Transcript Incorporating Secondhand Smoke Messages into Cessation

Incorporating Secondhand
Smoke Messages into Cessation
Ruth A. Etzel, MD, PhD, FAAP
University of Wisconsin
Are we doing things right?
Are we doing the right things?
How we spend our time
Urgent
Important
Not Important
Not Urgent
How we spend our time
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Important
Not Important
Urgent
Important
Not Urgent
How we spend our time
Urgent
Important
Not Important
Urgent
Important:
Meningococcal
Meningitis
Not Urgent
How we spend our time
Urgent
Important
Not Important
Urgent
Important:
Meningococcal
Meningitis
Urgent
Not Important
Not Urgent
How we spend our time
Urgent
Important
Urgent
Important:
Meningococcal
Meningitis
Not Important
Urgent
Not Important:
Common Cold
Not Urgent
How we spend our time
Urgent
Important
Urgent
Important:
Meningococcal
Meningitis
Not Important
Urgent
Not Important:
Common Cold
Not Urgent
Not Urgent
Not Important
How we spend our time
Urgent
Important
Urgent
Important:
Meningococcal
Meningitis
Not Important
Urgent
Not Important:
Common Cold
Not Urgent
Not Urgent
Not Important:
Forms, More
Forms
How we spend our time
Urgent
Not Urgent
Important
Urgent
Important:
Meningococcal
Meningitis
Not Urgent
Important
Not Important
Urgent
Not Important:
Common Cold
Not Urgent
Not Important:
Forms, More Forms
How we spend our time
Urgent
Not Urgent
Important
Urgent
Important:
Meningococcal
Meningitis
Not Urgent
Important:
Tobacco
Prevention/
Control
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Common Cold
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Forms, More Forms
Mismatch between what we
know and what we do
Global burden of disease from
secondhand smoke (SHS)
Individuals exposed to secondhand smoke (%)
World, 2004
45%
40%
Percent exposed to SHS
40%
35%
35%
33%
30%
Globally, more than a third of
all people are regularly
exposed to the harmful
effects of smoke
25%
20%
15%
10%
Source:
WHO/The
Lancet 2011
5%
0%
Children
Females
Males
World-wide burden of disease from SHS
More than 600,000 deaths per year worldwide are caused by
SHS - this is more than 1% of all deaths. 165,000 of these
deaths are among children.
Smokers put 1.8 billion non-smokers at risk. In 2004, this led to:
• 379,000 deaths from ischemic heart disease
• 165,000 deaths from lower respiratory infections
• 36,900 deaths from asthma
• 21,400 deaths from lung cancer
Disease burden from SHS by region, in
2004
Protection from Secondhand Smoke Exposure
 Policies designed to
eliminate cigarette
smoking in work and
public settings have
been shown to be
effective measures for
reducing exposure to
secondhand smoke.
 Only 7.4% of world lives
in areas with such laws.
DOCTORS’ CRITICAL ROLES
Diagnose and treat
Educate
– Patients and families
– Colleagues and
students
Advocate
Role model
WHO
Ask your Doctor campaigns have come a long way
Ask your Doctor, RJ Reynolds, 1947
2013
How Children are Different
Short Staturecloser to ground
Increased food
intake and
metabolic rate
Hand to mouth
activity
Increased air intake
Increased skin
surface area
Altered excretion
Long “shelf life”
Ongoing organ
development
The Life Cycle of the Effects
of Smoking on Health
Asthma
Otitis Media
Fire-related Injuries
SIDS
RSV/Bronchiolitis
Meningitis
Influences
to Start
Smoking
Childhood
Infancy
In utero
Adolescence
Nicotine Addiction
Adulthood
Low Birth Weight
Stillbirth
Cancer
Cardiovascular Disease
COPD
Aligni CA, Stodal JJ. Tobacco and children: An economic evaluation of the medical effects of
parental smoking. Arch Pediatr Adolesc Med. 1997;151:652
Young people are more likely to smoke
if they:
• Have access to smoking areas and tobacco
products – especially to low-cost or free tobacco
• Have friends, brothers or sisters who use tobacco
• Watch movies that have smoking in them
• Are not doing well in school or have friends who
are not doing well in school
• Are not engaged in school or religious activities
• Use other substances, such as alcohol or
marijuana
Before each visit – Asking about tobacco exposure
• Do you live with anyone who uses
tobacco?
• Are children living with anyone who
uses tobacco?
• Utilize “teachable moments” – such
as birth of a baby to help families
become smoke-free
– Home
– Car
– Child care settings
`
Work on this issue for over 50
years, what factors have limited
progress?
US Body Count
• 1200 die per day due to smoking
• Every day 4000 kids under age 18 try their first
cigarette
• Every day more than 2500 youth and young
adults who have been occasional smokers
become regular smokers
Patient by patient approach is not
enough
What will make us a force to be reckoned with?
“Killer” infrastructure:
trade associations
think tanks
publications
advertising
newsletter
spokespeople
media connections
Craziness is doing the same thing
over and over and expecting a
different result
DOCTORS PLAY A CRITICAL ROLE
 Role of physician in the clinic setting
 BEWARE: Tobacco industry actively seeks to keep tobacco within the
clinical domain.
 We are beginning to harness the power of
organized medicine…
 The 5 A’s
WHO
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26/03/2016
 Learn from labor organizing and community
organizing
Big Tobacco / National Rifle Assn
What makes them Powerful?
Infrastructure!
“Tobacco use is unlike other threats
to global health. Infectious diseases
do not employ multinational public
relations firms. There are no front
groups to promote the spread of
cholera. Mosquitoes have no
lobbyists.”
-- WHO Zeltner Report, 2000
Physicians organized with a
single focus can have a powerful
impact
Medical Professional Organizations
are Juggling Many Problems
• Obesity
• Poverty
• Mental health issues
• Injury control
• Chemicals in the environment
• Abuse and neglect
• Bioterrorism preparedness
• Emerging infectious diseases
• Reimbursement
• Cancer
• Global climate change
• Tobacco
www.AAP.org/RichmondCenter
Changing young doctors’
trajectories
Is it time for a single organization
of physicians against tobacco?
“Waging War” on Tobacco the same
way we waged war on polio
Sweden– Doctors Against Tobacco (1992)
Health Improvements
In the US, less than 4% of the total improvement in life
expectancy since the 1700s can be credited to 20th
Century advances in medical care.
– McKinley & McKinley, The Milbank Memorial Fund Quarterly 1977,55:405-28.
BIG TOBACCO – BIG DOCS
 ferocious for the public good
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