Tobacco Epidemic And Control Dr Rohit A PG
Tobacco Epidemic And Control Dr. Rohit A PG in Community Medicine SDMCMSH Dharwad
Outline • • • History of tobacco Epidemiological model Trends of tobacco use Tobacco epidemic curve Trans theoretical model of smoking cessation Tobacco control: WHO-FCTC and India
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
History of tobacco use • Origin- South America • 1492 - Columbus • 1700 s ü Europeans- snuffed it ü Native Americans- chewed it • 1800 s • 19 and 20 th century
Tobacco production Smoking tobacco Smokeless tobacco
Epidemiological model- AGENT
Epidemiological model- HOST
Epidemiological model- HOST INCIDENTAL HOST
Epidemiological model- ENVIRONMENT Historical Economic Political Cultural
Epidemiological model- VECTOR
Trends in tobacco consumption • WORLD: Last two decades-1% annual increase in per capita consumption of tobacco • Median age of initiation: 15 years • INDIA: 10% of world smokers • 30. 8% men, 2. 8% women • WOMEN: 200 million worldwide smoke • Kerala -22% chew tobacco[rural]
• Deaths due to tobacco in India q 1990 -1. 4% q 2020 -13. 3% • Consumers of tobacco q. Male 46. 5% q. Female 13. 8% • 30 crores for NTCP • 27 thousand crore-each year
Exposure to SHS/ETS • Side stream smoke + Main stream smoke • Indicator of exposure • Influencing factors
Exposure to SHS • Side stream smoke + Main stream smoke • Indicator of exposure • Influencing factors Direct • Exposure measurement • Biomarker Surrogate • Marriage to a smoker
Exposure to SHS • Side stream smoke + Main stream smoke • Indicator of exposure • Influencing factors Number of smokers Intensity of smoking Duration of exposure Volume of indoor environment Ventilation characteristics
Tobacco related diseases
Four stage tobacco epidemic
Stage - I
Stage - II
Stage - III
Stage - IV
The Kobe declaration • 1999 • “ global ban on direct and indirect advertising, promotion and sponsorship by the tobacco industry across all media and all forms of entertainment and demand public funding for counter advertising that disconnects women's liberation and tobacco use that reaches women and girls in cultural context”
Tobacco control • Main focus • Multi faceted strategy • Political commitment q. Prevent initiation of tobacco use q. Promote quitting among youth q. Eliminate second hand smoke exposure q. Programmes that are applicable
Tobacco control • Main focus • Multi faceted strategy • Political commitment q. Education and information q. Legislative measures q. Cessation efforts q. Crop substitution and diversification q. Litigation q. Administration and management
Tobacco control • Main focus • Multi faceted strategy • Political commitment q. National level q. Global level q. Appropriate monitoring, evaluation and surveillance
Trans theoretical model of cessation
WHO FCTC Article Issue dealt with Article 8 Production from exposure to SHS Article 9 Regulations of contents of tobacco products Article 11 Packaging and labeling of tobacco products Article 12 Education, communication, training and public awareness Article 13 Tobacco advertising, promotion and sponsorship 27 February, 2005
Monitoring, surveillance and evaluation • • Surveillance of agent factor Surveillance of host factors Surveillance of vectors Surveillance of environment q. Toxic constituents qp. H q. Additives
Monitoring, surveillance and evaluation • • Surveillance of agent factor Surveillance of host factors Surveillance of vectors Surveillance of environment q. Initiation pattern q. Susceptibility q. Dependence q. Quitting pattern q. Tobacco source q. Tobacco price q. Marketing and brand q. Awareness
Monitoring, surveillance and evaluation • • Surveillance of agent factor Surveillance of host factors Surveillance of vectors Surveillance of environment q. Industry and public relationship q. Lobbying and marketing activity
Monitoring, surveillance and evaluation • • Surveillance of agent factor Surveillance of host factors Surveillance of vectors Surveillance of environment q. National tobacco control legislation and programmes q. Exposure to health messages q. Tobacco promotions, prices and placements
Protect people from tobacco smoke
Offer help to quit • Integrating tobacco cessation programmes • Pharmacological therapy[NRT] • Over the counter prescription
Warn about dangers of tobacco
Enforce bans on advertising
Raise taxes on tobacco • 10% increase in cigarette price-demand reduction q 4% reduction in high income countries q 8% reduction in high income countries • 70% increase in cigarette price-prevent quarter of all tobacco related deaths
Tobacco control legislation- INDIA • “the cigarettes and other tobacco products act, 2003” • 2 nd October, 2008 • National tobacco control programme
Tobacco control legislation- INDIA • “the cigarettes and other tobacco products act, 2003” • • • Smoking in public places Direct and indirect advertising Product sale <18 years Educational institutions Warning signs Tar and nicotine content
Tobacco control legislation- INDIA • “the cigarettes and other tobacco products act, 2003” • 2 nd October, 2008 • National tobacco control programme
Tobacco control legislation- INDIA • “the cigarettes and other tobacco products act, 2003” • 2 nd October, 2008 • National tobacco control programme q 11 th five year plan q. Pilot phase q 42 districts and 21 states
• Cessation clinic, 2002[WHO-GOI] • NOTE- National Organization For Tobacco Eradication, 1992 • Product regulation
References • Michael D et al. Tobacco 10. 1 In. Oxford textbook of public health, 5 th ed. • WHO report on global tobacco epidemic, 2008: The MPOWER Package. WHO, Geneva • Lopez AD (1999). A descriptive model of cigarette epidemic in Cigarette epidemic in developed countries. Tobacco control; 3, 242 -7. WHO (2004), Kobe Declaration, Tobacco free initiative report, WHO, Geneva
References • WHO (2004), Tobacco free initiative. Building blocks for tobacco control; A hand book, WHO. Geneva • Park’s textbook of preventive and social medicine, 22 nd edition – K Park. • Community medicine with recent advances, 2 nd edition – AH Suryakantha • Glarti, FM Lewis and B K Rimer, ed Health behaviour and health education. Jorrey-base, San Francisco CA.
- Slides: 49