CHILD HEALTH AND TOBACCO IN THE PHILIPPINES

BENJAMIN P. SABLAN, JR., MD, FPPSPROFESSOR

UNIVERSITY OF THE PHILIPPINES MANILA

DISCLOSURE Commissioned work given to the PHILIPPINE

AMBULATORY PEDIATRIC ASSOCIATION

Funded by the World Health Organization Endorsed by the Department of Health Manila

TOBACCO FREE INITIATIVEWHO

Children are a vulnerable group (GYTS) Need for concerted efforts

Push for critical reforms and interventions that would impact on significant tobacco control

In consonance with the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2010-2014)

Share of total mortality of the ten leading causes of death, Philippines, 2004

17.6%

12.8%

10.1%8.6%

8.0%

6.4%

5.3%

4.7%

4.1%3.3%

1. Diseases of the heart

2. Diseases of the vascular system

3. Malignant neoplasms

4. Pneumonia

5. Accidents

6. Tuberculosis, all forms

7. Chronic lower respiratory diseases

8. Diabetes mellitus

9.Certain conditions originating in theperinatal period10. Nephritis, nephrotic syndrome andnephrosis

Tobacco use was responsible for over 58,000 deaths, or nearly 12% of all deaths in the Philippines.

Global Youth Tobacco Survey (GYTS)

Current usage: ~3/10 of students (27.3%; M>F) Current smokers: ~1/5 of students (21.7%; M>F) Other tobacco users: 1/10 (9.7%; M~F) Ever smoked: ~½ of students (46.2%; M>F) Likely to smoke: ~1/10 of students (13.6%; M>F)

GYTS ETS exposure at home: ~50% ETS exposure in public places: ~60% Desire to quit smoking: ~80% of current

cigarette smokers Taught in school about smoking and its

dangers: ~65% BUT

Buy cigarettes in a store: 56% Not refused purchase due to age: 64%

GYTS Conclusions

1. Cigarette smoking among young people in the Philippines is high

Compared to 1995 data 33% increase of prevalence of smoking in

Filipino youth 12% increase in current smoking prevalence

GYTS Conclusions

2. Filipino boys are more likely than girls to use tobacco

Almost one-fifth of young people begin smoking before the age of 10 years

Over ¼ of never smokers are likely to start smoking this year

GYTS Conclusions

3. Environmental Tobacco Smoke exposure is very high

• Over half of parents smoke• About 3 in 4 are around others who smoke in

places outside their homes• Filipino youth smokers usually smoke at home

but majority of them prefer to smoke in a friend’s home

• Only 4 in 10 think smoking is harmful to their health

GYTS Conclusions

4. The majority of young people currently smoking want to stop smoking

Over two-thirds or 8 in 10 smokers want to stop There is lack of access to smoking cessation program

ISSUESPositive indicators for

anti-smoking campaign in the Philippines

72% think cigarette smoking is harmful

72% think cigarette smoking makes one less attractive

85% of current smokers want to stop smoking

Challenges 27% of never smokers

are likely to initiate smoking in the next year

39% agree that smoking should be banned from public places

Only 6% of those who wish to quit smoking had access to professional help

Global Heath Issues Affecting the Filipino Child

PAPA CONVENTION 2010 First International Visiting Lecture of Richmond

Center, Dr. Jonathan Klein, Executive Director AAP

Paediatric health care providers need to be aware of the continuing pharmacological and health effects of tobacco smoke either through use or second hand exposure

Doctors and other health care professionals can become more effective public advocates for tobacco control in their respective communities

Global Heath Issues Affecting the Filipino Child

PAPA CONVENTION 2010 Physicians may know Tobacco effects

Lack the skills needed to advocate for tobacco control

Physicians are a major force needed in the community for tobacco control advocacy Coalition on Tobacco control (FCAP – NGOs,

media, DOH) Physicians may be the silent link!!!!

BRIEF TOBACCO INTERVENTION

SKILLS TRAININGOBJECTIVES

To provide paediatric health care providers with current information regarding

Physiologic and health effects of Tobacco Exposure Intervention initiatives for Tobacco Control

To promote practice changes to enhance Medical provider skills for clinical interventions Medical provider skills for public advocacy

FRAMEWORK

TARGET HEALTH PROVIDERS Physicians (Child and Adolescent Health Care

providers) All health care providers (nurses, midwives, etc.)

TARGET POPULATION Under 5 infants/toddlers (IMCI counseling) Children over 5 years old Adolescents

BTIS TRAINING

Training Modules Trainors Training Manual

Health Provider Encounter form Health Education Materials

BTIS TRAINING

4 hour training Training on technical aspects of running course

Didactics Role Playing Evaluation

Training on technical issues on Tobacco and Tobacco control

BTISWriteshop and Training

BTIS

BTIS

ALGORITHM Young Child Less than 5 years old

Parent/Caregiver IMCI approach (Pneumonia, ear infection,

nutrition, fever) Older Child (6-9 years old)

Parent/Caregiver Child

Adolescent

PARENT/CAREGIVER

OLDER CHILD (6-9 YEARS OLD)

ADOLESCENT

VIDEO

Generic Version Concepts 5As Algorithm used Easily adaptable (translated in local

dialect) BTIS in real time

BTIS Training

PRE TEST POST TEST

TARLAC 6.9 17.25

METRO MANILA 11 19

BATAAN 9 19.8

DAVAO 12 23

BTIS Learnings

Knowledge and Skills Improved Knowledge Acquired Skills for BTIS for every health care

encounter Need for community resources development

COMMITMENT

Continue BTIS Training all over the country 16th Annual Convention (March 8-9, 2011)

BTIS Training as a pre-conventiona. Academeb. Key Government

Physicians/Program Managers

COMMITMENTTo Develop Resource Centers for Motivational Counseling

29

COMMITMENT

COALITION BUILDING Physicians as the

MISSING LINK Involve Medical

Organizations

Department of Health Philippine Medical Association Philippine College of

Physicians Philippine College of Chest

Physicians Philippine Academy of

Pediatric Pulmnologists Philippine Society of Oncology Society of Adolescent

Medicine (SAMPI) Philippine Ambulatory

Pediatric Association

THANK YOU