1. Evidence-based/Best Practices Tobacco Control Hadii Mamudu, PhD, MPA COPH-China Institute November 17, 2011

2. Outline of Presentation Types of tobacco products Scientific bases for tobacco control Health and Economic Consequences of Tobacco Use (Smoke and Smokeless) Approaches to tobacco control ◦ Demand-side ◦ Supply-side ◦ Production-side ◦ Addressing tobacco industry interference in policy ◦ Building capacity Effects of tobacco control

3. Scientific Bases for Tobacco Control Biomedical research Epidemiology Policy Analysis Documents research

4. Scientific Bases for Tobacco Control U.S. Surgeon General since 1964 UK Royal College of Physicians since 1962 World Health Organization since 1970 International Agency for Research on Cancer World Bank

5. Tobacco Products

6. Smoke Contains 400-500 known carcinogens Cigarette Cigar Kretek Hooka/Waterpipe

7. Smoke The future of many kids is at stake From Indonesia

8. Smokeless Chewing Snuff Snus Dip

9. Emerging Tobacco Products E-cigarettes Herbal Cigarettes

10. Tobacco Use as a Global Problem Smoking prevalence The United States: 46+ million China: 350+ million Globally: 1.35+ billion

11. Consequences of Tobacco Use Leading Cause of Preventable Diseases and Deaths

12. Health Consequences Direct tobacco use Death ◦ United States: 443,000 ◦ Globally: 5.4 million Increased health risks Cardiovascular Diseases Respiratory Diseases Cancer Adverse Reproductive Effects Adverse Early Childhood Effects NB: Tobacco kills half of its users

13. Health Consequences Secondhand smoke (SHS) /environmental tobacco (ETS)/Involuntary or Passive Smoking Heart Disease ◦ United States: 46, 000 deaths among nonsmokers ◦ Globally: 600,000 deaths among nonsmokers Lung Cancer Sudden Infant Death Syndrome (SID) Adverse effects for children ◦ Bronchitis and pneumonia ◦ Cough ◦ Asthma attacks ◦ Ear infections

14. Health Consequences Tobacco Addiction ◦ Nicotine is a drug U.S. Surgeon General Report, 1988 UK Royal College of Physicians Tobacco is addictive more than banned substances

15. Health Consequences Source: U.S. Surgeon General Report, 2010

16. Economic Consequences Direct Medical Costs + Lost Productivity ◦ United States: $193 billion ◦ Globally: $500+ billion Household expenditure ◦ Crowd out expenditure on essential needs ◦ Increases poverty Environmental damage ◦ Deforestation ◦ Toxic chemicals

17. Approaches to Tobacco Control

18. Prohibition vs. Control Prohibition Late 19 th and early 20 th Century: Cigarettes Prohibition in the U.S. ◦ Failed Country with prohibition: Bhutan ◦ Illicit trade: smuggling, counterfeiting, bootlegging Control ◦ Since the mid-20 th Century ◦ Has been successful  Cut smoking rates in the U.S. and Europe by more than a half.

19. CDC Best Practices for Tobacco Control, 1999, 2007

20. World Bank Curbing the Epidemic, 1999

21. World Health Organization The WHO Framework Convention on Tobacco Control (FCTC) International tobacco control treaty 174 Members ◦ Not including United States

22. World Health Organization The MPOWER Reports, 2008, 2009, 2011

23. Experts/Scientists

24. Individual vs. Population-Based Individual-base: Cessation and treatment for tobacco dependence ◦ Clinical interventions ◦ Therapies ◦ Counseling ◦ Nicotine Replacement (e.g., patches, gum, inhalers, drugs) Note ◦ Majority of smokers quit without cessation treatments ◦ Most ex-smokers try several times before quitting  ≈5-7 times

25. Individual vs. Population-Based Population-based Tax increases Ban on advertising and promotions Preventions Anti-tobacco campaign Smoke-free environments Quitlines Monitoring Advocacy

26. Individual vs. Population-Based

27. Demand-side policies Tax increases (70% of Retail Price) ◦ Reduce consumption ◦ Encourage cessation Health Warnings (45 countries with Pictograms)

28. Supply-side policies Ban on sale to minors ◦ Youth access laws ◦ Restricting tobacco industry promotions Control illicit trade in tobacco products ◦ Smuggling ◦ Counterfeiting ◦ Bootlegging Tracing and Tracing

29. Production-side policies Tobacco and Poverty Alternative sources of livelihoods ◦ Switching from tobacco production

30. Capacity Building for Tobacco Control Institutions Education Advocacy ◦ Encouraging civil society groups ◦ Liaising with the international community Scientific research ◦ Country-specific data Understand the Tobacco Industry’s Role(s) in Policy ◦ The tobacco industry documents The tobacco industry documents

31. The Tobacco Industry The Global Industry: Market Share

32. The Tobacco Industry Promote tobacco use Undermine policy ◦ Lobbying ◦ Corrupting the policy process ◦ Focus attention on economics; not health ◦ Divert attention from the effects of tobacco use ◦ Etc.

33. Effects of Tobacco Control

34. Smoking Prevalence Prevent smoking initiation Reduce tobacco use

35. Health Improves health Reduces health risks Helps with cessation

36. Economic benefits Does not harm economy ◦ See the World Bank’s Cubing the Epidemic Saves medical costs ◦ $80+ billion saved by the California Tobacco Control Program Generates revenue through higher taxes (“sin tax”) Makes more money available to households

37. The Scientific Consensus Mamudu et al., 2011

38. Thank you!!