World No Tobacco Day 2011

Today, 31 May 2011, is World No Tobacco Day. The World Health Organization (WHO) has selected “The WHO Framework Convention on Tobacco Control” as the theme for 2011.

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the world’s foremost tobacco control instrument. The first treaty ever negotiated under the auspices of WHO, it represents a signal achievement in the advancement of public health. In force only since 2005, it is already one of the most rapidly and widely embraced treaties in the history of the United Nations, with more than 170 parties. “An evidence-based treaty, it reaffirms the right of all people to the highest standard of health and provides new legal dimensions for cooperation in tobacco control,” WHO says.

• The tobacco epidemic kills nearly 6 million people each year, including 600,000 non-smokers.
• After high blood pressure, tobacco use is the biggest contributor to the epidemic of non-communicable diseases—such as heart attack, stroke, cancer, and emphysema—which accounts for 63 percent of all deaths worldwide.
• No consumer product kills as many people and as needlessly as does tobacco. It killed 100 million people in the 20th century. Unless we act, it could kill up to one billion people in the 21st. All of these deaths will have been entirely preventable.

The most powerful tool at our disposal to curtail the tobacco epidemic is the WHO FCTC, which effectively protects people from the many harms of tobacco. The WHO FCTC obliges its parties to take incremental action against tobacco consumption, marketing and exposure, among many other measures.

The key is full implementation of the WHO FCTC.

Click here to learn more about World No Tobacco Day 2011.

Smoking, secondhand smoke linked to breast cancer after menopause

A study of nearly 80,000 middle-aged women in the U.S. links smoking with an increased risk of breast cancer after menopause. The study also found an association between secondhand smoke and breast cancer among these postmenopausal women.

Compared with women who had never smoked, breast cancer risk was elevated by nine percent among former smokers and by 16 percent among current smokers. Breast cancer risk was significantly higher among chain smokers, as well as those who started smoking in their teenage years. An increased risk of breast cancer persisted for up to 20 years after smoking cessation.

Among women who had never smoked, those with the most extensive exposure to secondhand smoke (10 years or more during childhood, 20 years or more in adulthood at home, and 10 years or more in adulthood at work) had a 32 percent excess risk of breast cancer compared with those who had never been exposed to passive smoking.

Source:
1. Luo J, Margolis KL, Wactawski-Wende J, et al. Association of active and passive smoking with risk of breast cancer among postmenopausal women: a prospective cohort study. BMJ 2011; 342: d1016. (open access)

Recommendations for addressing smoking among doctors in Laos

Doctors in Laos, a low-income country in Southeast Asia where community smoking prevalence is high, are prepared to contribute to tobacco control programs if equipped with the appropriate tools, according to a study assessing smoking prevalence among Laotian medical doctors. The study also makes government recommendations to engage doctors in tobacco control.

The study found that 9.2 percent of medical doctors in Laos are current smokers, the majority being male (17.3 percent, compared to only 0.4 percent of female doctors) and older. Over 84 percent of current smokers wanted to quit, and 74.7 percent had made a recent serious attempt to do so. More than 18 percent were ex-smokers.

Doctors had excellent knowledge about the harms of smoking and had positive attitudes towards quitting, but the large majority lacked confidence in providing assistance for cessation, with few having undergone training. Three-fourths of doctors were engaged in cessation support, but just 24 percent had been trained to do so, and a mere 8.8 percent considered themselves ‘well prepared.’

“The willingness of doctors to take up their tobacco control role and the lower smoking rates among younger respondents offers an important window of opportunity to consolidate their knowledge, attitudes, skills and enthusiasm as cessation advocates and supports,” the study concluded.

Recommendations for the Laos Ministry of Health

The study offered the following recommendations to engage doctors in smoking prevention and cessation more actively:

• Targeted cessation support for doctors to assist their quit attempts and bolster their image as role models for non-smoking;
• Training programs for doctors (and medical students) on brief advice and cessation counseling to enable them to support patients and community;
• Training programs for lower level health professionals in cessation support to reach greater numbers of the Lao population;
• Expansion to all regions of nicotine replacement therapy and medications of proved effectiveness to aid cessation;
• Medical school and in-service education for doctors (and health professionals) on the health, financial and other costs of tobacco use;
• Raising consciousness for doctors and the broader community about the negative impacts of gender norms for men and boys that encourage tobacco uptake; and
• Implementation of Framework Convention on Tobacco Control (FCTC) measures of greatest impact on prevention and cessation of tobacco use, including price increases and strict enforcement of smoking bans in workplaces and public spaces.

Source:
1. Vanphanom S, Morrow M, Phengsavanh A, et al. Smoking among Lao medical doctors: challenges and opportunities for tobacco control. Tobacco Control 2011; 20: 144-150. (open access)

Tobacco industry tactics in the developing world

Tobacco consumption has fallen over the past 20 years in the United States, Australia, Canada and most European countries; and so tobacco companies are turning their marketing efforts to low- and middle-income countries in Africa, Asia and Latin America to compensate for the loss of markets in high-income countries.

The tobacco industry has employed various strategies and tactics including cigarettes smuggling, recruiting of new and young smokers, denying the health consequences of smoking, manipulating governments to delay tobacco control legislations and the sponsoring of health professionals and academic institutions to act in their favor.

In addition to the negative health consequences, this focus has also fostered an economic dependence on tobacco in countries like Malawi and Brazil, who depend on tobacco exports.

Currently, there are over 1.2 billion tobacco users in the world. Around two-thirds of all smokers live in developing countries. Out of the total burden of tobacco-related diseases globally, 70 percent will occur in developing countries by 2030.

Source:
1. Doku D. The tobacco industry tactics—a challenge for tobacco control in low and middle income countries. African Health Sciences 2010; 10(2): 201-203. (open access)

Anti-smoking images, multimedia most effective among Pakistani youth

Anti-smoking graphic images and multimedia depictions are most effective at getting teens to abstain from smoking and using tobacco, according to a study of high school students in Pakistan.

The students in the study perceived a picture of oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator to be the most effective anti-smoking messages. Messages about addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective.

“These aids, in the form of health warnings, health promotion campaigns and material in school curricula, may be useful as effective tobacco control modalities in developing countries with young populations,” the study concluded.

Source:
1. Zaidi SMA, Bikak AL, Shaheryar A, et al. Perceptions of anti-smoking messages amongst high school students in Pakistan. BMC Public Health 2011; 11: 117 (open access)

Secondhand smoke levels unacceptably high in Ghana

In Ghana, as in most countries in Africa, little is known about the extent of secondhand smoke exposure in public places. A study found that seconhand levels were unacceptably high in public places in Ghana where smoking is allowed, comparable to those measured in American, Asian and European countries without or before smoking bans.

The study measured particulate matter and air nicotine concentrations in hospitality venues and hair nicotine concentrations in non-smoking employees in Ghana.

Implementing a comprehensive smoke-free legislation that protects workers and customers from secondhand smoke exposure in indoor public places is urgently needed in Ghana, according to the study.

Source:
1. Agbenyikey W, Wellington E, Gyapong J, et al. Secondhand tobacco smoke exposure in selected public places (PM2.5 and air nicotine) and non-smoking employees (hair nicotine) in Ghana. Tobacco Control 2011; 20: 107-111. (open access)

Smoking increases breast cancer risk after menopause

Postmenopausal women who smoke have up to a 16 percent higher risk of developing breast cancer compared to women who have never smoked, according to a 10-year study of 80,000 women. In addition, the risk of developing breast cancer was elevated by nine percent among women who used to smoke.

The study also finds that postmenopausal women who were exposed extensively to secondhand smoke, either in childhood or as adults, may have a more than 30 percent excess risk of developing breast cancer.

Read more at Suite101.

Source:
1. Luo J, Margolis KL, Wactawski-Wende J, et al. Association of active and passive smoking with risk of breast cancer among postmenopausal women: a prospective cohort study. BMJ 2011; 342: d1016. (open access)

Impact of Mexico City’s smoking ban on local businesses

Smoking ban had positive impact on Mexico City businesses

Mexico City’s 2008 city-wide smoking ban has not had a negative effect on revenues, wages and employment levels in the businesses affected by the law, including restaurants, nightclubs, bars and taverns, a study finds.

The study’s findings are consistent with results from similar studies carried out in other countries and settings globally. Smoke-free environments protect the health of non-smokers and workers in the hospitality industry, and also contribute to decreasing the social acceptability of smoking and the consumption of active cigarette smokers.

“These results provide scientific evidence to policymakers and legislators in Mexico and in other countries to impel local laws that promote 100% smoke-free public places in order to fulfill the provisions of the Framework Convention on Tobacco Control,” the study concluded.

Read more at Suite101.

Source:
1. Guerrero López CM, Jiménez Ruiz JA, Reynales Shigematsu LM, Waters HR. The economic impact of Mexico City’s smoke-free law. Tobacco Control, published online 3 Feb 2011.  (open access)

Smokers who drink heavily are at highest risk of death

Smoking and drinking is unhealthy

Cigarette smoking and heavy alcohol drinking are both related to an increased risk of death. A study from Scotland found that smokers who drank 15 or more units of alcohol per week were at highest risk of death, particularly because these heaviest drinkers were more likely to smoke more than people who drank less.

Smoking had stronger effects than alcohol for most of the causes of early death investigated, including coronary heart disease, stroke and cancer. Blood pressure and body mass index (BMI) generally increased with alcohol consumption, but decreased with smoking, with those who had never smoked but who drank 15 or more units per week having the highest blood pressures and BMIs.

A person’s socioeconomic position and level of education were strongly related to both alcohol consumption and smoking. For example, 30 percent of men who worked in manual jobs were both smokers and heavy drinkers compared with only 13 percent of men in other jobs. “Given the increased mortality rates associated with both smoking and heavy drinking, this will inevitably contribute to socioeconomic health inequalities,” researchers said.

These findings reinforce the importance of continuing to prioritize smoking cessation. “Given the strong links between smoking and heavy drinking, it may also be helpful to devise policies aimed at reducing both smoking and alcohol consumption in population groups where this is common,” the study concluded.

Source:
1. Hart CL, Smith GD, Gruer L, Watt GCM. The combined effect of smoking tobacco and drinking alcohol on cause-specific mortality: a 30-year cohort study. BMC Public Health 2010; 10: 789. (open access)

Teen smoking and socioeconomic disparities in Ghana

Teenagers of lower socioeconomic status are more likely to take up smoking than their more affluent counterparts, finds a study from Ghana.

Those teens in the study who are expected to end up in adulthood in a lower socioeconomic status than their families (downwardly mobile) are more likely to use tobacco than those teens who are stable in the high socioeconomic status.

Health promotion and tobacco control strategies aimed at reducing teen smoking should pay attention to adolescents of lower socioeconomic statuses and those in danger of dropping out of school, the study concludes.

Source:
1. Doku D, Koivusilta L, Raisamo S. Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents. BMC Public Health 2010; 10: 758. (open access)