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TOBACCO CONTROL in TURKEY:NGOs EFFORTS for CONTROL and PREVENTION: 

TOBACCO CONTROL in TURKEY: NGOs EFFORTS for CONTROL and PREVENTION Prof. Hikmet PEKCAN, MD Turkish Public Health Association (TPHA) hikmetp@hacettepe.edu.tr

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SMOKING IS AN EPIDEMIC PROBLEM

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GLOBAL TOBACCO CONTROL IS A MAJOR CHALLENGE FOR THE PUBLIC HEALTH.

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In developing countries; communities are increasingly subjected to intense direct and indirect marketing of tobacco products.

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WE ARE IN THE CIGARETTE BUSSINESS. WE ARE NOT IN THE SPORTS BUSSINESS. WE USE SPORTS AS AN AVENUE FOR ADVERTISING OUR PRODUCTS. R.J. REYNOLDS EXECUTIVE, 1989

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Tobacco prevention success requires; cross-sector platforms and long-term cooperative partnerships.

Government’s Role: 

Government’s Role strong political commitment presidental, ministreal leadership multinational agreements

Universities’ Role: 

Universities’ Role Ongoing researches Evolving tobacco preventive and control strategies Tobacco burden and outcome measurement

Media’s Role: 

Media’s Role Support and challenge human resources Political support/ change of norms Multinational collaboration

Non-Governmental Organizations (NGOs) Role: 

Non-Governmental Organizations (NGOs) Role Continuous strong advocacy Real-time surveillance Internet organization tools Steering wheel tools

Studies done in Turkey: 

Studies done in Turkey Studies were done to estimate the burden of tobacco use on mortality and morbidity. In Turkey; 17 million cigarette users Can et al. Sigarayı Bırakma Tedavisi. 2004.

DEATHS DUE TO SMOKING: 

DEATHS DUE TO SMOKING 70-100 000 deaths annually (daily 200-250 deaths) 8% of total adult deaths/year were due to cigarette smoking. Can et al. Sigarayı Bırakma Tedavisi. 2004.

2% of the smoking of the World takes place in Turkey. 14% of the smoking of the region is in Turkey.: 

2% of the smoking of the World takes place in Turkey. 14% of the smoking of the region is in Turkey. World Bank, 2001

Smoking rate is increasing in Turkey. : 

Smoking rate is increasing in Turkey. State Monopol and State Institute of Statistics

Prevalence of smoking is very high.Smoking is accepted as a social normal behaviour and attitude in Turkey, 1996.: 

Prevalence of smoking is very high. Smoking is accepted as a social normal behaviour and attitude in Turkey, 1996. Bilir et al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey

Initiation ages of smoking are 12,13, 14 years. Ankara/Turkey, 1996. : 

Initiation ages of smoking are 12,13, 14 years. Ankara/Turkey, 1996. Bilir et.al, 1997. Smoking Behavior and Attitudes, Ankara-Turkey

Old generation had initiated smoking more later. Ankara-Turkey, 1996: 

Old generation had initiated smoking more later. Ankara-Turkey, 1996 Source: Bilir et al. 1997 Smoking Behavior and Attitudes, Ankara-Turkey.

People are feeling remorse for smoking Ankara-Turkey, 1996: 

People are feeling remorse for smoking Ankara-Turkey, 1996 Bilir et.al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey.

 Tobacco creates addiction, it is hard to quit.: 

Tobacco creates addiction, it is hard to quit. Bilir et al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey

Some of the smokers don’t know that they need help to quit: 

Some of the smokers don’t know that they need help to quit Bilir et al. 1997 Smoking Behavior and Attitudes, Ankara-Turkey

In most of the countries smoking is prevalent in poor people; but in Turkey it is not the case.Rate of smoking increases with the increase in the income!: 

In most of the countries smoking is prevalent in poor people; but in Turkey it is not the case. Rate of smoking increases with the increase in the income! Bilir et al. 1997 Smoking Behavior and Attitudes, Ankara-Turkey.

The rate of smoking is high among educated people.: 

The rate of smoking is high among educated people. Bilir et al. 1997 Smoking Behavior and Attitudes. Ankara-Turkey Rate of smoking (%)

Lack of knowledge and awareness of the mothers! The mothers and the grandmothers are smoking more heavily,1996.: 

Lack of knowledge and awareness of the mothers! The mothers and the grandmothers are smoking more heavily,1996. In all age groups, one out of three mothers are smoking. Out of total, 31% of the mothers are smoking. Smoking is much prevalent among young mothers. Bilir et al. 1997 Smoking behavior and attitudes, Ankara-Turkey. % Age (years)

Smoking status of mothers and teachers: 

Smoking status of mothers and teachers Bilir et al. 1997 Smoking Behavior and Attitudes, Ankara-Turkey Daily amount of cigarettes (number)

Lack of knowledge and awareness in smoking Nobody is mentioning of passive smoking.Why are we poisoning our children? : 

Lack of knowledge and awareness in smoking Nobody is mentioning of passive smoking. Why are we poisoning our children? Bilir et al. 1997 Smoking behavior and attitudes, Ankara-Turkey

What do the smokers say and do in Turkey?: 

What do the smokers say and do in Turkey? 99% of the teachers who are smoking, are against smoking in front of the students But; 68% are smoking in front of the students 97% of the medical doctors are against smoking in front of their patients But; 68% are still smoking in the office 98% of the smoking mothers are against of that teachers should not smoke in front of the students But; 85% are smoking in front of their children. Bilir et al. 1997 Smoking Behavior and Attitudes, Ankara-Turkey

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Why does NGOs involve in tobacco control? To prevent smoking in children Initiation age of smoking is decreasing The adolescents are not aware of the risks To prevent the passive smoking Passive smoking is dangerous as smoking Most of the adults are smoking in front of their children ./.

Why should NGOs involve in tobacco control? (cont.): 

Why should NGOs involve in tobacco control? (cont.) To present logical alternatives for adults Generally the smokers feel remorse for initiating smoking Smokers are spending most of their budget for tobacco To support the ones to quit smoking Tobacco is addictive and smokers need help Smokers do not know that they need help To arrange smoking quit programmes

WHO classifies interventions intotwo major groups, those aimed at reducing the demand for tobacco: 

WHO classifies interventions into two major groups, those aimed at reducing the demand for tobacco • price and tax measures • protection from exposure to second-hand tobacco smoke • regulation and disclosure of the contents of tobacco products • packaging and labelling • education, communication, training and public awareness-raising • comprehensive bans and restriction on tobacco advertising, promotion and sponsorship • tobacco-dependence cessation measures;

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AS THE PRICE AND THE TAX OF CIGARETTE INCREASE, THERE WOULD BE A DECREASE IN SMOKING RATE HIGH TAX

Cigarette Smoking Habits Among Men and Women in Turkey: A Meta Regression Analysis: 

Cigarette Smoking Habits Among Men and Women in Turkey: A Meta Regression Analysis Of the 92 researches related to smoking habits conducted from 1981 to 2003 in Turkey, 60 were deemed appropriate for the application of Meta analysis. 44 048 men and 24 966 women. The proportions of men and women smoking cigarettes were 0.51 and 0.35, respectively. The proportion of men smoking cigarette in 1996 and the years before it was 0.52, and for women as 0.35. However, the figures for the years following 1996 were 0.41 for men, and 0.32 for women. Mutlu et al. Iranian J Publ Health, 2006, 35:2:7-15.

Smoking in school children-1997: 

Smoking in school children-1997 Cross-sectional study A self-completed questionnaire was given Students in grades 2 through 5 (ages 7 to 13 years) 1093 students Prevalence of ever smokers was 11.7% (14% among boys and 9% among girls) The highest ever smoker rate was obtained in children aged ≤ 8 years (19.6%) Either one or both parents of 710 of 1080 children (65.7%) were smokers. The prevalence of ever smokers was significantly higher among children whose parents smoke, than those with nonsmoking parents (4.8% vs 15.3%) Seydioğulları M. Tobacco and cigarette year book 1996 in Turkey. 1997.

Global Youth Tobacco Survey (GYTS): 

Global Youth Tobacco Survey (GYTS) Cross-sectional study Data obtained from 15197 youth. Prevalence and determinants of cigarette smoking were examined. Males and high-school students have higher odds of being susceptible to smoking Exposure to parent, teacher, and peer smoking, anti-tobacco curricula, cigarette promotions, and perceived ease of access to cigarettes are all significant predictors of being susceptible to smoking

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The results reveal the importance of early prevention programmes, which should begin before high school, and targeting efforts towards male students and all students who are not yet smokers but susceptible to smoking. Ertaş N. The European Journal of Public Health Advance Access published online on July 12 2006.

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AS THE PRICE AND THE TAX OF CIGARETTE ARE INCREASED, QUITING RATE OF SMOKING ALSO INCREASES. CIGARETTE TAXES WERE INCREASED BY 25%.

TOBACCO CONTROL EFFORTS: 

TOBACCO CONTROL EFFORTS There is only one way to combat this epidemic, that is by implementing a comprehensive, continuous, sustainable and adequately funded tobacco control strategy. Tobacco control efforts should be focused on several fronts: • preventing people from taking up tobacco consumption; • promoting cessation • protecting non-smokers from the exposure to tobacco smoke • regulating tobacco products.

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“Cigarette producers, due to the ban of selling cigarettes containing high tar and high nicotine are sent to the market of the developing countries…” WHO

Role of TPHA for Implementation of Tobacco Control: 

Role of TPHA for Implementation of Tobacco Control by sending a clear message to their national counterparts that tobacco control is at the top of the agenda to provide support to national organization efforts to encourage and support their members to be role models by not using tobacco and by promoting a tobacco-free culture. include tobacco control in the agenda of all relevant health-related congresses and conferences. LEADERSHIP

Role of TPHA in Research for Implementation of Tobacco Control: 

Role of TPHA in Research for Implementation of Tobacco Control prevention of initiation of smoking among adolescents decreasing tobacco use among smokers decreasing passive smoking exposure among women and kids developing successful smoking cessation tools Interacts with national and international institutions and foster the production of scientific knowledge in

What is TPHA Doing, In Terms of Advocacy to Increase Tobacco Control Capacity?: 

What is TPHA Doing, In Terms of Advocacy to Increase Tobacco Control Capacity? Influence health institutions and educational centres such as universities to; include tobacco control in their health professionals’ curricula through continued education and other training programmes. Curriculum development at medical schools Maintaining a smoke free campus

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Actively participate in “World No Smoking Day” every 31 May. Participate in the tobacco-control activities of health professional networks. Support campaigns for tobacco-free public places.

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Media advocacy for tobacco laws and implementation Emphasis: Non-smokers rights to a smoke-free environment. In addition to awareness issues. Radio and TV talks by experts, with youth contests for prizes based on their knowledge of the right answers. Development of drama, songs and TV spots for use by national media and other NGO’s

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As a NGO our aim is no smoking community

In Turkey, “The Prevention of the Harms of Tobacco Products Law (Date: 26.11.1996 and No. 4207) should be protected. : 

Law and Our Gain - ban for advertisements - smoking is forbidden in bus journeys between provinces in trains in domestic and international flights Difficulties actions to pierce the ban for advertisements implementation of law is not satisfactory In Turkey, “The Prevention of the Harms of Tobacco Products Law (Date: 26.11.1996 and No. 4207) should be protected.

Campaigns of Increasing the Awareness of the Public: 

Campaigns of Increasing the Awareness of the Public Media is trying to keep the issue a current event. In the previous years campaigns as “Quit and Gain” were done. In the 31st of May “NO SMOKING DAY” activities on different topics were issued. Such as; Tobacco makes you poor. Quit smoking. etc.

The Treating Tobacco Use and Dependence –Clinical Practice Guideline, issued by the United States Department of Health and Human Services recommends the 5As approach:: 

The Treating Tobacco Use and Dependence – Clinical Practice Guideline, issued by the United States Department of Health and Human Services recommends the 5As approach: “5As” Approach Ask about tobacco use Advise all users to quit Assess willingness to make a quit attempt Assist the patient to quit Arrange follow-up contact

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Wind does not help you, if you do not know the bay you want to go. Montaigne Thinking is easy, doing something is difficult. But the most difficult thing in the world is to make, what you think. Goethe

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FOR TOBACCO CONTROL KNOWLEDGE FOR AWARENESS AWARENESS FOR KNOWLEDGE ARE IMPORTANT WISHES ARE; A SMOKE-FREE WORLD