CHILD HEALTH AND TOBACCO IN THE PHILIPPINES

1. CHILD HEALTH AND TOBACCO IN THE PHILIPPINES BENJAMIN P. SABLAN, JR., MD, FPPS PROFESSOR UNIVERSITY OF THE PHILIPPINES MANILA

2. DISCLOSURE • Commissioned work given to the PHILIPPINE AMBULATORY PEDIATRIC ASSOCIATION • Funded by the World Health Organization • Endorsed by the Department of Health Manila

3. TOBACCO FREE INITIATIVEWHO • Children are a vulnerable group (GYTS) • Need for concerted efforts • Push for critical reforms and interventions that would impact on significant tobacco control • In consonance with the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2010-2014)

4. Share of total mortality of the ten leading causes of death, Philippines, 2004 Tobacco use was responsible for over 58,000 deaths, or nearly 12% of all deaths in the Philippines.

5. Global Youth Tobacco Survey (GYTS) • Current usage: ~3/10 of students (27.3%; M>F) • Current smokers: ~1/5 of students (21.7%; M>F) • Other tobacco users: 1/10 (9.7%; M~F) • Ever smoked: ~½ of students (46.2%; M>F) • Likely to smoke: ~1/10 of students (13.6%; M>F)

6. GYTS • ETS exposure at home: ~50% • ETS exposure in public places: ~60% • Desire to quit smoking: ~80% of current cigarette smokers • Taught in school about smoking and its dangers: ~65% • BUT • Buy cigarettes in a store: 56% • Not refused purchase due to age: 64%

7. GYTS Conclusions • Cigarette smoking among young people in the Philippines is high Compared to 1995 data • 33% increase of prevalence of smoking in Filipino youth • 12% increase in current smoking prevalence

8. GYTS Conclusions • Filipino boys are more likely than girls to use tobacco • Almost one-fifth of young people begin smoking before the age of 10 years • Over ¼ of never smokers are likely to start smoking this year

9. GYTS Conclusions • Environmental Tobacco Smoke exposure is very high • Over half of parents smoke • About 3 in 4 are around others who smoke in places outside their homes • Filipino youth smokers usually smoke at home but majority of them prefer to smoke in a friend’s home • Only 4 in 10 think smoking is harmful to their health

10. GYTS Conclusions • The majority of young people currently smoking want to stop smoking • Over two-thirds or 8 in 10 smokers want to stop • There is lack of access to smoking cessation program

11. ISSUES Positive indicators for anti-smoking campaign in the Philippines • 72% think cigarette smoking is harmful • 72% think cigarette smoking makes one less attractive • 85% of current smokers want to stop smoking Challenges • 27% of never smokers are likely to initiate smoking in the next year • 39% agree that smoking should be banned from public places • Only 6% of those who wish to quit smoking had access to professional help

12. Global Heath Issues Affecting the Filipino Child PAPA CONVENTION 2010 • First International Visiting Lecture of Richmond Center, Dr. Jonathan Klein, Executive Director AAP • Paediatric health care providers need to be aware of the continuing pharmacological and health effects of tobacco smoke either through use or second hand exposure • Doctors and other health care professionals can become more effective public advocates for tobacco control in their respective communities

13. Global Heath Issues Affecting the Filipino Child PAPA CONVENTION 2010 • Physicians may know Tobacco effects • Lack the skills needed to advocate for tobacco control • Physicians are a major force needed in the community for tobacco control advocacy • Coalition on Tobacco control (FCAP – NGOs, media, DOH) • Physicians may be the silent link!!!!

14. BRIEF TOBACCO INTERVENTION SKILLS TRAININGOBJECTIVES • To provide paediatric health care providers with current information regarding • Physiologic and health effects of Tobacco Exposure • Intervention initiatives for Tobacco Control • To promote practice changes to enhance • Medical provider skills for clinical interventions • Medical provider skills for public advocacy

15. FRAMEWORK TARGET HEALTH PROVIDERS • Physicians (Child and Adolescent Health Care providers) • All health care providers (nurses, midwives, etc.) TARGET POPULATION • Under 5 infants/toddlers (IMCI counseling) • Children over 5 years old • Adolescents

16. BTIS TRAINING • Training Modules • Trainors • Training Manual • Health Provider Encounter form • Health Education Materials

17. BTIS TRAINING • 4 hour training • Training on technical aspects of running course • Didactics • Role Playing • Evaluation • Training on technical issues on Tobacco and Tobacco control

18. BTISWriteshop and Training

19. BTIS

20. BTIS

21. ALGORITHM • Young Child Less than 5 years old • Parent/Caregiver • IMCI approach (Pneumonia, ear infection, nutrition, fever) • Older Child (6-9 years old) • Parent/Caregiver • Child • Adolescent

22. PARENT/CAREGIVER

23. OLDER CHILD (6-9 YEARS OLD)

24. ADOLESCENT

25. VIDEO • Generic Version • Concepts 5As • Algorithm used • Easily adaptable (translated in local dialect) • BTIS in real time

26. BTIS Training

27. BTIS Learnings • Knowledge and Skills • Improved Knowledge • Acquired Skills for BTIS for every health care encounter • Need for community resources development

28. COMMITMENT • Continue BTIS Training all over the country • 16th Annual Convention (March 8-9, 2011) BTIS Training as a pre-convention a. Academe b. Key Government Physicians/Program Managers

29. COMMITMENTTo Develop Resource Centers for Motivational Counseling

30. COMMITMENT • COALITION BUILDING • Physicians as the MISSING LINK • Involve Medical Organizations • Department of Health • Philippine Medical Association • Philippine College of Physicians • Philippine College of Chest Physicians • Philippine Academy of Pediatric Pulmnologists • Philippine Society of Oncology • Society of Adolescent Medicine (SAMPI) • Philippine Ambulatory Pediatric Association

32. THANK YOU