69
Healthy Lifestyle Summit Balanga City, 26 Nov 2010 1 | 1 TOBACCO CONTROL IN THE PHILIPPINES R FLORANTE E TRINIDAD echnical Officer – Tobacco Free Initiative

Balanga Presentation

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Page 1: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 1

| 1

TOBACCO CONTROL IN THE PHILIPPINES

TOBACCO CONTROL IN THE PHILIPPINES

DR FLORANTE E TRINIDAD Technical Officer ndash Tobacco Free Initiative

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 2

|

4000 chemicals 60 known carcinogens

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 3

|

AFR EMR EURSEAR WPR AMR

25

50

75

Communicable diseases maternal and perinatal conditions and nutritional deficiencies

Noncommunicableconditions

Injuries

Deaths by broad cause group and WHO Region 2000

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 4

|

10 Filipinosdie by the hour from tobacco-related disease

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 5

|

Risk Factors Common to Major

Noncommunicable Conditions Condition Risk factor

Cardio-vascular disease

Diabetes Cancer Respiratory conditions

Smoking

Alcohol

Nutrition Physical inactivity

Obesity

Raised blood pressure

Blood glucose

Blood lipids

Including heart disease stroke hypertension

Including chronic-obstructive pulmonary disease and asthma

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 2: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 2

|

4000 chemicals 60 known carcinogens

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 3

|

AFR EMR EURSEAR WPR AMR

25

50

75

Communicable diseases maternal and perinatal conditions and nutritional deficiencies

Noncommunicableconditions

Injuries

Deaths by broad cause group and WHO Region 2000

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 4

|

10 Filipinosdie by the hour from tobacco-related disease

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 5

|

Risk Factors Common to Major

Noncommunicable Conditions Condition Risk factor

Cardio-vascular disease

Diabetes Cancer Respiratory conditions

Smoking

Alcohol

Nutrition Physical inactivity

Obesity

Raised blood pressure

Blood glucose

Blood lipids

Including heart disease stroke hypertension

Including chronic-obstructive pulmonary disease and asthma

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 3: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 3

|

AFR EMR EURSEAR WPR AMR

25

50

75

Communicable diseases maternal and perinatal conditions and nutritional deficiencies

Noncommunicableconditions

Injuries

Deaths by broad cause group and WHO Region 2000

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 4

|

10 Filipinosdie by the hour from tobacco-related disease

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 5

|

Risk Factors Common to Major

Noncommunicable Conditions Condition Risk factor

Cardio-vascular disease

Diabetes Cancer Respiratory conditions

Smoking

Alcohol

Nutrition Physical inactivity

Obesity

Raised blood pressure

Blood glucose

Blood lipids

Including heart disease stroke hypertension

Including chronic-obstructive pulmonary disease and asthma

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 4: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 4

|

10 Filipinosdie by the hour from tobacco-related disease

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 5

|

Risk Factors Common to Major

Noncommunicable Conditions Condition Risk factor

Cardio-vascular disease

Diabetes Cancer Respiratory conditions

Smoking

Alcohol

Nutrition Physical inactivity

Obesity

Raised blood pressure

Blood glucose

Blood lipids

Including heart disease stroke hypertension

Including chronic-obstructive pulmonary disease and asthma

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 5: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 5

|

Risk Factors Common to Major

Noncommunicable Conditions Condition Risk factor

Cardio-vascular disease

Diabetes Cancer Respiratory conditions

Smoking

Alcohol

Nutrition Physical inactivity

Obesity

Raised blood pressure

Blood glucose

Blood lipids

Including heart disease stroke hypertension

Including chronic-obstructive pulmonary disease and asthma

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 6: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 6

|

WHO Report on Global Tobacco Epidemic 2008

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 7: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 7

|

SMOKING CAUSED DISEASES

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 8: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 8

|

Second hand smoke is a carcinogenSecond hand smoke is a carcinogen

The following countries have classified SHS as a carcinogen

Germany

Finland

USA ndash SHS is a group A carcinogen with arsenic asbestos benzene radon and vinyl chloride

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 9: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 9

|

There is no safe

level of exposure

to second hand

smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 10: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 10

|

DISEASES AND ADVERSE HEALTH

EFFECTS CAUSED BY SECOND HAND SMOKE

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 11: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 11

|

TUBERCULOSIS AND SMOKING

A STRONG ASSOCIATION bullSmoking substantially increases the risk of tuberculosis and death

from TB

bullMore than 20 of global TB incidence may be attributable to

smoking

bullSmoking is a risk factor for TB independent of alcohol use and

other socioeconomic risk factors

bullSmoking increases the risk of TB disease by more than 2 frac12 times

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 12: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 12

|

One out of five heavy smokers will die of lung cancer

RISK

Mouth larynx

throat - 455

Esophagus - 401

Stomach - 141

Cervix - 175

Bladder - 272

Pancreas - 186

Anus - 318

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 13: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 13

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 14: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 14

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 15: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 15

|

THE TOBACCO ATLAS 2009

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 16: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 16

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 17: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 17

|

Womens uptake and cessation of smoking Womens uptake and cessation of smoking

ndash Women are more susceptible to nicotine addiction than men

ndash Biopsychosocial factors make it harder for women to quit smoking such as

bull hormonal cycles and pregnancy bull the fear of weight gain bull the need for social support in quitting

smoking

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 18: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 18

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Irreversible and serious health consequences for pregnant women and fetus such as low-birth-weight infants and possible long-term effects on child behaviour

(Source WHO 2008)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 19: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 19

|

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 20: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 20

|

Different health risks associated with womenrsquos smoking

Different health risks associated with womenrsquos smoking

ndash Smoking women have shown to have enhanced mortality from breast cancer than non-smoking women

ndash Smoking women develop certain diseases like lung cancer faster than men

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 21: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 21

|

Tobacco industry targeting womenTobacco industry targeting women

The tobacco industry has developed deceitful marketing strategies to target female smokers

ndash Tobacco advertisements have associated womenrsquos smoking with independence glamour and sexual attractiveness

ndash Marketing efforts calling cigarettes low tar light or mild thereby sending out misleading messages that smoking is less harmful

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 22: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 22

|Deadly product packaged in candy colors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 23: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 23

|

Deadly product packaged in fruity flavors

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 24: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 24

|

Tobacco Advertising and YouthTobacco Advertising and Youth

bullMuch tobacco advertising targets the needs of young people

bullExposure to tobacco marketing is causally related to youth smoking initiation dagger

bullYouth who own tobacco company promotional items are morelikely to become smokers Dagger

bullYouth smoking is much more responsive to advertising than adult smoking

Sources National Cancer Institute Tobacco Control Monograph No 19 2008 daggerIbid DaggerPierce et al (1998) Biener and Siegel (2000) Sargent et al (2000) Pollay et al (1996)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 25: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 25

|

Tobacco use is a

pediatric disease

80-90 of smokers initiate

use before the age of 18

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 26: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 26

|

Is the health sector convinced that

this is about addiction

Is the health sector convinced that

this is about addiction

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

It is estimated that it

takes a child 3-4 years

of regular use

for dependence to

set in

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 27: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 27

|

If it is so bad why do people smoke

If it is so bad why do people smoke

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 28: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 28

|

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Paradigm shift SMOKING is now considered a DISEASE not just a habit

Smoking Cessation A form of medical treatment

not just a preventive measure

NICOTINE DEPENDENCE SYNDROME

Mental amp behavioral disorder due to use of

tobaccoICD 10 F172

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 29: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 29

|Source J Henningfield

ldquoldquoAmong All Who Have Ever Tried Among All Who Have Ever Tried

a Single Cigarette Almost 13 a Single Cigarette Almost 13

Would Develop Nicotine Would Develop Nicotine

DependencerdquoDependencerdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 30: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 30

|

- US Judge Gladys Kessler 2006

ldquoThe TOBACCO INDUSTRY is an industryhellip that survives and profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year an immeasurable amount of human suffering and economic losshelliprdquo

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 31: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 31

|

The Role of the Industry in Causing Disease

Industry actions

Public actions

Healthconsequences

DeceptionNicotine manipulationAdvertisingConspiracy

Youth smokingAddictionContinued smoking

Tobacco-related diseases

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 32: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 32

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullBe vigilant about industry tactics that seek to obstruct delay or circumvent the development andor implementation of public health legislation

bullLimit interactions with the tobacco industry

bullEnsure transparency of interactions that do occur

bullNot enter into any partnerships or non-enforceable agreements with the tobacco industry

bullProtect against conflicts of interest for those involved in setting and implementing tobacco control policies

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 33: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 33

|

To strengthen national tobacco control measures and implementation of national legislation governments should

bullEnsure transparency of tobacco industry operations and activities

bullSet their own targets and determine implementation dates based on best practices rather than be subject to the industryrsquos direction and

timetable

bullNot compromise on tobacco control measures when threatened with legal action by the tobacco industry

bullNot hesitate to apply FCTC Article 19 (Liability) and take the tobacco industry to court when it violates legislation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 34: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 34

|

Building Blocks of Tobacco Control

bullDo not partner with the tobacco companies on activities that are not tobacco-relatedbullDo not participate in industry-initiated dialoguesbullDo not accept compromises in smoke-free spaces initiatives that include the use of ventilation technology andor separate smoking and non-smoking areas bullDo not endorse the tobacco companiesrsquo ldquoaccommodationrdquo and ldquocourtesy of choicerdquo programmesbullDo not endorse participate or partner with the tobacco companiesrsquo youth smoking prevention programmesbullDo not focus all tobacco control activities on school-based programmes often paid for by the tobacco companiesbullDo not accept compromises on tax increases because of the tobacco companiesrsquoarguments that it will lead to an increase in smugglingbullDo not compromise on a comprehensive advertising ban

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 35: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 35

|35

Lies of the Tobacco IndustryLies of the Tobacco Industry1 Causation cannot be established for SHS and disease

2 Epidemiological studies are ldquojunk sciencerdquo and subject to serious bias

3 Controversy exists among scientists

4 Ventilationaccommodation are effective SHS control strategies

5 Bans hurt the hospitality industry and restaurants lose money when complete indoor bans are implemented

6 Local government units cannot enact an anti-tobacco ordinance much stricter than the national law

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 36: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 36

|

Framework Convention on Tobacco Control (FCTC)

Aim protect present and future generations from the consequences of tobacco

Powerful global public health tool ndash first Public Health Treaty under WHO

Unique introduced urgency into tobacco control negotiated binding international law comprehensive approach

36

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 37: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 37

|

MPOWER

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about dangers of tobacco

Enforce bans on tobacco advertising promotion amp sponsorship

Raise taxes on tobacco

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 38: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 38

|

Paradigm for Tobacco Control

INDIVIDUAL

SOCIETY

TOBACCOADDICTION

PriceeconomicSmoke-free AirCounter

marketingCessation

treatmentPrevention

activitiesProduct

regulationLiability

Pro-tobacco MarketingAccess

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 39: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 39

|

Global Tobacco Surveillance System (GTSS) - Components

Global Tobacco Surveillance System (GTSS) - Components

Youthndash Global Youth Tobacco Survey (GYTS)

Adultsndash Global School Personnel Survey (GSPS)ndash Global Health Professions Students Survey (GHPSS)ndash Global Adult Tobacco Survey (GATS)+

School based survey+ Household survey

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 40: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 40

|

GLOBAL YOUTH TOBACCO SURVEYPrevalence

GLOBAL YOUTH TOBACCO SURVEYPrevalence

Prevalence of Students who are ldquoCurrent Cigarette Smokersrdquo

115

175166

234

12

182

262

124

78

0

10

20

30

40

50

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 41: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 41

|

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

GLOBAL YOUTH TOBACCO SURVEYExposure to Second Hand Smoke

Percentage of Students with One or More Parents who Smoke

554 551 541547 529 525

561 563 553

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Percentage of Students Exposed to Smoke in Public Places

582 586 648588 594 672

578 582 628

0

20

40

60

80

100

1999 2003 2007

TotalBoyGirl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 42: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 42

|

GLOBAL YOUTH TOBACCO SURVEYCessation

GLOBAL YOUTH TOBACCO SURVEYCessation

Percentage of ldquoCurrent Smokers who Always Feel Like Having a Cigarette

First Thing in the Morningrdquo

3

54

08

47

08

32

5

07 030

2

4

6

8

10

1999 2003 2007

Total

Boy

Girl

Percentage of ldquoCurrent Smokers who Want to Stop Smoking Nowrdquo

852 88881

846

896

88

857

882

893

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 43: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 43

|

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

GLOBAL YOUTH TOBACCO SURVEYTobacco Control Initiatives

Percentage of Students NOT Refused Sale When Buying Cigarettes in a Store

596

477

636

48 567

637487

725

511

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Percentage of Students Offered a ldquoFreerdquo Cigarette by a Representative

14 101 55

176 156 7

114

66

41

0

20

40

60

80

100

1999 2003 2007

Total

Boy

Girl

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 44: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 44

|

Global Adult Tobacco Survey (GATS)Global Adult Tobacco Survey (GATS)

Purpose

To systematically monitor adult tobacco use amp track key tobacco control measures

ndash Within country comparisons over timendash Between country comparisons

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 45: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 45

|

Number of current

smokers in the

Philippines

173 million

(283)

Male smokers 146 million (477)Female smokers 27 million (89)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 46: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 46

|

GATS (2009) GATS (2009)

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 47: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 47

|

GATS (2009) GATS (2009)

Figure 2 Average Number of Cigarette Smoked by Daily Cigarette Smokers by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

106113

70

0

2

4

6

8

10

12

OVERALL Men Women

Sex

Number of Cigarettes

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 48: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 48

|

GATS (2009) GATS (2009)

Figure 3 Average Age of Initiation of Daily Smoking Among Ever Daily Smokers 18-34 years old by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

191

176 174

15

16

17

18

19

20

OVERALL Men Women

Sex

Age in years

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 49: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 49

|

GATS (2009) GATS (2009)

Figure 4 Second Hand Smoke Exposure at Home Philippines Global Adult Tobacco Survey (GATS) 2009

488396

544

0

20

40

60

80

100

Smoking Allowed insidethe Home

Exposure Daily inside theHome

Exposure Monthly insidethe Home

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 50: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 50

|

GATS (2009) GATS (2009)

Figure 6 Second Hand Smoke Exposure in Public Places Philippines Global Adult Tobacco Survey (GATS) 2009

255

553

336

76

0

20

40

60

80

100

PublicTransport

RestaurantsGovernmentOffices

Health CareFacilities

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 51: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 51

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 52: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 52

|

GATS (2009) GATS (2009)

Figure 7 Smoking Cessation Status of Adults 15 years and older by Sex Philippines Global Adult Tobacco Survey (GATS) 2009

215

478

606

467

605

209250

539611

0

20

40

60

80

100

Quit Rate (EverDaily)

Quit Attempt(Past Year)

Interested inQuitting (Current

C igaretteSmokers)

Percent

Total Men Women

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 53: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 53

|

GATS (2009) GATS (2009)

Figure 8 Percent of Respondents Who Believe That Smoking Causes Certain Illness Philippines Global Adult Tobacco Survey (GATS) 2009

940956

813755

0

20

40

60

80

100

Smokingcauses

lungcancer

Smokingcausesseriousillness

Smokingcausesheartattack

Smokingcausesstroke

Illness

Percent

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 54: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 54

|

GATS (2009) GATS (2009)

Figure 10 Average Cigarette Expenditure per Month Among Manufactured Cigarette Smokers by Sex Philippine Global Adult

Php3264 Php3392

Php 2328

050

100150200250300350

OVERALL Men Women

Sex

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 55: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 55

|

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Percent Distribution of Current Manufactured Cigarette Smokers by Last

Brand of Manufactured Cigarettes Purchased (Philippine GATS 2009)

Fortune334

Marlboro194

Champion111

Hope72

Philip Morris52

Winston26

More29

Might52

Other130

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 56: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 56

|

Distribution of monthly expenditures of poor household

Distribution of monthly expenditures of poor household

13

16

131

26

63

82

33

26

611

Food

Clothing

Housing

Health

Education

Utilities

Transport ampCommunicationTobacco

Other expenses

Source Tobacco and Poverty Study in the Philippines May 2006 Basic Data FIES 2003

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 57: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 57

|

Impact of Tobacco Use on Individuals and Families

Impact of Tobacco Use on Individuals and Families

bullPoor families spend a larger proportion of their income on tobacco than do people of higher socioeconomic groups

bullMoney spent on tobacco cannot be spent on food sheltereducation and health care

bullTobacco users are more likely to fall ill and die prematurely of tobacco-related diseases resulting in loss of income and high health care costs

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 58: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 58

|

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Summary of Economic Costs in US$) for Four Smoking-related Diseases

(2003 using SAMMEC methodology figures)

Smoking-related Diseases

Health Care Costs

Productivity Losses from

Death

Productivity Losses from

DiseaseTotal Costs

Lung Cancer 9188871 189709987 3407151 202306009

CVD 507315052 2930533343 38910556 3476758951

CAD 236888476 1312836695 88922515 1638647686

COPD 104561119 569530925 54043648 728135692

All 4 Diseases 857953518 5002610950 185283871 6045848339

Source Tobacco and Poverty Study in the Philippines 2006

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 59: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 59

|

How Tobacco Contributes to Poverty National-Level

bullTobacco not only impoverishes those who use it it puts an enormous financial burden on countries from

1048590 Increased health-care costs1048590 Lost productivity due to illness and early death1048590 Foreign exchange losses1048590 Environmental damage

Environmental degradationbull1048590 About 200000 hectares of forests consumed each year by

tobacco farmingbull1048590 Estimated 5 of all deforestation in developing countries

where tobacco is grown is due to tobacco productionbull1048590 Pollution from pesticides and fertilizersbull1048590 Solid and chemical waste from manufacturing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 60: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 60

|

Key Population-Level InterventionsKey Population-Level Interventions

bullTobacco tax increases are the best way to cut consumption especially among the young and the poor

Support national law that would increase excise taxes of cigarettes

bullEnact and enforce ordinances establishing 100 smoke-free public places

bullChange image of smokingSupport national law on graphic health warning

bullHelp with cessationSimple medical advice pharmacotherapy

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 61: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 61

|

Tobacco Free Plan-It Mini Survey

Core Adult Tobacco Survey (9 CATShellipand 3 kittens)

Q1 Current tobacco smoking statusDo you currently smoke tobacco on a daily basisless than daily or not at all

Q2 Past tobacco smoking statusIn the past have you smoked tobacco on a daily basis less

than daily or not at all

Q3 Currently chewing tobaccoDo you currently chew tobacco on a daily basis less than daily or not at all

Q4 Frequency of smoking in the homeHow often does anyone smoke your home Daily weekly

monthly less than monthly or never

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 62: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 62

|

Core Adult Tobacco Survey

Q5 Smoking at the workplaceDuring the past 30 days did anyone smoke in indoor (enclosed)

areas where you work

Q6 Receiving brief cessation advice from a health care workerDuring any visit to a health care worker in the past 12 months wereyou advised to quit using tobacco

Q7 Thinking about quitting because of health warnings on cigarette packs

In the last 30 days have warning labels on cigarette packages led you to think about quitting

Q8 Tobacco advertisingIn the last 30 days have you noticed any pro-tobacco advertisements

Q9 Cigarette promotionsIn the last 30 days have you noticed promotion of cigarette brands in

clothing gift items or free samples

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 63: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 63

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

Penalties

Citation Ticket System

Smoking Cessation Program

Smoke Free Task Force Duties and Responsibilities

Information Campaign

Financing

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 64: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 64

|

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

ELEMENTS OF AN IDEAL ANTI-TOBACCO ORDINANCE

Prohibited Acts

ndash Smoking in enclosed or partially enclosed public places workplaces public conveyances or other public places

ndash Selling or distributing tobacco products in a school public playground or other facility frequented by minors or within 100 meters from any point in the perimeter of these places

ndash Selling or distributing tobacco products to minorsndash Purchasing tobacco products from minorsndash Placing cinema and outdoor advertisements of tobacco products ndash Placing posting or distributing advertising materials of tobacco

products such as leaflets posters and similar materials outside the premises of point-of-sale establishments

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 65: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 65

|

Five Arsquos for the Health Care Practitioner

ASK Systematically identify all smokers at every visit

ADVISE Strongly urge all smokers to quit

ASSESS Determine willingness to make a quit attempt

ASSIST Aid the patient in quitting

ARRANGE Schedule follow-up contact

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 66: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 66

|

Need to pass a National Law on Graphic Health Information

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 67: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 67

|

What you can do to Protect Kids from Second Hand Smoke

What you can do to Protect Kids from Second Hand Smoke

Make your home and vehicle smoke-free at all times If there are smokers in your family they should always go outside to smoke Opening the window is not enough

Make sure your childrenrsquos day care centers and schools are 100 smoke- and tobacco-free

Insist that no one smokes around your children

Choose smoke-free restaurants and malls

The single best step If you smoke QUIT Quitting smoking will also reduce the chance that your children will grow up to become smokers themselves

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 68: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 68

|

ldquoThe cure for this devastating epidemic is dependent not on medicines or vaccines but on the concerted actions of government and civil societyrdquo

mdashMargaret Chan 2008Director General World Health Organization

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|

Page 69: Balanga Presentation

Healthy Lifestyle Summit

Balanga City 26 Nov 2010 69

|