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La législation Italienne pour la prévention du tabagisme Daniela Galeone, MD

Ministero della Salute. La législation Italienne pour la prévention du tabagisme Daniela Galeone, MD Ministry of Health – ITALY. BACKGROUND (2003). Population: 57 million (the first “great” European country to ban smoking) Smokers: 23.9% of Italian adults (2003)

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La législation Italienne pour la prévention du tabagisme Daniela Galeone, MD

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  1. Ministero della Salute La législation Italienne pour la prévention du tabagisme Daniela Galeone, MD Ministry of Health – ITALY

  2. BACKGROUND (2003) • Population: 57 million (the first “great” European country to ban smoking) • Smokers: 23.9% of Italian adults (2003) • Higher prevalence in men (31% versus 17.4%) • High prevalence in young people • Passive smokers: 26.5% of Italians • Cigarettes sold in tobacco shops, some bars, vending machines (opened from 9 p.m. to 7a.m.) • Cost/pack: from 3.00 to 4.00 euros

  3. SMOKING ATTRIBUTABLE DEATHS ITALY-2000 Cause Males Females TOTAL Cancer 31,365 4,504 35,869 Cardiovascular 22,028 7,187 29,215 Respiratory 12,220 4,551 16,771 Total 65,613 16,242 81,855

  4. ESTIMATED EFFECTS OF SECONDHAND SMOKE IN ITALY (DEATHS OR ILLS A YEAR) HOME EXPOSUREChildren with smoking parents CASES:216,392 (acute respiratory infections, asthma, chronic respiratory symptoms, acute otitis, SIDS) WORKPLACE EXPOSURE CASES: 2,592 (low birth weigh - for pregnancy exposure -, lung cancer, ischaemic heart diseases)

  5. - 2004 ITALIAN STRATEGY ON TOBACCO CONTROL • Protecting non-smokers’ health • Reducing prevalence of new smokers • Promoting smoking cessation

  6. ITALIAN STRATEGY ON TOBACCO CONTROL SMOKING BAN : 1975:Schools, Hospitals, Cinemas, Museums, Libraries, Public transports 1995: Public offices (open to citizens) 2005: Smoking banned in ALL indoor places open to the public, including private offices, bars, restaurants, clubs and discos Protecting no smokers’ health

  7. 2005 – the Italian Smoking Banthe process of approval Enabling factors: -- Leadership of 2 Ministry of Health (both prestigious physicians) -- First bill presented from Umberto Veronesi on May, 2000 Minister Sirchia’s Strategy: Nov 2001: four-fold increase in fines for people who smoked in public places where smoking was already forbidden by previous restrictions Jan-May 2002: “inserted” the smoking ban within a framework bill on public administration: a tactic branded the “Trojan horse” strategy by journalists. After three attempts, the smoking ban has been approved on January, 2003

  8. Limiting Factors: -- the 6-months delay in approving the regulation on smoking rooms. -- the 1.5-year delay in approving the regulation establishing owners’ responsibility for enforcing the ban in hospitality premises -- the legal action in August 2005, which shifted responsibility for enforcement from public places owners to police 2005 – the Italian Smoking Banthe process of approval

  9. Press Release,1998-2008, 50 Italian newspapers Key-words: smoke, cigarettes, Minister’s surname

  10. Press release Print media coverage peaked around key stages in the policy process highlighting the value of engaging with the media to support the smoke-free policy process. Press devoted a lot of attention to the political debate surrounding the ban. However, the long legislative process of the bill and its related regulations (2000-2004), stimulated journalists to publish articles informing people about tobacco control issues. Press articles reported the smoking ban was almost unavoidable after 4 presentations by 2 Ministers of Health, both of whom were important physicians

  11. 2005 BAN – LAW 3/2003 • Designed to protect non-smokers health in all indoor spaces • No-smoking signs must be posted up • Clear identification of enforcement responsibilities • Fines for persons found smoking € 275 • Fines for managers or owners € 220 • Smoking areas allowed, but must meet strict criteria (enclosed, negative-pressure ventilated to prevent no-smoking areas pollution)

  12. IMPLEMENTATION PHASEMULTIMEDIA EDUCATION CAMPAIGNS • Spots and debates on tv and radio • Billboards and posters • Inserts in newspapers and magazines • Booklets • Stickers

  13. 2003-2004: Before law enforcement

  14. 2005: after law enforcement In cooperation with: “Italian Association Against Cancer” LILT “National Institutes of Health (ISS)”

  15. IMPLEMENTATION PHASE HEALTH MINISTRY PHONE “HOT LINE” PROVIDING INFORMATION ON THE NEW LAW (Jan-Feb 2005)AIMS • Give suggestions, clarifications, explanations about the law • Detect critical aspects to the application of the ban • Identify stakeholders, their needs, doubts, opinions and concerns about the law

  16. IMPLEMENTATION PHASE HEALTH MINISTRY PHONE “HOT LINE” PROVIDING INFORMATION ON THE NEW LAW (Jan-Feb 2005) FIRST MONTH RESULTS > 4,000 CALLS RECEIVED • 13% on first day • 55% during first week • 60% from smokers • 98% for clarifications about law application (no-smoking signs, definition of “public indoor space”) • <1% complaints about the law • Thousands more accessed Ministry website, updated daily on the basis of most FAQ

  17. Controversial questions and weak points “Peculiar places” “Problematic places” Gazebo newsstand Shopping center Protected patios of restaurant, bar… Courtyard Apartment building Stadium Club (only for associated) Open market Jails Terapeuthic communities Rest homes Psichiatrical wards

  18. HEALTH MINISTRY PHONE “HOT LINE” PROVIDING INFORMATION ON THE NEW LAW (Jan-Feb 2005) What did it work? • Staff prompt to deal with a great level of job condensed in a very short period • back-office of experts who can aid in technical questions and grant accuracy and reliability of the answers • Analisys in real time of the data, quick updating of manuals for the staff and of the informations loaded on the website. Press releases permitted a broad dissemination of the information

  19. HEALTH MINISTRY PHONE “HOT LINE” PROVIDING INFORMATION ON THE NEW LAW (Jan-Feb 2005) • Give ear to stakeholders • Critical points • Allies • Groups to support

  20. OPINION ON THE SMOKING BAN “ENFASI” STUDY ON PUBS/RESTAURANTS OPINIONS AND BEHAVIOURS OF CLIENTS AND OWNERS BEFORE AND AFTER LAW ENFORCEMENT Source:National Health Institute 2004-2005

  21. “ENFASI” STUDY ON PUBS/RESTAURANTS • Self-administered questionnaire for owners or managers • Observational component: no-smoking signs, presence of smoke/smokers during peak business hours • 1,600 locals visited BEFORE LAW ENFORCEMENT OWNERS OPINION • High knowledge level about law • High knowledge of potential health risks of passive smoke • 25% expecting financial losses • 40% smokers themselves Source:National Health Institute 2004-2005

  22. OPINION ON THE SMOKING BAN STUDY OF PUBS/RESTAURANTS “ENFASI” AFTER LAW ENFORCEMENT OWNERS OPINION • 10% asked smokers to put out their cigarettes • 2% had clients disagreeing • 76% reported favourable clients opinion • Only 11% reported significant financial losses Source:National Health Institute 2004-2005

  23. STUDY OF PUBS/RESTAURANTS AFTER LAW ENFORCEMENT OBSERVATIONAL COMPONENT • Owners themselves are smoking less: 27% “a lot less” 33% “a little less” 15% reported stopping • 0.2% premises had currently smoking people • All premises had no-smoking signs • Less than 2% had “smoking roms”

  24. Fear of economical effects

  25. Tobacco control strategy • based on modification of environmental and social factors • part of a national strategy for prevention of non communicable diseases (“Gaining health: making healthy choices easier”)

  26. “Gaining health” What is it ? A coordinated action plan for counteracting physical inactivity, poor nutrition, alcohol abuse, tobacco consumption the 4 leading risk factors for non-communicable diseases (cardiovascular and respiratory disorders, cancer, diabetes mellitus)

  27. “Gaining health” What is it? A Government initiative • led by the Ministry of Health • based on: • Institutional alliance with Regions and Municipalities • Partnership with food industry, distribution networks, consumer associations, NGOs

  28. “Gaining health” Why ? It isalreadypossible to prevent non-communicable diseases by reducing risk factors prevalence Actions on social and environmental conditions Interventions at individual level

  29. “Gaining health” Why ? • To make healthy choices easier • To promote better social conditions • To protect vulnerable people (children, old people, poor people) • To reduce health inequalities An ethical program

  30. Transport and urbanistic policies Economical Policies Agricultural Policies School World Youth and Leisure time Health in all policies Health System

  31. Protecting non-smokers’ health Reducing prevalence of new smokers Promoting smoking cessation TOBACCO CONTROL STRATEGY in “Gaining Health”

  32. Prize for the excellence to “Sistema Italia” Ministry of Health, Regions, LILT, CSPO/Florence, CPO/Turin, IOR/Forlì, INT/Milan For the optimum activities in preparation, application and monitoring of the Italian smoking ban An incisive instrument for the protection of non smokers and for the promotion of public health Edinburgh - September, 10th 2007

  33. Tobacco Control Strategy Monitoring of the law’s implementation is still ongoing and focuses on six aspects Surveillance (prevalence, behaviours) Sales of tobacco products Effects on Health Compliance with the Law Smoking cessation Prevention and communication activities

  34. THANKS! Ministry of Health Prevention Department Daniela Galeone Lorenzo Spizzichino

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