IPA AAP Global Tobacco Prevention program
This program is being jointly done by the IPA Adolescent Program TA Swati Bhave, IPA
Environment and child health TA Ruth Etzel and Jonathan Klein from AAP .This is a
multi-year international effort to raise awareness and promote involvement of child
health clinicians worldwide in calling attention to children’s exposure to tobacco and
second-hand smoke. The program plans to increase awareness about environmental
health implications of tobacco and second-hand smoke, interventions to effectively
influence lifestyle and behaviors, the effect of media on tobacco use, and promotion of
public health policies to protect children from tobacco.
A preliminary report of this program and its launch in Mumbai.India in March 2009 has
been published on IPA news letter volume 5 no1 Jan March 2009 pg 12 under the
section NEWS from Program Areas
Introduction: Tobacco is a leading preventable cause of death, and prevention of
tobacco use and elimination of second hand smoke exposure directly impacts MDG 4
and 5. Tobacco is responsible for a proportion of the deaths from 6 of the 8 top causes
of death worldwide. Annual toll is now at 5 million deaths/year, and this will rise to 8
million/year by 2030, if current tobacco use continues. Second hand smoke causes
600,000 deaths/year worldwide; most of these are in women. Exposure to secondhand
smoke during childhood and the initiation of tobacco use in formative years jeopardizes
children’s short and long-term health. Tobacco farming also contributes to malnutrition
in low-income countries by diverting croplands from food production. Death of wage
earners due to tobacco related diseases in mid-life may have catastrophic impact on
children whose families live in poverty. Moreover, farm labor deprives children of
educational opportunities and exposes them to high levels of toxic pesticides.
Tobacco use, exposure, and cultivation result in global paediatric diseases. Multiple
exposures and the initiation of use long before adulthood make tobacco a threat to
children’s health. Children are harmed by their own tobacco use at very early ages,
through exposures to smoke in their homes and in other settings, through malnutrition
as parents in poor households spend money on tobacco rather than on adequate food
supplies, and through their own labour and that of family members on tobacco farms.
The WHO Global Youth Tobacco Survey found that nearly half of never smokers were
exposed to second-hand tobacco smoke. The impact and harms of second-hand smoke
exposure range from low birth weight, exacerbation of asthma, increased incidence of
Sudden Infant Death Syndrome and cancer.
WHO has identified 11 countries in the world that has the most adverse impact of
tobacco? This program will be done in 3 of these countries China, Brazil and India in
collaboration with the National Paediatric societies of these countries .with the help of
President Chok Wan Chan and President Elect Sergio Cabrol
The AAP Julius B. Richmond Centre is a National centre of excellence dedicated to
the elimination of children’s exposure to tobacco and second hand tobacco smoke. The
Centre, and the AAP’s Tobacco Consortium are working to create a healthy
environment for children and families by: Making all child health clinicians aware of the
consequences of childhood tobacco exposure; Giving child health clinicians the skills
and tools to help parents, families, and communities protect children from tobacco; and
Encouraging public education and the promotion of public health policies to eliminate
tobacco exposure As part of the AAP Julius B. Richmond Centre’s work to disseminate
best practices to reduce second-hand smoke and tobacco exposure of children,
paediatric clinicians are being trained in effective ways to counsel parents to change
behaviors so that children are not exposed to smoke.
Relevant materials and best practices developed by groups such as the CDC Guide to
Community Preventive Service www.thecommunityguide.org/tobacco/), the WHO
Tobacco Free Initiative (www.who.int/tobacco/mpower/en/) and the Global Dialogue for
Effective Stop Smoking Campaigns (www.stopsmokingcampaigns.org) have been
adopted as part of these collaborative efforts. The WHO MPOWER policies address:
monitoring tobacco use and prevention policies, protecting people from tobacco smoke,
offering help to quit tobacco use, warning about the dangers of tobacco, enforcing bans
on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco.
To further advance the goals of the Global Tobacco Prevention Program the AAP
Richmond Center also collaborated with the Institute for Global Tobacco Control at the
Johns Hopkins Bloomberg School of Public Health to online modules on children, youth
and tobacco control were released in December, 2009.
The modules form part of the Global Tobacco Control: Learning from the Experts
training program, supported by Bloomberg Philanthropies. The AAP modules, “Role of
Healthcare Professionals in Tobacco Control” consists of four lecture/slide shows:
Adolescents and Tobacco Prevention and Cessation, Tobacco Use Prevention for
Children and Youth, Protecting Children from Secondhand Smoke Exposure and
Establishing Smoke-free Environments for Children. The online training is available for
free (at www.GlobalTobaccoControl.org.) and a certificate can be printed after
completion of each module.
Launch of the IPA AAP global Tobacco Program
Partipation in the The 14th WCTOH (World Conference on Tobacco or Health) was
held on March, 2009, at the (WCTOH) in Mumbai, India,
There was a one session by AAP on March 9 .The speakers were Professor Harry
Lando, the Vice President of the Conference, Swati Bhave and Ruth Etzel.
Dr Swati Bhave spoke about the impact of tobacco on Youth and the IPA AAP global
tobacco program .Dr Ruth Etzel spoke on the effect of second hand tobacco smoking
Dr Harry Lando .Swati Bhave and Ruth
Etzel; at the AAP session at 14th WCTOH
Mumbai India March 2009
It was decided to use this opportunity to launch the IPA AAP tobacco control program in
India in collaboration with the IAP (Indian Academy of Paediatrics) With help of AAP we
plan to have the program launch in China and Brazil in the coming months
IPA AAP Global Tobacco program launch with two events
1
Focus group Meeting on awareness of Tobacco ’
Dr Ruth Etzel held a focus group discussion with Mumbai Pediatricians on March 8
2009 .This was hosted by IAP
Focus group discussion in IAP office Mumbai
L-R Drs Dhanshree , Paula Goel Deepak Ugra
(President Elect of IAP ) Archana Kher , Vinoo
Tiberewala, PG Samdani ,Swati Bhave
L_R Gonsalves* , Ruth Etzel ,Swati Bhave, Rohit
Agarwal (General secretary IAP) Ajay *
* IAP office staff
2 Community awareness program
This was held in collaboration with IAP Mumbai Branch & KJ Soumaya Colleges
trust .The speakers and panelists were Dr Ruth Etzel and Swati Bhave .A poster
competition for students was held by a NGO AACCI (Association of Adolescent and
Child Care in India) and the prizes were shared by AAP and AACCI
Tanmaya Amaldi, Sujata Kanhere, Swati Bhave, Ruth Etzel
Dean KJ Somayai Medical College with the Prize winners
of the poster Competition In the community program.
Dr Tanamya Amaldi President of IAP Mumbai
Branch welcomes address community program
Further activities of this program
In August, 2009, Dr. Klein and AAP COO John Forbes met with the Dr. Chok-Won
Chan and the leadership of the Hong Kong Pediatric Society, and facilitated a meeting
between the HKPS and HK Department of Health’s exemplary Tobacco Control Office.
This meeting has led to establishment of a new and ongoing collaboration between
HKPS and DOH in addressing parent’s smoking and children’s secondhand smoke
exposure.
In January, 2010 , Dr. Klein and Spencer Li, MPA, Director of the AAP Office of
International Affairs, visited Shanghai as part of an AAP delegation, and met with
Xiaoming Shen, MD, MPH, Deputy Mayor of Shanghai, Fan Wu, MD, MPH, Director of
the Shanghai CDC, and Fan Jiang, MD, PhD, Associate Professor of Pediatrics at
SCMC, and others to discuss planning and development of a training center for
pediatric tobacco control and prevention. As the leading institution in Shanghai
province, SCMC has referral, training and educational missions, which include 18
district/county hospitals, and 228 township-based primary health centers.
On February 18-19, 2010 , Dr. Klein represented the AAP/IPA Tobacco Control Project
and the AAP in an invited presentation to the 8th Session of the United Nations Ad Hoc
Interagency Task Force on Tobacco Control. Chaired by the WHO Tobacco Free
Initiative, the session included WHO, UNICEF, World Bank, UNESCO, UNFPA, ILO
(Labor), World Customs Organization, etc., for a total of 18 UN agencies, the
Conference of Parties (Framework Convention on Tobacco Control monitoring group)
and representatives from the permanent missions of Egypt, India, France, Pakistan,
Japan, and Brazil. The theme of the session was focused on the role of tobacco control
in achieving MDGs 4 and 5. The AAP/IPA collaboration was one of 8 NGO’s invited to
present at the session.
Dr. Klein reviewed the framing of tobacco as a pediatric disease, the evidence for the
importance and effectiveness of pediatric interventions, AAP/IPA projects and goals,
and successful models (the Neonatal Resuscitation Program worldwide, and the AAP
Richmond Center dissemination of best practices in the US )for train-the-trainers spread
of tobacco control interventions.
We proposed a model for collaborative projects to develop and implement training for
child health clinicians in tobacco control to promote
1) best practice clinical interventions to prevent adolescent and adult tobacco use and
children’s exposure to secondhand smoke (SHS), and
2) clinician advocacy for effective community public health and policy interventions.
Specific activities include: 1. Convening a planning workshop of tobacco control and
child health experts; 2. Modifying and producing a pediatric tobacco control curriculum
appropriate for each country’s language and culture, consistent with local health care
systems; providing clinical practice tools and resources; and advocacy materials to
engage pediatric leaders in tobacco control policies.
3. Use a train-the-trainers model to engage lead trainers and assist them in spreading
the training to child health clinicians; and 4. Providing technical assistance and
resources. We hope that follow-up discussions with WHO may result in specific
commitments to support training in target countries in the year ahead.
Also in February 2010, AAP President Dr. Judith Palfrey and Dr. Klein attended the 15th
Annual meeting of the Philippine Ambulatory Pediatric Association, (PAPA) and a joint
collaborative meeting between the AAP and PAPA in Manila, in February, 2010. In
addition to delivering talks on the convention theme “Global Health Issues Affecting the
Filipino Child,” they participated in workshops on tobacco and secondhand smoke to
child health clinicians and professional, civic, government, and non-government
organizations, and met with the Philippine Pediatric Society, P-NIH, Department of
Health, and WHO Regional Tobacco Control Office to plan a series of workshops and
lectures for 2010, focused on tobacco control policy change, and improving the skills of
physicians, residents, medical students and other health care providers in counseling
patients and families on smoking cessation. This Philippines trip was partially
supported by the AAP Richmond Center’s Visiting Lectureship program. Richmond
Center Visiting Lectureships initiatives have been expanded to allow support for
international tobacco control work: More information about the AAP/FAMRI Visiting
Lectureships is at http://www.aap.org/richmondcenter/fundingOpportunities.html.
Pesident IPA (Chok-wan), AAP (Judith Palfrey and
Jonathan Klein) and PAPA Leaders at the Conference
To further advance the goals of the Global Tobacco Prevention Program the AAP
Richmond Center also collaborated with the Institute for Global Tobacco Control at the
Johns Hopkins Bloomberg School of Public Health to online modules on children, youth
and tobacco control were released in December, 2009. The modules form part of the
Global Tobacco Control: Learning from the Experts training program, supported by
Bloomberg Philanthropies. The AAP modules, “Role of Healthcare Professionals in
Tobacco Control” consists of four lecture/slide shows: Adolescents and Tobacco
Prevention and Cessation, Tobacco Use Prevention for Children and Youth, Protecting
Children from Secondhand Smoke Exposure and Establishing Smoke-free
Environments for Children. The online training is available for free (at
www.GlobalTobaccoControl.org.) and a certificate can be printed after completion of
each module.
For more information about other aspects of this report please contact Swati Bhave at
sybhave@gmail.com or Ruth Etzel at retzel@earthlink.net or Jonathan Klein at
jklein@aap.org