Global tobacco surveillance system

7/29/2019 Global tobacco surveillance system

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World HealthOrganization

GLOBAL TOBACCO SURVEILLANCE SYSTEM

Chairperson: Dr Sonali Jhanjee

Presenter: Dr Saurabh Kuma


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SCOPE OF THE SEMINAR INTRODUCTION

OVERVIEW

COMPONENTS GYTS

GSPS

GHPSS

GATS

LINKING THE DATA TO CONTROLPOLICIES

LIMITATIONS

FUTURE DIRECTION


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Tobacco is the single greatest

preventable cause of death in theworld today

>1 billion people worldwide

currently smoke tobacco More than 600 million people alive

today will die from smoking-relatedcauses; half of them children.

Cigarettes kill half of all lifetimeusers. Half of all deaths fromsmoking occur in middle age

between 35 and 69 years old, whenindividuals are most productive.

INTRODUCTION
http://fr.hot-cigs.com/marques/marlboro/marlboro-red.html


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TOBACCO USE IS THE MAJOR RISKFACTOR FOR ALL 4 LEADING NCD

The UN High-LevelMeeting on Non-

Communicable Diseases(NCDs) in September, 2011proposed:

Most urgent andimmediate priority istobacco control

Goal for 2040, a worldessentially free from tobaccowhere less than 5% ofpeople use tobacco


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WHO has played a pioneer role indeveloping effective global strategies

for tobacco control


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Mechanisms for Tobacco Control

Policy

WHO FrameworkConvention for

Tobacco Control(WHO FCTC)

Foundation stone in theglobal fight againsttobacco control

Establishes tobaccocontrol as a priority onthe public healthagenda

Introduces amechanism for country

commitment andaccountability

Tool

MPOWER: Six policiesfor tobacco control

Key entry point forscaling up tobaccocontrol

Help countries build onWHO FCTCcommitments

Integral part of theWHO Action Plan forthe Prevention andControl of Non-

Communicable Diseases


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WHO FCTC-MAIN PROVISIONS

Article 6: Price and TaxMeasures to reduce thedemand for tobacco

Article 8: Protection fromExposure to TobaccoSmoke

Article 11: Packaging and

Labelling of TobaccoProducts

Article 12: Education,training and

communication to raiseawareness

Article 13: TobaccoAdvertising, Promotion andSponsorship

Article 14: Demand ReductionMeasures for TobaccoDependence and Cessation

Article 16: Ban on sales to and

by minors

Article 20: Research,Surveillance and Exchange ofInformation


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Article 6r Article 11, 12w

Article 8

pArticle 13e

Article 14o

Article 20m

Monitor tobacco use and prevention policiesProtect people from tobacco smokeOffer help to quit tobaccoWarn about the dangers of tobacco

Enforce bans on advertising and promotionRaise taxes on tobacco

The MPOWER package of effectivetobacco control measures


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What gets measured gets done

The Parties shall establish, as appropriate, programmesfor national, regional and global surveillance of themagnitude, patterns, determinants, and consequencesof tobacco consumption and exposure to tobacco

smoke. Towards this end, the Parties should integratetobacco surveillance programmes into national, regionaland global health surveillance programmes so that dataare comparable and can be analyzed at the regional andinternational levels, asappropriate

(Article 20 FCTC)

MPOWER monitoring of tobacco use and its keyindicators


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Public Health Surveillance

Ongoing, systematic

collection, analysis, and

interpretation of health-

related data essential to

the planning,

implementation, and

evaluation of public

health practice,

with the timely

dissemination of these

data to those responsible

for prevention and

control


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Essential activities of surveillance

1. Identify; define and measure the health problem of interest;

2. Collect and compile data about the problem (and if possible, factors thatinfluence it)

3. Analyze and interpret these data

4. Provide these data and their interpretation to those responsible forcontrolling the health problem and

5. Monitor and periodically evaluate the usefulness and quality ofsurveillance to improve it for future use

N.B

The key objective of surveillance is to provideinformation to guide interventions


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EXAMPLES OF DATA COLLECTIONSYSTEMS FOR SUBSTANCE USE

Alcohol:

Global Information System on Alcohol and Health

Global Survey on Alcohol and Health

Global Status Report on Alcohol and Health

World drug report

Depends upon reporting by individual countries whichuse different survey methodology

No globally active surveillance system formonitoring substance use which uses similarmethod for collection of data


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GLOBAL TOBACCO

SURVEILLANCE SYSTEM Is the most

comprehensivesurveillance system everdeveloped, implementedand maintained

Aims to enhance countrycapacity to design,implement and evaluatetobacco controlinterventions


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GLOBAL TOBACCO SURVEILLANCE

SYSTEM

1998- A meeting was convened to discuss the need forcollecting data on tobacco use

Participants:

World Health Organizations Tobacco Free Initiative(WHO TFI)

US Centers for Disease Control and Preventions Officeon Smoking and Health (CDC OSH)

At least one country representative from each of the sixWHO Regions

Other international agencies, such as UNICEF and theWorld Bank


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GLOBAL TOBACCO SURVEILLANCE

SYSTEM

The groups reached consensus on several points:

Consistent cross-country data did not exist

Cross-country data for adolescents was a top priority

The surveys should include a core set of questions,identical sampling methodology, and consistent field

procedures and data management

This meeting paved the way for GTSS in 1998


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FUNDAMENTAL PRINCIPLES

Partnership

Consistency

Survey methodologyField procedure

Data management and processing system

Dissemination of data to expand science base

Sustainability

Cost effective

Feasibility to repeat


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COMPONENTS

School surveys:

For Youth and Adolescent

Global Youth Tobacco survey (GYTS)

For adults

Global School Personnel Survey (GSPS)

Global Health Professions Student Survey (GHPSS)

Household survey:

Global Adult Tobacco Survey (GATS)


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PARTNERS

World Health Organization (WHO)

Provide a global policy framework

Plan, organize, operationalize, and manage the survey Center for data dissemination

Building political commitment across countries

Centre for Disease control and prevention (CDC)

provides technical assistance for survey design andsample selection, fieldwork procedures, datamanagement processing and analysis


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NEED TO TARGET YOUNG

POPULATION? More than 80% of tobacco user initiate before the

age of 18 and if young people can remain free oftobacco until age 18, most will never start tosmoke

Many of the long-term diseases associated withsmoking, such as lung cancer, are more likelyamong those who begin to smoke earlier in life

About 80% will smoke into adulthood and thosewho persist one-half will die about 13 yearsearlier than his or her non smoking peers

(U.S.Surgeon General Report 2012)


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GYTS

GYTS is a school-based survey of a defined geographicsite that can be a country, a province, a city, or anyother geographic entity

In March 1999, 11 countries (Barbados, China, Fiji,Jordan, Poland, Russian Federation, South Africa, SriLanka, Ukraine, Venezuela, and Zimbabwe) acceptedthe challenge of pilot testing the first GYTS

All 11 countries completed successful GYTSs during1999

Currently it has covered >154 WHO Member States


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Currently it has covered >154 WHO Member States107 countries have conducted a 2nd round10 countries have conducted a 3rd round


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METHODOLOGY

School-based survey of students aged 1315 years

Multistage sample design with schools selected

proportional to enrollment size

Classrooms chosen randomly within selected schools

All students in selected classes eligible for participation

Anonymous and confidential self-administeredquestionnaire


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METHODOLOGY

Countries may add questions to the questionnaire

Computer-scannable answer sheets

Requires only 3040 minutes to administer

Fieldwork conducted in 68 weeks

Country-level data with regional-level stratificationpossible

Core questionnaire (standard set of survey questionsused in all locations


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The core GYTS questionnaireincludes 54 questions covering eight

categories:

Prevalence of tobacco use

Knowledge and attitudes regarding tobacco

Second hand smoke exposure

Pro- and anti-tobacco media and advertising exposure

Desire for cessation

Access and availability to obtain tobacco

School curricula addressing tobacco use and its healtheffects

Demographics

KEY FINDINGS


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KEY FINDINGS

CIGARETTE SMOKING : 1999-2008

5

15

2

17

2

87

14 14

7

21

10

19

12

A

FR

AMR

EMR

EUR

SEAR

WPR

TOTA

L

Values

in

Percentage

Percentage of Girls whocurrently smoke

cigarettes

Percentage of Boys who

currently smoke

cigarettes

BOYS-Rates:Highest in Europe and Western

Pacific

Lowest in Eastern Mediterraneanand South-East Asia

GIRLS-Rates:Highest in Europe and the AmericaLowest in Eastern Mediterranean

and South-East Asia

Girls are much less likely to smokecigarettes than boys in the regions ofAfrica, Eastern Mediterranean, South-East Asia, and Western Pacific

Americas girls are more likely thanboys to smoke Cigarettes

No significant gender differenceswere observed in the Americas andEuropean region

Over 60% of current smoker wantto quit smoking

QUITTING : PERCENTAGE OF STUDENTS WANTING

TO QUIT SMOKING 1999-2008

75

53

71

63

7381

69

AFR AMR EMR EUR SEAR WPR TOTAL

Values

In

Percentages


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TOBACCO USE

11

7

9

8 76

8

12 12

14

1213

7

12

AFR

AMR

EMR

EUR

SEAR

WPR

TOTAL

Values

In

Per

centages

Percentage of Girls

currently using tobacco

products other than

cigarettesPercentage of Boys

currently using tobacco

products other than

cigarettes

Rates of other tobaccouse is fairly uniform across

regions except for Westernpacific region

In South-East Asia, othertobacco use mainly takes

the form of bidis, and inthe Eastern Mediterranean,the shisha (waterpipe) isthe most prevalent form

Use of other tobaccoproducts is greater than

cigarette use in the regionsof Eastern Mediterraneanand South-East Asia


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SECOND HAND SMOKE : PERCENTAGE OF STUDENTS

EXPOSED 1999-2008

28

41 38

78

34

514344

5546

86

49

64

55


Values

in

Perc

entage

At Home

In Public Places

Exposure to second handsmoke is alarmingly highworld wide with highest rates

in European region andlowest in African region

Over half of the studentsreported that they had beenexposed to second-hand

smoke in public places

Four in 10 were exposed tosmoke in their home

Eight in 10 students favor aban on smoking in publicplaces

SMOKING BAN : PERCETAGE OF STUDENTS WHO

FAVOR A BAN IN PUBLIC PLACES

59

82 84 83

78

84

78


Values

In

Percentages


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0

20

40

60

80

100

To

tal

AFRO

EMRO

EURO

PAHO

SEARO

WPRO

Percent

Saw Anti Message

Saw Pro Message on Billboards

Saw Pro Message in Newspapers/Magazines

Role of media and advertisements

GYTS-INDIA


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GYTS-INDIA

Initiated in 2003

One of few countries tohave conducted 3 roundsof survey 2003, 2006, 2009

2003 survey was

conducted state wisewhereas in 2006 and 2009 ithas been conducted regionwise

2009 survey wasconducted in >150 schools

with >10,000 studentsparticipating


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KEY FINDINGS

Current use of smoked tobacco was lower in India for bothboys and girls (Boys: 12% vs 5.8%, Girls: 7% vs 2.4%)

Current use of other forms of tobacco was higher in boys(16.2% vs 12%) and was comparable for girls (8% vs 7.2%)

No of students exposed to second hand smoke at home was

significantly lower (47% vs 22%) but those exposed to smokeat public places were comparable (48% vs 55 %)

About two third of student favored ban smoking at publicplaces and similar no of smokers want to quit which iscomparable to world data

Three-quarters of the students saw anti-smoking mediamessages in the past 30 days; three-quarters of the studentssaw pro-cigarette ads on billboards


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GLOBAL

SCHOOL

PERSONELSURVEY


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GSPS

It is a school based survey focused on school personelsmainly teachers and administrators

Need to target them:

Act as role models for students

Are conveyors of tobacco-prevention curricula

Are key opinion leaders for school tobacco-controlpolicies

Initiated in 2000


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Conducted in 74 WHO Member States19 countries have conducted a 2nd round of the GSPS


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METHODOLOGY

All schools selected for GYTS eligible

All school personnel eligible

Confidential self-administered questionnaire

Names of schools or personnel are not collected and

participation is voluntary

Surveys are conducted generally at staff meetings orafter school


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The core GSPS questionnaireincludes 45

questions covering five categories:

Prevalence of tobacco use

Knowledge and attitudes regarding tobacco

School policy

School curricula on preventing tobacco use

Demographics


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KEY FINDINGSCIGARETTES : PERCENTAGE OF SCHOOL TEACHERS

AND ADMINISTRATORS WHO CURRENTLY SMOKE

CIGATERRES 2000-2008

6

11

18 19

2

8

12

16

20

26

34

30

42

26


Values

In

Percentages

Females

Males

OTHER TOBACCO PRODUCTS : PERCENTAGE OF

SCHOOL TEACHERS AND ADMINISTRATORS WHO USE

OTHER TOBACCO PRODUCTS 2000-2008

54

13

45

3

78 8

16

13

18

8

12

AFR AMR EMR EUR SE AR WP R TOTAL

Values

In

Percenatges

Females

Males

Alarming proportion ofschool personnel smokecigarettes and use otherforms of tobacco

Scarcity of tobacco-freeschools and the high levelof smoking on schoolgrounds by schoolpersonnel indicate howseriously school practices

and staff actionsundermine the educationalmessages and otherprevention efforts toreduce the prevalence ofsmoking among

adolescents


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BAN ON THE USE OF TOBACCO PRODUCTS

54

38

51

66 67

63 56

78

67 68

88 87 8577

AFR

A

MR

E

MR

EUR

SEAR

W

PR

TO

TAL

Values

In

Percen

tages

STAFF BAN : Percentage

of schools with a ban on

the use of tobacco

products by teachers2000-2008

STUDENT BAN :

Percentage of schools

with a ban on the use of

tobacco products by

students 2000-2008

TRAINING AND MATERIALS

1217 16

23

1619

16

40

27

40

59

40 4044

AFR

AM

R

EM

R

EU

R

SEA

R

WP

R

TOTAL

Values

In

Percentag

es Percentage of teachers

trained to prevent youthtobacco use 2000-2008

Percentage of teachers

with access to materials

on how to prevent tobacco

use among youth 2000-

2008

Three-quarters of schools bansmoking among students, yet

only over half of schools bansmoking among the staff

Policies restricting smokingamong school personnel mustbe applied to both students andstaff because seeing adultssmoking increases thelikelihood of regular smokingamong students

Majority of school personnelhave not received specifictraining to help Students

Most teachers reported thatthey donot have adequate

teaching materials


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GSPS-INDIA

Initiated in 2006

2 rounds of survey has been completed 2006 and 2009

In 2009:

School response rate was 98.3%

84.3% of the school personnel completed the survey

2,575 teachers and administrators participated in survey


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KEY FINDINGS

One-quarter of school personnel currently use anytobacco product

One in 10 currently smoke cigarettes and 17.5%currently use other tobacco products

Seven in 10 schools have a policy prohibiting tobaccouse among students

Nearly twothirds have a policy for personnel

Two in 5 schools include tobacco use prevention inschool curriculum


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KEY FINDINGS

More than one-third of the teachers have access toteaching materials on tobacco use

One in 10 teachers has ever received training on youthtobacco use prevention

Four in 5 think smoking should be banned from publicplaces

Almost 9 in 10 think teacher tobacco use influencesyouth tobacco use

G O


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GLOBAL

HEALTH

PROFESSIONSSTUDENT

SURVEY


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GHPSS

Is a standardized school-based survey of third-yearstudents pursuing advanced degrees in:

Dentistry Medicine

Nursing

Pharmacy

Is important to collect data on health professionals asthey play a key role as service provider in tobaccocontrol

Initiated in 2005

Conducted in 50 who member states


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Conducted in 50 who member states38 countries in dental school, 38 in nursing schools,49 in medical schools and 33 in pharmacy schools


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METHODOLOGY

School-based survey of third-year students in dentistry,medicine, nursing, and pharmacy programs

Can include public and private schools

Sampling possibilities:

Multistage sample design with schools selectedproportional to enrollment size

Classrooms chosen randomly within selectedschools or

Census of schools and students in countries withfew health professional schools

All students in selected classes eligible for participation

KEY FINDINGS


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KEY FINDINGS

KEY FINDINGS


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KEY FINDINGS

KEY FINDINGS


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KEY FINDINGS


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GHPSS-INDIA

YEAR NO OFSCHOOLS

NO OFSTUDENT

OVERALLRESPONSERATE

DENTAL 2OO5 24 1499 89.4

MEDICAL 2006 13 1177 77.2

NURSING 2007 22 1082 92.9

PHARMACY 2008 25 1428 84.8


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KEY FINDINGS

1 in 10 health professional smoke cigarette currentlyand there was no significant gender difference across all4 disciplines

Use of other tobacco products is significantly less thancigarette smoking

~ 2 in 3 dental and nursing colleges have smokingbanned in their premises whereas less then half ofmedical and pharmacy colleges had such policy

In less than half of all colleges smoking ban policy isenforced


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KEY FINDINGS

~2 in 3 health professionals currently using tobaccoproducts want to quit but less than half of them havereceived any advice to quit

More than 50% of all health professional were exposedto second hand smoke at public places

~80% of health professional believe they serve as rolemodels

~ 90% of health professional believe they shouldreceive specific training on cessation techniques but lessthan 33% have received such training

GLOBAL


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ADULTTOBACCO

SURVEY


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GATS

Nationally representative household survey of all non-institutionalized, men and women age 15 years old andolder

Initiated in 2007

Sponsors:

The Bloomberg Initiative to Reduce Tobacco Use

The Bill and Melinda Gates Foundation

The U.S. Centers for Disease Control and Prevention

World Health Organization

Currently it has been completed in 14 countries


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Countries Completed 2nd Phase Countries


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METHODOLOGY

Non-institutionalized, men and women age 15 years oldand older were included

Three-Stage Cluster Design

Stage 1 primary sampling units (PSU) selectedprobability proportional to size

Stage 2 selection of Enumeration Area in eachselected PSU

Stage 3 selection of Households in each selected EA

ONE ELIGIBLE (15+) SELECTED TO PARTICIPATEFROM EACH HOUSEHOLD

Residents from all regions of every nation were eligible

to be sampled


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METHODOLOGY

Minimum sample size of 8000 households wasrecommended

Face to- face interviews were done in the participants

local language

Handheld electronic data collection device was used

Interviews were done privately

Fieldwork was completed within 16 months

Ethics review and approval was undertaken

GATS i i i f


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GATS core questionnaire consists ofeight sections, each containing

multiple questions

Background characteristics

Tobacco smoking

Smokeless tobacco

Cessation

Second-hand smoke exposure

Economics

Media

Knowledge, attitudes and perceptions


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GATS-INDIA

Is the project ofMOHFW, GOI

IIPS, Mumbai is thenodal implementing

agency

Has been conducted inall 29 states and 2 Union

Territories, Chandigarh &Pondicherry

The survey covered99.92% of Indiaspopulation


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Total

(%)

Males

(%)

Females

(%)

Tobacco

users

34.6 47.9 20.3

Smokers(Bidis)

14.0

(9.0)

24.3

(16.0)

2.9

(2.0)

Smokeless tobacco

25.9 32.9 18.4

275 million tobacco users

197 million males, 78million females

164 million use onlysmokeless tobacco

42 million use smokingand smokeless tobacco

Mean age of initiation oftobacco use 17.8 yrs

KEY FINDINGS


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KEY FINDINGS

Nearly two in five smokers (38%) and users ofsmokeless tobacco (35%) made an attempt to quitrespective tobacco use in the past 12 month

Among 47 percent of smokers who had visited a healthcare provider in the past 12 months:

53%- were asked if they smoked

46% were advised to stop smoking

Among 47 percent of smokeless tobacco users who hadvisited a health care provider in the past 12 months:

34% were asked whether they used smokeless tobacco

27% were advised to stop such use


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KEY FINDINGS

52% of adults were exposed to second-handsmoke (SHS) at home and 30% at outdoor places

51% of who had visited restaurants during past 30days had seen a designated non-smoking area inthe restaurant and 16 percent observed smokingin such an area

About 2 in 3 (66%) saw advertisement orpromotional message for tobacco products

DATA DISSEMINATION


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DATA DISSEMINATION

Website:www.cdc.gov/tobacco/

global

Fact sheets: one-pagedocument highlighting thecountrys survey results

Public use data sheets

Country reports

Publications:

86 articles in peer-reviewed

journals A GTSS publication is

released approximatelyevery 6 weeks


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LINKING DATA TO TOBACCOCONTROL POLICIES

High prevalence of tobacco use

Interventions:

Enforce ban on sale of tobacco products to minors

Raising taxes to make tobacco product expensive

Require effective package warning labels

Implement counter-tobacco advertising Obtain free media coverage of anti-tobacco activities


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2/3 want to

quit

3/4 approve

of warningsMore

than half

changedopinions

Pack warnings are effective, especially ifthey have pictures covering half of pack


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2/3 of tobacco users want to quit

Interventions:

Strengthen health systems so they can make tobaccocessation advice available as part of primary health care

Support quit lines and other community initiatives

Easily accessible, lowcost pharmacological treatmentwhere appropriate


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High rates of exposureto second hand smoke:

Interventions:

Enact and enforcecompletely smoke-freeenvironments in health-care and educational

facilities and in all indoorpublic places includingworkplaces, restaurantsand bars


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Role of tobaccoindustries in promotingtobacco use

Intervention:

Enact and enforceeffective legislation thatcomprehensively bansany form of directtobacco advertising,promotion andsponsorship

Enact and enforceeffective legislation toban indirect tobaccoadvertising, promotionand sponsorship


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LIMITATIONS

Although gyts has extensive coverage othercomponents of GTSS still has to go long way togenerate globally comparable data

Data for GTSS are based on the self-report and it mightbe under-reported or over-reported

Limited to students, GYTS is not representative of allyouths aged 1315 years

GYTS data apply only to youths who were in school onthe day of the survey and who completed the survey


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LIMITATIONS

GSPS is not an independent sample of schools and isdependent on the success of the GYTS

GHPS-Respondents have not had substantial interaction

with patients, survey results cannot not be extrapolatedto practicing health professionals

Students in all health professions whose members couldprovide patients with cessation counseling were notsurveyed

Reliability studies of the GATS core questionnaire itemshave not been undertaken

FUTURE DIRECTION


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FUTURE DIRECTIONGTSS has to further widen its coverage

Provide countries with valuable feedback to evaluate and improve


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Provide countries with valuable feedback to evaluate and improveCountry National Action Plans and to develop plans where none exist

Examples of countries using GTSS data to enact laws

Seychelles enforced ban on smoking in public places from2009

Turkey included a provision to mandate broadcasts of anti-

tobacco educational programming during daytime and earlyevening hours (8:0022:00) in 2003

Venezuela establishes an intergovernmental commission forTobacco Control in 2006

Philippines: Tobacco Regulatory Act 2003 Regulatesthe packaging, use, sales distribution, & ads of tobaccoproducts

Build political commitment across countries to spend on tobacco controlP li i i l di it i t


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Per capita tobacco tax revenue andPublic spending on tobacco control

Policies including monitoring systems


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FUTURE DIRECTION

Continuing to provide data crucial to measureglobal tobacco epidemic

Dissemination of data to build scientific base

Establish GYTS, GSPS and GHPS as primary datasources for monitoring FCTC

To be changed...


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To be changed...

GTSS JUNE 2009-ATLANTA CELEBRATING 10 YRS


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GTSS JUNE 2009 ATLANTA CELEBRATING 10 YRS

Global tobacco surveillance system

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