Virtual Library
Start Your Search
F. Mihaltan
Moderator of
-
+
ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)
- Event: WCLC 2016
- Type: Education Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 6
- Moderators:Z. Zain, F. Mihaltan
- Coordinates: 12/07/2016, 11:00 - 12:30, Hall C7
-
+
- Abstract
- Presentation
Abstract:
According to the regional distribution of the World Health Organization (WHO), Europe extends from the Atlantic Ocean to Central Asia, encompassing states of the former Soviet Union. In political terms however, Eastern Europe refers to countries located on the eastern border of the European Union (EU). Consequently, in our presentation we focus on how smoking status has changed in some of the policy-wise emerging countries located here – namely the Czech Republic, Hungary, Poland and Romania – and how these data compare to Austria’s indicators. We present data on smoking prevalence and trends, restricting use, taxation and average cigarette prices, as well as the distribution of tobacco products in specific countries. Reference is made to restricting advertising and tobacco industry sponsorship activities. Smoking cessation support practice is another important aspect, while electronic cigarette (e-cigarette) regulation is a relatively new issue. Table 1 presents smoking prevalence and trends of specific countries.
Table 1. Smoking prevalence (%) (+15 years old) It is striking that while the proportion of smokers has decreased in Hungary and Poland, an opposite tendency may be observed in Austria. Smoking prevalence stagnated in Romania and the Czech Republic. It is noteworthy that the proportion of women smokers is high in Austria (28.3%), in Hungary (25.8%) and in Poland (24.1%). Smoke-free laws were adopted in the beginning of this Century in North America and Western Europe, and soon resulted in decreasing the proportion of smokers. Although there were smoking and trade control laws earlier in the presented countries, effective legislation has only been promulgated a few years ago and in some countries it hasn’t even been published. Hungary applies total ban on smoking in enclosed public places (with the exception of psychiatric units) since 2011. In Poland, a partial ban is in place, smoking is allowed in certain restaurants. The Czech Republic exercises a slightly more liberal regulation regarding restaurants. A partial ban exists in Romania in restaurants and there may be designated smoking areas in enclosed places where smoking is prohibited. Smoking is allowed in restaurants in Austria. Smoking is otherwise banned in all other enclosed places in these countries as well. It is well known that raising the price of tobacco products is the best tobacco control measure, we therefore compared tax rates and prices of popular cigarette brands. Although EU member states must comply with EU tax regulation requirements, recently joined members are allowed several years to converge, therefore significant differences may be observed in this manner between discussed countries. Countries generally apply combined taxation policy on cigarettes in agreement with Article 6 of the WHO Framework Convention on Tobacco Control Guideline: apart from the value added tax (VAT), the excise duty consists of an ad valorem and a specific element In 2015, the average 20 piece pack price (in Euro) was 4.6 in Austria, 3 in the Czech Republic, 3.2 in Hungary, 3.2 in Poland and 2.8 in Romania. Regulating the distribution and limiting the access to certain tobacco products is an important tool in tobacco control, and even more so in the prevention of youth smoking. The sale of tobacco products to minors is generally prohibited under 18 years (in Austria, under 16 years), however there are noteworthy differences where vending machines are concerned, e.g. in Austria these are allowed to operate. Sale of cigarettes over the internet is legal in the Czech Republic. Directly accessible distribution of tobacco products is allowed in Poland and Romania. Hungary applies the highest degree on distribution restriction: tobacco may only be purchased in supervised tobacco stores, vending machines and internet sale are prohibited. Advertising and tobacco industry sponsorship activities are uniformly forbidden in these countries. Yet another important issue of tobacco control is the accessibility and financial support of smoking cessation programs. Austria focuses its efforts on youth smoking prevention, nevertheless cessation programs are also coordinated nationally. The Czech Republic lays great effort on disseminating brief intervention practice among physicians and nurses. Health insurance covers smoking cessation programs, however pharmacotherapies are excluded. The National Health Fund partially covers smoking cessation programs in Poland. Romania has established specialized quit centers whose activities are partially covered by health insurance. In Hungary, the Methodological Centre coordinates cessation activity in nearly one hundred pulmonary outpatient clinics around the country, offering individual and group cessation counseling. Counseling is covered by health insurance, excluding pharmacotherapy. In addition, telephone counseling and cessation support is also available free of charge. Regarding e-cigarettes, diverse regulatory schemes are detected across Europe. In Hungary, the distribution of nicotine containing e-cigarette cartridges fall under the drugs act, whereas the same regulation applies to the use as to regular cigarettes. The latter is observed also in Poland. Promotion and distribution of e-cigarettes is prohibited in Austria. In the Czech Republic however, both advertising and distribution is analogues to that of regular cigarettes. The Association of European Cancer Leagues (ECL) assesses European countries’ efforts in tobacco control every three years using the Tobacco Control Scale (TCS). The TCS quantifies the implementation of tobacco control policies based on six strategies described by the World Bank: price increases, public information campaigns, bans on advertising and promotion, smoke free work and other public places, health warnings and treatment to help smokers stop. It is informative to observe the 2013 ranking of the discussed countries: the Czech Republic had a continuously deteriorating position and ranked 31[st], while Austria earned the 34[th], Poland the 20[th] and Romania the 19[th] position among the 34 surveyed countries. Hungary has significantly improved its position between 2010 and 2013, and due to fierce government measures in recent years it ranked 11[th] as compared to the previous 27[th] spot. References: 1. World Health Organization Framework Convention on Tobacco Control Implementation Database. 2. Ng, M., et al.: Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012. JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692CZE HUN POL ROM AUT 1980 26,2 34,8 42,5 26,8 27,8 1996 26,6 31,1 33,7 30,6 29,6 2006 26,3 32,9 30,5 26,7 32,5 2012 24,4 28,5 27,6 27,5 32,3
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
ED12.02 - Tobacco Control: The Turkish Experience (ID 6490)
11:15 - 11:30 | Author(s): N. Bilir
- Abstract
- Presentation
Abstract:
Tobacco Control: The Turkish Experience Turkey has been a tobacco producing country since Ottoman time. At that time tobacco production mostly was in the hands of foreign companies. Following the establishment of Turkish Republic in 1923, the State Monopoly on tobacco was established and tobacco production and sales was nationalized by the government, therefore production and sales of tobacco was planned and implemented by the State Monopoly (TEKEL). Only domestic tobacco products were on sale in the country, and importation and sales of foreign tobacco products was not allowed. TEKEL provided tobacco products for the smokers, but did not make any effort to increase its use; i.e. did not make any advertisement of tobacco. The tobacco monopoly has been the only responsible body on tobacco production and sales, until 1980’s. In 1984 the law passed at the Parliament allowing importation of foreign cigarettes into the country, and then tobacco advertisements started. In 1987 Minister of Health invited some interested scientists to discuss the way to control tobacco use in the country. The first tobacco control law was drafted by the Ministry and adopted at the Parliament in 1991; but vetoed by the President. Same year another law passed from the Parliament to allow multinational tobacco companies to establish tobacco production factories in the country. As the result of these changes, tobacco use started to increase, more than the population increase (Table 1) [(][1][)]. The first large-scale survey in 1988 [(2][)] on tobacco use revealed that 63% of males and 24% of females smoke. Table 1. Cigarette sales, Turkey, 1925 - 2011 As reaction to these developments, a civil society organization was established in 1993; “National Coalition on Tobacco or Health, SSUK”. By this way an organized fight against the multinational tobacco companies started. In 1995 a large scale survey on tobacco use among role model groups revealed that 43% of physicians, almost 50% of teachers, 27% of members of the Parliament and 24% of religious leaders were smoking [(3][)]. At the same time, draft tobacco control law was in the agenda of the Parliament. SSUK worked closely with some of the “sensitive” MP’s, participated in the Parliamentary Commissions to discuss the draft tobacco control law, and visited Head of the Parliament, Parliamentary Groups of the political parties. At the end of these efforts, Tobacco Control Law was adopted by the Parliament in November 1996. The Law banned smoking at some of the indoor public places, i.e. heath and education facilities and public transport, banned all kinds of advertisement and promotion of tobacco products, banned selling of tobacco products to children, etc. After more than 10 years of implementation, the Law was amended in 2008, to cover all indoor public places, including restaurants, cafes and tea houses etc. as smoke-free. In the meantime, the WHO, FCTC was adopted and MPOWER policies were announced. At that time National Tobacco control Program and Action Plan was prepared; and several studies were performed to demonstrate the results of smoke-free implementation. Three kinds of studies were done [(4)]: · Indoor air quality measurements: PM2.5 levels at various indoor public places were measured before and after the implementation of smoke-free law, (in offices, shops, restaurants, etc.) and considerable decrease were observed (Figure 1). · Complaints of the workers at hospitality workplaces: Some symptoms (watering in eyes, stuffy nose, cough, etc) of the same workers at the restaurants and cafes were inquired before and after the implementation of the smoke-free law at the same places, and good reductions in the presence of symptoms were observed. · Health consequences of passive exposure to tobacco smoke: Admissions due to acute cardiovascular and/or respiratory conditions to the emergency medical services were evaluated before and after the implementation of smoke-free policies, and some reductions were observed, particularly among males. Figure 1. Indoor air quality of some indoor public places before and after the implementation of smoke-free policies In conclusion, implementation of comprehensive tobacco control measures help to improve indoor air quality; reduces the health complaints of the workers at hospitality workplaces and reduces the emergency admissions due to acute cardiovascular and respiratory conditions. Also smoking prevalence was reduced during the 20 years period between 1993 (before the introduction of first tobacco control law) and 2012 (5 years after the comprehensive tobacco control law). In addition to smoke-free policy, Turkey is implementing more than 80% of tax to tobacco products, bans all kinds of advertisement and promotion of tobacco products and sponsorship by tobacco industry, monitors tobacco use prevalence at 4 years intervals (Global Adult Tobacco Surveys in 2008 and 2012, and was planned in 2016) [(5][)], prohibits selling of tobacco products to children less than 18 years of age and provides free treatment for tobacco dependency. As a result, Turkey was declared as the single country in the world implementing all six MPOWER measures with great success, and was awarded by WHO. Political commitment of the government and active participation of civil society and the academia were the major keys to success [(6)]. References 1. Tobacco and Alcohol Market Regulatory Authority. 2. PIAR. Public Research on Smoking Habits and Campaign against Smoking in Turkey, Ministry of Health, 1988. 3. Bilir N, Güçiz B, Yıldız AN. Smoking Behaviors and Attitudes, Ankara, Hacettepe Public Health Foundation, International Development Research Centre, Ankara, 1997. 4. Expansion of Smoke-free Public Places and Workplaces, Evaluation of Impact of Tobacco Control Policies, Turkey; Project conducted by Society of Public Health Specialists, in collaboration of Ministry of Health, H. Özcebe, N. Bilir and D. Aslan, Ankara 2011. 5. Global Adult Tobacco Survey, Turkey Report, Ministry of Health, 2012. 6. Bilir, N, Özcebe H, Ergüder T and Mauer-Stender K., Tobacco Control in Turkey; Story of Commitment and Leadership, WHO Euro, 2012.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
ED12.03 - Tobacco Control: The Indian Experience (ID 6491)
11:30 - 11:45 | Author(s): S. Shastri
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
ED12.04 - Tobacco Control Policies in China (ID 6492)
11:45 - 12:00 | Author(s): X. Zhi
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
ED12.05 - Tobacco Control Policies in Japan (ID 6493)
12:00 - 12:15 | Author(s): T. Sobue
- Abstract
- Presentation
Abstract:
Background Although Japan ratified the FCTC in 2004, progress in tobacco control is still limited. In the WHO report on the global tobacco epidemic, 2015,[1)] Japan was scored “No or weak policy” for smoke-free policies, mass media and advertising bans, “Minimal policy” for health warnings, and “Moderate policy” for cessation program and taxation. In order to accelerate tobacco control activities, evidence-based official summary report on health effects of tobacco products and effectiveness of tobacco control is needed. A report of Surgeon General in the US[ 2)] and Monograph series from International Agency for Research on Cancer [3)] are the examples. In these reports, causal relationship was judged systematically considering scientific evidences through systematic review comprehensively based on certain criteria. A causal conclusion conveys the inference that changing a given factor will actually reduce a population’s burden of disease, either by reducing the overall number of cases or by making disease occur later than it would have. So far in Japan, although such official summary reports were published three times, judgement on the causal relationship was not included. Here we report the 4th version of the report which contain judgement on the causal relationship between smoking and various diseases.[4)] Methods Health effect of active and passive cigarette smoking was categorized into 4 levels (sufficient/suggestive causal relation, insufficient evidence and suggestive no causal relation). Causal relationship was judged comprehensively in terms of consistency, strength, time-relation, biological plausibility, dose-response relation and risk reduction after cessation, which are similar to US Surgeon General Report.[5) ]It was judged by each corresponding writer of the disease first, then discussed in the committee and determined by consensus. Effectiveness of tobacco control activities and economic impact was also evaluated. Results Based on the previous evidence reports (domestic and international), health effects of active cigarette smoking were evaluated for cancer, cardiovascular diseases, respiratory diseases, reproductive effects, and other effects, such as diabetes and dental diseases. Health effects of passive smoking and adolescence use was also evaluated. It is judged that the evidence is sufficient to infer a causal relationship with active smoking (Level 1) for cancer of the lung, oral cavity/pharynx, larynx, nasal cavity, esophagus, stomach, liver, pancreas, bladder and cervix uteri. For cardiovascular diseases, ischemic heart disease, stroke, abdominal dissecting aneurysm and peripheral arteriosclerosis, and for respiratory diseases, chronic obstructive pulmonary diseases (COPD), decline of pulmonary function and deaths due to tuberculosis are judged as Level 1. Active smoking of pregnant women is judged as causally related to preterm delivery, low birth weight, fetus growth retardation and sudden infant deaths syndrome (SIDS). For other diseases, type 2 diabetes mellitus, periodontitis and nicotine dependency are judged as Level 1. For passive smoking, it is judged to be sufficiently causally related (level 1) for lung cancer and ischemic heart disease and stroke in adulthood. Odor annoyance and nasal irritation as acute effect for respiratory system, and asthma and sudden infant death syndrome (SIDS) for children are judged as level 1. For smoking in adolescence, deaths due to all cause deaths, cancer and circulatory disease and increased risk of cancer incidence are judged as level 1. Tobacco control activities were summarized according to the MPOWER.Although prevalence of current smokers has decreased (32.2% for males and 8.5% for females in 2014), pace of decrease slowed recently. Although the Health Promotion Act (2003) and revision of the Industrial Safety and Health Act (2015), which mandates company to protect workers from passive smoking with best efforts, have made some progress to promote smoke-free environment, especially in schools, hospitals and governmental offices, problems still remain in other places, such as restaurants and bars.
Cessation support in the community and workplace, cessation support using OTC cessation medicines at pharmacy and cessation treatment using health insurance are the 3 pillow conducted in Japan. Warning labels on tobacco packages in Japan uses only characters and too many words, which results in few impact on smokers. Almost no mass media campaign has been conduct to provide information to the public. Regulation to tobacco industry mostly relies on voluntary basis and their CSR activities have been conducted with no regulation. Although after recent tax increases, tax rate became almost in the middle among developed countries and tobacco consumption decreased, tobacco price is still low (Fig 1).[6-8)] It is summarized that activities were weak for smoke-free policies, mass media advertising bans and health warnings in Japan. Regarding smoke-free policy, Tokyo Olympic/Paralympic 2020 will be the best occasion to further promote the policy at national level. Conclusion Evidence-based summary reports should be effectively used in order to accelerate tobacco control activities in Japan. References 1) WHO Tobacco Free Initiative （TFI）. 2015. 'Tobacco control country profiles', Accessed 2016/01/31. http://www. who. int/tobacco/surveillance/policy/country_profile/en/ 2) The Health Consequences of Smoking - 50 Years of Progress A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 3) IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 100E, Personal Habits and Indoor Combustions. Lyon, France: International Agency for Research on Cancer; 2012 4) Committee on the health effect of smoking. Smoking and Health – report from the committee on the health effect of smoking, 2016. 5) The Health Consequences of Smoking: A Report of the Surgeon General. In: Service USPH, ed. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. 6) Ministry of Finance. Tax and stamp revenue settlement amount investigation. List of statistical tables. 7) Ministry of Internal Affairs and Communications. White paper for local finance. 8) Tobacco Institute of Japan. Statistical data on cigarette. Time trend table for sales performance by fiscal year. Fig 1. Trends of tax income, tobacco consumption and smoking rate in Japan.[6-8)] Figure 1
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
ED12.06 - Tobacco Control Policies in Latin America (ID 6494)
12:15 - 12:30 | Author(s): N. Yamaguchi, N. Pilnik, J. De La Garza, L.P. Ashton, A.L. Garcia, E. Bianco, G. Kevorkof
- Abstract
- Presentation
Abstract:
Introduction Smoking is the single most important cancer risk factor and accounts for 26% of all cancer deaths and 84% of lung cancer deaths in Latin America[1]. Lung cancer is one of the most preventable cancer types; and doctors of all expertise are essential to impart to patients and their families the idea of smoking prevention, thereby contributing to the reduction of mortality from lung cancer. There are around 145 million smokers age 15 years or older in Latin American. Adult smoking prevalence varies from 35% in Chile and 30% in Bolivia to 11% in Panama and 11∙7% in El Salvador[2, 3]. The continuing popularity of smoking among adolescents is particularly worrisome as smoking rates among teens and young adults predict future lung cancer rates. Smoking rates among young people aged 13–15 years are now higher than in adults in many Latin American countries. Prevalence among female adolescents has surpassed their male counterparts in Argentina, Brazil, Chile, Mexico, and Uruguay. Unless these high rates of smoking are curtailed, cancer mortality rates will continue to rise[3]. We have assessed the impact on smoking rates of anti-tobacco policies adopted by five Latin American countries, in compliance to the WHO’s Framework Convention on Tobacco Control (FCTC). Argentina, Brazil, Mexico, Peru, and Uruguay were used as case studies to illustrate the challenges and ways in which governments and civil society organizations can effectively work together to reduce lung cancer deaths and other tobacco-related diseases. Since the endeavor for approving anti-tobacco policies was met with a strong lobby against it in these countries, different degrees of compliance with the FCTC terms were reached. We analyzed reports issued by local governments and epidemiologic surveys found in the literature. Tobacco farming in Latin-America has increased in recent years, representing almost 16% of the global production. Argentina and Brazil are among the ten largest world producers and the cultivated area in Latin America reaches 13.55% of the global land dedicated to tobacco farming worldwide. The prices paid by the tobacco industry to farmers are also increasing since 2007, and the sector employs 650,000 people. Tobacco farming is also present in Colombia, Dominican Republic, Honduras, Ecuador, Guatemala, Mexico, Nicaragua and Paraguay[4]. Therefore, tobacco control policies must necessarily include solutions to help tobacco growers to escape from the influence of the tobacco industry without loss of income and jobs. Results We have found a differential decrease (and increase) in smoking among the population of the studied countries in the last decades: Argentina: (from 29% in 2007 to 22.1% in 2014); Brazil (from 34.8% in 1989 to 14.7% in 2013); Mexico (21.7% in 2008-2011 to 23.6% in 2014); Peru (from 44.5% in 1998 to 21.1% in 2010 and 13.3% in 2013); Uruguay (from 34% in 1998 to 23.5% in 2011)[5 – 11]. Discussion According to the 2014 FCTC Progress Report[12], the implementation degree of the articles among the countries varied from <20% to more than >75% in most cases. One-third of all FCTC signing countries have not enacted anti-tobacco legislation or reached the full implementation of at least two important time-bound articles: tobacco advertising ban and health warnings on cigarette packages and at the selling points. Our data also showed uneven degrees of implementation among the studied countries. One of the underlying causes for slow implementation in some countries, like Mexico and Argentina, is the strong political lobby by the tobacco industry. In our study, Argentina has come in third in smoking prevalence, with a 22.1% smoking rate among adults, due to the strong pressure upon legislators by the tobacco industry that so far has prevented the FCTC ratification by the Congress. Nevertheless, the Argentinean political environment was more sensitive than the Mexican, to the persistent anti-smoking advocacy by the medical associations and organizations of the civil society. Therefore, some of the FCTC tobacco control policies were enacted by legislators in 2011 and implemented in 2013. Mexico, however, was the one with the poorest implementation of tobacco control policies and the highest in smoking prevalence among adults (23,60%), seconded by Uruguay (23.5%), where the past administration has neither enforced the already existing tobacco-control policies, nor promoted new ones, such as heavy taxes upon tobacco products. One of the important measures recommended by the FCTC - which has proved to be effective in smoking prevention among children and teenagers - is high taxation (over 75%) of tobacco products[12]. Conclusion The degree of compliance with the terms of the Convention seems to have a direct impact on the reduction of smoking rates in the countries studied. Other solutions should contemplate tobacco farmers, whose fear of shifting to new unfamiliar cultures is exploited by the tobacco industry to prevent FCTC ratification in many countries. But farmers should not stop growing tobacco plants, but just shift to transgenic tobacco farming[13]. Transgenic tobacco is being successfully tested for expression of for more than fifteen human therapeutic proteins, including antibodies, antigens for vaccines, and autoimmune inhibitor factors. [(14-17)]. Pharmaceutical companies could benefit from the existing agricultural tradition of tobacco farming in Brazil, Argentina, and elsewhere by fostering the commercial production of those molecules. Transgenic tobacco is improper for smoking and could also have the nicotine gene knocked out to discourage misuse. Therefore, the pharma industry could open new roads to smoking eradication while preserving the economic activity and profitability of traditional tobacco farmers. Effective tobacco control requires a close cooperation between health institutions, medical societies, NGOs, and the press - and the regular funding of surveillance programs and educational campaigns. Smoking prevention programs must be part of the educational curricula from the pre-school onwards.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
Author of
-
+
IA08 - Tobacco & Youth (ID 294)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
-
+
IA08.04 - Tobacco Control Policies and Youth Smoking (ID 6926)
17:00 - 17:20 | Author(s): F. Mihaltan
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
