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The Science Behind Combating the Greatest Threat to Global Health: Tobacco Use
37,000 Canadians die every year of smoking. Researchers with the International Tobacco Control Policy Evaluation Project are using research evidence to promote methods for reducing these preventable deathsin Canada and throughout the world.
At a Glance
Who - Geoffrey Fong is a professor of psychology and Founder and Principal Investigator of the International Tobacco Control Policy Evaluation Project at the University of Waterloo, Ontario, and Senior Investigator at the Ontario Institute of Cancer Research. Mary Thompson, a professor of statistics and actuarial science, and David Hammond, assistant professor of health studies and gerontology, are two principal investigators of the ITC Project, also at the University of Waterloo.
Issue - Smoking is the world's largest public health problem and this is particularly true in developing countries. But what can governments do to stop people from smoking?
Solution - By measuring changes in people's attitudes and behaviour after various tobacco control policies are implemented over time and across countries, the ITC Project can determine the impact of those policies.
Impact - Many countries, including Ireland, France, Malaysia, the United Kingdom, and China, have used findings from the ITC Project to shape their tobacco control policies.
In the 20th century, 100 million people lost their lives because of tobacco-related causes. Today, smoking kills more people than AIDS, malaria, and tuberculosis combined. But the global tobacco epidemic will reach unprecedented proportions in the 21st century, because tobacco use is increasing in low and middle income countries. By the end of the century tobacco-related deaths are projected to grow as high as 1 billion.
To reduce preventable deaths from using tobacco, the nations of the world, under the auspices of the World Health Organization, created the first-ever health treaty: the Framework Convention on Tobacco Control (FCTC), which includes tobacco control policies that ratifying nations (now over 160) are required to implement, such as more prominent warning labels, smoke-free laws, and higher taxes. While many public health authorities hope FCTC policies will be effective, the International Tobacco Control Policy Evaluation Project (ITC), centered at the University of Waterloo, is providing evidence from a state-of-the-art multinational evaluation program to give strength and direction to those hopes. The ITC Project is the only research program that focuses on evaluating FCTC policies as they are implemented throughout the world.
As an example, when Ireland decided to ban smoking in public places, including their famous pubs, the ITC Project was on hand to collect data on public opinion and behavior before and after the change. Led by Dr. Geoffrey Fong, a professor of psychology, Dr. Mary Thompson, professor of Statistics and Actuarial Science, and Dr. David Hammond, Assistant Professor of Health Studies and Gerontology at the University of Waterloo, with colleagues in the United States, Australia, and United Kingdom, the ITC Project is the world's authority on the effectiveness of tobacco control policies such as smoke-free laws. And what they found in Ireland was significant for tobacco control throughout the world.
Compared to the United Kingdom, which did not implement a smoke free law, one year later Ireland saw a dramatic reduction of smoking in public places. In addition, smokers and non-smokers alike widely supported the ban. This set of findings from the ITC Project provided powerful feedback for politicians and public health officials, and has been the foundation for the many smoke-free laws that have been implemented throughout the world, including the UK, Thailand, Brazil, and even France and Germany.
Combining research methods from epidemiology, social psychology, health behavior, economics, and preventive medicine, Fong's group has been evaluating the impact of tobacco control policies on attitudes and behavior in 20 countries that make up over 50% of the world's population and 60% of the world's smokers, including China, India, Bangladesh, Mexico, Brazil, the US, the UK and Canada.
Closer to home, the ITC Project has documented the loss of effectiveness of certain policies over time. For instance, Canada was one of the first countries to put graphic warning labels on smoking packages in 2001. But, in the intervening eight years, ITC data has shown that the impact of those labels is declining.
In light of these ITC findings, Fong believes that Brazil, already into its third round of very powerful graphic warning labels, could be seen as an example for Canada and other countries in their use of research evidence.. According to Fong, Brazil is a "world leader in the conceptualization of graphic warning labels that will create negative associations with tobacco products."
Perhaps just like our need to develop stronger antibiotics to combat more powerful bugs, Fong suggests that tobacco control measures need continual strengthening in order to keep them effective.
"Despite the fact that prevalence rates have dropped dramatically in Canada, smoking is still by far the number one preventable cause of death in Canada and around the world," said Fong. "The tobacco industry will challenge any tobacco control policy, especially policies that work. And so the presence of strong evidence to guide health policies is even more important in the case of tobacco use. That is our mission and what keeps us going."
