Involving Health Professionals in Tobacco Control

1. Involving Health Professionals in Tobacco Control Prof. Javaid Khan FRCP (Edin) Head Section of Pulmonary and Critical Care Medicine The Aga Khan University, Karachi, Pakistan

2. Involving Health Professionals in Tobacco Control • Why involve health professionals in tobacco control? • What are the barriers to involving health professionals in tobacco control? • What are practical examples of the ways in which health professionals can contribute in tobacco control?

3. Which Health Professionals? • Medical, nursing, dental, and pharmacy students • Deans, principals, and professors of these schools • Midwives • Hospital employees • Clinic employees

4. Doctors and the Tobacco Industry • Doctors have a very important marketing value • Tobacco industry used doctors for promoting tobacco in 1950s Image source: www.tobaccodocuments.org

5. Video: What Cigarette Do You Smoke, Doctor? At this point in the presentation, you will view an online video that will appear in another browser window. Follow these steps to view the video and then return to this lecture. • Click this link to view the video:http://www.youtube.com/watch?v=hxUZI0vE0FM • After viewing the video, return to this slide, and click Play to continue the lecturepresentation.

6. Video: What Cigarette Do You Smoke, Doctor?

7. The Potential of Doctors to Change Patient Behavior • Doctors have probably the greatest potential of any group in society to promote reduction in tobacco use, and thus cause a reduction in tobacco-induced morbidity and mortality Source: Simpson. (2000). Doctors and tobacco: Medicine’s big challenge.

8. Health Professionals Are in a Powerful Position • Respected position in society • In the front line in dealing with health consequences of tobacco use • Unique opportunities to give advice to patients • Considered “expert” on health-related issues • Lines of access to decision makers

9. Barriers to Involving Health Professionals • Barriers to involving health professionals in tobacco control • Health professionals extremely busy in their clinical work • Tobacco use is not considered as a serious public health issue in the country • High smoking rates in health professionals • Low perception of risk among the public • Most health professionals do not receive any training on tobacco control/smoking cessation in their medical schools • Many health professionals are not aware of how certain policies/legislation affect their ability to help patients quit tobacco • Poor health care infrastructure in many low-income countries

10. Health Professionals and Smoking • Credibility of anti-smoking message is lost if public see health professionals smoking • Overall the current smoking prevalence among Chinese physicians differed significantly by gender • Men: 26% to 61% • Women: 0% to 19% • In countries with the highest smoking rates, doctors smoke even more than the general public and, as a result, serve as negative role models Text source: Abdullah et al. (2011). Tob Control, 22(1): 9-14. Image source: Javaid Kahn.

11. Global Health Professionals Survey Pilot Study, 2005 • Surveys conducted in ten countries among third-year students in four health-professional disciplines (dentistry, medicine, nursing, and pharmacy) • Results indicated that current cigarette smoking among these students was higher than 20% in seven of the ten countries surveyed • 87%-99% of the students surveyed believed they should have a role in counseling patients to quit smoking • Only 5%-37% of students had actually received formal training in how to conduct such counseling Source: Centers for Disease Control and Prevention (2005). Tobacco use and cessation counseling—Global health professionals survey pilot study, 10 countries, 2005.MMWR, 54(20): 505-509.

12. Health Professionals Must Not Forget Other Measures • Prevention of smoking-related diseases in society demands more than just smoking cessation • Comprehensive ban on tobacco advertising and promotion • Mass media campaign • Powerful pictorial health warnings • Implementation of clean air laws • Increase taxation on tobacco • Preventing the youth from tobacco experimentation

13. Why Doctors Don’t Discuss Tobacco with Patients • Too time-consuming • Advice is ineffective • Lacking confidence • Discussions are unpleasant • Knowledge is deficient • Discussing smoking is outside of their professional duty • Intrudes upon patients’ privacy • Discussions are inappropriate Source: Vogt. (2005). Addiction, 100(10): 1423-1431.

14. How Can Health Professionals Contribute? • Acting as a role model by not smoking, or by quitting smoking • Counseling patients not to smoke • Providing smoking cessation treatment • Speaking out publicly and lobbying for comprehensive public policies to control tobacco use • Using professional societies and medical associations as pressure groups for implementation of tobacco control laws • Doing research related to tobacco control in the country Source: American Cancer Society. (2003). Engaging doctors in tobacco control: Volume 2 of tobacco control strategy planning, companion guide.  

15. What Can Clinicians Do? • Do not smoke or use other forms of tobacco • Take a smoking history from every patient • Give firm advice to patients on quitting smoking • Learn “how to counsel patients” in order to make them quit smoking • Educate the public regarding the hazards of active and passive smoking

16. Future Professionals • Medical, nursing, pharmacy, and dental students must be taught about tobacco control and smoking cessation • Smoking rates in medical students is very high in many countries of the world • Curriculum is deficient in tobacco control and smoking cessation Text source: Richmond. (1999). Thorax, 54(1):70-78; Image source: Javaid Kahn.

17. Does Advice from Doctors Encourage Smokers to Quit? • Advice from doctors helps people to quit • Even brief advice of 2-3 minutes about quitting smoking works • More intensive advice results in slightly higher rates of quitting • Providing follow-up support after offering the advice may increase quit rates Source: Stead et al. (2008). Cochrane Database of Syst Rev (2): CD000165.

18. The 5 A’s of Tobacco Cessation • Ask about tobacco use • Advise all users to quit • Assess willingness to make a quit attempt • Assist in quit attempt • Arrange for follow-up

19. Health Professionals Lobbying for Tobacco Control Image source: Javaid Khan.

20. Lobby to Make Your Hospital and Clinics Smoke-Free Image source: Javaid Khan.

21. Let’s Get Our Own House in Order Image source: Javaid Khan.

22. Raising Voice on Non-Implementation of Clean Air Laws 22

23. Educating Public Using Print Media Image source: www.tobaccodocuments.org

24. Educating Public Using Print Media Image source: www.tobaccodocuments.org

25. Writing Letters to Editors and Appearing on Television Image sources: (left) Javaid Kahn, (right) courtesy of Health TV Pakistan.

26. Health Professionals With Politicians at Press Club Image source: Javaid Khan.

27. Role of Medical Professional Societies • Train members as tobacco control advocates • Include tobacco as an issue in conferences • Exert pressure on decision makers for tobacco control measures in the country • Ensure that all conferences are smoke-free • Create public awareness of tobacco industry tactics

28. Role of Medical Professional Societies • Issue brochures and guidelines on smoking cessation in local languages • Hold workshops for doctors on tobacco control and smoking cessation • Help organize talk shows on the tobacco epidemic • Encourage medical leaders to write letters and articles to newspapers

29. Local Research • Health professionals must do local research to seek public attention

30. At Medical School Level • Introduce tobacco control and smoking cessation in medical curriculum • Professors can use their status to speak out about the importance of tobacco control • Do research related to tobacco control • Raise issue of tobacco on World No Tobacco Day, World Cancer Day, etc. • Run smoke-free doctors and medical school campaign

31. Training Future Health Professionals

32. Quit Smoking!

33. Thank You!