2011 johns hopkins bloomberg school of public health special populations: update stephen a. tamplin,...

2011 Johns Hopkins Bloomberg School of Public Health

Special Populations: UpdateSpecial Populations: Update

Stephen A. Tamplin, MSEDepartment of Health, Behavior and SocietyInstitute for Global Tobacco Control


Objective

To highlight new or recent developments related to tobacco control in “special populations” Tobacco and poverty Tobacco and youth Women and tobacco The role of nurses in tobacco control

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Messages from Previous Lectures—Tobacco and Poverty

84% of smokers live in developing and transitional economy countries

The poor smoke the most and bear most of the economic and disease burden of tobacco use

Smoking prevalence among men is higher in low- and middle-income countries (about 50%)

Tobacco contributes to poverty at the individual and household levels: Opportunity cost Lost earnings due to

higher risk of illness Risks of tobacco

farming

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Messages from Previous Lectures—Tobacco and Poverty

Tobacco contributes to poverty at the national level: High health care costs Lost productivity Loss of foreign

exchange Smuggling Environmental

degradation

Breaking the tobacco-poverty relationship requires consideration of: The local context Relationships and

partnerships Local champions The need to situate

interventions in the social development climate

Timing

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New Knowledge Regarding Tobacco and Poverty

Meta-analysis involved the review of 9,500 references, of which 765 were included

Overall objective was to assess the association between income level and tobacco consumption, tobacco expenditures and morbidity, and mortality attributed to tobacco

Compared high-income groups with low-income groups on four factors: Prevalence of tobacco use Quantity of tobacco consumed Incidence of disease and death attributed to

tobacco Household expenditures on tobacco

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Source: Ciapponi, A. (2011).



The major conclusion: there is an inverse relationship between income level and tobacco use prevalence (particularly in the last two decades) and its related consequences Smoking prevalence: low-income people (both

genders) smoke more than high-income people Tobacco-attributable deaths and diseases: “…

statistically significant higher risk at decreasing income strata.”

Tobacco spending related to total expenditures: “… an inverse relationship … between income level and the proportion of tobacco spending related to total expenditures.”

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Causes for disparity are “… still under discussion …” but several factors are alluded to: Relative deprivation inside societies Tobacco as a marker of social status Tobacco price structures

Greater efforts to reduce tobacco use among the poor are needed

The association between tobacco and poverty should be repeatedly assessed as implementation of the WHO’s FCTC is likely to modify the current situation

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Messages from Previous Lectures—Tobacco and Youth

The majority of all long-term tobacco users start as youth Nearly one-fourth have their first cigarette before age

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There is no single image of youth tobacco use

“Tobacco is a communicated disease … through advertising and sponsorship ….” (WHO, 2000)

The tobacco industry targets youth by selling “coolness,” “independence,” and “lifestyle”

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Messages from Previous Lectures—Tobacco and Youth

We know how to reduce youth tobacco use: Smoke-free laws Increasing taxes and retail prices Strong sustained public education campaigns Powerful graphic health warnings Curtailing tobacco marketing Expanding access to cessation Involving the community and health care professionals

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New Knowledge Regarding Tobacco and Youth

The Global Tobacco Surveillance System Atlas (2009), Global Youth Tobacco Survey (GYTS), 1999-2008 12% of boys and nearly 7% of girls currently smoke

cigarettes Susceptibility to initiate cigarette smoking is higher than

current smoking rates in most regions 19% said they were susceptible to start smoking

within the next year 12% of boys and 8% of girls use other tobacco (e.g., pipes,

water pipes, cigars, smokeless tobacco, and bidis) besides cigarettes

In relation to boys, 8 of 165 countries surveyed reported a prevalence ≥ 30%

In relation to girls, 6 of the surveyed countries reported a prevalence ≥ 30%

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Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008).


New Knowledge Regarding Tobacco and Youth

The Global Tobacco Surveillance System Atlas (2009), Global Youth Tobacco Survey (GYTS), 1999-2008 (surveys of students aged 13-15 years): 55% of the students surveyed reported exposure to

secondhand smoke in public places during the previous week

Fewer than 5% of people are protected by comprehensive smoke-free laws

4 in 10 youth were exposed to secondhand smoke in their homes with 43% having at least one smoking parent

8 in 10 students favor a ban on smoking in public places and 69% of current youth smokers would like to quit

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Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008).


Messages from Previous Lectures—Women and Tobacco

12% of women smoke (22% in high-income countries; 9% in low- and middle-income countries) By 2025, about 20% of women will smoke

Smoking has negative effects on nearly every system of a woman’s body

Tobacco farming and processing exploit the labor of women and girls

The tobacco industry targets women by selling “coolness,” “independence,” “sex appeal,” and “lifestyle”

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Messages from Previous Lectures—Women and Tobacco

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Policy recommendations

Ratify and implement the FCTC

Design empowering messages and ads for improving women’s health

Promote tobacco control policies that address social and economic issues

Monitor women’s and men’s tobacco use rates

Conduct further research on the health effects of tobacco use on women

Build capacity and engage women and girls in conducting tobacco control research

Program recommendations

Implement gender- and age-specific tobacco control programs

Provide information on occupational health and safety for women and girls

Engage women in designing and delivering programs


New Knowledge Regarding Women and Tobacco

Women comprise about 20% of the world’s 1+ billion smokers

In half the countries surveyed by the Global Youth Tobacco Survey, there is no difference in rates of youth smoking based on gender

Smoking is responsible for 12% of male deaths and 6% of female deaths in the world

In a recent retrospective study (Oberg, M. et. al., 2011) of the world burden of disease from exposure to secondhand smoke, the authors concluded that women comprised almost 50% of the deaths attributable to secondhand smoke in 2004

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Source: U.S. Centers for Disease Control and Prevention. GYTS Data. (2008); Oberg et. al., (2011).



Tobacco advertising increasingly targets women and girls: Glamour Sophistication and style Luxury Class and quality Romance and sex Sociability Enjoyment and success Health and freshness Emancipation Being slim

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Specialty Packs Aimed at Women

Specialty packs and formulations (“light,” “slim,” and “super-slim”) target the female market For example, about 100 special women’s brands have

been introduced to the Russian market where the prevalence of smoking among women is increasing rapidly

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Specialty Packs Aimed at Women

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Source: Institute for Global Tobacco Control. (2011).



While policy design may be gender-neutral, the policies may affect women and men very differently It is important that the WHO FCTC be implemented

through a gender perspective as part of a country’s political and development agenda:

Monitor tobacco use by gender Protect girls and women of all ages from tobacco

smoke Offer help to assist women in quitting tobacco use Warn women and girls about the dangers of tobacco Enforce bans on tobacco advertising, promotion, and

sponsorship by empowering women to identify and counter these influences

Raise taxes on tobacco, with the active participation of women leaders

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Messages from Previous Lectures—The Role of Nurses

Over 11 million nurses in the world have the power to make a huge difference

Nurses enjoy public trust and can be pivotal partners

Barriers to nursing involvement in tobacco control: Smoking status of nurses themselves Limited tobacco control content in nursing school

education Not traditionally a part of nursing practice Lack of knowledge and fear of causing patient/visitor

stress Lack of professional leadership

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Messages from Previous Lectures—The Role of Nurses

Opportunities for involvement in tobacco control: Nurses need to move beyond bedside care to influence

the policy making process Become advocates and get involved—World No

Tobacco Day, supporting smoke-free public places, etc. Integrate tobacco control interventions into current

practice Implement curriculum changes in nursing schools Create workplace committees to enhance awareness Include “smoking status” as a vital sign on patient

records Support improving the quality of cessation treatment

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New Knowledge Regarding the Role of Nurses

There are now over 17 million nurses worldwide

Research indicates that tobacco cessation activities can be effectively provided by nurses (Rice and Stead, 2008)

Continuous declines in smoking rates among nurses have been documented in countries where regular data has been recorded over time (e.g., the United States, New Zealand, and Australia)

However, research conducted among nursing students in some countries has found contemporary tobacco usage rates higher than that of the general population (Smith and Takahashi, 2008)

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2011 Johns Hopkins Bloomberg School of Public Health 22

New Knowledge Regarding the Role of Nurses

Challenges (Smith, 2010): The rate of smoking among nurses remains

unacceptably high in some countries Strategic directions for tobacco control in nursing are

needed The provision of educational programs in the workplace

and the addition of tobacco control programs to the nursing education curricula

Further research is needed to determine the most effective educational strategies


Summary

While progress has been made in controlling tobacco use among special populations, the tobacco industry remains relentless in its pursuit of new customers among the poor, youth, and women

The overall burden of the tobacco epidemic is increasingly being borne by the poor

Controlling the tobacco epidemic among special populations requires a concerted, collaborative effort across sectors In this context, the leadership of a fully engaged, non-smoking,

100% smoke-free health sector is essential

[email protected]

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2011 johns hopkins bloomberg school of public health special populations: update stephen a. tamplin,...

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