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Impacting policy for Tobacco Control: Johns Hopkins SPH

Department of Epidemiology. Impacting policy for Tobacco Control: Johns Hopkins SPH. Frances Stillman, Ed.D. June 9, 2005 Varna, Bulgaria. Institute’s Role in Global Tobacco Control. Conducting research on the magnitude of the epidemic and methods to control its spread.

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Impacting policy for Tobacco Control: Johns Hopkins SPH

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  1. Department of Epidemiology Impacting policy for Tobacco Control:Johns Hopkins SPH Frances Stillman, Ed.D. June 9, 2005 Varna, Bulgaria

  2. Institute’s Role in Global Tobacco Control • Conducting research on the magnitude of the epidemic and methods to control its spread. • Working to develop evidence-based policies and methods to evaluate progress to control tobacco use. • Building capacity through educating a cadre of tobacco control leaders around the world

  3. IGTC: WHO Collaborating Center • Designated in 2004 a collaborating center of the Pan American Health Organization (PAHO) and World Health Organization (WHO) • Focus on surveillance and evaluation • One of three WHO Collaborating Centers in the U.S.

  4. Korea National Cohort of Active and Passive Smoking Spain Secondhand Smoke Pilot Study Poland Cotinine FAMRI Secondhand Smoke Monitoring in Women and Children US: ASSIST & Smokeless States Evaluation STEP-UP Program Young Adult Smoking Study Vietnam Capacity & surveillance SHS Study in 8 Latin Countries Southeast Asia: Research capacity building India Cotinine Study Mexico Cotinine Study Fogarty • China: • 1996 National Survey • 1998 Survey • 2005 Survey • Cotinine Study • SHS Study Brazil Cotinine Study Fogarty Current Institute for Global Tobacco Control Projects

  5. Southeast AsiaTrading Tobacco for Health: Building Research Capacity • Magnitude of the problem Research and surveillance support to Thailand, Cambodia, Malaysia and Vietnam (others) • Policy action Synthesizing evidence for presentation to national policy makers • Training Regional workshops, research mentoring and network development

  6. Surveillance and Observational Study • Secondhand Smoke hospitals, schools, government buildings, and restaurants • Point of Purchase • Warning Labels

  7. Tobacco Control Tracking Tools and Database

  8. Posting of Signs in Health Facilities *p<0.05; **p<0.01; ***p<0.001 Signs with warnings of fines or penalty: 2.7% in Cambodia, 15.6% in Malaysia, and none in Vietnam

  9. Non-compliance in Restricted Areas of Health Facilities *p<0.05; **p<0.01; ***p<0.001

  10. Air Monitoring • Measures air nicotine(in the absence of smoking, nicotine is not • present in air) • Passive Monitoring Techniques • Provides data useful for policy development

  11. Fogarty Project:Building Epidemiology, Surveillance and Intervention Capacity GOAL: To build capacity to use evidence to promote effective policy strategies. • Mexico Establish Center of Excellence and build capacity in country and regionally • China Reduce SHS exposure and establish Center of Excellence for training and mentoring • Brazil Prevent youth uptake of smoking and promote tobacco control policy action

  12. Fogarty: China • Creation of Smoke-Free Public Places • Pilot test intervention model to implement smoke-free public places (government buildings, hospitals, schools, buses) • Use of observational tools and nicotine monitors to measure SHS exposure in public places • Household survey of knowledge, attitude, and practices

  13. Demographic Characteristics, Smoking Status and SHS Exposure N=15,096 Smoking Status by Gender • Mean Age: • 45 years • Gender: • 48% Male • 52% Female 58.5% Secondhand Smoke Exposure 3.2%

  14. SHS Exposure by Place and by Person* *Percentages do not add to 100%

  15. Practices of Smoking Inside the Home

  16. Flight Attendant Medical Research Institute (FAMRI) Project • Characterize levels of SHS in homes in a large number of countries (>20) • Characterize the average level of nicotine in women and children exposed to SHS in these homes • Generate a global profile of SHS exposure among women and children and estimate the associated risks to women and children

  17. FAMRI Project • Passive air monitors in homes • Biological samples from women and children (hair nicotine) • Smaller pool of urine samples (tobacco-specific nitrosamines) • Survey of perceptions and attitudes

  18. Airborne Nicotine in Public Places in Latin America Phase 1 7 Capital Cities in South America Phase 2 8 Additional Capital Cities in Central America and the Caribbean

  19. Airborne Nicotine in Public Places in 7 Latin American Countries Navas-Acien, A. et al. JAMA 2004;291:2741-2745.

  20. Study Outcomes 16/03/04 - SE CONSIDERAN LAS DEPENDENCIAS SANITARIAS DEL PAÍS AMBIENTES 100% LIBRES DE HUMO DE TABACO […] CONSIDERANDO: I) que según datos de la Organización Panamericana de la Salud, del 10% al 15% de las muertes producidas por enfermedades tabaco dependientes en las Américas se producen en no fumadores como consecuencia de la exposición pasiva al humo de tabaco II) que los resultados del Estudio de Vigilancia de la Exposición al Humo de Tabaco realizado en Uruguay en centros asistenciales, liceos, oficinas públicas y otros, a instancias de la Organización Panamericana de la Salud y del Instituto para el Control Mundial del Tabaco de la Universidad Johns Hopkins de los Estados Unidos de Norteamérica (julio 2003), demostraron que en todas las áreas estudiadas existían niveles importantes de contaminación por humo de tabaco […] ATENTO: a lo dispuesto por el artículo 2°. de la Ley N°9.202 de 12 de enero de 1934- Orgánica de Salud Pública EL PRESIDENTE DE LA REPÚBLICA DECRETA: Artículo 1°.- Dispónese que todas las dependencias sanitarias del país, tanto públicas como privadas, son consideradas "Ambientes 100% Libres de Humo de Tabaco“ Smoke-free laws passed in health-related facilities in Uruguay after publishing results of the study

  21. Global Tobacco Research Network (GTRN) Mission Statement “The Global Tobacco Research Network aims to enhance tobacco control worldwide by providing information, promoting partnerships, and encouraging research focused on reducing tobacco-related addiction, disease, and death.”

  22. GTRN Website www.tobaccoresearch.net

  23. GTRN Literature Database Reviewed and classified articles from 184 developing countries on tobacco control research from peer reviewed journals (published between 1999-2005) available from 10 databases: 1-Business Industry 2-CINAHL (Cumulative Index to Nursing & Allied Health Literature) 3-Academic Search Elite 4- EMBASE 5- PUBMED 6- Psychinfo 7- Business Source Premier 8- WHO database 9- World Bank- JOLIS 10- ABI/ Inform (Proquest)

  24. GTRN - Tobacco Atlas

  25. GTRN – Research Assistance Matching (RAM) Program Project RAM is an innovative online service that facilitates tobacco control research collaboration by connecting researchers and providing them with a platform to share and exchange information • What does RAM offer? • Personalized project pages • Categorized project directory • Expert directory • Participant profiles • Matching service • Ability to upload files • Messaging

  26. Johns Hopkins Online Tobacco Control Course Course URL:http://distance.jhsph.edu/tobacco

  27. Scientific Evidence to Inform Policy Makers

  28. Tools for Tobacco Control Active and Passive Smoking & Health CD-ROMs.

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