1. Prevention and Control of Public Health Hazards Tobacco, Alcohol, Drugs

2. Learning objectives You students will be capable to You students will be capable to 1. identify the risks of the tobacco, alcohol and drugs health hazards to public appointing the true figures of the implications they may have on the society. 2. commence educational programs for the public in order to participate in prevention of such hazards

3. Tobacco Consumption in The Eastern Mediterranean Region (EMR ) Prevalence among adult men ranges from 15.5% to 77%. Prevalence among adult men ranges from 15.5% to 77%. Prevalence among adult women ranges from 0.5% to 35%. Prevalence among adult women ranges from 0.5% to 35%. And; And; Among youth males from 4.6% to 47.4%. Among youth males from 4.6% to 47.4%. Among youth females from 0.1% to 14.5% Among youth females from 0.1% to 14.5%

4. Prevalence Among Adults (Men and Woman)

5. | World War II World War I

6. Rate/ 100,000 women (0-35) Breast cancer Lung cancer Years (1930-2000)

7. Percent (0-60%)

10. Control the Epidemic: Stages of Change PrecontemplationContemplationActionMaintenanceRelapse Not yet considering quitting Thinking about quitting Making a quit attempt Remaining a nonsmoker Starting to smoke again

11. Implementing Smoking Cessation Strategies The 4 R’s to enhance motivation – for patients unwilling to quit at this time The 4 R’s to enhance motivation – for patients unwilling to quit at this time RELEVANCE: Tailor advice and discussion to each patient RELEVANCE: Tailor advice and discussion to each patient RISKS: Outline risks of continued smoking RISKS: Outline risks of continued smoking REWARDS: Outline benefits of quitting REWARDS: Outline benefits of quitting REPETITION: Reinforce motivational message at every visit REPETITION: Reinforce motivational message at every visit The 4 A’s – for patients willing to make a quit attempt now ASK about tobacco use at every encounter ADVISE all smokers to quit ASSIST the patient in quitting ARRANGE for a follow-up

14. What about cutting down?

15. 1. Do you smoke? 2. Are you interested in quitting? - stages of change If no, encourage thinking about quitting If yes, proceed – 3.How much do you smoke? 4.How soon after waking do you smoke? 5.Have you tried to quit before? 6.In what situations do you enjoy smoking? 7.Do others in the home smoke? 8.Have you had problems with alcohol, drugs? 9.Have you had medical or psychiatric problems? “ASK” dependence antecedents Impact treat.

16. Variables Associated With Lower QRs Stressful life circumstances and/or recent major life change (eg, divorce, job change) High stress level Other smokers in the home or workplace Environmental risks Smoker reports perceived inability to quit Low self-efficacy Smoker reports not being ready to quit Low readiness to change Smoker reports low motivation to quit Low motivation Depression, schizophrenia, alcoholism, other chemical dependency Psychiatric Comorbidity Smoker reports severe withdrawal during previous quit attempts High nicotine dependence Examples Variable

17. Nicotine Withdrawal Symptoms Withdrawal peaks in 2 days and lasts up to 1-2 weeks (on average) Depressed mood, sadness Depressed mood, sadness Insomnia Insomnia Irritability, frustration, anger Irritability, frustration, anger Anxiety Anxiety Impaired concentration Impaired concentration Restlessness Restlessness u Increased appetite

18. INSERT FIG SHOWING KINETICS OF CIGS AND NRT, to illustrate why NRT might not work that well

19. Antecedents and ConsequencesAntecedents Persistent salience of environmental cues Persistent salience of environmental cues Expectancy of positive effects of smoking Expectancy of positive effects of smoking Modeling of smoking (being around other smokers) Modeling of smoking (being around other smokers) Easy availability of cigarettes Easy availability of cigarettes Reduced availability of alternative reinforcers. Reduced availability of alternative reinforcers.Consequences u Experiencing smoking effects (priming) u Secondary reinforcement (e.g. approval from other smokers, such as friends or spouse who smoke)

20. “ARRANGE” Follow-Up Schedule follow-up within one week Schedule follow-up within one week Follow up again within first month if possible Follow up again within first month if possible Set additional follow-up as necessary Set additional follow-up as necessary Congratulate success during all contacts Congratulate success during all contacts If smoking has occurred, review circumstances and encourage another try If smoking has occurred, review circumstances and encourage another try Identify problems encountered and anticipate challenges to a new quit attempt Identify problems encountered and anticipate challenges to a new quit attempt Assess use/misuse of nicotine replacement therapy or other medication Assess use/misuse of nicotine replacement therapy or other medication Consider referral Consider referral

21. Tobacco Free Initiative (TFI) in EMRO

22. TFI works to…. Change social acceptance; Policy analysis and communication (PAC). Change social acceptance; Policy analysis and communication (PAC). Strengthening national capacity; National capacity building (NAC). Strengthening national capacity; National capacity building (NAC). Support the Framework Convention for Tobacco Control related activities (FCTC). Support the Framework Convention for Tobacco Control related activities (FCTC). Apply Evaluation mechanisms to tobacco-related trends and control activities (AME). Apply Evaluation mechanisms to tobacco-related trends and control activities (AME).

24. Tobacco and religion Islamic ruling on smoking Islamic ruling on smoking The fatwa The fatwa Distribution of fatwa Distribution of fatwa Christian views on smoking Christian views on smoking International activities International activities Advocacy related activities Advocacy related activities MM (Mass Media) MM (Mass Media)

25. The tobacco industry Information are free and available on public health frontier but it is not like that with the industry Information are free and available on public health frontier but it is not like that with the industry They use all possible means, our means are limited They use all possible means, our means are limited They have unlimited funds unlike us They have unlimited funds unlike us

26. TIM monthly reports are disseminated:TIM monthly reports are disseminated: Among TFI collaborators (including WHO regional advisers) Among TFI collaborators (including WHO regional advisers) On tobacco control networks (Globalink) www.globalink.org/tim On tobacco control networks (Globalink) www.globalink.org/timwww.globalink.org/tim WHO/TFI webpage WHO/TFI webpage Monitoring the tobacco industry activities

31. Reports: Reports: The Voice of truth – Multinational tobacco industry activity in the Middle East: a review of internal industry documents (2001)The Voice of truth – Multinational tobacco industry activity in the Middle East: a review of internal industry documents (2001) http://www.emro.who.int/tfi/VOICE%20OF%20TRUTH.pdfhttp://www.emro.who.int/tfi/VOICE%20OF%20TRUTH.pdfhttp://www.emro.who.int/tfi/VOICE%20OF%20TRUTH.pdf The tobacco industry's tactics and plans to undermine control efforts in Egypt and North Africa, Cairo 2003 The tobacco industry's tactics and plans to undermine control efforts in Egypt and North Africa, Cairo 2003 The Tobacco Industry and Corporate Social Responsibility… an inherent contradiction (2003) The Tobacco Industry and Corporate Social Responsibility… an inherent contradiction (2003) Other projects of TFI Communications

32. In order to be able to implement effective tobacco control policies, governments and activists need to be very well informed of the industry's activities and strategies In order to be able to implement effective tobacco control policies, governments and activists need to be very well informed of the industry's activities and strategies

33. Media and Tobacco Control and Prevention

52. … and the EMRO work continues…

53. Learning objectives You students will be capable to You students will be capable to 1. identify the risks of the tobacco, alcohol and drugs health hazards to public appointing the true figures of the implications they may have on the society. 2. commence educational programs for the public in order to participate in prevention of such hazards