david simpson obe, hon mfphm director, international agency on tobacco and health
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10 th Annual Congress TURKISH THORACIC SOCIETY Antalya, 25-29 April 2007. Tobacco: health workers and institutions. David Simpson OBE, Hon MFPHM Director, International Agency on Tobacco and Health Visiting Professor, London School of Hygiene & Tropical Medicine - PowerPoint PPT PresentationTRANSCRIPT
David Simpson OBE, Hon MFPHM
Director, International Agency on Tobacco and Health
Visiting Professor, London School of Hygiene & Tropical Medicine
Honorary Fellow, Clinical Trial Service Unit, Oxford
Editor, News Analysis, Tobacco Control journal
Tobacco: health workers and institutions
10th Annual Congress
TURKISH THORACIC SOCIETY
Antalya, 25-29 April 2007
Richard Peto & Richard Doll, 2004
‘British Doctors Study’ – first results published:
1954: preliminary report
Doll R, Hill A B The mortality of doctors in relation to their smoking habits. A preliminary report. British Medical Journal 1954;4877:1451-1455
1954: preliminary report 1956: 2nd reportLung cancer and other causes of death in relation to smoking. A second report on the mortality of British doctors. British Medical Journal 1956; 233:1071-1081
British Doctors study: prospective study of > 50 years
- Started – wrote to British doctors - in 1951;
- preliminary report: 1954
- 2nd report: 1956
- 50-year follow up report: 2003
Important by-products of doctors being the subjects:
* doctors + first group to quit smoking;
* important evidence of health gains from quitting;
* made doctors press government for prevention;
UK: doctors’ reduction of smoking after publication of scientific evidence
0
2
4
6
8
10
12
14
1950 1955 1960 1965 1970
Ave
rage
no.
of c
igar
ette
s per
day
All men aged 35-59
Source: Doll & Peto, 1976
Doctors aged 35-59
All men aged 60+
Doctors aged 60+
UK: doctors health after quitting:changes in age-standardised death rates
1954/59 to 1966/71
-30-25-20-15-10-505
1015
All diseases Diseases notrelated tosmoking
Smoking-related diseases
All men
Male doctors
worse
% change
better
Doctors' % daily smoking in WHO European region
0 10 20 30 40 50 60 70
GeorgiaRomania
MacedoniaTurkeyFrance
ItalyCzech Rp
PolandEstonia
DenmarkSwitz'ldNorway
SloveniaIsrael
FinlandSwedenlreland
LuxembgIceland
UK
MaleFemale
WHO Europe, 2005
Potential of doctors
• Doctors & other health workers are in a uniquely powerful position to fight against tobacco
• In UK,
– Pioneering research & early political lobbying for tobacco control was undertaken by doctors
– Doctors led the way in realising that wide-ranging collaboration is required to solve the tobacco problem
Smoking cessation
• Doctors & other health workers have unique ability to help smokers to stop smoking
• Many smokers want to stop smoking, & others may be receptive to encouragement to stop
• A brief intervention by a doctor increases chances that a smoker will successfully stop smoking
• Nicotine replacement therapy (NRT) can increase the success rate of more dependent smokers
The brief intervention
• Offer information, advice, & encouragement to get the patient to consider making a firm commitment to quit
• Reinforce the decision to quit
• Give the patient a cessation leaflet, if available
• If appropriate, offer to prescribe NRT or other pharmaceutical, & give advice
• Advise the patient to plan a quit day in advance
• At the end, reinforce the patient’s decision to quit & offer further help
• inform patient of intention to follow up progress
Actions for doctors at local level
• Call in teenage patients to discuss health problems including tobacco
• Doctors can influence tobacco control policy at the community level
• Doctors can educate politicians & other decision makers about tobacco
• Many doctors have special opportunities as advisors to companies, local government & media
• Doctors can influence funding to support tobacco control efforts
Doctors can ask for change!
Doctors: role in education & training
• Training in tobacco control can increase success
• Exploit all opportunities:
– Smoking cessation
– Training medical students
– Put tobacco in Continuing Medical Education (CME) & continuing professional development (CPD) courses
– Media training, especially for tobacco group leaders & key representatives for news media
Increase doctors’ awareness: action for national medical organisations
• Survey of doctors’ smoking habits & attitudes to smoking
• Disseminate the results of the survey
• Set up a tobacco group in the national office
• Educate members about tobacco
• Make the organisation’s premises smoke-free
• Use medical publications for publicity
• Brief doctors about smoking cessation
• Support doctors’ cessation activities
• Review organisation’s investments to eliminate tobacco holdings
Tobacco control: action for national medical organisations
• Formulate a tobacco action programme• Work with other health organisations• Use the news media• Work with politicians• Campaign for smoke-free health care facilities• Influence medical education• Set up a tobacco control organisation• Prepare a baseline national tobacco report• Carry out regular surveys & evaluation
Doctors and Tobacco: Medicine’s Big ChallengeAn action manual on tobacco for medical associations and doctors
An action manual on tobacco for medical associations and doctors
http://www.doctorsandtobacco.org/
A few lessons learnt on the battlefield
• Tobacco control can be tough work
• At times, bravery and commitment are essential
• The tobacco industry always fights effective measures
• Measures it does not fight are ineffective
• Eventually, you can help save more lives and prevent more disease than all your country’s clinicians
Tobacco control…
Often, politicians and others do not seem to listen
It can be a long, hard, lonely journey …
and there’s always someone trying to knock you down