Tobacco

1. Tobacco The Burning Issues Explained Dr. Leslie Rollock Ministry of Health

2. Tobacco – the substance • From leaves of tobacco plant • Can be used as organic pesticide • Extract (nicotine tartrate) used in some medicines • Religious use among early native Americans • Now mostly recreational use – smoked, chewed, snuffed, sucked/dipped

3. Tobacco use in Barbados - Adults Behavior Risk Factor Survey 2007 • Overall prevalence 8.4%: males 15.4%, females 2.2% (smoked in the last 30 days) • Current daily smokers 6.1%: males 11.3%, females 1.4% • Mean number of manufactured cigarettes smoked 9.3 • Age of onset 20.0 years: males 19.7 yrs, females 21.9 yrs • 0.1% use smokeless tobacco products

4. Tobacco use in Barbados - Youth GYTS 2007: • 1499 13-15 year old secondary school students across Barbados • Experimentation and usage at 11.6 %: boys14.3%, girls 9.3% • 2% point increase over the GYTS done in 2003

5. Tobacco smoking worldwide • Globally 1.3 billion people currently smoke cigarettes or other tobacco products • The prevalence of tobacco use is substantially higher in men; 47% compared to women at 12% • More smokers live in low- and middle-income countries; 35% in developed, 50% in less developed • Around 5.4 million deaths a year are caused by tobacco. • Smokers die 15 years sooner than non-smokers

6. Smoking prevalence worldwide

7. Framework Convention on Tobacco Control - FCTC • First negotiated public health treaty under the auspices of the World Health Organization • Treaty is evidence-based and affirms the right of all persons to the highest standard of health • Aims to decrease the global burden of tobacco on the health and well-being of all citizens

8. Parties to the FCTC • 171 signatories – latest Party is Afghanistan 13th August 2010 • Member States that have signed the Convention indicate that they will strive in good faith to ratify, accept, or approve it, and show political commitment not to undermine the objectives set out in it. • Barbados signed the FCTC June 2004 and ratified it in November 2005 • Members who have ratified the convention constitute the Conference of the Parties. This is the highest decision making body of the Convention and meets every 2 years. Next meeting in Uruguay 2010

9. Features of the FCTC • Demand reduction measures include increases in price and taxation, Non Tax measures: • Article 8: Protection from exposure to tobacco smoke • Article 9: Regulation of the content of tobacco products • Article 10: Regulation of tobacco product disclosure • Article 11: Regulation of packaging & labeling of tobacco products • Article 12: Education, communication, training & public awareness • Article 13: Regulation of tobacco advertising, promotion & sponsorship • Article 14: Demand reduction, dependence and cessation treatment Measures to Regulate the Supply of Tobacco • Article 15: Reduction of illicit trade • Article 16: Regulation of the sale of tobacco to minors • Article 17: Promotion of alternative crops

10. Effects of Tobacco Smoking 1 • Addiction to tobacco • A proven cause of ill health, sickness and death in those who directly inhale tobacco smoke even via filtered tips or water pipes • Increased incidence of heart disease, respiratory disease, gum disease, cancers, other effects e.g decreased sperm count & motility, impotence

11. Smoking and vascular disease • Smokers risk of heart disease 2-4 x that of non-smokers • Risk for stroke doubled • Non-smokers risk of heart disease increased 25-30% by second hand smoke • Immediate effects of secondhand smoke, increase the risk of death in those with existing heart disease

12. Effects of Tobacco Smoking 1

13. Effects of Tobacco Smoking 2 • Tobacco smoke in the atmosphere i.e second -hand smoke, contains carcinogens, allergens and chemical toxins • Proven and direct association with upper and lower respiratory allergies and infection including ear infections in children, asthma and bronchitis; some cancers – e.g. lung, pancreas; premature labor, low birth weight babies and preterm infants; heart disease and stroke

14. Effects of Tobacco Smoking 2

15. Effects of smokeless tobacco use • Dependence and addiction • Tooth abrasion, gum disease, bad breath • Cancer – mouth, tongue, throat, pancreas, maybe esophagus • Possible contamination of environment – via spitting

16. Some effects of smokeless tobacco use

17. E-cigarettes

18. A word on e-cigarettes • Battery powered vaporising tube activated by sucking on end • Flavourings, ±Nicotine and propylene glycol vaporised in tube and inhaled • Excretion products of propylene glycol, flavourings, nicotine, any other ingredients • Not a proven tobacco cessation aid • Further testing needed to determine long-term effects, second hand effects

19. Because of …

20. And …

21. Also, this hasn’t worked too well…

22. A public health response… has been necessary: Anti smoking Legislation

23. Legislation to ban smoking in public places • No person shall smoke or be permitted to smoke in a public place • No occupier of a public place shall permit a person to smoke in a public place that is under the control or management of that occupier (owner, manager or person in charge)

24. Definition- Public Place • (a) building, place, structure, or facility that is owned, controlled, managed or occupied by the Crown or a statutory board in Barbados • (b) place, site, building, factory, plant, work- place or other structure that is fully or substantially enclosed • c) library, museum, auditorium, historic or other site of archeological or national significance

25. Public Place cont’d • To which the public or a member of the public has access or is permitted to have access, with or without restrictions to users and whether or not • (i) on the payment of money; or • (ii) by virtue of membership

26. Public Places…

27. Definition – substantially enclosed Substantially enclosed – means place, site, building, factory, plant, workplace or other structure that is • (i) covered by a permanent or temporary roof or covering whether semi-porous or otherwise

28. Definition – substantially enclosed • (ii) has walls or other erections that prevent passage, and also has doors, windows or openings in the walls or other erections

29. Substantially enclosed, work place

30. Definition- Smoking in a Public Place • ‘Smoke’ – to smoke, hold or otherwise have control over an ignited tobacco product

31. What the law means • This law does not affect the right of an individual to smoke • However, it dictates that any smoking is done in such a manner that it poses no threat to other persons • This law does not prohibit an individual from smoking in their homes, on the beach or other wide open spaces unless they fall under (a), (b) or (c ) above

32. Other provisions • Every occupier of a public place shall place, in at least two prominent positions within the public place, conspicuous signs, designed in the manner and setting out the information described in para (2) • Signage “No Smoking Permitted” of dimensions at least 35cm by 30 cm • Must be protected from damage etc.

33. Signage • No Smoking Permitted

34. Enforcement 1 • For the purpose of ensuring compliance with these regulations, an inspector, on presentation of a certificate of identification signed by the Minister of Health/ designate may, • at any reasonable time, including any time that a public place is open to conduct business, and without warrant on notice, • (i) enter and inspect a public place and make such examinations as the inspector considers necessary or advisable

35. Enforcement 2 • (ii) Take samples of a substance reasonably suspected of being a product containing tobacco that is found in the public place either ignited or having the appearance of having been ignited • (iii) Make enquiries of any person who is or was in the public place; and • (iv) Exercise other powers as may be necessary or incidental to the carrying out of the inspector’s powers pursuant to these Regulations

36. Enforcement 3 • An inspector, for the purposes of conducting an inspection referred to (i) above, may be assisted by a person who, in the opinion of the inspector, has special knowledge of or expertise in any relevant matter. • The inspector may • (a) direct the person to cease the contravention; • (b) may require the person to furnish his name and address; and • (c) shall report the commission of the offence and the details in respect thereof to a member of the Police Force

37. Definition- Inspector • Environmental Health Officer/ Assistant • Buildings inspector – EPD • Public Health Officer e.g public health nurse, medical officer

38. Penalties • For the individual - liable on summary conviction $500 or imprisonment for 12 months or both • For the occupier who permits a person to smoke in a public place - liable on summary conviction $5000 or imprisonment for 12 months or both

39. D-Day • These Regulations shall come into operation on the 1st day October 2010

40. Assistance to Quit • Enquire at your GP • Programmes at the Heart and Stroke Foundation of Barbados • Assistance at other organisations e.g Seventh Day Adventist Church

41. Observed effects of smoking bans • UK study showed drop in emergency admissions for heart attacks in year after ban • US city with ban showed drop in coronary cause admissions 1year and 3 years after ban compared to city without ban • Canada – reduction for respiratory and cardiovascular admissions

42. THANK YOU FOR YOUR ATTENTION !!!