Public health policies and approaches for reducing prevalence of tobacco use E Tursan d’Espaignet Comprehensive Information Systems for Tobacco Control Tobacco Free Initiative Prevention of Noncommunicable Diseases WHO Geneva tursandespaignet@who.int, pujaris@who.int,

Regional Comparison Smoking prevalence in WHO Member States, Adults 15+ years, 2011 Recent regional estimates on Smoking any tobacco products including shisha among adults in the region shows high rate among males , the GAP between men and women smoking estimates is very wide . average regional estimate for men is 38%, compared to 4% among women. Source: WHO Report on the Global Tobacco Epidemic 2013. Geneva, World Health Organization, 2014, in print. Definition: Smoking at the time of the survey any form of tobacco including cigarettes, cigars, pipes, bidis, shisha , etc

Regional Comparison Tobacco Use Among Youth, 13-15 GYTS

http://www.who.int/nmh/global_monitoring_framework/en/index.html

Global voluntary tobacco target under adopted by Member States Indicator: Prevalence of current tobacco use among persons aged 15+ years Target: 30% relative reduction in prevalence of current tobacco Use between 2010 and 2025 Example: Prevalence for country X in 2010 = 20% Absolute reduction by 2025 = 30% of 20% = 6% Target for 2025 = 20 - 6 = 14% Monitor change (simple assumption) of 6%/15 = -0.4%p.a.

Tobacco Use Smoking Smokeless

Analysis exercise to set the tobacco target   Mostly pre-FCTC Post-FCTC Ratio of post FCTC to pre FCTC annual change Initial, End year Prevalence level (%) Average annual change Average annual change Australia 1991 2004 30% 21% - 0.7% 2004 2010 18% - 0.5% 0.7 Iran 1993 2005 20% 14% -0.5% 2009 12% 1.0 Ireland 1998 2007 33% 29% - 0.4% 2007 24% - 1.7% 4.0 New Zealand 1991 2006 26% - 0.1% 2006 - 1.0% 10.0 Thailand 1991 32% -0.7% 2011 21% 24% +1.5% 0.0% -- Turkey 2003 2008 34% 31% 2008 2012 27% -1.0% 2.0 Uruguay 2000 35% 0% -1.2% ? ∞ United Kingdom 1994 2004 25% - 0.2% 5.0

Analysis exercise to set the tobacco target   Mostly pre-FCTC Post-FCTC Ratio post to pre FCTC change Initial, End year Prevalence level (%) Average annual change Average annual change Australia 1991 2004 30% 21% - 0.7% 2004 2010 18% - 0.5% 0.7 Ireland 1998 2007 33% 29% - 0.4% 2007 24% - 1.7% 4.0 New Zealand 1991 2006 26% - 0.1% 2006 2009 - 1.0% 10.0 Thailand 1991 32% -0.7% 2011 21% 24% +1.5% 0.0% -- Turkey 2003 2008 34% 31% -0.5% 2008 2012 27% -1.0% 2.0 United Kingdom 1994 2004 25% - 0.2% 2005 5.0

New Zealand, observed and projected current smoking, women, 2000-2040   Projected current smoking (%) YEAR Women 2000 23 2005 21 2010 18 2015 16 2020 14 2025 12 TARGET 12.7 2040 8

Country B, observed and projected current smoking, women, 2000-2040   Projected current smoking (%) YEAR Women 2000 25 2005 22 2010 20 2015 18 2020 16 2025 15 TARGET 12.7 2040 11

Country C, observed and projected current smoking, men, 2000-2025   Projected current smoking (%) YEAR Men 2000 37 2005 36 2010 34 2015 33 2020 32 2025 30 TARGET 23.9 2040 28

Analysis of changes over time and projected estimates to 2025. 2010 2014 2025 Region Men Women Both sexes AFRO 23.2 2.5 12.8 25.3 2.2 13.7 34.7 1.6 18.1 AMRO 23.8 14.0 18.7 21.3 12.2 16.7 16.1 8.5 EMRO 35.1 3.0 19.6 37.4 2.8 20.6 45.2 2.4 24.5 EURO 39.8 19.5 29.2 37.2 18.4 27.4 31.0 15.7 23.0 SEARO 33.1 2.9 18.2 31.3 2.3 17.0 27.5 1.2 14.5 WPRO 49.0 3.5 26.6 47.4 3.1 25.6 43.1 GLOBAL 36.7 7.2 21.9 35.2 6.3 20.8 33.0 4.6 18.8 http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/en/index4.html

The WHO FCTC Carefully constructed comprehensive antidote aimed at controlling demand for and supply of tobacco products The target to be achieved through full implementation of the WHO FCTC and, (in particular, demand reduction measures including high tobacco product tax, large pictorial health warning labels, comprehensive smoke-free legislation, and bans on all forms of tobacco advertising, promotion and sponsorship).

Protect people from tobacco smoke through smokefree environments 14 TFI current focus: MPOWER, a package of measures each reflecting one or more provisions of the WHO FCTC Articles Description 20 Monitoring 8 Protect people from tobacco smoke through smokefree environments 14 Offering help to quit 11 & 12 Warning about dangers of tobacco 13 Enforcing bans on promotion, sponsorship and advertising 6 Raising taxes on tobacco

Potential impact of tax on prevalence rates Policy Description Potential relative effect sizes on prevalence Tax – short term effects For each 10% tax increase : High income countries - 1.5% Middle income countries - 2.0% Low income countries - 2.5% Impact appears to hold for about 1-3 years and then require a new tax injection Source: WHO draft estimates *work in progress

Potential impact of smokefree public places on prevalence rates Policy Description Potential relative effect size on prevalence Smokefree effects No ban in place - 0.0% Partial bans - 1.5% Comprehensive ban - 6.0% Source: Levy et al., SimSmoke model

Potential impact of marketing bans on prevalence rates Policy Description Potential relative effect size on prevalence Comprehensive bans Applied to tv, radio, print, billboard, in-store displays, no sponsorships, no free samples - 5% in prevalence Strong advertising bans Applied to all media: television, radio, print and billboards - 3% in prevalence Weak advertising bans Applied to some but not all of television, radio, print and billboards - 1% in prevalence Source: Levy et al., SimSmoke model

Potential impact of warnings on packets of cigarettes on prevalence rates Policy Description Potential relative effect size on prevalence Strong health warnings Covers at least 50% of package and pictorial - 1.0% Moderate health warnings Covers at least 1/3 but no pictorial - 0.5% Weak health warnings Covers less than 1/3 and no pictorial - 0.1% Source: Levy et al., SimSmoke model

Tobacco questions for surveys

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