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Strategy is crucial to build a smoke-free world
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By Ma Kang-yao
According to World Health Organization, (WHO) 1.3 billion adults regularly smoke. Among them, about 1 billion are male and 250 million are female who accounts for 47% of all male and 12% female. What ensues with the huge numbers of smoker is the cost of health.
In 2000, 4.9 million people dead from tobacco hazards. Without proper strategy to control it, in 2020, the number will increase to 10 million and most of them will be in the developing countries.
Before 1984, as much as 60% of Taiwan's male smoked and that of female 4%. Since then, non-goverment anti- tobacco groups launched campaigns. The percentage of smokers has decreased year by year. However, in 1987, Taiwan opened up its market to import tobacco. Tobacco dealers tried to boost their sales by various kinds of promotion and commercials, which caused the number of smokers rose, especially in female and adolescent. To address the problem, government carried out a tobacco control program. In 1990, the "Five-year Tobacco Control Plan" was launched. Thereafter, the smoking percentage of male adults decreased, but that of female and adolescent kept rising.
"Under the pressure of international trade, Taiwan opened up its market. The fashioned design of the cigarette packages, the moving advertisements and the delicate giveaways are very attractive to the youths," said Chao Kun-yu, the deputy director-general of Bureau of Health Promotion, (BHP) the Department of Health (DOH).
According to BHP's survey in 2002, the smoking percentage of male between ages 15 to 17 was 17.0 % and that of female 4.1%. The survey also told that 41% of the smokers' first smoking experience is in campus and 68.8% of them were driven by curiosity. 76.9% of them are mainly affected by their friends and classmates. As for the adults above age 18, the percentage of male smoker was 45.9%, which is quite identical to that of other countries and female was 6.2%, much below other countries. The number of people die from smoking and the tobacco- related diseases is about 18,800, accounts for 12% of all causes of death.
About the tobacco- related diseases, a research in 2003 showed that above 35 years old, the probability of male smoker dying from the tobacco- related diseases such as cancer, cardiovascular and respiratory system was 1.7 times higher than the non-smoker. The heavier a smoker is and the longer he smokes, the more perilous tobacco is to his health.
In 2002, a survey by BHP showed that in Taiwan 47.73% of the respondents above age 15 say that they feel they are exposed to the secondhand smoke and especially in their family. In schools, 33.03% of adolescents said are exposed to the secondhand smoke. Such problem is serious especially smoking should be totally forbidden in the the primary schools, middle-high schools and high schools.
In work place, 52.45% workers say that they have exposed to the secondhand smoke especially in the work places without smoking regulations. In addition, 58.14% of the pregnant women say that they are exposed to the secondhand smoke and what worrisome is that most family wouldn't change their smoking habit when there is pregnant woman in their house.
The number of male smokers in Taiwan is starkly higher than that of female smokers but the percentage of quit smoking is very low. Even the overall percentage of quit smoking is getting high along with the ages, which is still lower than that of the United States.
"The percentage of quit smoking among male smokers above age 15 is about 23.4%. The smokers above age 60 have the highest percentage of quit smoking, which means to help people quit smoking is still a long way to go," said the deputy director- general Chao "Tobacco and Alcohol Tax Act passed in 2002 levy tax to fill about NT$ 1 billion in the task of tobacco hazards reduction every year. Since then, we are more capable of carrying out the policies of tobacco hazards reduction than before."
Policies to Tobacco Hazards Reduction
Three targets are aimed at for tobacco hazards reduction- decreasing the percentage of smoking, increasing the percentage of quit smoking and lessening the exposure percentage of secondhand smoke.
The Bureau of Health Promotion set six directions to achieve the goals.
1. Reinforcing the tobacco hazards reduction education.
2. Building up smoke-free environment to lessen the exposure percentage of secondhand smoke.
3. Expanding quit smoke service.
4. Training more people to join the tobacco hazards reduction.
5. Conducting research on tobacco hazards reduction and monitoring the going.
6. Strengthening multilateral cooperation with other countries to share experience with each other.
Education of Tobacco Hazards Reduction
"The most important job of tobacco hazards reduction in every country is prevention. Thus we strives to prevent people from forming the habit of smoking. The main task is to educate the adolescents and the present nonsmokers to stay away from smoking." said Chao. Besides integrating the anti- smoke content into the design of curricula, Bureau of Health Promotion also helps schools to hold extracurricular activities. For the advertisement on media, they produced different kinds of advertisements to target different groups.
The focal points in 2004 include promoting smoke-free campuses, spreading knowledge of tobacco hazards reduction to the public, and preaching the stores not to sell tobacco to the youth under age 18 through media.
Lessen Exposure Percentage of Secondhand Smoke Secondhand smoke has bad influence not only on smoker but also nonsmoker. Taiwan's tobacco-related diseases is getting more prevalent, especially the lung cancer which has caused the most deaths among all cancers.
Taiwan's secondhand smoke is seriously happening in houses, work places, restaurants, schools and army. Therefore, the BHP promotes a series of secondhand smoke control programs such as smoke-free family, smoke-free restaurants, smoke-free workplaces and smoke-free armed forces in hope of creating a smoke-free environment and lessening the exposure of secondhand smoke.
"For the past decades, government and public service organizations had promoted smoke-free environment, "said Chao, "in public occasions, people generally have the consensus of not smoking but family is still a major origin of secondhand smoke." According to the BHP, about 47.73% family suffering from secondhand smoke and the Tobacco Control Act doesn't stipulate that family is forbidden for smoking. Thus the BHP can only promotes smoke-free family through internet, oster and writing competition.
For smoke-free restaurants, the BHP in 2003 works with 25 counties' bureau of health and some scholars to promote smoke-free restaurants and build up a rating system to encourage food industry to participate certification. Till the end of 2004, there were about 5000 restaurants join smoke-free restaurants. The exposure of secondhand smoking dropped from 66.2% in 2003 to 41.4% in 2004. But for Taiwan's overall 500 thousand restaurants, it is still a long way to go.
Most people spend one third of their time every day on working. According to the survey published in November 2003, 98% employers and 85% employees support smoke-free environment in their workplaces. However, 40% employees say that they are suffering from secondhand smoke. In America, Norway and Australia, it has been forbidden to smoke in workplaces. Hence, the BHP, set up "Work places Tobacco Control Centers" in northern, central and southern by 2003. They issued guidebooks for smoke-free workplaces, cooperated with unions and media to hold tobacco control training courses.
Meanwhile, after review and assessment, the DOH prized 563 enterprises who promote fully smoke-free workplaces.
Another occasion that might have tobacco problem is army. The military service age is around age 18 to 25, which is a crucial period that might turn a nonsmoker to a smoker.
"We found that more than 50% of male started smoking between age 18 to 23 and 17.6% male's first smoking started in military, which shows the importance of controlling smoking in military," said Chao. In 2003, the BHP cooperates with the Ministry of National Defense to promote smoke-free armed forces. They expect the hierarchic order in military can successfully reach this goal.
Trend in addressing drinking problem
When we review the history of Taiwan's indigenous people, we can see that that they usually drink during sacrificial ceremonies or some special celebrations. But over the years, alcohol has become easier to acquire. The drinking culture has spread, leading to present-day drinking problem. According to research done by the Department of Health (DOH), 30.8% of indigenous people are habitual drinkers, much higher than the rest of the population at 8.47%.
Many indigenous people die from car accidents, chronic liver troubles, cirrhosis, heart attack, gout and cardiovascular diseases.
The DOH entrusted Ping- tung's Tian- sheng Memorial Hospital to execute a Drinking Control Plan. They invited many opinion leaders and volunteers to meet and communicate the need to deal with the drinking problem in their communities. They work together to come up with plans to curb drinking. In the process, 65 residents participated in the training program and 31 of them turned out to be volunteers. They organized a workshop to share their experience and find solutions. Such voluntary participation by the local people represents a sustainable and feasible trend in addressing the drinking problem, which coincides with the direction taken by the DOH.
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Strategy is crucial to build a smoke