Anne Buttigieg

abutt01@um.edu.mt
anne.buttigieg@gov.mt
Encourage and
support their
members to be
role models by
not using and by
promoting a
tobacco free
culture
 Make their own organizations’
premises and events tobacco-free
and encourage their members to
do the same.

 Includetobacco control in the

agenda of all relevant health-
related congresses and
conferences.
Assess and address tobacco
consumption patterns and
tobacco- control attitudes of
their members through
surveys and the introduction
of appropriate policies.
 Advise their members to routinely
ask patients and clients about
tobacco consumption and
exposure to tobacco smoke, using
evidence-based approaches and
best practices, give advice on how
to quit smoking and ensure
appropriate follow-up of their
cessation goals.
 Influence health institutions
and educational centres to
include tobacco control in
their health professionals’
curricula, through continued
education and other training
programmes.
 Do Not accept any kind of
tobacco industry support–
financial or otherwise-and
from investing in the tobacco
industry; encourage their
members to do the same.
•Doctors in every branch
of medicine-113,597 in
all
– cigarette preference?
•3 leading research
organizations
•What cigarette do you
smoke ,Dr ?

The brand named most

was Camel !!

Anne Buttigieg
9
 Ensure that their organization has a stated
policy on any commercial or other kind of
relationship with partners who interact with
or have interests in the tobacco industry
through a declaration of interest.

 Prohibit the sale or promotion of tobacco

products on their premises, and encourage
their members to do the same.
 Actively support governments in the process
leading to the implementation of the WHO
Framework Convention on Tobacco Control.

 Dedicate resources to tobacco control-

including the implementation of this code of
practice.

 Participate in the tobacco-control activities of

health professional networks and support
campaigns for tobacco-free public places.
 Unsafe sex
Urban outdoor air polution
Low fruit/vegetables

Alcohol use
High blood glucose
High cholesterol
Physical inactivity
Overweigh/obesity

Tobacco use
High blood pressure

0 1000 2000 3000

thousands
The main risks are known

Suboptimal breatfeeding
Illicit drug use
Low fruit/vegetables

High blood glucose

Physical inactivity
High cholesterol
Overweight/obesity

High blood pressure

Alcohol use
Tobacco use

0 5000 10000 15000 20000

thousands
Source: Global Health Risks.. Geneva, World Health Organization, 2009
(http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html/).
 The
Smoker.. !?

How do you view the smokers ?

How are smokers judged?

 Nonsmoker perception?
 Smokers opinion ?
Smokers minimize the relevance
of the health risks and not all
of them have the ability to
create well-judged
considerations to make
healthy choices...

The damage on health does not

become evident until years pass
 100

70%

70

30%

30

2.3%

2.3
0
Want to stop Try each Year Succeed each year
each Year

Bridgwood et al, General Household Survey 1998. 2. West, Getting serious about stopping smoking 1997.
3. Arnsten, Prim Psychiatry 1996.
 Legislation on tobacco and its products –
1986
 L.N.243 – Labeling of Tobacco Products
Regulations, 2003
 L.N. 244 – Smoking in Public Places
Regulations, 2003
 L.N.245 – Tobacco Products (Cigarette
Composition) Regulations, 2003.
Anne Buttigieg
20
 Ban in Public places -October 2004 2nd
EU following Ireland. Legal Notice 242 -
Commencement Notice relating to
amendments to the Tobacco (smoking
Control) Act, Chap.315.

 L.N. 406 0f 2005 Ban on advertising and

promotion of Tobacco products
Regulations

 L.N. 302 of 2009 Use of colour

photographs or other illustrations as
Health warnings on Tobacco packages
Regulations, October 2009 for April 2011
extended to June 2011 Anne Buttigieg
21
 Designated smoking rooms
- It shall not be lawful for any person to
smoke or allow smoking in a designated
smoking room after the 1st January 2013
 Promoting tobacco free, healthy
lifestyles.
 Guiding and informing people on
quitting.
 Brief effective tobacco cessation
intervention
- 5 A’s include: ASK, ADVISE ,ASSESS,
ASSIST,ARRANGE
Anne Buttigieg
23
 • Do you use tobacco. This is most easily
accomplished by including tobacco use as part of
Ask the medical history form

• Clear, strong, and personalized to the individual’s

situation. Correlate this to a medical condition or
ones medical history. Offer brief suggestions about
Advise
how to quit.

• Readiness and motivation to quit using tobacco by

asking e.g. "Are you willing to try to quit at this
Assess time? “
 • Brief suggestions about how to quit. Inform
them about free quitting programs by HPU,
Quit Line 23266116, Free phone 80073333.
One can also offer application forms to
Assist smoking cessation clinics or download
application KURA

• Follow-up to prevent relapse and offer

support.
Arrange
 Yet many health professionals do not ascertain
patients’ smoking status.
- Single most effective step to lengthen and
improve patients’ lives.
- Quitting smoking has immediate and long-
term benefits and is well worth the difficulty,
both for patient and clinician
1. Too busy
2. Lack of expertise
3. No financial incentive
4. Most smokers can’t/won’t quit
5. Stigmatizing smokers
6. Respect for privacy
7. Negative message might scare away patients
8. I smoke myself
 30 seconds
 Best health results with a small intervention
 Health professional job and part of basic visit
 No expertise needed to refer
 Straight forward counselling and NRT More
information through referring
 Unlikely to quit ?
◦ Quitting Doubles
◦ With Quitline triples
 Stigma attached to quitting?
 Smoking Cessation clinics
◦ On line application
◦ https://ehealth.gov.mt/HealthPortal
 Quitline
 One to one counseling
 Workplace Cessation Programmes
 Carbon Monoxide Testing
 Seminars on tobacco
 Health Professional Training

Anne Buttigieg
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 We need to
look deeper
into the
eyes
of the smoker
Knowing is not
enough;
We must apply.

Willing is not
enough;
WE MUST DO

Johann Wolfgang von Goethe (1749-1832)