Tobacco Control Policy and Legislation Antero Heloma, MD, PhD Principal Medical Adviser 20/03/2012 Presentation name / Author 1
Mortality from smoking in 1950-2000 About 63 million people died from smoking during this 50-year period in all developed countries About 62% of them died in middle age (35-69) 20/03/2012 Presentation name / Author 2
Annual deaths from smoking Smoking kills about 2 million people a year in developed countries About 1 million die in middle age from smoking Many of those who died from smoking in middle age would have lived on for 10, 20, 30 or more healthy years About 22 years of life are lost, on average, by those killed in middle age by smoking 20/03/2012 Presentation name / Author 3
Smoking causes twice as many deaths as all non-medical causes together 2 1,8 1,6 1,4 1,2 1 0,8 0,6 0,4 0,2 0 Smoking deaths Other causes 2 million smoking deaths 1 million other non-medical causes: accidental, suicide, natural disasters 20/03/2012 Presentation name / Author 4
Deaths from smoking in WHO-Euro subregions The WHO-Euro region can be divided into three sub-regions: EU-15 (countries that joined EU before 2004): =Western and Northern Europe EU-27 (countries that joined EU after May 2004): =Central and Eastern Europe included (the present European Union) CIS (Confederation of Independent States): =Countries of former Soviet Union 20/03/2012 Presentation name / Author 5
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Confederation of independent states (CIS) 20/03/2012 Presentation name / Author 7
Daily smokers in WHO-Euro sub-regions Widening gaps between the sub-regions % of regular daily smokers in the population, age 15+ CIS EU members since 2004 or 2007 EU members before May 2004 20/03/2012 Presentation Antero name Heloma / Author 8
Cardiovascular mortality before 65, WHO-Euroregions Widening gaps between the sub-regions Trends in premature mortality from cardiovascular disease in the WHO European Region (SDR, <65 years per 100,000) CIS EU members since 2004 or 2007 EU members before May 2004 20/03/2012 Presentation Antero name Heloma / Author 9
Deaths from smoking before the age of 65, WHO-Euro regions Widening gaps between the sub-regions Trends in premature mortality from smoking related causes in the WHO European Region (SDR, <65 years per 100,000) CIS EU members since 2004 or 2007 EU members before May 2004 20/03/2012 Presentation Antero name Heloma / Author 10
Smoking prevalence in northwestern Russia Smoking prevalence by education, men. 80% 70% 60% 50% 40% Lower Middle Higher 30% 20% 10% 0% 1992 1997 2002 2007 20/03/2012 Presentation name / Author 11
Smoking Prevalence in Northwestern Russia Smoking prevalence by education, women. 50% 40% 30% 20% Lower Middle Higher 10% 0% 1992 1997 2002 2007 20/03/2012 Presentation name / Author 12
Smoking prevalence in northwestern Russia Smoking prevalence in age groups, women. 50% 40% 30% 20% 25-34 35-44 45-54 55-64 10% 0% 1992 1997 2002 2007 20/03/2012 Presentation name / Author 13
Young women are tobacco industry s most important target group in Russia 20/03/2012 Presentation name / Author 14
Smoking prevalence in Finland 1960-2010 and tobacco control actions 20/03/2012 Presentation name / Author 15
Proportion of daily smokers in Finland by educational group, 25-64-year old population (age-standardised) % % 50 50 40 40 30 30 20 20 10 10 0 78-83 84-88 89-93 94-98 99-2003 2004-07 0 78-83 84-88 89-93 94-98 99-2003 2004-07 Low Middle High 20/03/2012 Presentation name / Author 16
Exposure to Second-hand Smoke at work by gender and smoking status in Finland 20/03/2012 Presentation name / Author 17
Reducing the health hazards of smoking (Finnish model) Legislation Health promotion, cessation Tax and price policy: Act on Tobacco excise, value added tax (approx. 80% of package price) Research Monitoring and evaluation Health effects, consumption, trends Other tobacco research 20/03/2012 Presentation name / Author 18
History of Finnish Tobacco Control legislation In 1976: Advertising ban; smoke-free schools (primary and secondary) smoke-free public transport and public premises; warning texts in packages; prohibition to sell tobacco to people under 16 Amendment 1994: smoke-free workplaces except restaurants; indirect advertising also prohibited; age limit for tobacco purchases up to 18 Amendment 2007: smoke-free restaurants (separately ventilated smoking room is allowed with licence) Amendment 2010: 1) 90% of hotel rooms smoke-free, smoke-free sporting arenas (even when outdoors), smoke-free public events (also outdoors) 2) the long-term aim of the tobacco act: to eliminate tobacco use (by 2040) 3) no tobacco display in the points of sale (implementation 2012) 20/03/2012 Presentation name / Author 19
Tobacco counter (before 2012) 20/03/2012 Presentation name / Author 20
New solutions for shop check-outs (packs not visible to customers) 20/03/2012 Presentation name / Author 21
Plain packaging Only brand name and health warning on cigarette packages. This proposition may be taken forward at the EU level (Community regulation) 20/03/2012 Presentation name / Author 22
Smokeless tobacco A can of traditional Swedish-type snus delivers an amount of nicotine equal to 50-75 cigarettes, ban in the EU except Sweden Average snus using time is 13 hours/day per user Snus is heavily addictive 20/03/2012 Presentation name / Author 23
Plasma nicotine levels in smokers and smokeless tobacco users Tobacco user group Plasma nicotine (ng/ml) Swedish smokers 36.7 Swedish snus users 36.6 British smokers 36.7 British nasal snuffers 36.1 (Vainio & Weiderpass 2003) 20/03/2012 Presentation name / Author 24
Boys snus use by age in Finland 20/03/2012 Presentation name / Author 25
% Tobacco use among young people in Sweden 2007 20 19 19 19 17 15 10 5 11 5 Boyst Girls 0 Cigarettes Snus Both cigarettes and snus 20/03/2012 Presentation name / Author 26
Snus and binge drinking Heavy alcohol use and binge drinking are associated with snus use among adolescents even more than with smoking (Wickholm et al. 2003) 20/03/2012 Presentation name / Author 27
Health warnings The European Union is planning to make pictorial warnings obligatory in Member States At present, pictorial warnings are in use only in a few countries The new warnings would be so-called combined warnings (text and picture) 20/03/2012 Presentation name / Author 28
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Majority of smokers want to quit Stopping smoking is difficult because of considerable physical, psychological and social addiction 80% of Finnish smokers stated that they are worried about the health risks of tobacco and 61% that they would like to stop smoking According to the same study 43% of smokers try to quit smoking each year but only 3-5% succeed in their quitting attempts 20/03/2012 Presentation name / Author 36
WHO-FCTC The Framework Convention on Tobacco Control (FCTC) was now been ratified by 174 countries in the world For information www.fctc.org 20/03/2012 Presentation name / Author 37
Thank you! 20/03/2012 Presentation name / Author 38