Tobacco and Health 2: Strategies and Action

Describe and discuss the factors that influence smoking in pregnancy and what action can be taken to reduce this problem.
1. Factors influencing smoking in pregnancy
2. Action taken to reduce smoking in pregnancy
  1. Routine part of ante-natal care.
  2. Training personalised/tailored approaches
  3. Don't victim blame/just increase guilt
  4. 5 A's : ask, advise, assist, assess, arrange
  5. NRT: but more research needed
  6. Social support: family, friends
  7. Financial incentives
  8. CO level testing
  9. Not just during/after pregnancy but for whole life course
  10. involve not just healthcare professionals but multi disciplinary
  11. Accessible, targeted services and support
  12. relapse prevention/support
  13. wider social circumstances
  14. health education
  15. reduce poverty
Discuss the tactics taken by the tobacco industry to maintain the market for tobacco
1. targeting second/third world countries
  1. dance parties
  2. use of visual advertisements
    1. posters with young western people
    2. celebrities
    3. films
2. walls of cigarettes in supermarkets
3. sponsoring businesses such as Formula 1
4. using stylish packaging
Outline and discuss the Government's tobacco control strategy and how this relates to the WHO Framework Convention on Tobacco Control.
1. FCTC: Key measures
  1. Increase taxation of tobacco products and develop measures to combat smuggling
    1. price = #1 factor influencing tobacco consumption
    2. 'regressive' taxation = those who are least able to pay are most affected
      1. but actually it is more beneficial to them in the long run
      2. argument that smoking is one of the few joys of working class
      3. BUT actually is not because they are worried for themselves and children
    3. higher prices may give rise to an increase in black markets
      1. ~10-15% of cigarettes now are illicit
    4. for every 1% increase in real price of cigarettes there is a 0.5% decrease in adult consumption
    5. decline is even greater for young people
    6. address factors (poverty) that make it difficult for smokers to quit
  2. comprehensive bans on advertisements, promotion and sponsorship of tobacco
    1. argument that banning smoke will make people live longer and therefore more money for pension required and therefore is less cost effective
    2. bans include direct advertising and sponsorship, indirect promotion, paying for cigarette brands to appear in films and all types of media (eg internet)
  3. protect people in workplaces and indoor public places from smoke
    1. 700 million children around the world exposed to second hand smoking
    2. smoking in public places ban 2006
    3. smoke free policies increase smokers' motivations to quit and reduce uptake rates
  4. promote and strengthen public awareness of tobacco control
    1. media campaigns
    2. media coverage
    3. Health education in schools, health services, community and workplace
      1. to raise awareness of the health effects, how quickly addiction starts and have motivation/skill not to start
  5. test and regulate the contents and emissions of tobacco products
    1. require large rotating health warnings on packaging and prohibit the use of misleading descriptors such as 'light' or 'mild'
      1. Use of pictures
      2. Use of health warnings
      3. Ban attractive packaging?
  6. promote cessation of tobacco use and adequate treatment for tobacco dependence
    1. NHS smoking cessation services
    2. two thirds of smokers want to quit
    3. mass-media campaigns, quitlines, group or one-to-one support, providing pharmacotherapy
  7. Prohibit sales to children
    1. young smokers can buy cigarettes even with the law
    2. ban vending machines
    3. ban 'proxy' sales
    4. possession of tobacco under 18
2. WHO framework convention on tobacco control
  1. Background info
    1. world's first public health treaty
    2. commits governments to action to protect their citizens from illness and death caused by tobacco
    3. came into effecto Feb 2005
    4. 168 countries and signatories
    5. 150 have ratified the treaty
    6. represents the 'floor' not the 'ceiling' of tobacco control
      1. 'floor' = minimum of what we can do since getting so many different countries involved is difficult
3. Other measures
  1. Scottish Smoking Prevention Action Plan
  2. Collecting data on smoking patterns, trends and attitudes
  3. Evaluating policies and services eg smokefree legislation, cessation services
  4. Funding research on new approaches to prevention and cessation
4. Government tobacco control strategy
  1. higher taxes on cigarettes and other tobacco products.
  2. bans/restrictions on smoking in public and workplaces
  3. better consumer information
  4. comprehensive bans on advertising and promotion of all tobacco products, logos and brand names
  5. large, direct warning labels on cigarette packets
  6. offering help for those who wish to quit such as NRT and other cessation therapies
Describe and discuss the role that doctors have played in reducing smoking both as individuals and through organisations and pressure groups.
1. helping smokers to quit= one of most cost-effective interventions
2. Doctor still have lots of respect
  1. people will generally try and take their advice/suggestions
3. Combining pharmacotherapy with behavioural support
  1. increases long-term quit rates to 15-20% - four times the unaided success rate
4. local specialist cessation services
  1. used by more than 600000 smokers in 2005-2006
Discuss why tobacco is a major global public health issue and the action that is being taken to address this
1. smoking is the largest preventable cause of premature death and disability in the UK and the world
2. largest cause of social inequality in health in most industrialized countries
3. cigarettes kill half of lifetime users
4. half of these deaths under 70s years
5. in 2000, tobacco killed over 4.8 million people
6. half these deaths in developing countries
7. increasing, morbidity and mortality due to tobacco is in developing countries
8. ACTION TAKEN