Using Data to Inform and Evaluate Tobacco Control

Measures

April 22, 2015Yogyakarta, Indonesia

Kalina Duncan, MPHPublic Health Advisor

Center for Global Healthkalina.duncan@nih.govTwitter: @kalinaduncan

@NCIGlobalHealth

Overview• Definition of surveillance• Tobacco control surveillance systems• CDC Global tobacco surveillance systems

(GTSS) framework and components • Accessing and using GTSS data• MPOWER examples• Case studies and examples

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Surveillance

Timely, useful evidence to empower public & policy makers to lead & manage effectively. That’s where public health begins.

- US CDC

Ongoing, systematic collection, analysis, & interpretation of data essential to planning, implementation, & evaluation of public health practice, integrated with timely dissemination to those responsible for prevention & control.

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WHO FCTC Monitoring Protocol 20.2

“…integrate tobacco surveillance programs into national, regional, and global health surveillance programs so that data are comparable and can be analyzed at the

regional and international levels, as appropriate.”

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Purpose of a Tobacco-Related Surveillance System

To provide timely information from populations on:•Prevalence of use of tobacco-related products•Factors that influence their use•Incidence, prevalence, and mortality from tobacco-attributable diseases•Impact of tobacco control programs and policies on relevant outcomes

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Uses of Tobacco Surveillance Data

• Understand the natural history and trends of tobacco use and consequences of use

• Identify emerging issues and research needs (e.g. tobacco harm reduction, SHS exposure)

• Evaluate tobacco use prevention and control programs, policies, and legislation

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Using Existing Tobacco Control Data

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• CDC Global Tobacco Surveillance Data• GATS, GYTS

• National Datasets• RISKESDAS/Basic Health Survey/ Indonesia

Demographic and Health Survey (IDHS) • National Health Information System (HIS)• Disease registries• Posbindo NCD Risk Factor Screening Program

(Ministry of Health)• Others

GLOBAL YOUTH TOBACCO SURVEY

GLOBAL ADULT TOBACCO SURVEY

TOBACCO QUESTIONS FOR SURVEYS

CDC Global Tobacco Surveillance System

GYTS: Global Youth Tobacco Survey

• Global Youth Tobacco Survey (GYTS)– Global standard for systematically monitoring youth

tobacco use & key tobacco control indicators (WHO FCTC & MPOWER).

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• School-based survey of students aged 13-15• Anonymous and confidential self-administered data

collection• Core questionnaire with optional questions• Option for countries to add additional questions• Use of answer sheets that can be optically scanned

GYTS Methodology

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GYTS in Indonesia• 2006, 2009, in the field now• Dataset available at:

http://nccd.cdc.gov/GTSSData/Default/SelectSurveySite.aspx. (select Indonesia)

• Highlights:– 22.5% of students use tobacco– 2/3 of students live in homes where others smoke– 8/10 of students who smoke want to quit

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GATS: Global Adult Tobacco Survey• Global Adult Tobacco Survey (GATS)

– Household-based survey of adults that aims to collect data on adult tobacco use and key tobacco control measures by using a standard global protocol.

• Methodology– Nationally representative household survey of persons aged

15 years and older– Cross sectional estimates by gender and urban/rural– Core questionnaire with optional questions– Options for countries to add additional questions– Face-to-face personal interview survey– Electronic data collection using handheld devices

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GATS in Indonesia• 2011

13http://www.who.int/tobacco/surveillance/survey/gats/indonesia_report.pdf

Tobacco Use in Indonesia

Source: Campaign for Tobacco Free Kids

TOBACCO QUESTIONS FOR SURVEYS

Tobacco Questions for Surveys (TQS)

• 22 Survey questions to collect data on tobacco use prevalence that can be used in national surveys.

• Currently TQS is integrated into:• World Bank Living Standards• WHO Stepwise• UNICEF National Surveys• USAID Demographic and Health Survey

• Available at: http://www.cdc.gov/tobacco/global/index.htm.

Accessing GTSS Data

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Access GTSSData at www.cdc.gov/tobacco/global

Click the GTSSData icon

GTSSData: Home Page Edward

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View one indicator for all locationsView one indicator for all locations

GTSS Data: Indicators by Tobacco Topic or MPOWER Objective

View results for one indicator for all countries and regions which have data available. Indicators are organized by tobacco topic or MPOWER objectives.

View results for one indicator for all countries and regions which have data available. Indicators are organized by tobacco topic or MPOWER objectives.

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Data Sharing & Dissemination

• Source data files• Publications• Public use datasets• Key Products

– Fact Sheets– Country Reports

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Country Fact Sheets and Reports

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MPOWER: M - Monitor

• Monitor tobacco use and prevention policies• Obtain nationally representative data on

youth and adults• Critical to understanding and reversing the

epidemic and ensuring success of the other five MPOWER measures

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MONITOR: Tobacco Use by Gender

Global Adult Tobacco Survey, 2008-2012

Female

Prevalence (%)

Male

MPOWER: PProtect People from Tobacco Smoke

• Exposure to smoke at work (for people who work outside the home)

• Exposure to smoke in the home

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PROTECT:SHS Exposure at Workplace

Global Adult Tobacco Survey, 2008-2012

* In the past 30 days preceding the survey

MPOWER: OOffer Help with Quitting

• Quit attempts during the previous 12 months

• Receipt of advice to quit from a doctor or other health care provides

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* Among those who visited a Health Care Provider (HCP) in the last 12 months

OFFER: Advised to Quit by a Health Care Professional

Global Adult Tobacco Survey, 2008-2012

MPOWER: WWarn About the Dangers of

Tobacco• Noticing anti-cigarette information:

– In newspapers/magazines– On television– On cigarette packs

• Both noticing and thinking about quitting

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WARN: Thoughts About Quitting Smoking Because of Warning Labels on Cigarette Packages

* Among those who noticed health warning label (WL) on cigarette packages in the past 30 days preceding the survey

Global Adult Tobacco Survey, 2008-2012

MPOWER: EEnforce Bans on Tobacco Marketing• Noticing cigarette advertising in stores• Noticing cigarette promotions:

– Free samples– Sale prices– Coupons– Free gifts or discounts with purchase– Clothing or other items– Promotions in the mail

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ENFORCE: Percent Who Noticed Cigarette Marketing in Stores

* In the past 30 days preceding the survey

Global Adult Tobacco Survey, 2008-2012

MPOWER: RRaise Taxes on Tobacco

• Purchasing patterns• Amount paid for cigarettes

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RAISE: Cigarette Affordability

Global Adult Tobacco Survey, 2008-2012

* Affordability as the relative income price - median price paid per 2000 sticks as % of per capita GDP

Using Data to Inform and Evaluate Tobacco Control Policies

Examples from the field…

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International Tobacco Control Policy Evaluation Project (ITC)

The ITC Project has established a research platform to guide strong, evidence-based implementation of FCTC policies to:•Evaluate FCTC policies at the level of the individual smoker•Identify the determinants of effective tobacco control policies•Disseminate research findings to the global tobacco control community, including researchers, policy makers, and advocates.

Source: http://www.itcproject.org/about

International Tobacco Control Policy Evaluation Project (ITC)

The ITC measures the psychosocial and behavioral impact of national level policies of the FCTC, studying:

– Health warning labels and package descriptors

– Smoke-free legislation– Pricing and taxation of tobacco

products– Communication and education– Cessation– Tobacco advertising and

promotion

Source: http://www.itcproject.org/about

Global Adult Tobacco Survey Data as a Tool to Monitor the WHO Framework Convention on Tobacco Control(WHO FCTC) Implementation: The Brazilian Case

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• The Global Adult Tobacco Survey (GATS) was conducted in Brazil to provide data on tobacco use in order to monitor the WHO FCTC implementation in the country.

• Data in this report can be used as baseline for evaluation of new tobacco control approaches in Brazil, vis-à-vis WHO FCTC demand reduction measures.

Available at: http://www.mdpi.com/1660-4601/9/7/2520.

Using Data to Inform and Evaluate Tobacco Control Policies

Examples from Indonesia…

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Using Data to Inform and Evaluate Tobacco Control Policies

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Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control: the case for Indonesia.Aditama TY1, Pradono J, Rahman K, Warren CW, Jones NR, Asma S, Lee J.

RESULTS: This report shows that more than 1 in 10 students (12.6%) currently smoked cigarettes, with the prevalence among boys (24.5%) significantly higher than among girls (2.3%). Of the students who currently smoked, more than 7 in 10 (75.9%) reported that they desired to stop smoking now….CONCLUSIONS: Tobacco control in Indonesia will likely not move forward until the government evaluates and strengthens existing laws, considers passing new strong laws, and develops protocols for enforcing all laws…

Available at: http://www.ncbi.nlm.nih.gov/pubmed/18585772

Using Data to Inform Tobacco Control Policies

Examples from Indonesia…

Susi Ari Kristina, MPH, PhD

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