Prevention and Control of Public Health Hazards

Tobacco, Alcohol, Drugs

Learning objectives

You students will be capable toYou students will be capable to

1.1. identify the risks of the tobacco, alcohol identify the risks of the tobacco, alcohol and drugs health hazards to public and drugs health hazards to public appointing the true figures of the appointing the true figures of the implications they may have on the society.implications they may have on the society.

2.2. commence educational programs for the commence educational programs for the public in order to participate in prevention public in order to participate in prevention of such hazardsof such hazards

Tobacco Consumption in The

Eastern Mediterranean Region (EMR)• Prevalence among adult men ranges from Prevalence among adult men ranges from

15.5% to 77%.15.5% to 77%.• Prevalence among adult women ranges Prevalence among adult women ranges

from 0.5% to 35%.from 0.5% to 35%.• And;And;• Among youth males from 4.6% to 47.4%.Among youth males from 4.6% to 47.4%.• Among youth females from 0.1% to 14.5%Among youth females from 0.1% to 14.5%

Prevalence Among Adults (Men and Woman)

DJITUN

YEM

SYRLEB

JOREGY

OPTSAA

PAKKUW

UAE IRA

SUD

OMABAH

MOR

0 10 20 30 40 50 60 70 80 90

|World War II

World War I

Rate/100,000women(0-35)

Breast cancer

Lung cancer

Years (1930-2000)

Percent (0-60%)

Control the Epidemic: Stages of Change

PrecontemplationPrecontemplation

ContemplationContemplation

ActionAction

MaintenanceMaintenance

RelapseRelapse

Not yet considering quittingNot yet considering quitting

Thinking about quittingThinking about quitting

Making a quit attemptMaking a quit attempt

Remaining a nonsmokerRemaining a nonsmoker

Starting to smoke againStarting to smoke again

Implementing Smoking Cessation Strategies

The 4 R’s to enhance motivation – for patients unwilling The 4 R’s to enhance motivation – for patients unwilling to quit at this timeto quit at this time

• RELEVANCE: Tailor advice and discussion to each RELEVANCE: Tailor advice and discussion to each patientpatient

• RISKS: Outline risks of continued smokingRISKS: Outline risks of continued smoking• REWARDS: Outline benefits of quittingREWARDS: Outline benefits of quitting• REPETITION: Reinforce motivational message at REPETITION: Reinforce motivational message at

every visitevery visit

The 4 A’s – for patients willing to make a quit attempt now•ASK about tobacco use at every encounter

•ADVISE all smokers to quit•ASSIST the patient in quitting•ARRANGE for a follow-up

What about cutting down?

1.1. Do you smoke?Do you smoke?

2.2. Are you interested in quitting? - Are you interested in quitting? - stages of stages of changechange

If no, encourage thinking about quittingIf no, encourage thinking about quitting

If yes, proceedIf yes, proceed – –

3.3. How much do you smoke?How much do you smoke?

4.4. How soon after waking do you smoke?How soon after waking do you smoke?

5.5. Have you tried to quit before?Have you tried to quit before?

6.6. In what situations do you enjoy smoking?In what situations do you enjoy smoking?

7.7. Do others in the home smoke?Do others in the home smoke?

8.8. Have you had problems with alcohol, drugs?Have you had problems with alcohol, drugs?

9.9. Have you had medical or psychiatric problems?Have you had medical or psychiatric problems?

“ASK”

dependence

antecedents

Impact treat.

Variables Associated With Lower QRs

Stressful life circumstances Stressful life circumstances and/or recent major life change and/or recent major life change (eg, divorce, job change)(eg, divorce, job change)

High stress levelHigh stress level

Other smokers in the home or workplaceOther smokers in the home or workplaceEnvironmental risksEnvironmental risks

Smoker reports perceived inability to quitSmoker reports perceived inability to quitLow self-efficacyLow self-efficacy

Smoker reports not being ready to quitSmoker reports not being ready to quitLow readiness to changeLow readiness to change

Smoker reports low motivation to quitSmoker reports low motivation to quitLow motivationLow motivation

Depression, schizophrenia, alcoholism, other Depression, schizophrenia, alcoholism, other chemical dependencychemical dependency

Psychiatric ComorbidityPsychiatric Comorbidity

Smoker reports severe withdrawal Smoker reports severe withdrawal during previous quit attemptsduring previous quit attempts

High nicotine dependenceHigh nicotine dependenceExamplesExamplesVariableVariable

Nicotine Withdrawal Symptoms

Withdrawal peaks in 2 days and Withdrawal peaks in 2 days and lasts up to 1-2 weeks lasts up to 1-2 weeks (on average)(on average)

• Depressed mood, sadnessDepressed mood, sadness• InsomniaInsomnia• Irritability, frustration, angerIrritability, frustration, anger• AnxietyAnxiety• Impaired concentrationImpaired concentration• RestlessnessRestlessness Increased appetiteIncreased appetite

INSERT FIG SHOWING KINETICS OF CIGS AND NRT, to illustrate why NRT might not work that well

Antecedents and Consequences

AntecedentsAntecedents• Persistent salience of environmental cuesPersistent salience of environmental cues• Expectancy of positive effects of smokingExpectancy of positive effects of smoking• Modeling of smoking (being around other smokers)Modeling of smoking (being around other smokers)• Easy availability of cigarettesEasy availability of cigarettes• Reduced availability of alternative reinforcers.Reduced availability of alternative reinforcers.

ConsequencesConsequences Experiencing smoking effects (priming)Experiencing smoking effects (priming) Secondary reinforcement (e.g. approval from other smokers, Secondary reinforcement (e.g. approval from other smokers,

such as friends or spouse who smoke)such as friends or spouse who smoke)

“ARRANGE” Follow-Up• Schedule follow-up within one weekSchedule follow-up within one week• Follow up again within first month if Follow up again within first month if

possiblepossible• Set additional follow-up as necessarySet additional follow-up as necessary• Congratulate success during all contactsCongratulate success during all contacts• If smoking has occurred, review If smoking has occurred, review

circumstances and encourage another trycircumstances and encourage another try• Identify problems encountered and Identify problems encountered and

anticipate challenges to a new quit attemptanticipate challenges to a new quit attempt• Assess use/misuse of nicotine replacement Assess use/misuse of nicotine replacement

therapy or other medicationtherapy or other medication• Consider referralConsider referral

Tobacco Free Initiative(TFI) in EMRO

TFI works to….

• Change social acceptance; Policy Change social acceptance; Policy analysis and communication (PAC).analysis and communication (PAC).

• Strengthening national capacity; Strengthening national capacity; National capacity building (NAC).National capacity building (NAC).

• Support the Framework Convention for Support the Framework Convention for Tobacco Control related activities Tobacco Control related activities (FCTC).(FCTC).

• Apply Evaluation mechanisms to Apply Evaluation mechanisms to tobacco-related trends and control tobacco-related trends and control activities (AME).activities (AME).

TFI/EMRO

Framework Conventionand Related Issues (FCTC)

Policy Analysisand Communication (PAC)

National Capacity (NAC)Assessment, Monitoring

and Evaluation (AME)

Tobacco and religion

• Islamic ruling on smokingIslamic ruling on smoking• The fatwaThe fatwa• Distribution of fatwaDistribution of fatwa• Christian views on smokingChristian views on smoking• International activitiesInternational activities• Advocacy related activitiesAdvocacy related activities• MM (Mass Media)MM (Mass Media)

The tobacco industry

• Information are free and available on Information are free and available on public health frontier but it is not like public health frontier but it is not like that with the industrythat with the industry

• They use all possible means, our They use all possible means, our means are limitedmeans are limited

• They have unlimited funds unlike usThey have unlimited funds unlike us

• TIM monthly reports are disseminated:TIM monthly reports are disseminated:

• Among TFI collaborators (including Among TFI collaborators (including WHO regional advisers)WHO regional advisers)

• On tobacco control networks On tobacco control networks (Globalink) (Globalink) www.globalink.org/timwww.globalink.org/tim

• WHO/TFI webpageWHO/TFI webpage

Monitoring the tobacco industry activities

Monitoring the tobacco industry activities

Monitoring the tobacco industry activities

• Reports: Reports: • The Voice of truth – Multinational tobacco The Voice of truth – Multinational tobacco

industry activity in the Middle East: a review of industry activity in the Middle East: a review of internal industry documents (2001) internal industry documents (2001)

• http://www.emro.who.int/tfi/VOICE%20OF%20TRUTH.pdfhttp://www.emro.who.int/tfi/VOICE%20OF%20TRUTH.pdf

• The tobacco industry's tactics and plans to The tobacco industry's tactics and plans to undermine control efforts in Egypt and North Africa, undermine control efforts in Egypt and North Africa, Cairo 2003Cairo 2003

• The Tobacco Industry and Corporate Social The Tobacco Industry and Corporate Social Responsibility… an inherent contradiction (2003)Responsibility… an inherent contradiction (2003)

Other projects of TFI Communications

• In order to be able to In order to be able to implement effective implement effective tobacco control policies, tobacco control policies, governments and activists governments and activists need to be very well need to be very well informed of the industry's informed of the industry's activities and strategiesactivities and strategies

Media and Tobacco Control and Prevention

… and the EMRO work continues…

Learning objectives

You students will be capable toYou students will be capable to

1.1. identify the risks of the tobacco, alcohol identify the risks of the tobacco, alcohol and drugs health hazards to public and drugs health hazards to public appointing the true figures of the appointing the true figures of the implications they may have on the society.implications they may have on the society.

2.2. commence educational programs for the commence educational programs for the public in order to participate in prevention public in order to participate in prevention of such hazardsof such hazards