Case for investment in tobacco cessation: a population-based analysis in low- and middle-income countries

This study aimed to estimate the return on investments of three population-level tobacco cessation strategies and three pharmacological interventions. The analysis included 124 low- and middle-income countries, and assumed a 10-year investment period (2021–2030). The results indicate that all six cessation programmes could help about 152 million tobacco users quit and save 2.7 million lives during 2021–2030. If quitters were followed until 65 years of age, 16 million lives could be saved from quitting. The combined investment cost was estimated at 1.68 United States dollars (US$) per capita a year, or US$ 115 billion over the period 2021–2030, with Caribbean countries showing the lowest investment cost at US$ 0.50 per capita a year. Return on investments was estimated at 0.79 (at the end of 2030) and 7.50 if benefits were assessed by the time quitters reach the age of 65 years. Disaggregated results by country income level and region also showed a return on investments less than 1.0 in the short term and greater than 1.0 in the medium-to-long term. In all countries, population-level interventions were less expensive and yielded a return on investments greater than 1.0 in the short and long term, with investment cost estimated at US$ 0.21 per capita a year, or US$ 14.3 billion over 2021–2030. Pharmacological interventions were more expensive and became cost beneficial over a longer time. These results are likely conservative and provide support for a phased approach implementing population-level strategies first, where most countries would reach break-even before 2030.

Protecting children and families from tobacco and tobacco-related NCDs in the Western Pacific: good practice examples from Malaysia, Philippines and Singapore

BACKGROUND

Non-communicable diseases (NCDs) are generally considered diseases of adulthood, but NCD risk factors like tobacco use often are taken up during childhood and adolescence, and second-hand smoke exposure affects child survival and development.

METHODS

At a regional meeting of the Asia Pacific Child and Family Health Alliance for Tobacco Control, members reviewed existing good practices of child-focused tobacco control approaches using health promotion strategies. These interventions were implemented nationally in Malaysia, the Philippines and Singapore.

RESULTS

Three good practice national examples were identified that focused on creating supportive tobacco-free environments and upgrading cessation skills among paediatricians. These country examples highlight strategic areas to protect children and families from the harms of tobacco, as part of NCD prevention and control. Training paediatricians in brief cessation advice has enabled them to address tobacco-using parents. Fully enforcing smoke-free public areas has led to an increase in smoke-free homes. The Tobacco Free Generation is a tobacco control 'endgame' strategy that taps into a social movement to deglamorize tobacco use and empower youth born in and after year 2000 to reject tobacco and nicotine addiction.

CONCLUSION

Tobacco control is pivotal in the fight against NCDs; health promotion strategies to protect children and youth from tobacco have a critical role to play in NCD prevention and control. Frontline health workers, including primary care paediatricians, need to step up and actively advocate for full implementation of the WHO Framework Convention on Tobacco Control, including tobacco tax increases and smoke-free areas, while monitoring patients and their parents for tobacco use and second-hand smoke exposure, preventing adolescent smoking uptake, and offering cessation support. A life-course approach incorporating child-focused efforts to prevent initiation of smoking and second-hand smoke exposure with measures promoting cessation among parents will offer the greatest chance of overcoming future tobacco-related NCD burden.

The use of tobacco tax revenues to fund the Guam Cancer Registry: A double win for cancer control

Cancer registries that provide reliable data on cancer incidence, mortality and burden are essential to cancer control. However, establishing sustainable local funding mechanisms to support cancer registries remains a challenge in many countries. Guam, an unincorporated Territory of the United States of America in the Western Pacific, enacted a bill that raised tobacco taxes, and earmarked a percentage of tobacco tax revenues to support its Cancer Registry. This provided a reliable funding stream for the Registry, allowing for continued staffing and capacity building; at the same time, youth tobacco consumption decreased following the tax increase. Linking tobacco tax revenues to cancer registry support is a feasible strategy with a double benefit: higher tobacco prices from higher tobacco taxes reduce tobacco-related cancer risk while assuring the long-term viability of systematic cancer data collection and dissemination.

Eliminating tobacco-related disparities among Pacific Islanders through leadership and capacity building: promising practices and lessons learned

Tobacco remains a major risk factor for premature death and ill health among Pacific Islanders, and tobacco-related disparities persist. Eliminating these disparities requires a comprehensive approach to transform community norms about tobacco use through policy change, as contained in the World Health Organization international Framework Convention on Tobacco Control. Three of the six U.S.-affiliated Pacific Islands-the Federated States of Micronesia, Palau, and the Marshall Islands-are Parties to the Framework; the remaining three territories-American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam-are excluded from the treaty by virtue of U.S. nonratification. Capacity building and leadership development are essential in achieving policy change and health equity within Pacific Islander communities. We describe promising practices from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, and Palau and highlight some of the key lessons learned in supporting and sustaining the reduction in tobacco use among Pacific Islanders as the first step toward eliminating tobacco-related disparities in these populations.

Building tobacco cessation capacity in the U.S.-affiliated Pacific Islands

Tobacco control stakeholders in priority populations are searching for culturally appropriate cessation training models to strengthen cessation capacity and infrastructure. We adapted the University of Arizona model for Brief Tobacco Cessation Interventions training for Pacific Islanders and pilot-tested it in four Pacific Islands-Palau, the Federated States of Micronesia, the Northern Mariana Islands and the Marshall Islands. All participants completed a posttraining knowledge assessment exam, pre- and posttraining confidence assessments, and a quality improvement evaluation. Of 70 participants, 65 (93%) completed the training. Forty-one (63%) passed the posttraining knowledge assessment exam at the first attempt; an additional 9 (14%) successfully passed on their second attempt, for a total pass rate of 77%. The pre- and posttraining confidence surveys demonstrated a statistically significant increase in confidence across all competency areas for delivering brief advice. The quality improvement survey revealed high acceptance and approval for the content and delivery of the locally adapted training model. As Pacific Island communities enact tobacco control policies, cessation demand is growing. The Guam cessation training model used culturally relevant data, materials, and training approaches and appeared effective in four different Pacific island countries. This underscores the importance of culturally competent adaptation of cessation training for priority populations such as Pacific Islanders.

Building capacity for implementation of the framework convention for tobacco control in Vietnam: lessons for developing countries

Effective implementation of the WHO international Framework Convention on Tobacco Control (FCTC) is the key to controlling the tobacco epidemic. Within countries, strong national tobacco control capacity is the primary determinant for successful implementation of the FCTC. This case study of tobacco control policy describes the experience of building national tobacco control capacity in Vietnam under the Reduce Smoking in Vietnam Partnership project within a national capacity-building framework. In the Vietnam experience, four components of tobacco control capacity emerged as especially important to achieve ‘quality’ outputs and measurable outcomes at the implementation level: (i) organizational structure/infrastructure; (ii) leadership and expertise; (iii) partnerships and networks and (iv) data and evidence from research. The experience gained in this project helps in adapting our tobacco control capacity-building model, and the lessons that emerged from this country case study can provide guidance to global funders, tobacco control technical assistance providers and nations as governments endeavor to meet their commitment to the FCTC.

A baseline profile of asbestos in the US-affiliated Pacific Islands

Asbestos is a recognized occupational and environmental hazard in the Asia-Pacific region, yet information regarding asbestos consumption, exposure, and asbestos-related diseases in the US-affiliated Pacific Islands (USAPIs) is scarce, and the situation regarding asbestos in these islands, particularly with regard to disease burden, surveillance, and health care capacity, is not well understood. Searching through scientific and "gray" literature and interviews with local cancer registry personnel and health professionals yielded no published data, only sufficient, indirect evidence of past and ongoing asbestos exposure, documented cases of mesothelioma and asbestosis, and minimal capacity for preventing and recognizing asbestos-related illnesses. Capacity and resource limitations within the USAPIs can impede regional progress in asbestos prevention and highlight the need for an integrated regional approach to address these data and capacity gaps. A regional mechanism to share expertise and resources and facilitate technical assistance to the USAPIs is urgently needed.

Getting the patients' perspective: a survey of diabetes services on Guam

The prevention and control of diabetes is a major public health priority for the US Territory of Guam. As part of a strategic planning process, a survey of diabetes patients was conducted to determine patients' perceptions of the availability and adequacy of preventive and clinical services to control diabetes. A total of 125 survey questionnaires were distributed to diabetes patients attending either one of the Guam Department of Public Health and Social Services Community Health Centers or a private Internal Medicine/Endocrinology clinical practice of the only endocrinologist on the island. All 125 questionnaires were returned. Respondents were highly aware of the duration of their diabetes, and almost 75% have had the opportunity to discuss the chronic nature of the illness and the importance of key lifestyle changes to help prevent or retard the progression of the disease. However, almost 40% of patients were not aware of the type of diabetes they had, and one in five have not received diabetes self-management education from their health care providers. Key interventions, such as nutritional counseling, brief tobacco cessation interventions, regular eye and foot examinations and immunization services were not being provided to 30% to 60% of patients, despite clinical practice guidelines that recommend these interventions for all diabetics. While over half of respondents were generally satisfied with the quality of preventive and routine medical care that they receive from their service providers, they identified the need for better quality diabetes self-management education, preventive services, enhanced access to specialists and specialized care, especially for diabetes-related complications, and better financial support to assist them in meeting the costs of chronic care and medications. The feedback from these respondents should provide guidance regarding service gaps and needs as the Department of Public Health and Social Services and its community partners collaboratively develop a strategic plan to better address diabetes prevention and control on Guam. The information should also serve to direct quality improvement efforts to enhance existing diabetes services on the island.

The prevention and control of HIV/AIDS, TB and Vector-borne diseases in informal settlements: challenges, opportunities and insights

Today's urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today's urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the "social determinants of disease" model, preventing and controlling HIV/AIDS, TB and vector-borne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda.

Community leader support for tobacco control activities & policies on Guam

OBJECTIVES

Guam has the highest smoking rate in the United States. This study examined Guam community leaders' attitudes toward cigarette smoking and their interest in changing local tobacco control policies.

DESIGN

Cross-sectional survey.

SETTING

Guam community leaders completed surveys while attending local professional conferences or meetings.

PARTICIPANTS

Seventy-three percent of the respondents were female; the mean age was 46 years (SD = 15), and over 86% were from ethnic minority groups (47% Filipino, 28% Chamorro, 10% Asian, 2% other Pacific Island groups). About 30% reported being native Guamanian, and of those who immigrated to Guam had lived on Guam a mean of 17 years (SD = 11).

OUTCOMES

Tobacco use was rated as a serious problem for Guam by 73% of the leaders surveyed, and a majority agreed that stricter tobacco control policies were needed on Guam.

RESULTS

When asked to rate their preferences for tobacco control efforts on Guam, most (63%) preferred to focus on cessation efforts and 55% wanted to focus on smoke-free public places.

CONCLUSIONS

This study provided critical insight about community leader support for stronger tobacco control measures on Guam, especially with respect to smoking cessation and smoke-free environments. Such a consensus of opinions could become a catalyst to promote community-wide tobacco control policies and programs. In addition, this study may provide a platform for future research on the structure and effectiveness of community leader support in a multicultural environment.

Hepatitis A outbreaks--methods of intervention in South-East Asian countries

INTRODUCTION

In many Asian countries, improved hygiene standards and socio-economic conditions have led to a reduction in exposure to the hepatitis A virus (HAV) in childhood. However, the persistence of circulating HAV may lead to hepatitis A outbreaks, particularly in adolescents and adults. In other countries and specific areas, where socio-economic conditions have not improved as markedly, HAV endemicity remains medium-to-high. A systematic approach to outbreak control is therefore urgently needed.

METHODS

The Steering Committee for Prevention and Control of Infectious Diseases reviewed reports on recent hepatitis A outbreaks in South-East Asian countries and determined that there is no systematic regional plan for the containment of such outbreaks. By contrast, on reviewing reports on outbreaks in several North American and European countries, it was found that the most important elements of successful outbreak control are a plan of action, rapid and widespread communication, public education and vaccination of household contacts to prevent secondary cases.

RESULTS

This investigation proposes an outbreak control programme consisting of six key stages -- initiation, planning, set-up, implementation, vaccination of at-risk populations and evaluation. Outbreak control requires the formation of an outbreak management team, plus a task force to implement intervention and educate the public. The vaccination of family members and close contacts is a central element of the programme.

CONCLUSION

This model programme for hepatitis A outbreak control provides a framework for action in countries and specific areas where the disease remains a problem.

Effect of lidocaine vs ketorolac tromethamine on postoperative laparoscopy pain control: a randomized study

Objective: To evaluate and compare the effectiveness of intraperitoneal lidocaine and intramuscular ketorolac tromethamine for immediate and delayed postoperative pain management in patients undergoing laparoscopy.Methods: Design-Seventy-four patients were prospectively randomized into four groups: intraperitoneal lidocaine; intramuscular ketorolac; both drugs; neither drug.Setting-Community Teaching Hospital Outpatient Surgery Center.Patients-Private and clinic patients needing operative laparoscopy.Intervention-One hundred milligrams of lidocaine was instilled into the peritoneal cavity just before the laparoscopy was completed. Sixty milligrams of ketorolac tromethamine was administered intramuscularly approximately 30 minutes before laparoscopy was completed.Main Outcome Measurements-The amount of analgesic used, the time required in postanesthesia recovery area, and a pain intensity score were used to evaluate the postoperative pain.Results: Pain intensity scores reported by those women receiving ketorolac and both medications were less than scores of untreated controls. Groups receiving either ketorolac, lidocaine, or both drugs required less morphine postoperatively.Conclusion: Both intraperitoneal lidocaine or intramuscular ketorolac are effective in reducing the perception of pain and the amount of morphine required postoperatively.