CHILD HEALTH AND TOBACCO IN THE PHILIPPINES

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CHILD HEALTH AND TOBACCO IN THE PHILIPPINES

• BENJAMIN P. SABLAN, JR., MD, FPPS
• PROFESSOR
• UNIVERSITY OF THE PHILIPPINES MANILA

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DISCLOSURE

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

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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)

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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.
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Global Youth Tobacco Survey (GYTS)

• Current usage 3/10 of students (27.3 MgtF)
• Current smokers 1/5 of students (21.7 MgtF)
• Other tobacco users 1/10 (9.7 MF)
• Ever smoked ½ of students (46.2 MgtF)
• Likely to smoke 1/10 of students (13.6 MgtF)

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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

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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

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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

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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 friends
  home
• Only 4 in 10 think smoking is harmful to their
  health

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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

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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

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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

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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!!!!

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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

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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

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BTIS TRAINING

• Training Modules
• Trainors
• Training Manual
• Health Provider Encounter form
• Health Education Materials

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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

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BTISWriteshop and Training
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BTIS
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BTIS
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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

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PARENT/CAREGIVER
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OLDER CHILD (6-9 YEARS OLD)
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ADOLESCENT
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VIDEO

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

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BTIS Training
PRE TEST POST TEST
TARLAC 6.9 17.25
METRO MANILA 11 19
BATAAN 9 19.8
DAVAO 12 23
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BTIS Learnings

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

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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

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COMMITMENTTo Develop Resource Centers for
Motivational Counseling
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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

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THANK YOU