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NATIONAL AND INTERNATIONAL ASPECTS OF TOBACCO CONTROLSzeged, 2011. június 18.

Priority aspects of the program:

Increasing Capacity of Tobacco Reasearch in Hungary

2008-2013

Dr. Balázs PéterSemmelweis Egyetem BudapestÁltalános Orvostudományi Kar

Népegészségtani Intézetbalazs-peter@windowslive.com

Kristie L. Foley, PhDAssociate Director Medical Humanities ProgramDavidson CollegeNorth Carolina, USA

Sponsored by Fogarty International CenteSponsored by Fogarty International Centerr(established on 1st of July 1968)

National Cancer Institute, and National

Institute on Drug Abuse International Tobacco and HealthResearch and Capacity BuildingProgram (RFA-TW-06-006 )

1. pursue observational, intervention and policy research

2. build capacity in epidemiological and behavioral research, prevention, treatment, communications, health services and policy research.

3. promote international collaboration

John Edward Fogarty 1913-1967

International Tobacco and Health Research International Tobacco and Health Research and Capacity Building Program and Capacity Building Program

(RFA-TW-06-006 )(RFA-TW-06-006 )

• Provided exceptional possibility to design a comprehensive and long-term funded program focused on the most exciting problems:- gaining reliable data about tobacco epidemic- concerning relevant financial and economic and socio-cultural questions - nationwide overview of local legislation - targeting most urgent public health problems- supporting anti-tobacco activities

• Communicating domestic problems to the international community

From biomedical tothe social approach

• Lung cancer + COPD and screening programs• Children’s otitis media and ETS• Smoking and pregnancy, LBW and PTBSmoking and pregnancy, LBW and PTB • Epidemiology of tobacco smoking among school children,

body image and weight control• Epidemiology of young adults’ smoking• Social and health related predictors of smoking and

quitting• The role of dentistry in cessation programs• Health economy impactHealth economy impact of tobacco smoking of tobacco smoking• Tobacco legislation (litigation,Tobacco legislation (litigation, law enforcement)law enforcement)

PPrioritiesriorities in Metodology in Metodology• NNo invasive biomedical o invasive biomedical methods methods ((IRB approved IRB approved

human research programhuman research program))• QuestionnaireQuestionnaire based based smoking habit inquirysmoking habit inquiry• SStatistical tatistical (descriptive and analytic) evaluation(descriptive and analytic) evaluation

of health related dataof health related data• Health economy impact of tobacco smoking Health economy impact of tobacco smoking

related diseasesrelated diseases,, based on clinical costs of based on clinical costs of treatmenttreatment

• AAnalysis of health nalysis of health legislation at national and legislation at national and local levelslocal levels

Ethnicity concerns in Ethnicity concerns in our researh...our researh...• Smoking is a complex socio-cultural

phenomenon responsible for a considerable part of disease burden

• According to the classic CanadianHealth Report (Marc Lalonde 1974) one of the 4 determinants of health is of genetic nature

• Is there a specific minority/ethnicity relevant as a socio-cultural and/or genetic factor responsible for tobacco smoking related diseases in Hungary?

• Yes, Roma people based on empiric knowledge in obstetrics, pulmomology and smoking habits

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Roma Roma eethnicity is a sensitive but thnicity is a sensitive but legitimate issue in Hungarylegitimate issue in Hungary46/2003. (IV. 16.) House resolution about the Decade of Health, a Public 46/2003. (IV. 16.) House resolution about the Decade of Health, a Public Health ProgramHealth Program

„We do not know exactly the relationship between Roma and different health services (GPs, outpatient care, etc.), We do not have exact knowledge of the prejudice of health care workers towards Roma and vice and verse, nor which type of prejudice. Based on evidence, there are apparent problems of communication in the doctor-patient relationship with obvious impact on understanding the Roma health behaviour. There is a more serious problem with GPs because they do not have any scientifically-based evidence about the health and mortality of their Roma patients wich is more serious related to the non-Roma population, consequently, in all probability, they do not have an increased interest for Roma patients.”

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Ethnicity was inevitable in our Ethnicity was inevitable in our smoking and pregnancy smoking and pregnancy research…research…

• There are basic demographic data about - newborns’ biometric parameters - PTB and LBW (weeks and weights)

• Roma versus non-Roma comparison of biological determinanats (if any) may be verified

• By addtitional socio-economic questions, we may understand the interrelation between deep poverty, Roma ethnicity, and birth outcomes while controlling for biologic determinants.

In the United KingdomIn the United Kingdom, the , the first census concerning ethnicityfirst census concerning ethnicityby by individuals' self-definition individuals' self-definition occurred in 1991occurred in 1991..

Office for National Statistics:

Membership of an ethnic group is something that is subjectively meaningful to the person concerned, and this is the principal basis for ethnic categorisation in the United Kingdom. So, in ethnic group questions, we are unable to base ethnic identifi-cation upon objective, quantifiable information as we would, say, for age or gender. And this means that we should rather ask people which group they see themselves as belonging to.

How do you defineHow do you define ethnicity?ethnicity?Office for National Statistics. 4 November 2003.

The ethnicity data used in UK national statistics relies on the individuals' self-definition. Factors contributing to this classification are as follows: - country where the individual was born - national identity - language spoken in the family - country where the parents were born - skin colour - country or geographic region of origin - specific race - religion

RomaRoma population populationin Hungary…in Hungary…

• Legitimate ethnic minority according to the Act. 1993. LXXVII. (13 minorities – 1 century – nationality/ethnicity)

• Anthropological characteristics (hidden v. obvious status)

• In social terms, anthropologic characteristics are irrelevant

• There is no regulation in Hungary prohibiting to ask questions about ethnicity of individuals, and it is his/her decision to answer this question

• What is the reason (if any) behind the prevalent situation in registered health data without self-determined ethnicity?

Act 1997.C. about the election procedures:

115 /E. (4) Application for enlisting in the voting list of minority elections must comprise the individual’s

a) actual first and second name,b) his/her name at birth,c) habitat,d) identity number,e) declaration about affiliation with a specific national or ethnic minority, furtherf) the signature.

115/G.§ (4) Voting lists of the minority elections must be deleted immediately after the official declaration of the final results, inclusive the legal deadline of appeal to the relevant courts.

Act 1993. LXXVII. 5§ (2): voting lists in the minority elections

Fear of beingFear of being registered…registered…

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Why just Borsod-Abaúj-Zemplén

andSzabolcs-Szatmár-Bereg

Counties?

Specific County CSO data - 2009

VariablesVariables BAZBAZ Szabolcs-Sz-BSzabolcs-Sz-B

Population 2001Population 2001 753,497753,497 589,989589,989

Population 2010Population 2010 692,771 (-60,726)692,771 (-60,726) 560,429 (-29,560)560,429 (-29,560)

Live births 7,142 (6,927) 5,944 (5,805)

Live birth proportion (9.6 ‰ ) 10.2 ‰ (3.) 10.6 ‰ (1.)

Reproductivity (1.33) 1.55 (1.) 1.50 (2.)

Infant death proportion (3.3-9.0) 9.0 ‰ (1.) 5 ‰ (15.)

0-14 years group 16.4 % (3.) 17.6 % (1.)

Roma population 2001.Roma population 2001. 45,525 (1.) = 6.4%45,525 (1.) = 6.4% 25,612 (3.) = 4.34%25,612 (3.) = 4.34%

Nr. of Roma Self-governments 173 (1.) (358) 133 (3.) (229)

Net average income/month 108,264 HUF. (9.) 95,950 HUF (1.)

Our results to be presented Our results to be presented in the afternoon programin the afternoon program

Grenczer A., Rákóczi I., Balázs P.:Interrelations of live birth cases with socio-economic situation in Borsod-Abaúj-Zemplén County in 2009.

Rákóczi I., Grenczer A., Balázs P.:Population dynamism related to socio-economic factors in Szabolcs-Szatmár-Bereg County in 2009.

Thank you for Thank you for attentionattention