Role of Health Professionals in Tobacco Control

2. Role of Health Professionals in Tobacco Control Manar Moneer, MD Maissa Kamel Epidemiology and Biostatistics Dept. NCI

3. Tobacco Consumption • The single preventable cause of morbidity and mortality. • There is an estimated 1.3 billion smokers in the world (1/3 of the global population >15y). • Majority in developing countries (800 million), mostly men (700 million) • By 2025, 1.7 billion IF • No dramatic changes in cessation rates, • No new interventions • Children start at expected rates

4. The Problem GLOBALLY • Tobacco kills • 1 person /6.5 seconds • 13,699 smoker/day • 5 million smoker/year • By 2020  10 million IF • present consumption patterns continue 70%in developing countries

5. In EGYPT • Egypt has one of highest rates of tobacco consumption in the Arab world. • Smoking is an increasing public health problem • ~ 13 million smokers • 20% of the population >15 yrs • ~ 60 billion cigs. annually • No. of smokers  by 8% per year • in 1970  12,027 million cigs. • in 1997  51,814 million cigs. •  # of smokers over twice as fast as the population growth

6. In EGYPT • WHO reports that smoking causes 90% of lung cancer cases in Egypt • Smoking has a definite economic cost to Egypt. • The direct annual cost of treating tobacco-related diseases in Egypt is estimated at 3 billion L.E.

7. In EGYPT In 1997

8. In EGYPT Among Professionals

9. ACTIONS to be taken • Governments and legislators have a role to play but they are not the only ones. • Society at large needs to be involved in the struggle against tobacco. • One group of professionals has a special role; Health Professionals

12. ROLES of Health Professionals • Role Model • Clinician • Educator • Scientist • Leader • Opinion builder • Alliance builder

13. ROLE MODEL Why ? • Most knowledgeable in health matters • Expected to act on basis of this knowledge. • Expected to be role models for the rest of the population • This includes, • in general, their behavior in health-related matters such as diet and exercise, and • particularly regarding tobacco

14. The Reality • Most people addicted tobacco before becoming a health-care provider. • > 90% of all adult smokers begin when teens, or earlier • > 1/2 become regular, daily smokers before the age of 19. • Groups of health professionals may have a similar (if not higher) smoking prevalence than the rest of the population.

15. The Reality • Health professional is aware of the health consequences of tobacco use, more than any professional in a different field. • Knowing the health hazards of tobacco is not enough to overcome tobacco addiction • Using their professional and popular respect, • they could change current smoking trends & • spread head a national antismoking movement.

16. The Reality IfTHEY ARE SMOKERS • This will create conflict • It affects their image • credibility as a spokesperson on tobacco • They are less • To promote smoking cessation • To engage in tobacco control.

17. So, health professionals smokers need • further support & more efforts to assist them in becoming tobacco-free role models • the smoking-cessation program must assist not only their patients but also themselves. • Health professionals should be tobacco-free role models • Peers should encourage & assist one another. • By providing supportive, non-judgmental care

18. Health professionals should know that • Tobacco dependence is a disease • It is not a moral issue • Smoker is not a weak-willed person • BUT a human being thathas a health problem and needs treatment with a human and empathic approach

19. Remind patients that stopping smoking • at any age results in tremendous health benefits, • The earlier the better CLINICIAN Incorporate Cessation Counseling in your Practice Assess Tobacco Use • With vital signs monitoring. • And at every visit • Mark on the patient's chart • Explain short and long term effects • Advise quitting & its benefits

20. Immediate health benefits of Giving up Tobacco AFTER • 20 Minutes • BP & pulse ↓↓ to a normal rate • Temperature of hands & feet ↑↑ to normal • 8 Hours • CO level in blood ↓↓ to normal • O2 level in blood ↑↑to normal • 24 Hours • Chance of heart attack starts ↓↓ • 48 Hours • Nerve endings start growing again • Smell & taste begin to improve

21. Short-term health benefits of Giving up Tobacco • 2 Weeks to 3 Months • Circulation improves • Walking gets easier • Lung function improves up to 30% "It's great not have to clear my throat all the time." "I can talk again when I walk upstairs!"

22. Short-term health benefits of Giving up Tobacco • 1 Month to 9 Months • ↓↓ coughing, sinus congestion, tiredness & shortness of breath • Cilia (small hairs) grow back in lungs • to better handle mucous, • clean the lungs & • reduce infection “I’m not bogged down with headaches" "I get fewer colds and sore throats." "I concentrate much better."

23. Long-term health benefits of Giving up Tobacco • 1 Year • Risk of coronary artery disease is 1/2 that of a smoker “No more heaviness in my chest in the morning"

24. Long-term health benefits of Giving up Tobacco • 5 Years • Lung cancer death rate  by 1/2 • Risk of stroke = as non-smoker • Risk of cancer of mouth, throat, esophagus, bladder, kidney and pancreas . • In addition: • Quitting can dramatically improve chronic illnesses (diabetes, asthma or kidney failure)

25. Simple advice from a physician has been shown to ↑↑ abstinence rates significantly (by 30%) compared to no advice.

26. Nursing-led interventions for smoking cessation increase by 50% the chances of successfully quitting.

27. Interventions that use multiple providers are very effective All health-care professionals can have an impact in assisting with cessation

28. Essentially, the more a person hears a consistent message from all health professionals, the more likely that person will be able to quit successfully.

29. You Need Not to be a Cessation Specialist • This is a specially trained counselors, who can be: • physician • nurses, • social workers, • psychologists • any other health professional

30. In your daily routine • Implement the minimal intervention steps of • ask about tobacco use, • advise quitting • assess willingness' to quit • assist the patient to quit • arrange for follow up 5 A’s Approach

31. Health professionals should also be: • science-based in developing & disseminating practical materials about cessation • adapted to the • culture, age, language, • health status ofpatient • attitude towards quitting tobacco use.

32. Health professionals need to make Cessation Advice relevant to Patient's Current Situation by linking it • with existing diagnosis • or current lifestyle. Relevant Advice

33. For a young patient • smoking can cause bad breath • it is an expensive habit • it will mean poorer performance in sports

34. For an older patient • the possibility of lung cancer could be more compelling as he has been a tobacco user for a longer period of time.

35. In pediatrics and maternal-child health clinics • assess exposure to tobacco smoke • provide information about avoiding all exposure (especially passive smoking). • more important when tobacco use by the client may not be an issue So, tobacco assessment & advice on quitting can be incorporated in a variety of clinical settings.

36. EDUCATOR • Preparation of new generations of health professionals. • This involves: • students training (pre- & post-graduate) • bedside education • continued education and training • research and evaluation. Training Changes Practice

37. Tobacco control can be taught as a separate matter or be a part of existing content: epidemiology, health promotion, prevention and treatment, etc.. Training time is also an ideal opportunity to offer support to students who are tobacco users and are trying to quit. In Health Professional Curricula

38. SCIENTIST • Tobacco control measures must be based on • facts • evidence • All health professionals should be aware of science-based information to implement tobacco control measures

39. Tobacco is a cross-cutting issue • SO research on tobacco should be included in several fields: • cancer clinical trials, • maternal-child health programs • cardiovascular disease studies. • For Funding & Research agencies; Create awareness and educate

40. LEADER • Health is a leadership responsibility • Many health professionals have leadership positions • Leadersare involved inpolicy-making process • This leadership position can be exerted at level: • Community • National • Global

41. Leaders Should support comprehensive tobacco control: • smoke-free workplaces • increased taxation • increased prices of tobacco products; • campaigns to prevent youth from taking up tobacco • funding for tobacco control programs • All health professionals can take small steps to address at least one issue at their own workplace (e.g. promoting smoke-free environments)

42. Health professionals who belong to professional organizations can also influence their organization • to become involved in tobacco control policy-making & • to place tobacco control in the organization's agenda,

43. Encourage their members to be role models by not using tobacco by promoting a tobacco-free culture. Assess & address the tobacco consumption patterns and tobacco-control attitudes of their members through surveys Introduction of appropriate policies. Make the organizations’ events tobacco-free Include tobacco control in the agenda of all relevant health-related congresses & conferences. Role of Health Professional Organizations

44. Role of Health Professional Organizations • Advise their members to 5 A’s approach to their patients. • Influence other health institutions & educational centers to include tobacco control in their curricula, through • continued education • other training programs. • Actively participate in World No Tobacco Day every 31 May. • Refuse financial support from tobacco industry.

45. Role of Health Professional Organizations • Prohibit the sale or promotion of tobacco products on their premises • Participate in the tobacco-control activities of health professional networks. • Support campaigns for tobacco-free public places.

46. OPINION-BUILDER • This role has great potential as: • a citizen of a community • member of an NGO • through national associations, • They can & should express clearly the magnitude of the tobacco issue in terms of • diseases • suffering • premature deaths • economic burden for society

47. OPINION-BUILDER • Becoming politically active • Writing letters to newspapers and other media, • Issuing press releases • Collecting signatures • Assisting in disseminating information. • Should be knowledgeable of existing information resources.

48. ALLIANCE-BUILDER • Health is important to • all health professionals • other groups. Public health is no one's domain but everyone's arena. • Sometimes a health professional group should • act by itself but • cooperation with others should always be considered carefully. • Tobacco control cut across a vast range of health disciplines • To ensure that all of those, support in one way or another tobacco control.

49. ALLIANCE-BUILDER • Health professionals can form alliances • as individuals, • between societies & organizations. • The results of such alliances • can have a much greater impact & • the benefits to tobacco control, are enhanced.

50. ALLIANCE-BUILDER • Building alliances in a vertical way is also a way • to synergize efforts • To obtain better outcomes by using existing resources. • Every type of health professional association • at the local or national level has its counterpart • at the regional, international or global level.