SAY YES TO NO SMOKING SAY YES TO NO SMOKING Evidence-Based Public Health and HTA The World Bank PMU Conference Prof.dr. Stipe Oreskovic Vilnius, 26 September 2003
Transcript
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SAY YES TO NO SMOKING Evidence-Based Public Health and HTA The
World Bank PMU Conference Prof.dr. Stipe Oreskovic Vilnius, 26
September 2003
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SAY YES TO NO SMOKING A Definition of EBM The conscientious,
explicit, judicious use of the current best evidence in making
decisions about the care of individual patients. (Ref: Sackett et
al, 1996)
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SAY YES TO NO SMOKING A Definition of EBPH The conscientious,
explicit, judicious use of the current best evidence in making
decisions in routine PH practice, and in developing PH policies and
programs. (Ref: Sackett et al, 1996)
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SAY YES TO NO SMOKING Increasing Knowledge
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SAY YES TO NO SMOKING Rationale for Evidence-Based Practice for
Public Health Project Increasing amount of high quality, relevant
research in PH and in disciplines related to PH (medical,
behavioral, social sciences). Great need for high quality,
evidence-based information by PH practitioners. Access to best
evidence limited
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SAY YES TO NO SMOKING Public Health and HTA Any Relation? HTA
is a part/heart of public health (D. Banta)HTA is a part/heart of
public health (D. Banta) Health promotion campaigns medical,
behavioral and economics changes Conscientious, explicit,
judicious?
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SAY YES TO NO SMOKING Public Health and HTA Any Relation?
Tobacco control policies involve different medical technologies
including drugs (nicorette, zybane..) It is not only about
traditional medical technologies involve also communication
technologies and their efficiency Cost-effectiveness of smoking
cessation interventions?
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SAY YES TO NO SMOKING Question no 1: What is priority? And how
the priority setting works? Between 72 and 81% of citizens express
they intention (need) to stop smoking It is the most cost-effective
intervention The negative consequences are massive However...
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SAY YES TO NO SMOKING Consequences of Smoking: 1 Titanic each
78 minutes!
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SAY YES TO NO SMOKING
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Questions about tobacco policies Can it work? Efficacy Does it
work? Effectiveness Should it be used, given other calls on a fixed
budget? Economics Is it reaching those whom it should? Availability
EBM Policy Audit Development
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SAY YES TO NO SMOKING Tobacco: Health and Economics Dr. Joy de
Beyer World Bank
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SAY YES TO NO SMOKING Cost effectiveness of the cessation
strategies Mass media anti- smoking campaign which includes the
telephone helpline, Smokeline. This type of mass media-led campaign
appears to have been cost- effective (Ratcliffe et al 1997). Buck
and colleagues estimate that costs per life year gained range from
21 to 711. Analysis shows that smoking cessation is more effective
in producing population health gains than almost any other medical
intervention.
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SAY YES TO NO SMOKING Effectiveness and cost-effectiveness of
smoking cessation interventions
http://www.nelh.nhs.uk/guidelinesdb/html/ smoking-refs.htm
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SAY YES TO NO SMOKING Evidence for Intervention Title
AuthorsDate Publication Choosing the most effective health
promotion options for reducing a nation's smoking prevalence Reid
DJ, Killoran AJ, McNeill AD, et al.. 1998.Health Education
Authority London Nicotine replacement therapy for smoking cessation
(Cochrane review) AbstractAbstract Silagy C, Mant D, Fowler G, et
al. Updated quarterly.The Cochrane Library Issue 2. : Effectiveness
of training health professionals to provide smoking cessation
interventions (Cochrane review) Silagy C, Lancaster T, Fowler G, et
al. 1998. Updated quarterly.) The Cochrane Library Issue 2.Oxford:
Update Software
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SAY YES TO NO SMOKING Evidence for Intervention.Five hundred
life saving interventions and their cost- effectiveness. Tengs TO,
Adams ME, Pliskin JS, et al.. Risk Analysis 15
:369-390[Medline]..Clinical guidelines. Using clinical guidelines
to improve patient care within the NHS. Mann T.. Leeds: National
Health Service Executive.Promoting clinical effectiveness. A
framework for action in and through the NHS. NHSE.. Leeds: National
Health Service Executive :.Smoking cessation.NHS Centre for Reviews
and Dissemination. Effectiveness Matters, York: NHS Centre for
Reviews and Dissemination, University of York Vol 3, Issue 1. :.The
new NHS.Secretary of State for Health.. London: Stationery Office
:
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SAY YES TO NO SMOKING
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Alternative less effective and more costly E Alternative
cheaper but less effective D Alternative more effective and less
costly C E.g. 20,000 per QALY COST OUTCOME A B Alternative more
effective but more costly
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SAY YES TO NO SMOKING WHQ Most supply side actions do not
reduce tobacco use / improve health Prohibition Youth access
restrictions Trade restrictions Crop substitution Control of
smuggling is the only exception and is the key supply-side
measure
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SAY YES TO NO SMOKING Comprehensive advertising bans reduce
cigarette consumption Consumption trends in countries with strong
bans compared with countries with no bans (102 countries)
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SAY YES TO NO SMOKING Facts and evidence Policy-relevant
global, regional and country-level evidence-based research Do
strong tobacco control measures: Reduce tax revenues ? No Increase
smuggling ? Depends Role of organized smuggling, corruption Cause
net job/income losses ? Not necessarily, but needs more research
Hurt poor people ? Some, benefit some
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SAY YES TO NO SMOKING Economics of Tobacco in Croatia? Tobacco
is the most profitable business in Croatia: generates tax revenues
(7,6 % of the budget) provides jobs, incomes and large profits may
attract foreign private investment (fight between TDR, BAT and PM
generates export earnings (or smuggling?) gives smokers pleasure
(for the timebeing)
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SAY YES TO NO SMOKING As Cigarette Tax Rises Revenue Increases
Tax per pack and cigarette tax revenues in Norway, 1990-1998
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SAY YES TO NO SMOKING Successful Tobacco Control Broad
partnership is the KEY Join comparative advantages for effective
policy dialogue Address concerns of key decision makers Policy
relevant research, and Disseminate research evidence
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SAY YES TO NO SMOKING
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Mass Media Strategies ProsCons Reach large numbers of teens Can
change social norms Can be linked to more intensive interventions
Message may not be relevant Superficial prevention message
Expensive on primary networks Needs frequent updating Types:
Television counter-advertising, radio ads, print media, internet
print media, internet
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SAY YES TO NO SMOKING Mass Media Campaign Message Themes
Consequences of Smoking: Social Norms and Imagery: n Short-term n
Long-term n Family-related n Addiction n De-glamorization of
smoking n Smoking not normative Role Models: n Smoker is negative
role model n Celebrities promote non-smoking Industry and Product
Focus: Second-Hand Smoke Adapted from Farrelly et al., 2002
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SAY YES TO NO SMOKING CELEBRITIES IN ACTION! Janica Kosteli 3
olimpic Gold medals Ivica Kosteli World Ski Champion Lancet EJPH
ZFG WHO Award Year 2001 and 2002
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SAY YES TO NO SMOKING Free telefone help line 0800 2000 37
Stipe Mesi, president of Croatia
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SAY YES TO NO SMOKING Media Communication Australian cartoons
Croatian cartoons Logo completely recongnized
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SAY YES TO NO SMOKING Public Health Experts Profile
Participating in the Anti-Tobacco Campaign Epidemiologists
Statisticians Environmental Engineers Sanitarians Food Scientists
Health Care Administrators Health Economists Politicians Social
Workers Mental Health Workers Substance Abuse Counselors Doctors
Nurses Teachers Nutritionists Lab Technicians
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SAY YES TO NO SMOKING INTERACTIVE INTERNET SITE 17 000 VISITS
www.snz.hr/nepusenje
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SAY YES TO NO SMOKING SCHOOL HOW TO QUIT SMOKING NETWORK OF 55
SCHOOL ARROUND COUNTRY GPs, PSYCHOLOGIST SPECIALY EDUCATED AND
LICENCED
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SAY YES TO NO SMOKING Have you ever smoked a whole cigarette?
Ever tried even a few puffs? Never Smoker No Never Smoker Yes Trier
No Trier Smoked > 1 whole cigarette? Trier No Trier Yes On how
many of last 30 days did you smoke? < Monthly smoker None <
Monthly smoker < 20 days Established smoker > 20 days
Established smoker On how many of last 7 days did you smoke?
Experimental Smoker None Experimental Smoker Regular Smoker At
least one Regular Smoker 1 2 2 3 4 5 Stage Model of Smoking
Acquisition 6
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SAY YES TO NO SMOKING Decisions made because of the campaing?
12,36 39,69 25,99 0 5 10 15 20 25 30 35 40 45 % ispitanika Reduce
number Of cigarettes cigareta Stop smokingStart healthy lifestile
Other Female Male Total
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SAY YES TO NO SMOKING Do you know and recognize the action Say
yes to no smoking? Yes 88,92 % positive 1.724.866 270.814 1.595.132
247.034 3.320.121 517.725 0 500.000 1.000.000 1.500.000 2.000.000
2.500.000 3.000.000 3.500.000 Population FemaleMale Total Yes
No
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SAY YES TO NO SMOKING Say yes to no smoking: Yes or No? 15,31
19,75 35,06 66,71 0 10 20 30 40 50 60 70 % surveyed sample 12345 4
and 5 Marks Female Male Total
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SAY YES TO NO SMOKING No of cigarettes per day 19,09 15,52 17,3
0 5 10 15 20 25 No of cigarettes per day Female Male Total
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SAY YES TO NO SMOKING Number of packages sold in Croatia 100
94,59 78,24 83,76 60 65 70 75 80 85 90 95 100 1996199820002002
Years 1996 is 100
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SAY YES TO NO SMOKING Smoke Out Day - Evaluation 26 % smokers
quit for one day on 5. march HRT-a agency (2143 sample): 27,2 %
smokers quit for one day on 5. march PULS agency (600 sample)
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SAY YES TO NO SMOKING Why you stop smoking?
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SAY YES TO NO SMOKING Have you had at least one cigarette
today? (smokers only) 74% 26% YES NO
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SAY YES TO NO SMOKING
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Are you thinking about giving up smoking permanently? 69 31 1
0102030405060708090100 % DON'T KNOW NO YES
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SAY YES TO NO SMOKING Final Thoughts Existing systems produce
existing results. If something different is required, the system
must be changed. - Sir Christopher Ball The world we have created
today, as a result of our thinking thus far, has problems which
cannot be solved by thinking the way we thought when we created
them. - Albert Einstein