importance of research on tobacco control from research to action prof. gonghuan yang china cdc/pumc
TRANSCRIPT
Importance of Research on Tobacco control
From research to action
Prof. Gonghuan Yang
China CDC/PUMC
Outline
Importance of Research on Tobacco control Research proved the risk of tobacco use Research proved the effective of strategy of tobacco
control From research to action on tobacco control
Research on tobacco control has translated to global action on tobacco control
Evidence-based research to support tobacco control in China
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The Importance of Research on Tobacco Control
Established the relationship between tobacco use and disease;
Estimated disease burden and economic cost quantitatively;
Verified the efficiency of strategies on tobacco control
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MPOWER POLICIES
Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising,
promotion and sponsorship; Raise taxes on tobacco)
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Borio G. Tobacco Timeline, 1998
Early Indications that Tobacco Causes Disease: German Research
1929: Fritz Lickint publishes statistical evidence linking lung cancer and cigarettes
1939: Lickint publishes ‘Tabak und Organismus’ a 1,100 page volume, “the most comprehensive scholarly indictment of tobacco ever published”
1939: Muller presents the world’s first controlled epidemiological study of the tobacco–lung cancer relationship
Borio G. Tobacco Timeline, 1998
Survivorship of white males after 30 years of age according to smoking habits
Pearl, 1938
100
30Age in years
90
80
70
60
50
40
30
Non-users
Th
ou
sa
nd
s o
f s
urv
ivo
rs20
10
0
40 50 60 70 80 90 100
Moderate smokers
Heavy smokers
Early Indications that Tobacco Causes Disease 1938: Raymond Pearl
reports smokers do not live as long as non-smokers
1950: Three key case-control studies link smoking with lung cancer
1953: Ernst Wynder’s study showed that tobacco painted on the backs of mice produced tumors
Early Indications of Tobacco-related Disease 1954: Richard Doll and Bradford
Hill’s study of British doctors published in the British Medical Journal
1962: Royal College of Physicians Report
1964: First Surgeon General’s Report on tobacco and health
1981: First major study on passive smoking and lung cancer by Takeshi Hirayama (Japan)
Borio G. Tobacco Timeline. 1998
Surgeon General Luther Terry holding the 1964 Report
Pattern on tobacco control & Health
Epidemilogical Study on tobacco & Health in China
Smoking and lung cancer in Shanghai , Gao YT,. IARC Sci. Rubi.1986;(74):115-21.
Early health effects of the emerging tobacco epidemic in China,( Chen ZM JAMA, 1997, 278(18):1500-4)
Retrospective proportional mortality study of one million deaths( Liu BQ et al , BMJ, 1998; 317:1411-1422)
Early mortality results from a prospective study ( Niu SR et al BMJ, 1998; 317:1423-1424
Mortality attributable to smoking in China (Gu DF , N Engl J Med 2009 Jan 8;360(2):150-9. ,
Body mass index and mortality from lung cancer in smokers and nonsmokers(Yang L, Int J Cancer. 2009 Nov 1;125(9):2136-43.
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Death numbers of Attributed tobacco use/Total Death, 1990 (1000)
Male Female
<30 30-69 ≥70 <30 30-69 ≥70
Cancer 0/45 146/629 47/250 0/32 11/334 10/174
COPD 0/8 66/290 140/512 0/11 19/201 48/552
TB 0/11 13/111 13/53 0/12 2/63 2/30
Stroke 0/11 30/302 15/359 0/8 0/221 0/372
CHD 0/5 24/164 6/217 0/3 5/123 5/251
Other 0/822 0/745 0/448 0/817 0/568 0/473
Total 0/870 279/2154 221/1805 0/859 37/1390 65/1807
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JAMA , 1999 , 282 : 1247-53BMJ , 1999 , 282 : 1247-53Tobacco Control , 1999 , 282 : 1247-53
5年死亡追踪研究结果
Cohort Study on Tobacco & Health in Chinese ( 1991-95)
Alan Lopez’ comments in BMJ
These studies are important both for their concordance conclusions about tobacco and for their epidemiological methods.
This system could be extended to other countries and is particularly useful for prospective studies
These two new studies provide the first nationwide evidence of tobacco's effects in a developing country.
BMJ 1998 ; 317 : 1423-24
Disease Burden attributed to tobacco use
The health consequences of the tobacco epidemic are very serious
Minus Net Benefits on Integrated Tobacco Social Costs and Benefits Assessment
2010年负效应已达 600亿。
Report of the Surgeon General
How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for smoking Attributable Disease
Conclusion:
1. The evidence on the mechanisms by which smoking causes disease indicates that there is no risk-free level of exposure to tobacco smoke.
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19851984 19861980 19811982 198919881987 1991199019831979
18
21
24
27
30
230
15
270
250
210
190
48
39
33
42
36
45
170
150
130
110
90
Year
Sm
oki
ng
pre
vale
nce
(%
)
Real cig
arette price in
dex
Teenage smoking
Real tobacco price index
Real cigarette prices and cigarette smoking prevalence among
Canadians aged 15–19 years
Health and Welfare Canada
Impact of Increasing Price on Smoking Among Canadian Teenagers
Region
Change in number of smokers(millions)
Change innumber of deaths
(millions)East Asia and Pacific - 16 - 4Eastern Europe and Central Asia - 6 - 1.5Latin America and the Caribbean - 4 - 1.0Middle East and North Africa - 2 - 0.4South Asia (cigarettes) - 3 - 0.7South Asia (bidis) - 2 - 0.4Sub-Saharan Africa - 3 - 0.7Low/middle Income countries - 36 - 9High Income countries - 4 - 1World - 40 - 10
Note: Numbers have been rounded
Potential number of smokers persuaded to quit, and lives saved, by a price increase of 10%
Estimated Impact of Increasing Price on Prevalence and Mortality
World Bank, 1999
From Research to Action
Research results has been translated to global action of tobacco control
Need to strengthen research on tobacco control in China.
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The State of selected tobacco control policies in the World, 2010
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Prevalence of NCD in China need to active tobacco control
Proportion of NCD in total death rates is increasing: 82% in 2005, Daly in 2005: 72%
The age-standard death rates of the major NCDs were increasing;
The NCDs prevalence in rural was still increasing;
Aging will blow up the diseases burden of NCD.
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proportion of death by death causes in different years
0
0
0
0
0
1
1
1
1
1
1
1973y 1991y 1995y 2000y 2005y
%
Unknown
Injury
Other NCD
COPD
Cardiovascular
Cancer
Martenal & perinatal
Communicable
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1991- 2000死亡率呈上升趋势的疾病,
0
15
30
45
60
75
90
105
120
135
150
1985 1990 1995 2000 2005 2010
1/10
标化
死亡
率(
万)
Increasing trend of standard death rates of 6 chronic diseases
Stroke
CHDLung Cancer
Liver cancer
Diabetes
Breast cancer
Traffic injury
NCD Control & Economy in China While China has had an enviable economic growth and
development performance for more than 30 years, its human development has lagged behind the most advanced economies.
China ranked 89th in the 2010 human development index prepared by the United Nations Development Program(UNDP).
The Chinese population’s healthy life expectancy(HALE) at birth is about 10 years shorter than in some of the leading G-20 countries .
China could narrow these gaps in human development by identifying the priority health issues affecting its population, mustering political support to overcome them, and implementing appropriate interventions, as described below.
China’s 12th Five-year Plan (2011–2015) aims to promote inclusive, equitable growth and development by placing an increased emphasis on human development .
Political declaration on the Prevention and Control of NCD
The global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world, and threatens the achievement of internationally agreed development goals;
Non-communicable diseases are a threat to the economies of many Member States, and may lead to increasing inequalities between countries and populations;
The primary role and responsibility of Governments in responding to the challenge of non-communicable diseases and the essential need for the efforts and engagement of all sectors of society to generate effective responses for the prevention and control of non-communicable diseases;
…….
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Completely promote banning smoking in Public Places in National “12.5” Social Economic Development Plan has been approved by NPC in March 2011.MOH issued the detailed rules and regulations of banning smoking in public places in March, 22, 2011.
Research on TC in China Search: tobacco use, prevalence, China 627 article, Key words: tobacco use,
prevalence, China
Resources: by Authors 31
CNTC supports academic research A research and education-oriented institute with the goals of
promoting the use of technology in tobacco farming, manufacturing and research and training tobacco researchers.
Number of Paper is as 20 times as one of tobacco control. Increasing paper on the research on less harmful and low-tar cigarettes
besides the traditional research paper ;
Resources: Relationship between the Chinese tobacco industry and academic institutions in ChinaBy Quan Gan1 and Stanton A Glantz
32
Research Fund Tobacco control:
A fewNIH Fogarty international centerCMBNational Ministry of Science & Technology
Tobacco IndustryUnclearBut for museum of tobacco: 180 million
RBM
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THANKS