Best Practices in International Tobacco Control
Annette David, MD, MPH, FACOEM
Senior Partner for Health Consulting Services at Health
Partners, L.L.C. (Guam)
 2012 Johns Hopkins Bloomberg School of Public Health
Learning Objectives
Identify key population strategies embodied in the WHO FCTC and
MPOWER
Delineate actions that health professionals can take to promote
tobacco control
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World Cigarette Production
Image source: Tobacco Atlas. (2012). www.tobaccoatlas.org
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A Global Solution to a Global Epidemic
Image sources: (left) World Health Organization. (2000). Geneva public hearing; (right) World Health Organization.
(2011).
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MPOWER
The six MPOWER measures are:
 Monitor tobacco use and
prevention policies
 Protect people from tobacco use
 Offer help to quit tobacco use
 Warn about the dangers of tobacco
 Enforce bans on tobacco
advertising, promotion, and
sponsorship
 Raise taxes on tobacco
Image source: World Health Organization.
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Monitor Tobacco Use and Prevention Policies
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Sources of Data
Global Tobacco
Surveillance
System—GATS,
GYTS, GHPSS
Other
global/regional
surveys—WHO
Steps, BRFSS,
YRBSS
National surveys
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Protect from Tobacco Smoke
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Smoke-Free Polices
Smoke-free
policies
decrease
exposure to
secondhand
tobacco smoke
by 80-90% in
high-exposure
settings
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Offer Help to Quit Tobacco Use
Three types of
treatment should be
included in any tobacco
prevention effort:
1. Cessation advice
in health care
2. Quit lines
3. Pharmacological
therapy
Tobacco cessation
interventions are
effective
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Offer Help to Quit Tobacco Use
Studies show that even brief advice from health professionals can
increase tobacco abstinence rates up to 30%
Interventions for smoking cessation led by nurses have shown to
increase the chance of successfully quitting smoking by up to 50%
There also needs to be a systematic approach for incorporating
brief tobacco interventions (the “5 A’s” and “5 R’s”) into primary
health care services
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Warn about the Dangers of Tobacco
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Graphic Warnings Increase Smokers’ Intention to Quit
Image source: iStockphoto.com
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Smokeless Tobacco Products and Warning Labels
Smokeless tobacco products are less likely to have health warning
labels
Images source: iStockphoto.com
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Enforce Bans
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Total Ad Bans Work
Image source: Annette David.
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Only 19 Countries Have Total Ad Bans
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Raise Taxes on Tobacco
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Higher Taxes, Lower Consumption
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Optimal Tobacco Tax Rates
Less than 10%
of middle- and
low-income
countries have
optimal
tobacco tax
rates
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Average Retail Price and Taxation
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Impact on Consumption
Source: Mendez et al. (2013). Tob Control, 22(1): 46-51.
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Why Health Professionals?
Witness to patients’ suffering from tobacco-related illnesses
Advocate for patients’ well-being
Key opinion leader—credibility
Expert—technical knowledge
Unique position to influence others
Professional and personal role model for the community
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Health Professionals’ Role in Tobacco Control
In 2004, a global meeting of medical organizations at the WHO
headquarters in Geneva resulted in the publication of a code of
practice for health professionals and health organizations
Individual actions:
1. Physician, heal thyself—become tobacco-free
2. Patient care—advise all smoking patients to quit
3. Personal policies—tobacco-free clinics/homes
4. Pursue skills and knowledge on tobacco cessation
5. Refuse tobacco industry support of any kind
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Health Professionals’ Role in Tobacco Control
Institutional actions:
1. Making all meetings and events tobacco-free
2. Including tobacco issues in conference agendas
3. Assessing and addressing tobacco consumption patterns
among members of health associations
4. Refusing tobacco industry support
5. Promoting capacity building for tobacco cessation
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Health Professionals’ Role in Tobacco Control
Health system actions:
1. Integrating training on tobacco control and cessation into all
health professionals curriculae
2. Incorporating at least brief tobacco cessation advice into
primary health care
3. Building a strong cessation infrastructure and instituting
cessation programs into all health care settings
4. Promoting tobacco-free policies in all health care settings and
supporting all health professionals to become tobacco-free
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Health Professionals’ Role in Tobacco Control
National level:
 Health professionals should support and advocate for effective
tobacco control public policies as embodied by the MPOWER
Package and full implementation of the WHO Framework
Convention on Tobacco Control
 Advise legislators on evidence-based tobacco-control policies
and laws
As experts we should choose to be tobacco-free, recognize and
treat tobacco dependence, advocate for and support tobacco-free
policies and programs, and avoid tobacco sponsorship
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Thank You!
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