Comparing effects of tobacco use prevention modalities: need for complex system models
Tobacco Use - Tobaccosis - ICTOH
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Transcript of Tobacco Use - Tobaccosis - ICTOH
http://www.worldtobacco.co.uk/asia/
Indonesia is a recognized tobacco-friendly market with no smoking bans or other restrictions and regulations in contrast to neighboring ASEAN countries.
Tobacco emergency
• About 800 million adult men worldwide smoke cigarette (20% in high income and 80% in low income countries)
• Nearly 200 million adult women worldwide smoke cigarette
• Each year Tobacco kills more
than 5 million worldwide
and > 200,000 people in Indonesia
World cigarette consumption (5.9 trillion) by region, 2009
Source: World Health Organization
Tobacco Is Now the World’s Leading
Single Agent of Death
5.0
3.9
3.0
1.8 1.71.2 1.0
0.6
0
1
2
3
4
5
6
Tobacco Lower
Resp
Infect
AIDS Diarrheal
Disease
TB Traffic
Injuries
Malaria Measles
Glo
ba
l D
ea
ths
pe
r Y
ea
r
(millio
ns
)
Unless urgent action is taken, tobacco will soon kill twice as many people and could
kill 1 billion people this century
Source: World Health Organization
Interventions are needed
– prevent youth from starting to
use tobacco
– encourage and help users to
quit
180
parties
The International Responses
MPOWER- A key strategy
Source: World Health Organization
• monitor tobacco use and prevention
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
Source: Levy et al "Smoking-related deaths averted due to three years of policy progress", Bulletin, WHO 2013, 91:509–518
Raise tobacco taxes
Protect air
Warnings on
packages
Offer cessation Enforce marketing bans
0 million
1 million
2 million
3 million
4 million
5 million
6 million
7 million
8 million
Deaths averted by 2050
Effective policy reduces smoking-related deaths The evidence from 41 countries
Pictorial Health Warnings are effective
• Educate people on danger of tobacco use
• Motivate smokers/tobacco users to quit
• Convince youth not to start smoking/tobacco use
• Re-convince ex-tobacco users to remain quitter
Countries requiring picture warnings on cigarette packages- 2016
1 2 2 3 5 11 12
18
26
34 40
55
63
70
77
102 105
0
20
40
60
80
100
120
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
50%+ Countries/jurisdictions requiring warnings of at least 50% of package (on average)
24 32
46
66
94
0
10
20
30
40
50
60
70
80
90
100
2008 2010 2012 2014 2016
Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
Pictorial Health Warning in South and South East Asian Countries
90% 85% 85% 85%
80% 75% 75% 75%
55% 55% 50% 50% 50% 50%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
Nepal 90% Thailand 85% India 85% Sri Lanka 80%
Brunei 75% Myanmar 75%
Larger Pictorial Health Warning
Malaysia 55% Lao PDR
Cigarettes produced in Indonesia carry a 90% pictorial health warning on packaging for Nepal, 75% PHW for
Brunei and plain packaging for Australia
Nepal 90% Brunei 75% Plain Packaging Australia
Myanmar- Comparison between text and pictorial health warning in building public awareness on danger of
tobacco use
34.1%
85.9%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Textwarning
PictorialWarning
Not scary Scary
37.6%
88.1%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Textwarning
Pictorialwarning
Not scary Scary
Adult population Youth population
Source- Ministry of Health, Myanmar 2014
Evidences proved that PHWs are effective
• In Thailand, nine out of 10 current smokers noticed a pictorial health warning on cigarette packs, and six in 10 current smokers intended quitting because of PHW (GATS 2011)
• In Australia, PHW and plain packaging was found effective. Number of adolescents currently smoking reduced by more than 70 per cent, from 23.5% in 1996 to 6.7% in 2014 (Dessaix A et al Public Health Res Pract. 2016).
Larger pictorial health warnings are effective PHW made the smokers to reduce cigarettes smoked/day
Indonesia Nepal
Source: Indonesian Public Health Association, 2015 (N=5355, current smokers – 1901)
Action Nepal and Nepal Health Research Council, 2015 ( N = 2250, current smokers - 670)
15
11
0
2
4
6
8
10
12
14
16
Cigarettes smoked(text warnings)
Cigarettes smoked(PHW)
11
5
0
2
4
6
8
10
12
14
16
Cigarettes smoked(text warnings)
Cigarettes smoked(PHW)
27% 55%
Retailers support Pictorial health warnings
policies and implementation
84.6% of the
retailers support government policy on pictorial health warnings
90% of the retailers
were found selling cigarettes with pictorial health warning
92.6% of the
retailers support government policy on pictorial health warnings
99.3% of the
retailers were found selling cigarettes with pictorial health warnings
Indonesia (N = 1425) Nepal (N = 270)
Source: Tobacco Control Support Centre, Indonesian Public Health Association, 2015
Action Nepal and Nepal Health Research Council, 2015
Indonesia: RI farmers support tougher
tobacco control, study says -
62.5%
83.3%
70.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Current tobaccofarmers
Ex-tobacco farmers All
Don't know
Not support
Support
Source: http://www.thejakartapost.com/news/2015/10/28/ri-farmers-
support-tougher-tobacco-control-study-says.html#sthash.GYBfj6fJ.dpuf
Muhammadiyah University Yogyakarta, October 2015
Public Health WINS • UK- Tobacco companies have lost a High Court challenge over
government “standardised packaging” – 19 May 2016
• European Union (EU)- Tobacco companies have lost a legal challenge against EU rules that force them to put graphic images on cigarette packages warning people of the dangers of smoking – 4 May 2016
• India – Supreme Court ruling to require 85% pictorial health warning – 4 May 2016
• India - The Supreme Court issued notice to the Health Ministry on a PIL which sought immediate implementation of plain packaging rules for cigarette and other tobacco products – 8 March 2016
Summary
• Larger PHWs are more effective
• All segments of community support PHW; public, youth, retailers and tobacco farmers
• PHW is the most cost effective strategy – No cost to government, easy to implement and monitor – Government commitments
Indonesia: Let’s join hands together to increase a size pictorial health warning to at least 75%
Indonesia- ready for larger pictorial health warning and plain packaging
Text warning 40% PHW 90% PHW Plain packaging
