tobacco control in nepal and indonesia - dr tara singh bam
DESCRIPTION
Dr Tara Singh Bam, Technical Advisor on Tobacco Control to Nepal and Indonesia for International Union Against Tuberculosis and Lung Disease (The Union) was a key panelist at the webinar for media around World No Tobacco Day 2015.TRANSCRIPT
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Pictorial Health Warning
Tara Singh Bam
Regional Advisor Tobacco Control The Union Asia Pacific, Singapore
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Cost-effective interventions are needed
We know:
There are only two ways to reduce tobacco use: prevent youth from starting to use tobacco and encourage and help users to quit
Pictorial Health Warnings are effective To convince smokers to quit smoking
To convince youth not to start smoking
To re-convince ex-smokers to remain smokefree
To build public awareness
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A journey of Pictorial Health Warnings-challenging but successful
Text
Injurious to health
2009 2010
30% PHW
2011 April 2014
75%
PHW
?Adopted a
comprehensive
TC law in 2011
Government
regulation
(never
implemented)
Enforcement
Taking risks
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2011- Litigation: Industrys claims
75% PHW is against WHO FCTC Against Consumers protection law, Excise Law
25% space on the pack is not sufficient enough for trademark and other information
The provision of 75% PHW is not constitutional
6 months is not sufficient; 18 months is needed
Source: Supreme Court Verdict No. 068-wo-0383, page
12/25
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29 December 2013- Final verdict of the Supreme Court
It has been proven that tobacco use is harmful and threatens the populations health and right to health.
It is the states responsibility to protect health and the right to health.
The Tobacco Control Law of 2011 adapts constitutional provisions, established principles of the Supreme Court, WHO FCTC and other international treaties on human and social rights.
The Supreme Court orders the government to effectively enforce the law beginning immediately and remove all tobacco products from the market that do not comply with the law.
Source: Supreme Court Verdict No. 068-wo-
0383, page 25/25
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Enforcement of PHW
April 2014
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Do Pictorial Health Warning work?
Conducted a national survey to assess peoples opinions, retailers views, and implementation status from JanuaryFeb 2015
2,250 individuals were randomly selected from 9 districts representing all five regions in Nepal
The study was conducted by Civil Society Action Nepal. Ethical clearance was obtained from Nepal Health Research Council
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Results from Public Opinion Survey
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Did you notice PHW on cigarette packs? 93.8% noticed PHW on cigarette packs in the last 30
days (current smokers 99.3%, ex-smokers 95.9%, never smokers 90.9%)
90.3% said PHW made them think about the harms of smoking (current smokers 82.1%, ex-smokers 96.2%, never smokers 93.7%)
Total N = 2250, Noticed 2110, current smokers = 670, ex-smokers = 193, Never smokers = 1387
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Do you support PHWs on cigarette packs?
Total N = 2250, current smokers = 670, ex-smokers = 193, Never smokers = 1387
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How worried do you feel when you see PHW on a pack?
Total N = 2250, current smokers = 670, ex-smokers = 193, Never smokers = 1387
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How effective would PHW be in convincing smokers to quit smoking?
Total N = 2250, current smokers = 670, ex-smokers = 193, Never smokers = 1387
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Did PHW make you consider quitting (only for smokers) ?
Total N = 2250, current smokers = 670
PHW made about 55% of the current smokers consider quitting
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Did PHW make you reduce the number of cigarettes smoked?
Yes; 45.5% of current smokers reduced the amount of cigarettes smoked
On average, the number of cigarettes smoked per day reduced to 5 sticks from 11 sticks due to PHW
Before PHW = 11 cigarettes/day After PHW = 5 cigarettes/day
Average money spent on
cigarettes/day = Rs. 50.7
(USD. 0.51)
Average amount spent on
cigarettes/day = Rs. 102.6
(USD. 1.02)
PHW reduces consumption and saves out-of-pocket expenditure
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How effective are PHW in convincing youth not to start smoking?
Total N = 2250, Adult = 431, Young Adult = 1255, Youth= 564
About 90% of youth said PHW would be effective in preventing initiation
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How effective are PHW in re-convincing ex-smokers remain quitter?
Total N = 2250, current smokers = 670, ex-smokers = 193, Never smokers = 1387
More than 95% of ex-smokers said PHW would be effective in re-
convincing ex-smokers to remain quitter
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How effective PHW in informing people on danger of tobacco use?
Total N = 2250, Male= 1717, Female= 533
More than 90% of the respondents said PHWs would be effective in building
public awareness
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Do you still buy cigarette packs without PHW?
Yes, Still buy cigarette packs without PHW, 0.4% (n=3)
No, not available in the market 99.6% (n=667)
Total N = 2250, current smokers = 670,
PHW is effective in controlling illicit trade
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Results from Retailers opinion survey
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Retailers opinion on PHW (N=270)Questions/statement Yes (%) No
Do you support PHW regulation that aims to make people aware of the dangers of smoking?
250(92.6)
20 (7.4)
Is there any decline in cigarette sales because of PHW?
95 (35.2)
175 (64.8)
Do smokers prefer to buy cigarette pack without PHW?
172 (63.7)
98 (36.3)
Do you still sell cigarettes without PHW? 6 (2.2)
264 (97.8)
Do you still receive cigarette packs without PHW from distributors or manufactures?
2 (0.7)
268 (99.3)
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Results from point of sale observation
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Observation at point of sale (N=270)
Of the 270 point of sale (POS);
96.3% (260) observed all packs with PHW
3% (8) observed >90% packs with PHW
0.4% (1) observed >50% packs with PHW
0.4% (1) observed all packs without PHW
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Tobacco industrys interference at point of sale
Buy 3
cigarettes for
Rs. 10
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Did you buy a pack of cigarettes or loose/sticks during your last purchase?
Total N = 2250, current smokers = 670
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Reasons for buying loose cigarettes
23.3% (122) of current smokers said they did not have sufficient money to buy a pack of cigarettes
66.2% (346) of current smokers said they do not like to regularly see lung cancer pictures on packs
10.5% (55) of current smokers cited other reasons
Evidence: know share - ACT?
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Ministry of Health- Action taken
2015- Nepal adopted a new TC regulation
Bans selling loose/single sticks
Makes it mandatory for a pack of cigarettes to contain at least 20 sticks
Bans TI interference (adoption of Article 5.3)
Bans e-cigarettes, shisha, cigars
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Nepal increased size of PHW from 75% to 90%
Enforcement of a 90% pictorial health warning on 15 May 2015
Some obstacles from
- US Chamber of Commerce
- Tobacco Industry Litigation
National Commitment
We know we have won
90% 75%
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Pictorial Health Warning in Indonesia
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Pictorial Health Warning in Indonesia
Government Implementation Regulation (PP109/2012) and Ministerial decree number 28/2013 mandate a 40%PHW with text consisting of 5 (five) different images
Implemented on 24 June 2014
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Survey methods
The survey was conducted in February 2015
5409 people were randomly selected from 18 cities/districts representing 13 provinces in Indonesia (54 respondents were excluded from the analysis because of the missing information for many variables)
1429 points of sale (POS) were observed and 1425 retailers were interviewed
557 packs of cigarettes from 160 brands were assessed to monitor compliance
Ethical clearance was obtained from Univ. Airlangga , Surabaya
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Results:
Public opinion regarding the effectiveness of PHW
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Did you see PHW on cigarette packs?
94.3% noticed PHW on cigarette packs in the last 30 days (current smokers 96.9%, ex-smokers 94.6%, never smokers 92.5%)
83.9% of the respondents said PHW made them think about the harms of smoking (current smokers 70.8%, ex-smokers 87.2%, never smokers 92.4%)
Total N = 5355, tahu PHW 5038, perokok = 1898, mantan perokok = 553, bukan perokok = 2892
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Do you support pictorial health warning on cigarette pack?
Total N = 5355, Smoker = 1901, Ex Smoker = 555, Non Smoker = 2899,
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How effective would PHW be in convincing smokers to quit smoking?
Total N = 5355, Smoker = 1901, Ex Smoker= 555, Non Smoker= 2899,
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How effective would PHW be in re-convincing ex-smokers to remain smokefree?
Total N = 5355, Smoker= 1901, Ex Smoker= 555, Non Smoker= 2899,
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How effective would PHW be in convincing youth not to start smoking (by age group)?
Total N = 5355, Youth (12-17 ) = 1580, Young-Adult (18-35) = 2823, Adult (>35) = 925
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Did PHW on cigarette packs make you consider quitting?
Total N = 5355, Smoker = 1901
Smokers only
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Did PHW make you reduce the number of cigarettes smoked per day?Before and after viewing PHW on cigarette packs
n = 515 current smokers
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Do you support the government in increasing the size of PHW to 75% from the current 40%?
Total N = 5355, current Smoker = 1893, Ex-smoker= 554, Never Smoker= 2843, No response= 65
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Retailers opinion on PHW (N= 1425)
Questions Yes (%) No No response
Do you support PHW regulation that aims to make people aware of the harms of smoking?
1205(84.6)
220 (15.4)
0(0)
Is there any decline of cigarette sales because of PHW?
315 (22.1)
1109(77.8)
1(0.1)
Do smokers prefer to buy cigarettes without PHW ?
807 (56.6)
613 (43.0)
5(0.4)
Do smokers prefer to buy loose or single cigarette ?
507(35.6)
913(64.1)
5(0.4)
Do you still sell cigarettes without PHW ? 306 (21.5)
1110 (77.9)
9(0.6)
Do you still receive cigarette packs without PHW from distributors or manufactures?
142 (10.0)
1272 (89.3)
11(0.8)
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Observation at point of sale (N=1429)
Of the 1429 Points of Sale (POS):
72.1% (1030) observed all packs (100%) with PHW
21.1% (301) observed >90% packs with PHW
3.4% (49) observed >50% packs with PHW
0.6% (8) observed all packs without PHW
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Conclusions PHW were found effective in building public awareness both in
Nepal and Indonesia
Larger PHW encourage current smokers to quit as demonstrated in Nepal (54.8%) vs. Indonesia (47.7%)
PHW motivates current smokers to reduce the number of cigarettes smoked per day
Both the public and retailers strongly support PHW
PHW was found to be an effective intervention in eliminating illicit trade
Effective implementation of PHW has encouraged MOH in both countries to increase PHW size: In Nepal, PHW has already increased from 75% to 90%
In Indonesia, MOH plans to increase PHW from 40% to 75%