Regional case studies of strategies to achieve clean indoor air policies

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Regional case studies of strategies to achieve
clean indoor air policies

• Florin Dumitru Mihaltan,
• Aer Pur, Romania

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Smoke free environments

• Smoke free hospitals
• Smoke free workplaces
• Smoke free social places

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Air pollution

• Indoor air pollution
• Outdoor air pollution

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Arguments of the industry

• The tobacco industry has developed its own
  campaign
• to defend the rights of smokers and
• to cast doubt on the scientific link between
  passive tobacco use and death and disease.
• smokers rights campaign

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Arguments of the industry

• The tobacco industry will do whatever it can to
  avoid being regulated not intrusive rules and
  regulations if people will only cooperate with
  each other.
• The Harm is Uncertain
• Its a Ventilation Problem
• Separate Tobacco use Sections Will Solve the
  Problem
• There Are More Serious Problems
• Small Group of Fanatics

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What does the tobacco industry fear

• Clean air activity
• the most dangerous development to the viability
  of the tobacco industry that has yet occurred
• fewer opportunities to enjoy our products, they
  will use them less frequently and the result will
  be an adverse impact on our bottom line.
• - Philip Morris, 1994

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Arguments of the governmental and nongovernmental
organization

• 1 They promote health and save lives.
• 2 They make breathing easier.
• 3 They save business money.
• 4 They save society money.
• They help our children grow up tobacco-free.
• Smoke-Free Americas Workshop

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Medical ArgumentsSecondhand Smoke -Adults

• In smoky, unventilated rooms, the level of carbon
  monoxide can be two to three times the level
  found at highly polluted city intersections.
• The exposure to other carcinogenetic substance

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Some of the areas that need to be targeted for
smoke-free policies include

•      worksites
•      schools and day care centers
•      health care settings  
•      public transportation
•      restaurants
•      government buildings
•      retail stores
•      sports arenas
•      theaters
•      any place frequented by young children.

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Smoke free environments

• Increase productivity by encouraging smokers to
  quit.
• Nonsmokers get sick less often.
• Cut down on cleaning and other maintenance costs.
• Increase workplace safety.
• Offer an attractive working environment for most
  people.
• Smoke-Free Americas Workshop

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Percentage of decline in tobacco use attributable
to smoke free workplaces (does not include impact
of other smoke-free environments)
Australia
United States
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Attitudes of the governmental and nongovernmental
organization

• Direct advocacy
• Media advocacy.

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Direct advocacy

• the efforts you undertake to directly persuade
  government leaders or other decision makers to
  adopt policy changes.
• a single small victory can serve as a model
• targeting one environment, such as a hospital or
  government building, can be just as important as
  advocating for broader policies

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Media advocacy

• includes techniques and tactics that gain access
  to the mass media in ways that educate the public
  about the dangers of secondhand smoke and frame
  the issues so as to create an environment where
  broad support for smoke-free policies exists.

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Activities to promote smoke-free policies

• activities that promote community wide smoke-free
  policies
• activities aimed at specific targets

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Community wide Activities

• Try to convince public authorities with
  regulatory powers to ban tobacco use
• Ask property owners and store managers to
  voluntarily ban tobacco use on their premises.
• Talk with editors of your local newspaper to
  write editorials in support of both mandatory and
  voluntary tobacco use bans.

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Community wide Activities

• Arrange meetings or presentations with
  policymakers
• -to write editorials in support of both mandatory
  and voluntary tobacco use bans.
• -to inform them about the risks associated
• about secondhand smoke and about their
  responsibility to ban tobacco use in all public
  places.

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Community wide Activities

• Use policy examples from other communities or
  countries to convince or shame leaders into
  adopting similar policies.
• Use that victory to build support for a different
  type of policy.

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Activities aimed at specific targets

•   Call a radio talk show host to suggest that a
  visiting expert would be available to discuss
  issues relating to secondhand smoke and
  smoke-free environments.
•   Use creative epidemiology to present old
  statistics in a new and interesting way. (compare
  the number of deaths caused by secondhand smoke
  to some other cause of death, such as car crashes
  or homicides).

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Activities aimed at specific targets

• To write about the right to breathe clean air
  and the real issues surrounding exposure to
  secondhand smoke
• Press conference featuring local medical
  officials to call for smoke-free public
  transportation in your community
• To highlight the dangers of secondhand smoke and
  the lack of tobacco use-control policies in your
  community.

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Activities aimed at specific targets

• promote public events, such as contests or
  demonstrations that support smoke-free policies.
• alert the media to efforts to implement
  smoke-free policies.
• contact local media and explain the importance of
  the legislation to your community and your
  nation.
• suggest local experts on tobacco and health who
  can discuss the legislation with reporters or in
  radio and television interviews

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In Romania in 1995 29193 persons died by
diseases caused by smoking. (Richard Peto et
all. WHO)
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Smokefree worksites

• Have workshops to provide information to
  worksite managers, employees, and union officials
  
•  Provide employers with signs to post and
  leaflets secondhand smoke
• Assist employers in surveying individual
  workplaces
• Work with labor unions to develop methods for
  implementing worksite policies
•   Adapt information detailing the job-related
  costs of secondhand smoke

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Smokefree workplaces in Romania

• First places- McDonalds and some private owners
  of factories
• A certain presure of European Union
• First law protecting the pasive smoker -2003
• Many problems of implementing the law
• Who is in charge to make the control ?
• Very criticised by the cigarette producers
• Where is the right of the manager or of the
  privat propriety ?

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Smokefree Hospitals

• Persuade health care providers and managers to
  ban tobacco use in all health care facilities and
  to educate their patients,
• Promote voluntary tobacco use bans in health
  care facilities through resolutions and campaigns
  initiated by medical and dental societies and
  other professional associations.  
• speak with every patient about the harmful
  nature of direct and involuntary tobacco use.  
•     

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Smokefree Hospitals

• Display posters and distribute pamphlets in
  health care clinics
• Publishing the financial benefits to hospitals
  that go smoke-free
• Sample media advocacy activities
•  Initiate media coverage of any of the above
  direct advocacy initiatives by suggesting that
  your local newspaper write a feature story about
  health care providers that go smoke-free.  
• Issue public awards to smoke-free health
  facilities.

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Smoke free hospitals actions in Romania
(1989-2001)

• An ancient law unsustained by the government and
  medical staff
• An unchanged prevalence of smokers at the medical
  staff
• Bad habits coming from school and teaching staff
• Absence of quit smoking department in hospitals

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Smoke free hospitals actions in Romania
(1989-2001)

• Absence of regular minimal advice
• Absence of education course for certain
  generation of doctors
• Absence of a good collaboration between NGO and
  Minister of Health
• Absence on the march of the quit smoking products

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The prevalence of smoking by profession(Mihaltan
et all.2002)
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Prevalence of smoking to the students
(Lupu-1995)
I. Lupu et I. Zanc, 1994/1995
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Prevalence of smoking to pharmacists
(Fl.Mihaltan1997)
Mm1997
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Prevalence of smoking to surgeons
(Fl.Mihaltan-1999)
Fl. Mihaltan, M Costea et coll, 1999
45,8
Ocasionnels
15.9
Permanents
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Age of quitting smoking by doctors
(Didilescu-1999)
Enquête de C. Didilescu et Ioana Munteanu, 1999
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In 2003 we are more optimistic

• A new law for protecting the passive smokers/2003
• Courses with medical students in university
  centers
• Romania is in a project of the EU (Smokefree
  hospitals)
• New interests from the part of the pharmaceutical
  producers
• Courses for preparing doctors in quit smoking
  methods
• First broadcastings for doctors and students
  speaking about secondhand smoking

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Prevalence of smoking to GP and
Pneumologists-2002(Fl.Mihaltan)
GP

Pneumologist
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The prevalence of smoking to the medical staff in
a pneumology departament(Mihaltan et all.2002)
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Schools, Preschools, and Day Care Centers

• Provide schools with curricula on the dangers of
  direct and involuntary tobacco use and the need
  for smoke-free environments.
• Promote adoption of civics projects centered on
  student initiatives,
• Provide school boards and administrators with
  model smoke-free policies for schools
• Use local media to raise the general issue of the
  harmful effects of secondhand smoke on children.
  

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Restaurants and Retailers

• Find out if there are any associations that
  represent restaurants or other businesses in your
  community. Provide these organizations with
  information about secondhand smoke and ask that
  they accept voluntary smoke-free standards among
  all their members.
•  Offer to hold your organizations meeting in a
  local smoke-free restaurant as a way of rewarding
  their healthy policy.
• Conduct a survey of restaurant patrons to ask
  whether they feel comfortable asking their fellow
  patrons not to smoke

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Other Smoke free social places in Romania

• Some campaign in schools ( not very good
  coordination)
• Many aspects neglected
• High prevalence of smoking to teachers and
  children
• In the restaurants their own politics
• In reality smoke free areas only in airports

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Benefits of smokefree placesSmoke free
environments normalize nonsmoking. Youth stop
seeing smoking as a normal part of growing
upSmokers receive encouragement to quit or to
smoke less.
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Clean Indoor pollution-Romania

• Many aspects neglected even in the medical books
• Absence of the courses in the curriculum of the
  Medical Universities
• Creating new partnerships, finding new partners
• Electrolux-Romanian Society of Pneumology-Aer Pur
  (articles, broadcasting,symposia)

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