Research to Policy to Action for a

Smoke-Free Community

Prof Dr Abu Bakar Bin Abdul MajidUniversity Cyberjaya, College of Medical Sciences

Why research

For many years the tobacco industry alone recognized the power of politics and framed the debate:

• Individuals Choose to Smoke

• Adults have a right to smoke

• Tobacco is a Legal product

• Tobacco use is inevitable

• The Science of passive smoking is dubious

• Tobacco related diseases is the smoker’s

fault

Our Role in Linking Research to Change

• Make the science - relevant, clear and visible

• Make smoke-free issue visible to public

• Frame the issue for the public• Promote specific public policies • Mobilize effective support

Research Role

• Research should drive the need to act and

identify Policy/program Goals

– Substantiate the problem, its scope and

impact

– Identify specific solutions that policy

makers can impact

• Research helps Frame the Message for Media

& Policy Makers

Research issues

• The community often does not to recognize the keys to change are public policies that requires political and mass support

• Research often fails to focus adequately on the causes of tobacco use, the role of industry influences and concrete achievable solutions

• Research and change agents are too often not connected

The gap between research and policy

More research is needed.. tobacco manufacturers disagree even after 100 careful studies showing the same result all over the world. Cabinet ministers trying to act on the smoking data have lost their posts in the USA and the UK.

We have to accept that all of us have our particular values and biases and that these affect our priorities in research and in policy making.

The importance in doing the right kind of research, practical and applicable that works for a particular community is the challenge for policy makers and tobacco advocators

Different levels would need different strategies with different emphasis and objectives

One factor governing the implementationof research findings and policy is ease of- their application.

Research showing that fluoride reducescaries has had a major impact via fluoride toothpasteeven where fluoridation of the water supply has beenbitterly opposed.

The use of fluoride toothpaste spread widely with little need to educate the public as it costs the same as regular toothpaste, fits naturally into our daily toothbrushing habit, and doesn't raise the spectre of poisoned water.

The gap between research and policy

ADVANCING SMOKE-FREE POLICY CHANGE :

Bringing Together Science, Communications, Mobilization of

Public Support and Advocacy

Scientifically Proven Solutions

Tobacco Taxes as an Example of the Power of research Combined with

effective policy and media advocacy

Example:

Cigarette Prices and Smoking

• Higher cigarette prices induce quitting, prevent relapse, reduce consumption and prevent initiation

• 10% price rise reduces overall cigarette consumption by 4%

• Smoking in low-income populations are more sensitive to price

Examples of simple surveys conducted that ultimately paved the way for a

smoke-free community

Smoking behavior around children at home

Methods: a cross-sectional survey in a convenience sample of 40 households, with at least one child under the age of 11 years. A questionnaire covering SES, tobacco use, SHS exposure, attitudes and beliefs about the harms of smoking

Examples of simple surveys conducted that ultimately paved the way for a

smoke-free community

Results: reported smoking around children was 82%. The prevalence of smoking inside the home was around 80% Most of the smokers (70%) agreed that parents and adults should not smoke near children.

Conclusions: Smokers commonly smoke around their children and inside their homes.

Most homes do not have smoke-free policies.

Examples of not so simple surveys The impact on cotinine levels in children of implementation of smokefree legislation in England

Salivary cotinine is an excellent marker of exposure to tobacco: using a sensitive assay

Method: Around 7,500 children were interviewed. 2,000 aged 4-15 gave saliva samples.Findings: In 1998-2003, proportion of children with no exposure (<0.1ng/ml salivary cotinine) ranged from 11% aged 4yrs to 17% aged 10yrs.

Not for NGOs probably? For universities….

Building on a Smoke-Free Foundation--Reducing Secondhand Smoke in Multi-Unit Housing

Smoke-free multi-unit housing is a relatively new frontier for secondhand smoke interventions in California;

Method: statewide polls revealed that 82% of apartment dwellers prefer to live in a smoke-free building or section of a building. A 2005 survey of Northern Californian apartment managers and owners suggested an apparent trend that they are more willing to consider smoke-free housing for California’s tenants.

Smoke-free Multi-unit Dwellings in Canada

Obj: Educating landlords, condominium corporations and builders about the law and encouraging them to voluntarily adopt smoke-free policies, the Coalition is working to increase the supply of smoke-free housing in Canada. Methods

A national strategy has been developed which focuses on building capacity in the tobacco control community, networking with and educating the housing sector, increasing public awareness and creating favourable conditions for smoke-free housing.

Results With greater awareness and understanding of the issue, more landlords, condominium corporations and builders are beginning to adopt smoke-free policies.

Conclusions

There is market demand for smoke-free multi-unit housing. Through the work of the Canadian Smoke-free Housing Coalition, supply is catching up and smoke-free housing will soon become a social norm in Canada

Public opinion and publicity on smoke-free workplaces in Finland

In democratic decision-making legislation needs public support in order to be enforced effectively. Several efforts to create smoke-free workplaces in Finland. ObjectivesWhat are the changes in public opinion over the years. MethodsThe changes in public opinion are depicted by opinion polls carried out in 2002, 2004, 2006, 2007 and 2008. ResultsOver time public opinion has become more supportive of smoking restrictions. Media publicity was at its most critical before the ban, became but favorable soon after enforcement of the ban. ConclusionsThe findings highlight the importance to understand the process in public opinion formation and media publicity. The strategy to have smoke-free restaurants needs scientific facts, public debate and media support as well as active co-operation.

Example

Smoking in Cars in the Republic of Ireland: Cross-sectional surveys

Second-hand-smoke (SHS) in a car is 23 times more toxic than in a house due to the enclosed space. Children while traveling in vehicles (cars) are exposed to SHS.

30 representative and randomly selected schools throughout Ireland took part in the 2007 Irish Study Results : Overall 14.9% (13.9% boys, 15.6% girls) of Irish children aged 13-15 years were exposed to smoking in cars.

Conclusions: Smoking in cars is a public health policy issue. Our findings show that children are regularly exposed to SHS in cars in Ireland and this demands legislation.

The responsibility for enforcing tobacco control regulations in the 1970s was vested primarily with the French Ministry of Justice.

However, in response to increasing tobacco industry violations of the law and the need for enhanced enforcement, the Government recruited non-governmental organizations to play a more direct role in enforcement efforts.

France : Engaging Civil Society in Enforcement

USSG 2004

Research in Smoke-free Environment

Knowledge of second hand smoke

Perceptions of community on second hand smoke

Acceptance of second hand smoke

Second hand smoke in cars, homes, restaurants, closed buildings air-condition or non air-condition

Perceptions on ban smoking, hazards

Research in Smoke-free Environment

Role of mediaSmoke-free beach, Smoke-free playgrounds, Smoke-free walkways, Smoke-free clubs

Can be simple or complex that needs expert eg second hand smoke & breast Ca. effects the CNS Pharmacogenetics or prevalence of smoke-free homes by NGOs in village.……depending on your needs.

To implement smoke-free homes in residential areas, taman / village

Research in S-F Environment

PurposeKnow that everyone can play a role and do research, simpleNeed many different type for different purposeResearch help in making policy and thus decision making tool to mobilise and change Community/people.

Research is vital to get the population to accept truthTruth distorted by tobacco industry

Show the truth of Shs in cars, homes, restaurants,,The level of problems we share…. The level of support of majority Can help government make decision / or can change government

Research to policy to action

Doing research is not always difficult, can be very easy.

Think of high end, difficult, complicated research.Think of difficulty in design or analysis

Not enough time – health staffs

There is a role for all NGOs and health providers to do research All can do some forms of researchResearch needed at many levels, many fronts

How to Involve civil society on Research

How to translate scientific research into advocacy and policy

Understand how science helps facilitate smoke-free conditions

Alignment with political-cultural norms In US, successful advocacy was “bottom up”; most activity originated at local level.

In countries like Ireland and NZ (small with strong central government) successful action was “top down”, but consultative.

In Australia ?, the level is in-between… Framing also varies, from protecting non-smokers, to protecting workers

Simple survey - Timely

The Prevalence of second hand smoke exposure and Public Policy of Smoke-Free Homes in a community, Sepang.

(i) To study the prevalence of second hand smoke in the houses in a population in Sepang.(ii) Health Intervention with a public policy on smoke-free homes in the area after community leaders were briefed.

Methods: A cross sectional survey on prevalence of second hand smoking via face to face interview.

Study results were than disseminated to the community and an intervention program to create a smoke-free home policy was carried out with the involvement of community leaders and technical support from local health providers.

The Prevalence of second hand smoke exposure and Public Policy of Smoke-Free Homes in a community, Sepang.

Results: 67.7% of homes are exposed to second hand smoke with 43.1% of homes have smokers that smoke in front of family members . 96% of the population knows that secondhand smoke it hazardous to health.

The results enabled the community to take preventive and control measures on their own through a public policy on smoke free home in their residential area.

Example: Letter by the Residential area’s committee chairman. (Translated from Bahasa Malaysia) Dear families of Megah V, Sepang A recent study conducted in our community found that a high percentage of children and families are exposed to second hand smoke in the home. 55.6% of the homes in our residential area have smoking activity in their homes. 74.5% of family members are exposed to smoke from smokers in their family. However, 94.7% of the smokers also realize the dangers of second hand smoke to others. The health consultants informed that second hand smoke cause an increase of 300% of upper respiratory tract infections and 900% of asthma among children besides many other hazards to others.  I appeal that we make our residents live in a healthy environment and try to make all our homes smoke free. For our dear friends who are smokers, we appeal that smoking is done outside the house. May our concerted action improve the health of our families in Megah V, Sepang. Thank you, 

Sincerely, Hj. Muhammad bin AhmadChairman,

Megah V Residents Committee

Essential steps in getting community involvement in implementing Smoke Free homes in a confined geographical, residential area. Planning stage – involve the community leaders in a community survey Do a simple prevalence survey on smoking prevalence and smoking activity in the homes. Include some aspects of lifestyle determinants, example frequency of exercise. Present the community diagnosis to the community leaders. Get the community to act on the findings and suggest a smoke free home policy in their community.

Lessons learned - application

1. Start simple surveys

?% of homes are smoke-free in your residential area/taman/kampung

% homes where smokers smoke infront of family /children % of children are exposed to smoking in public% of smokers smoke in cars% smoke in eating places with family% agree to ban cigarette% smoking is Haram% smoking should be ban in restaurants

Assistance readily available – MCTC - Universities - ministry

2. All in your taman3. Create data for your local community- very effective4. Start to use available findings from existing results5. Disseminate findings to local community6. Take local action

Civil society need to move forward shs agenda

NGOs need to voice effectively and make changes

Down –up by the civil society/Non-Governmental Organizations

Up-down approach compliment by the ministry of Health. Remember MOH is at times conflicting with MOF It is always people’s power.

Lessons learned - application

THANK YOU