CHILD HEALTH AND
TOBACCO IN THE
PHILIPPINES
BENJAMIN P. SABLAN, JR., MD, FPPS
PROFESSOR
UNIVERSITY OF THE PHILIPPINES MANILA
DISCLOSURE

Commissioned work given to the PHILIPPINE
AMBULATORY PEDIATRIC ASSOCIATION

Funded by the World Health Organization
Endorsed by the Department of Health
Manila

TOBACCO FREE INITIATIVE
WHO


Children are a vulnerable group (GYTS)
Need for concerted efforts


Push for critical reforms and interventions that
would impact on significant tobacco control
In consonance with the Regional Action Plan for
the Tobacco Free Initiative in the Western Pacific
(2010-2014)
Share of total mortality of the ten leading causes of death, Philippines,
2004
1. Diseases of the heart
4.1%
2. Diseases of the vascular system
3.3%
17.6%
4.7%
3. Malignant neoplasms
4. Pneumonia
5.3%
5. Accidents
6.4%
6. Tuberculosis, all forms
12.8%
8.0%
7. Chronic lower respiratory diseases
8. Diabetes mellitus
8.6%
10.1%
9.Certain conditions originating in the
perinatal period
10. Nephritis, nephrotic syndrome and
nephrosis
Tobacco use was responsible for over 58,000 deaths,
or nearly 12% of all deaths in the Philippines.
Global Youth Tobacco Survey
(GYTS)





Current usage: ~3/10 of students (27.3%; M>F)
Current smokers: ~1/5 of students (21.7%; M>F)
Other tobacco users: 1/10 (9.7%; M~F)
Ever smoked: ~½ of students (46.2%; M>F)
Likely to smoke: ~1/10 of students (13.6%; M>F)
GYTS




ETS exposure at home: ~50%
ETS exposure in public places: ~60%
Desire to quit smoking: ~80% of current
cigarette smokers
Taught in school about smoking and its
dangers: ~65%

BUT


Buy cigarettes in a store: 56%
Not refused purchase due to age: 64%
GYTS Conclusions
1.
Cigarette smoking among young people in
the Philippines is high
Compared to 1995 data

33% increase of prevalence of smoking in
Filipino youth

12% increase in current smoking prevalence
GYTS Conclusions
2.
Filipino boys are more likely than girls to
use tobacco


Almost one-fifth of young people begin smoking
before the age of 10 years
Over ¼ of never smokers are likely to start smoking
this year
GYTS Conclusions
Environmental Tobacco Smoke exposure is
very high
3.
•
•
•
•
Over half of parents smoke
About 3 in 4 are around others who smoke in
places outside their homes
Filipino youth smokers usually smoke at home
but majority of them prefer to smoke in a
friend’s home
Only 4 in 10 think smoking is harmful to their
health
GYTS Conclusions
4.
The majority of young people currently
smoking want to stop smoking


Over two-thirds or 8 in 10 smokers want to stop
There is lack of access to smoking cessation program
ISSUES
Positive indicators for
anti-smoking campaign
in the Philippines
 72% think cigarette
smoking is harmful
 72% think cigarette
smoking makes one less
attractive
 85% of current smokers
want to stop smoking
Challenges
 27% of never smokers
are likely to initiate
smoking in the next year
 39% agree that smoking
should be banned from
public places
 Only 6% of those who
wish to quit smoking
had access to
professional help
Global Heath Issues Affecting the Filipino Child
PAPA CONVENTION 2010



First International Visiting Lecture of Richmond
Center, Dr. Jonathan Klein, Executive Director
AAP
Paediatric health care providers need to be
aware of the continuing pharmacological and
health effects of tobacco smoke either through
use or second hand exposure
Doctors and other health care professionals can
become more effective public advocates for
tobacco control in their respective communities
Global Heath Issues Affecting the Filipino Child
PAPA CONVENTION 2010

Physicians may know Tobacco effects


Lack the skills needed to advocate for tobacco
control
Physicians are a major force needed in the
community for tobacco control advocacy


Coalition on Tobacco control (FCAP – NGOs,
media, DOH)
Physicians may be the silent link!!!!
BRIEF TOBACCO
INTERVENTION SKILLS
TRAINING
OBJECTIVES
To provide paediatric health care providers with
current information regarding



Physiologic and health effects of Tobacco Exposure
Intervention initiatives for Tobacco Control
To promote practice changes to enhance



Medical provider skills for clinical interventions
Medical provider skills for public advocacy
FRAMEWORK
TARGET HEALTH PROVIDERS


Physicians (Child and Adolescent Health Care
providers)
All health care providers (nurses, midwives, etc.)
TARGET POPULATION



Under 5 infants/toddlers (IMCI counseling)
Children over 5 years old
Adolescents
BTIS TRAINING

Training Modules



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Trainors
Training Manual
Health Provider Encounter form
Health Education Materials
BTIS TRAINING


4 hour training
Training on technical aspects of running course




Didactics
Role Playing
Evaluation
Training on technical issues on Tobacco and
Tobacco control
BTIS
Writeshop and Training
BTIS
BTIS
ALGORITHM

Young Child Less than 5 years old



Older Child (6-9 years old)



Parent/Caregiver
IMCI approach (Pneumonia, ear infection,
nutrition, fever)
Parent/Caregiver
Child
Adolescent
PARENT/CAREGIVER
OLDER CHILD (6-9 YEARS OLD)
ADOLESCENT
VIDEO

Generic Version
Concepts 5As
 Algorithm used
 Easily adaptable (translated in local
dialect)
 BTIS in real time

BTIS Training
PRE TEST
POST TEST
TARLAC
6.9
17.25
METRO MANILA
11
19
BATAAN
9
19.8
DAVAO
12
23
BTIS Learnings

Knowledge and Skills



Improved Knowledge
Acquired Skills for BTIS for every health care
encounter
Need for community resources development
COMMITMENT

Continue BTIS Training all over the country

16th Annual Convention (March 8-9, 2011)
BTIS Training as a pre-convention
a. Academe
b. Key Government Physicians/Program
Managers
COMMITMENT
To Develop Resource Centers for
Motivational Counseling
Medical
treatment
Intensive
counseling
Brief Advice
29
COMMITMENT


COALITION
BUILDING


Physicians as the
MISSING LINK
Involve Medical
Organizations



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
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Department of Health
Philippine Medical Association
Philippine College of
Physicians
Philippine College of Chest
Physicians
Philippine Academy of
Pediatric Pulmnologists
Philippine Society of Oncology
Society of Adolescent
Medicine (SAMPI)
Philippine Ambulatory
Pediatric Association
THANK YOU