Tobacco Epidemic And Control
Dr. Rohit A
PG in Community Medicine
SDMCMSH
Dharwad
Outline
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History of tobacco
Epidemiological model
Trends of tobacco use
Tobacco epidemic curve
Trans theoretical model of smoking cessation
Tobacco control: WHO-FCTC and India
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
History of tobacco use
• Origin- South America
• 1492- Columbus
• 1700s
Europeans- snuffed it
Native Americans- chewed it
• 1800s
• 19 and 20th century
Tobacco production
Smoking tobacco
Smokeless tobacco
Epidemiological model- AGENT
Epidemiological model- HOST
Epidemiological model- HOST
INCIDENTAL HOST
Epidemiological model- ENVIRONMENT
Historical
Economic
Political
Cultural
Epidemiological model- VECTOR
Trends in tobacco consumption
• WORLD: Last two decades-1% annual increase
in per capita consumption of tobacco
• Median age of initiation: 15years
• INDIA: 10% of world smokers
• 30.8% men, 2.8% women
• WOMEN: 200 million worldwide smoke
• Kerala -22% chew tobacco[rural]
• Deaths due to tobacco in India
1990-1.4%
2020-13.3%
• Consumers of tobacco
Male 46.5%
Female 13.8%
• 30 crores for NTCP
• 27 thousand crore-each
year
Exposure to SHS/ETS
• Side stream smoke + Main stream smoke
• Indicator of exposure
• Influencing factors
Exposure to SHS
• Side stream smoke + Main stream smoke
• Indicator of exposure
• Influencing factors
Direct
• Exposure
measurement
• Biomarker
Surrogate
• Marriage to a
smoker
Exposure to SHS
• Side stream smoke + Main stream smoke
• Indicator of exposure
• Influencing factors
Number of smokers
Intensity of smoking
Duration of exposure
Volume of indoor environment
Ventilation characteristics
Tobacco related diseases
Four stage tobacco epidemic
Stage - I
Stage - II
Stage - III
Stage - IV
The Kobe declaration
• 1999
• “ global ban on direct and indirect advertising,
promotion and sponsorship by the tobacco
industry across all media and all forms of
entertainment and demand public funding for
counter advertising that disconnects women's
liberation and tobacco use that reaches
women and girls in cultural context”
Tobacco control
• Main focus
• Multi faceted strategy
• Political commitment
Prevent initiation of tobacco use
Promote quitting among youth
Eliminate second hand smoke exposure
Programmes that are applicable
Tobacco control
• Main focus
• Multi faceted strategy
• Political commitment
Education and information
Legislative measures
Cessation efforts
Crop substitution and diversification
Litigation
Administration and management
Tobacco control
• Main focus
• Multi faceted strategy
• Political commitment
National level
Global level
Appropriate monitoring, evaluation and surveillance
Trans theoretical model of cessation
WHO FCTC
Article
Issue dealt with
Article 8
Production from exposure to SHS
Article 9
Regulations of contents of tobacco products
Article 11 Packaging and labeling of tobacco products
Article 12 Education, communication, training and public awareness
Article 13
Tobacco advertising, promotion and sponsorship
27 February, 2005
Monitoring, surveillance and
evaluation
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Surveillance of agent factor
Surveillance of host factors
Surveillance of vectors
Surveillance of environment
Toxic constituents
pH
Additives
Monitoring, surveillance and
evaluation
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Surveillance of agent factor
Surveillance of host factors
Surveillance of vectors
Surveillance of environment
Initiation pattern
Susceptibility
Dependence
Quitting pattern
Tobacco source
Tobacco price
Marketing and brand
Awareness
Monitoring, surveillance and
evaluation
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Surveillance of agent factor
Surveillance of host factors
Surveillance of vectors
Surveillance of environment
Industry and public relationship
Lobbying and marketing activity
Monitoring, surveillance and
evaluation
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Surveillance of agent factor
Surveillance of host factors
Surveillance of vectors
Surveillance of environment
National tobacco control legislation and programmes
Exposure to health messages
Tobacco promotions, prices and placements
Protect people from tobacco smoke
Offer help to quit
• Integrating tobacco cessation programmes
• Pharmacological therapy[NRT]
• Over the counter prescription
Warn about dangers of tobacco
Enforce bans on advertising
Raise taxes on tobacco
• 10% increase in cigarette price-demand reduction
4% reduction in high income countries
8% reduction in high income countries
• 70% increase in cigarette price-prevent quarter of
all tobacco related deaths
Tobacco control legislation- INDIA
• “the cigarettes and other tobacco products
act,2003”
• 2nd October, 2008
• National tobacco control programme
Tobacco control legislation- INDIA
• “the cigarettes and other tobacco products
act,2003”
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Smoking in public places
Direct and indirect advertising
Product sale <18years
Educational institutions
Warning signs
Tar and nicotine content
Tobacco control legislation- INDIA
• “the cigarettes and other tobacco products
act,2003”
• 2nd October, 2008
• National tobacco control programme
Tobacco control legislation- INDIA
• “the cigarettes and other tobacco products
act,2003”
• 2nd October, 2008
• National tobacco control programme
11th five year plan
Pilot phase
42 districts and 21 states
• Cessation clinic, 2002[WHO-GOI]
• NOTE- National Organization For Tobacco
Eradication, 1992
• Product regulation
References
• Michael D et al. Tobacco 10.1 In.Oxford textbook
of public health, 5th ed.
• WHO. WHO report on global tobacco epidemic,
2008: The MPOWER Package. WHO, Geneva
• Lopez AD (1999).A descriptive model of cigarette
epidemic in Cigarette epidemic in developed
countries. Tobacco control;3,242-7. WHO (2004),
Kobe Declaration, Tobacco free initiative report,
WHO,Geneva
References
• WHO (2004), Tobacco free initiative. Building
blocks for tobacco control; A hand book, WHO.
Geneva
• Park’s textbook of preventive and social
medicine, 22nd edition – K Park.
• Community medicine with recent advances, 2nd
edition – AH Suryakantha
• Glarti, FM Lewis and B K Rimer, ed Health
behaviour and health education. Jorrey-base, San
Francisco CA.