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Special Populations: Update: Stephen A. Tamplin, MSE
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Special Populations: UpdateSpecial Populations: Update
Stephen A. Tamplin, MSE
2011 Johns Hopkins Bloomberg School of Public Health
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 Tobacco and youth
Women and tobacco
The role of nurses in tobacco control
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Special Populations: Update: Stephen A. Tamplin, MSE
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Messages from Previous Lectures—Tobacco and Poverty
84% of smokers live in developing and transitional economy countries
Smoking prevalence among men is higher in low- and middle-income countries (about 50%)
The poor smoke the most and bear most of the economic and disease burden of tobacco use
( )
Tobacco contributes to poverty at the individual and household levels:
Opportunity cost
Lost earnings due to higher risk of illness
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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
Breaking the tobacco-poverty relationship requires consideration of:
The local context Lost productivity
Loss of foreign exchange
Smuggling
Environmental degradation
The local context
Relationships and partnerships
Local champions
The need to situate interventions in the social development climate
Ti i
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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 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:
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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).
New Knowledge Regarding Tobacco and Poverty
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) 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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Source: Ciapponi, A. (2011).
Special Populations: Update: Stephen A. Tamplin, MSE
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New Knowledge Regarding Tobacco and Poverty
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 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
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assessed as implementation of the WHO s FCTC is likely to modify the current situation
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Source: Ciapponi, A. (2011).
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 10
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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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
S i d bli d i i 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 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
I l i b 8 f 165 i d d
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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).
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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 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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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
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The tobacco industry targets women by selling “coolness,” “independence,” “sex appeal,” and “lifestyle”
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Messages from Previous Lectures—Women and Tobacco
Policy recommendations
Ratify and implement the FCTC
Program recommendations
Implement gender- and age-specific tobacco control programsDesign 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
specific tobacco control programs
Provide information on occupational health and safety for women and girls
Engage women in designing and delivering programs
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health effects of tobacco use on women
Build capacity and engage women and girls in conducting tobacco control research
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 genderthere 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
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p ,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).
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New Knowledge Regarding Women and Tobacco
Tobacco advertising increasingly targets women and girls:
Glamour
Sophistication and style Sophistication and style
Luxury
Class and quality
Romance and sex
Sociability
Enjoyment and success
Health and freshness
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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 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).
New Knowledge Regarding Women and Tobacco
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 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
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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 partnersNurses 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
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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 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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Support improving the quality of cessation treatment
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Special Populations: Update: Stephen A. Tamplin, MSE
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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)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
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, g gcountries has found contemporary tobacco usage rates higher than that of the general population (Smith and Takahashi, 2008)
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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 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
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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-
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smoking, 100% smoke-free health sector is essential
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