1. The Bulgarian Journey to Freedom from Tobacco Smoking Vilia Velikova, Senior Expert, Ministry of Health, Republic of Bulgaria

2. Content of the Presentation:  1. Tobacco Smoking in Bulgaria: 13 – 64 years old.  2. Levers of the National Program:  National Quitline;  Internet Page;  Action Plan.  3. The Curves of the Bulgarian Legislation for Tobacco Limitation.  4. Number of Deaths by Cause of Tobacco Consumptions.  5. Our Hope.

3. Bulgarian attitude towards tobacco plant  Since XVII century has been cultivated tobacco plant in Bulgaria.  At the end of XIX century was established tobacco production by many small growers and producers.  1947 – it was established the first tobacco manufactury in Bulgaria, “Bulgartabac Holding AD”, by integration of all small growers and producers of tobacco plant & cigarettes. Today it covers 85% of the domestic cigarette market.

4. Tobacco smoking, 1952-2008 (%) Sources: NSI, MH & NSI-EHIS

5. Households consumption of cigarettes for 2005-2009 (average pieces per month, source: NSI)

6. 15-16 years old students who had been smoking during the last month (%) Source: ESPAD, 1999-2007

7. 13-15 years old students who are current cigarette smokers (%) Source: GYTS, 2002 & 2008

8. Republic of Bulgaria, Council of Ministers National Program for Limitation of Tobacco Smoking Ministry of Health: Program, Action Plan & Financial Plan 2011-2015 2007-2010 2002-2005

9. Levers of the National Program for Limitation of Tobacco Smoking Action Plan Activities Web Page www.aznepusha.bg National Quitline 0700 10 323

10. The National Quitline 0700 10 323 – in transition  3 psychologists and 1 physician  during 2009: 1059 calls – 514 men and 545 women; 12-65 years old;10-21 calls weekly.  NGO will support both National Quitlines: Tobacco & Alcohol Quitlines

11. Great support from ENQ to our National Quitline  Trainings during the conferences & training courses in Warsaw, Amsterdam, Lisbon, Budapest, Paris, Prague, and now, again in Lisbon; Special organized training for Bulgarian 28 + 4 consultants in Sofia + 2 persons from Ministry of Health;  Gifted 15 smokerlyzers and their attributes for our Regional Inspections for Public Health Control & Prevention (RIPHCP);  A huge amount of materials on electronic/paper bearers;  A lot of consultations and advices;  Successful collaboration as regards the “European Smokefree Quitter of the 2009”.

12. “European Smokefree Quitter of the 2009”, Bulgarian Preconference

13. Survey for levels of carbon monoxide in exhaled air of public health inspectors and their supervisors (by smokerlysers in the 14 RIPHCP): Results:  Among 277 health inspectors and their supervisors 159 are smokers, i.e. 57,4% smoke and are not enough effective inspectors or supervisors during the tobacco control;  There are good news – 56 % of them want to quit.

14. Eurobarometer - 2007 Do you think smokers generally respect lows prohibiting smoking in public places? (%) Source: Eurobarometer - 2007

15. Web page: www.aznepusha.bg

16. Visitors in www.aznepusha.bg YearsVisits Visits per 24 hours Number of page charging Max visitors on line Pages per visitors 20108 979 8 478 44 677 515.27 200926 398 24 242144 767 735.97 2008182157 2 168813.81

17. Action Plan - 1  Training, communication and public awareness:  Working with medical specialists. Trainings & information materials. First member of ENSH “Tokuda Hospital - Sofia”.  Working with students:  National Scool Competition “Projects of our Class – for a Life without Tobacco 1 & 2 “ (SFC);  National School CompetitNational School Competition for Cartoons;  ion for Graffitties;  Competition among NGO;  Working with employers;

18. Action Plan - 2  Applying price and tax measures;  Restrictive legislation for advertising of tobacco products;  Controlling the contents of tobacco products and their labelling;  Restricting the smuggling of tobacco products;  Gradual substitution of tobacco plants with other crops or activities;  Monitoring, assessment and reporting on tobacco use.

19. A History of Bulgarian Legislation for Tobacco Limitation  1974 – People’s Health Act & Regulations;  2005 – New Health Act & Regulations of Conditions and Order of Permitted Smoking as an Exception in Separated Enclosed Areas of Indoor Public Places and Indoor Places of Employment, 50:50% smoking;  2009 – New article in the Health Act for complete ban of tobacco smoking at indoor public places;  2010 – Parliament discussions, amendments in Health Act, separate smoking.

20. Places Where Smoking is Forbidden according current Regulations o nursery schools, kindergartens, schools; o institutions of higher education; o cultural institutions- cinemas, theaters, concert halls etc.; o internet clubs; o areas in premises for production and trade with foodstuffs; o buses, trolley cars, trams, subway-cars, mini-buses for rout taxis and taxicabs; o subway terminals; o Bulgarian passenger airplanes; o elevators in all buildings; o premises with separated places of work.

21. State Journal, №41, 2.06.2009 The current LAW OF HEALTH In force from 1st of January 2005 (after amendments during June 2009) Art. 56. Smoking shall be prohibited in the covered public places, including the public transport and the covered working premises.

22. New Proposal since 18.02.2010: It is created new para: „(3) It is permitted tobacco smoking in indoor public places in:  closed private premises, which are not opened for public access;  closed public premises, which are isolated and designated as such.”

23. 3. It is created new para 4: „(4) It is permitted to be differentiated separated tobacco smoking rooms in the hospitality sector (restaurants & others). The general area for non-smoking must predominate over the total area of the establishment. If the establishment is less than 100 m 2 then the owner has a right to choose the establishment to be for smoking or not for smoking.”

24. Number of Deaths by Cause Lung Cancer (per 100 000 0f the population)

25. Number of Deaths by Cause Circulatory System – percentage from all deaths in Bulgaria (per 100 000 of the population)

26. There is a Hope  The first Bulgarian country town – free of tobacco smoking at indoor public places, municipality Kyustendil, since 1 July 2010;  Bars, restaurants, pubs, voluntary free from tobacco smoking become more & more;  Coalition “Life without Tobacco” from more than 25 NGOs expresses its indignation from the new discussions in the Parliament;  The Building of Ministry of Health is completely free of smoking since the 3-d of May 2010 by special Order of the Minister of Health.

27. One of the first protests of the Coalition

28. Do you support the complete smoking ban? Source: ББСС “Галъп Интернешънъл”

29. Next different protests of the Coalition

30. Internet groups against amendments of Health Law, 2010