  –   Sustained nature of tobacco control
  –   Multi level activity needed
  –   Benefits of collaboration and sharing internationally
  –   Leadership within EU - MPOWER standards in ALL
      countries
Anti-Smoking policies in Ireland

Anti-Smoking policies in Ireland

  • 1.
    Anti – smokingpolicies in Ireland Dr Siobhan Jennings, Consultant in Public Health Medicine Health Service Executive and representative for Irish Cardiac Society
  • 2.
  • 3.
    TOBACCO USE ISA RISK FACTOR FOR SIX OF THE EIGHT LEADING CAUSES OF DEATH IN THE WORLD Source: MPOWER: a Policy Package to Reverse the Tobacco Epidemic
  • 5.
  • 6.
    Monitoring tobacco useand prevention in Ireland 1. SLAN survey 1998, 2002 and 2006 2. HBSC survey in children 2002 and 2006 3. Office for Tobacco Control (OTC) monthly telephone survey
  • 7.
    SLAN 07 Smoking rates Overall smoking prevalence 29% in SLAN 07 male (31%), female (27%)
  • 8.
    Health Behaviour inSchool-aged Children Study (BOYS)
  • 9.
    Health Behaviour inSchool-aged Children Study (GIRLS)
  • 10.
    Protect people fromtobacco smoke
  • 11.
    Milestones in tobaccocontrol in Ireland • 1964 Voluntary Advertising Ban • 1988 Ban on sale to < 16yr olds, raised to < 18 yrs in 2001 • 1990s Health strategy (also CHD strategy), Quitline, health warning on tobacco products, restrictions on advertising • 2000 ‘Towards a Tobacco Free Society’ , Ban on all print advertising, end of sponsorship, OTC and RIFTFS • 2003 Report on health effects of environmental tobacco smoke • 2004 Legislation ‘Smoking ban’ • 2006 Packets of cigs < 20 banned. • 2009 Point of sale ban on display of cigs and advertising Two hospitals banned smoking on campus
  • 12.
    Protect people fromtobacco smoke March 2004 Legislation prohibiting smoking in workplaces ‘Smoking Ban’ Evaluation (Office for Tobacco Control) High compliance 2005 93% in hotels, 99% in restaurants, 90% in licensed premises / pubs 2008 97% workplaces compliant Hugh public support 96% believed smoking ban ‘was successful’ (89% of smokers) 98% believed that workplaces were more healthy (94% of smokers)
  • 13.
  • 14.
    Office of TobaccoControl, Monthly telephone survey of trend in prevalence in smoking in Ireland, 2003 - 2008
  • 15.
    Impact of anational smoking ban on the rate of admissions to hospital with acute coronary syndromes – CHAIR Registry, Ireland (population ~550,000) Smoking ban in 2004… 11% decrease in following year 1400 1215 1200 1079 1072 No. of ACS patients 1000 800 600 400 200 0 29.03.03- 29.03.04- 29.03.05­ 28.03.04 28.03.05 28.03.06 Acknowledgement Edmond Cronin 1, Patricia Kearney 2, Peter Kearney 1, Pat Sullivan 3 1 Cork University Hospital, 2 University College Cork, and 3 Mallow General Hospital, Ireland
  • 17.
    Ban on smokingin public places, 2008 Malta
  • 19.
    Offer help toquit tobacco use Benefits for those who quit smoking • Within 20 minutes Blood pressure and pulse drop • Within 8 hours Carbon monoxide levels return to normal • Within 24 hours Risk of heart attack decreases • Within 72 hours Lung capacity increases • After 1 year Risk of sudden death from heart attack is almost cut in half • After 5 years Lung cancer death rate for the average smoker decreases • Within 10 years Risk of sudden heart attack and strokes becomes almost the same as a non smoker, risk of cancer drops significantly Source: Burnside, G., Spiers, A., Winckles, W. Help Smokers Quit Kit. Ulster Cancer Foundation, Northern Ireland.
  • 20.
    Offer help toquit tobacco use 1. National telephone Quitline (trained counsellors) 2.www.giveupsmoking.ie launched May 2009 information, personal quit plan 3. Smoking cessation services 4. NRT therapies
  • 22.
    Offer help toquit tobacco use 1. National telephone Quitline (trained counsellors) 2.www.giveupsmoking.ie launched May 2009 information, personal quit plan 3. Smoking cessation services 4. NRT therapies
  • 23.
    Warn about dangersof tobacco Social marketing campaigns – ‘Break the habit for good: NICO’ – targeting youth in 2000 – Dangers of Second Hand Smoke in 2004 – ‘Every cigarette is doing you damage’ in 2003/04 – ‘Beauty of Quitting’ in 2007 - targeting young women – Promotion of Quitline – Campaigns targeting parents – EU campaigns - ‘Feel free to say No’
  • 25.
    Expenditure on socialmarketing campaigns warning of dangers of tobacco HSE Expenditure on Anti-smoking campaigns (€ ) 1,200,000 1,000,000 800,000 600,000 Expenditure 400,000 200,000 0 2006 2007 2008 2009 € 625k in 2009 = € 0.15c per head (Recommended € 2 - 3 per head)
  • 26.
    Consideration being givento photo warning on cigarette packs in Ireland
  • 27.
    Enforce advertising andsponsorship bans Tobacco product display prior to Ban in 2009
  • 28.
    Tobacco product displayin back lit panels in stores
  • 29.
  • 30.
  • 31.
    Enforce bans onadvertising, promotion and sponsorship • From July 2009 New Legislation to protect minors – Point of sale ban on advertising or display of tobacco products – Introduction of closed container/dispensers to store tobacco products – Tighter control on location and operation of vending machines – Register of retailers who sell tobacco
  • 32.
  • 33.
    Trend in theprice of a pack of 20 cigarettes, the Tax Take and Tax Exclusive Price in Ireland Ireland has the highest tax take on cigarettes in EU (tax = >70% )
  • 34.
    2009 • € 95.8msmuggled tobacco seized in 2009 ($50m from single seizure in October) - 70% increase on 2008 seizures • Finance Bill in 2010 - increase in fines by a factor of 10
  • 35.
    Summary • Ireland – 2nd on WHO Tobacco Control Scales – Many elements of MPOWER – Became complacent?? – Point of sale advertising ban in 2009 (expected to pay dividends in medium term) • Reflections – Sustained nature of tobacco control – Multi level activity needed – Benefits of collaboration and sharing internationally – Leadership within EU - MPOWER standards in ALL countries