Smokefree Environments.pptx health education and peromotion

health priority AGENDA, health education, health promotion, priority agenda 4, universal healthcare

1. Republic of the Philippines DEPARTMENT OF HEALTH Eastern Visayas CENTER FOR HEALTH DEVELOPMENT

2. Department of Health – Eastern Visayas Center for Health Development Top 10 Leading Causes of Morbidity, 2021 RANK CAUSES NO. RATE 1 Acute Upper Respiratory Tract Infections 69,597 1,448.80 2 COVID-19 Confirmed 39,955 831.74 3 Hypertensive Cardiovascular Disease/Hypertension 23,636 492.03 4 Trauma/Injuries and Accident 10,976 228.49 5 Pneumonia 6,696 139.39 6 Animal Bites 5,499 131.18 7 Dermatitis Unspecified/Skin Diseases 5,033 104.77 8 Urinary Tract Infection 4,572 95.18 9 Diarrhea 4,676 99.32 10 Diabetes Mellitus 2,851 59.35

3. Department of Health – Eastern Visayas Center for Health Development Top 10 Leading Causes of Mortality, 2021 RANK CAUSES NO. RATE 1 Hypertensive Cardiovascular Disease 6,336 131.90 2 Pneumonia 3,088 64.28 3 Malignant Neoplasm/Cancer all Forms 1,213 25.25 4 Kidney Diseases/Disorder 937 19.51 5 Diabetes Mellitus (Type 1 and Type 2) 868 18.07 6 Trauma/Injuries and Accident 790 16.45 7 Pulmonary Diseases 671 13.95 8 Tuberculosis, all Forms 397 8.26 9 Gastrointestinal Disorder 342 7.12 10 Liver Disease 249 5.18

4. The only legal consumer product that kills half of its users when used as directed by the manufacturer.

5. Problem or Concern The Philippines loses approximately Php 186 billion due to tobacco-related healthcare and productivity losses (2022). Scientific research shows that no less than 12 different types of cancer are attributed to smoking with trachea, bronchus and lung as the most common cancer sites.

6. HOW LARGE IS THE PROBLEM/ CONCERN?

7. Department of Health – Eastern Visayas Center for Health Development Global Youth Tobacco Survey 2019

8. 17 Filipinos die each hour from tobacco-related disease

9. Why TOBACCO USE is common in the Philippines • EASY ACCESS & LOW PRICES • LACK OF AWARENESS ABOUT ITS DANGER • WEAKNESSES IN THE IMPLEMENTATION OF POLICIES AND PROGRAMS TO CURB THE TOBACCO EPIDEMIC

10. • AGGRESSIVE AND WIDESPREAD MARKETING

11. KINDS OF TOBACCO SMOKE Mainstream smoke is a combination of inhaled and exhaled smoke after taking a puff on a lit cigarette.

12. Second-hand Smoke The combination of smoke from the burning end of the cigarette and the smoke breathed out by smokers. When non-smokers breathe secondhand smoke, it is like them who are smoking.

13. FCAP 2001

14. Third-hand Smoke is the combination of cigarette by products that cling to smokers’ hair and clothing as well as to floors, surfaces, carpets, furniture, appliances, fabrics and children’s toys

15. 3 MAIN COMPONENTS OF TOBACCO SMOKE NICOTINE is the addictive component of tobacco. Within 10 seconds absorbed into the blood and affects the brain. Causes smokers to feel good Causes a surge of heart rate , blood pressure , and adrenaline which also feels good.

16. TAR is a thick, sticky substance, and when inhaled it sticks to the tiny hairs on the lungs, the cilia. Tar also coats the walls of the whole respiration system, narrowing the tubes that transport air (the bronchioles) and reducing elasticity of the lungs.

17. CARBON MONOXIDE is the poisonous chemical found in car exhaust fumes. It decreases the amount of oxygen in the blood, which deprives all the organs of oxygen too.

18. There are 7,000 harmful chemicals in a cigarette, 70 are carcinogens! ACETONE- used in nail polish remover ACETIC ACID- used in vinegar AMMONIA- used in food and toilet cleaners ARSENIC- used to make rat poison BUTANE- used in cigarette lighter fluid CADMIUM- used in rechargeable batteries CARBON MONOXIDE- found in exhaust fumes DDT/DIELDRIN- used in insecticide ETHANOL- alcohol FORMALDEHY DE- used to preserve dead bodies HEXAMINE- used in lighter fluid METHANE- used like gasoline NAPHTHALENE- used to make moth balls NICOTINE- used in insecticide NITROBENZENE- used as gasoline additive NITROUS OXIDE- used as disinfectant STEARIC ACID- used in candle wax TOLUENE- used in industrial solvent VINYL CHLORIDE- used to make PVC pipe.

19. Studies say that Filipino children start smoking at the age of 7

20. It is estimated that it takes a child 3 - 4 years of regular use for dependence to set in.

21. CDC, 2015 US Surgeon General Report 2014 Health Effects of Smoking Advancing a Healthy Life for All Filipinos

22. CDC, 2014 US Surgeon General Report 2014 Health Effects of Secondhand Smoke Advancing a Healthy Life for All Filipinos

23. If you think that smoking is associated with lung cancer only, you're wrong! Smoking causes other types of cancer such us Oropharyngeal Esophageal Laryngeal Anal cancers.

24. CHRONIC OBSTRUCTIVE PULMONARY DISEASE

25. Smoking damages small blood vessels, and restricts blood flow to the hands and feet, can lead to gangrene and even the amputation of limbs.

26. Smoking leads to tooth decay, and turns your teeth and fingers yellow.

27. Smoking affects your skin and complexion; it leads to premature aging and wrinkles.

28. Male smokers also have a lower sperm count and more abnormal sperm than non-smokers. Men who smoked for years were often unable to have an erection due to low penile blood pressure.

29. Smoking may make it harder for women to get pregnant , the smoke causes problem with the fallopian tubes where the egg cell passes from the ovaries to the uterus.

30. When women use oral contraceptives and smoke at the same time, they are 10 times more likely to suffer a heart attack and have a higher incidence of stroke and blood clots in the legs. Women who smoke also increase their chance of getting cancer of the uterine cervix and may go through menopause earlier.

31. Pregnant women who smoke endanger two lives- their own and their unborn babies. Smoking mothers have more premature births, more stillbirths, and more infant deaths.

32. There is increased risk of miscarriage and having low birth weight babies. Nicotine, carbon dioxide and all the other dangerous chemicals in cigarettes reach the baby through the mother’s blood stream. Smoking causes blood vessels to become narrow and the baby gets less of the mother’s blood supply. Babies born of smoking mother’s also have fewer white blood cells, poorer immune systems, and suffer a higher incidence of infectious disease.

33. Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) Electronic cigarettes or electronic nicotine delivery systems (e-cigarettes) include a range of devices designed to heat and deliver nicotine, flavorings and other chemical substances to users in the form of an aerosol. ENDS/ENNDS may or may not contain nicotine. Devices do not burn or use tobacco leaves, instead vaporize a solution that the user inhales. The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents. ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants. Source: World Health Organization 46

34. Propylene glycol Glycerin Flavorings (many) Nicotine NNN NNK NAB NAT Ethylbenzene Benzene Xylene Toluene Acetaldehyde Formaldehyde Naphthalene Styrene Benzo (b) fluoranthene Cadmium Silicon Lithium Lead Magnesium Manganese Potassium Titanium Zinc Zirconium Calcium Iron Sulfur Vanadium Cobalt Rubidium Benzo ( ghi ) perylene Acetone Acrolein Silver Nickel Tin Sodium Strontium Barium Aluminum Chromium Boron Copper Selenium Arsenic Nitrosamines Polycyclic aromatic hydrocarbons Chlorobenzene Crotonaldehyde Propionaldehyde Benzaldehyde Valeric acid Hexanal Fluorine Anthracene Pyrene Acenaphthylene Acenapthene Fluoranthene Benz(a) anthracene Chrysene Retene Benzo (a) pyrene Indeno (1,2,3-cd) pyrene Mga Kemikal Sa Sigarilyo

35. Alin kayang mga kemikal ang maari din makita sa Ecigarette /Vape? Compounds in yellow are from FDA 2012, Harmful and Potentially Harmful Substances – Established List Propylene glycol Glycerin Flavorings (many) Nicotine NNN NNK NAB NAT Ethylbenzene Benzene Xylene Toluene Acetaldehyde Formaldehyde Naphthalene Styrene Benzo (b) fluoranthene Cadmium Silicon Lithium Lead Magnesium Manganese Potassium Titanium Zinc Zirconium Calcium Iron Sulfur Vanadium Cobalt Rubidium Benzo ( ghi ) perylene Acetone Acrolein Silver Nickel Tin Sodium Strontium Barium Aluminum Chromium Boron Copper Selenium Arsenic Nitrosamines Polycyclic aromatic hydrocarbons Chlorobenzene Crotonaldehyde Propionaldehyde Benzaldehyde Valeric acid Hexanal Fluorine Anthracene Pyrene Acenaphthylene Acenapthene Fluoranthene Benz(a) anthracene Chrysene Retene Benzo (a) pyrene Indeno (1,2,3-cd) pyrene Ang lahat ng ito ay natagpuan sa e-cigarette/vape pen aerosol

36. Glycerol – responsible for the smoke/aerosol that a vape user exhales. The more glycerol, the thicker the smoke. In studies, when glycerol is mixed with e-cig/vape wire, it produces a chemical called acrolein, which can cause cancer. Propylene Glycol – a common food additive; also used to make things like anti-freeze, paint solvent and artificial smoke in fog machines. This is what gives the "throat heat" or throat rub that e-cig/vape users are looking for. 49 Chemicals in E-cigarette/Vape

37. 50 Nicotine – a highly addictive substance that negatively affects the brain development of young people Acrolein – a herbicide used primarily to kill weeds. This can cause lung damage. Diacetyl – a chemical linked to a lung disease called bronchiolitis obliterans or popcorn lung. Cadmium – a toxic metal found in traditional cigarettes that causes breathing problems. Benzene – a volatile organic compound found in automobile exhaust Chemicals in E-cigarette/Vape

38. Flavors

39. Simply put, ENDS/ENNDS produce an aerosol that often contain many harmful chemicals and toxins, some known to cause cancer, ischemic heart disease, lung disease, and stroke. Toxicologic analyses Experiments in cell cultures and animal studies show that e-cigarettes can have multiple negative effects. Animal and human cell line studies. Case Reports: “popcorn lung” (bronchiolitis obliterans), accelerated COPD, seizures Case-control studies: Heart disease Population epidemiologic data: EVALI (E-cigarette or Vaping Product Use Associated Lung Injury) Evidence in humans Growing evidence that use of ENDS/ENNDS causes harm. Not safe to “vape”…

40. 44% of those vaping are non-smokers (NNS 2019) NOT TRUE that vaping is being offered as alternative to smoking!!! This is NOT harm reduction but rather INCREASED HARM!!!

41. Does “vaping” help smokers quit? Most adult ENDS/ENNDS users do NOT stop smoking cigarettes but end up using both products. ( Increased harm) A study of the effect of "real world" ENDS use on the population quit rates among 1284 U.S. adult smokers showed that the adjusted odds of quitting smoking were lower for those that used ENDS at baseline (9.4%) compared to smokers who did not use ENDS (18.9%). Among Italian e-cigarette users, those (re)starting smoking after using e-cigarettes outnumber those who stop smoking after using e-cigarettes.

42. WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL First global health treaty negotiated under auspices of WHO – adopted in 2003 181 parties , covering about 90 % of the world population Entry into force -27 Feb 2005

43. Introduction to Smoke-free Environments Department of Health – Eastern Visayas Center for Health Development Krystel Charisse B. Daya-Magos , RN Tobacco Control Program Manager

44. I. Smoke-free Environments Department of Health – Eastern Visayas Center for Health Development

45. 1. What does a “Smoke-free Environment” mean? Smoke-free refers to an environment where everyone is protected from the hazards of secondhand smoke, in all enclosed workplaces and public places, including all restaurants, bars and other hospitality venues. It also means there are no designated smoking rooms, no exempted premises, and no exempted people. Department of Health – Eastern Visayas Center for Health Development

46. 2. What is a SMOKE-FREE Policy? A SMOKE-FREE Policy generally refers to a plan or course of action adopted by government, usually embodied in some form of legislation or executive issuance, with primary objective of achieving a smoke-free environment. Department of Health – Eastern Visayas Center for Health Development

47. 3. Why should we adopt and support Smokefree Policies? As a party to the Framework Convention on Tobacco Control (FCTC), the Philippines is obliged to do so. Right to health provided by the Philippine Constitution. Smokefree policies save lives by protecting people from the dangers of exposure to tobacco smoke. Smokefree policies safeguard workers, especially those in the hospitality industry who are the most heavily exposed. Smokefree policies are cost-effective. The economic benefits of smokefree legislation outweigh any potential costs of implementation and enforcement. Smokefree policies are popular. There is clear and demonstrable public support for smokefree laws in many countries. Smokefree policies work. Smokefree laws are the only effective way to protect people from secondhand smoke. They have been successful in a variety of settings. Department of Health – Eastern Visayas Center for Health Development

48. 4. Are there smoke-free policies currently being implemented anywhere in the world? Yes. As of 2013, 17 EU countries have comprehensive smoke-free laws in place. Among these, Ireland, the UK, Greece, Bulgaria, Malta, Spain and Hungary have the strictest smoke-free provisions with a complete ban on smoking in enclosed public places, on public transport and in workplaces, with only limited exceptions allowed. Countries – Iran, Ireland, New Zealand, Northern Ireland, Scotland, South Africa, Uruguay, Wales, England, Thailand – have adopted comprehensive smoke-free laws. Subnational jurisdictions in the USA, Canada, Australia, the United Kingdom, China, Bermuda and Argentina have adopted similar laws. Ten countries have passed legislation Department of Health – Eastern Visayas Center for Health Development

49. 5. Are there Smokefree policies currently being implemented in the Philippines? YES. There are 130 local government units (LGUs) that currently have smokefree policies. Region 8: Maasin City Mapanas , Northern Samar Naval, Biliran Tomas Oppus , S. Leyte San Juan, S. Leyte Alangalang , Leyte Pintuyan , S. Leyte San Miguel, Leyte Libagon , S. Leyte Hinunangan , S. Leyte Anahawan , S. Leyte Padre Burgos, S. Leyte Limasawa , S. Leyte San Antonio, N. Samar Ormoc City Arteche , E. Samar Department of Health – Eastern Visayas Center for Health Development

50. II. Smoke-free Environments and Health Department of Health – Eastern Visayas Center for Health Development

51. 1. What is secondhand smoke (SHS) or Environmental Tobacco Smoke (ETS)? Secondhand smoke is a complex mixture of thousands of gasses and fine particles emitted from the burning end of a cigarette or from other tobacco products usually in combination with the smoke exhaled by the smoker. It can linger for more than two (2) hours, and may be visible and odorless. It is also known as a “human carcinogen” (cancer-causing agent) by the US Environmental Protection Agency (EPA), the US National Toxicology Program and the International Agency for Research on Cancer (IARC), a branch of the World Health Organization. Department of Health – Eastern Visayas Center for Health Development

52. 2. Is there a safe level of exposure to cigarette smoke? NO. There is no safe level of exposure to SHS. Completely smoke-free environments protect smokers and non-smokers, and reduce tobacco use in current smokers, it will also help those who want to quit. SHS is a significant health risk for all those exposed to it – from persons near the smoker, to the unborn child of a pregnant smoker, to someone in a room where particles from SHS linger along after the smoker has left. Even pets of smokers are affected. Exposure to secondhand smoke increase the risk of cardiovascular disease by 25 to 30% and the risk of lung cancer by 20 to 30% and has been attributed for an estimated annual 7,300 lung cancer deaths and 34,000 cardiovascular diseases deaths among non-smokers. Department of Health – Eastern Visayas Center for Health Development

53. 3. What diseases are people at risk of acquiring because of exposure to SHS? In adults, there is sufficient evidence proving SHS causes: Coronary Artery Disease, Lung Cancer, Reproductive effects in women Evidence also suggests that SHS contributes to the incidence of the ff: Stroke, Nasal Sinus Cancer, Breast Cancer, Atherosclerosis In children, there is sufficient evidence proving that SHS causes: Middle Ear Disease, Respiratory Symptoms, Impaired lung function, SIDS, Lower Respiratory Illness, Low birth weight Evidence also suggest that SHS leads to the ff: Brain tumor, lymphoma, leukemia, asthma Department of Health – Eastern Visayas Center for Health Development

54. 6. Are SMOKEFREE Policies effective in protecting people from the hazards of Secondhand smoke? YES, where smokefree laws are: - air pollution levels go down. Air quality drastically improves because the amount of toxins and fine particles in the air are greatly reduced. - there is increased productivity in the workplace, and less health and building maintenance and cleaning costs. - workers and employees previously exposed to SHS have less respiratory illness and symptoms. - there are less heart attacks and strokes, less asthma attacks. - children grow up healthier, and are less likely to start smoking as they grow older. - even smokers benefit, they may smoke less, and less often, or quit smoking altogether Department of Health – Eastern Visayas Center for Health Development

55. 7. Where is Secondhand Smoke a problem? Department of Health – Eastern Visayas Center for Health Development At Work

56. III. Smoke-free Environments and the Tobacco Industry/Myths about SF Environment Department of Health – Eastern Visayas Center for Health Development

57. 1. Will proper ventilation solve the problem of secondhand smoke? NO. Ventilation systems cannot solve the problem of secondhand smoke. American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE) – have concluded that ventilation and other air filtration technologies cannot eliminate the health risks caused by SHS exposure, and that the only effective option is to make indoor places smokefree. International and national expert reviews in a range of countries agree. Numerous air filtration companies have publicly stated that no ventilation system can protect people from the death , Department of Health – Eastern Visayas Center for Health Development

58. OPEN SPACE - Entrances/Exits DSA If in Open Space of Bldg premises DSA If inside Bldg - Where People Pass - Where People Congregate - Air Intake Ducts at least 2m away SF Buffer Zone - Entrances/Exits - Where People Pass - Where People Congregate - Air Intake Ducts <------- at least 10 meters away from the ff : --------> <------- at least 10 meters away from the ff : --------> Not less than 10sqm, not more than 20% of total floor space ENCLOSED SPACE

59. 2. Are Smoke-free policies bad for business? Studies have repeatedly shown that SF laws do not have a negative economic impact on the hospitality or tourism industries. In some jurisdictions even, SF laws have been followed by increased profits for the hospitality industry. Benefits for employers include increased productivity, reduced sickness in employees from smoking and secondhand smoke exposure, reduced injuries, and reduced risk of fire damage. The only business that is guaranteed to lose money after an SF law takes effect is the tobacco industry. Department of Health – Eastern Visayas Center for Health Development

60. 3. Do Smoke-free policies constitute Human Rights Validation? NO. The right to clean, safe air applies to everyone, and should come first. No worker should have to choose between their job and their health. SMOKEFREE policies are not about whether people smoke. They are about where people smoke. They remove the health risks to other people caused by SHS. Department of Health – Eastern Visayas Center for Health Development

61. Department of Health – Eastern Visayas Center for Health Development