Center for Communications, Health and the Environment
Winter 2011 Vol. 6, Issue 2
Targeted Anti-Tobacco Programs, Policy and Media Messages Expected to Save Millions Worldwide

CECHE Champions Tobacco Control and Intervention Programs Around the World

Over the past two decades, CECHE has conceived, launched and stewarded an immense array of tobacco control and intervention initiatives across the globe.  Some of these programs have been entirely devoted to tobacco control, while others have featured tobacco as a key component.

Leading the International Community in Tobacco-Control Legislation

CECHE leaders have played an active role in this and other conferences on tobacco.
(Source: NIH, National Institute on Drug Abuse)

CECHE’s leadership on the public policy and international tobacco-control fronts has been particularly notable.  Through its Global Tobacco Control Program, it spearheaded an international tobacco-control partnership with the World Health Organization (WHO) and other high-profile groups, and has been the driving and organizing force behind several tobacco-related workshops and symposia.  CECHE’s U.S. activities have helped raise the profile of international tobacco-control issues among members of Congress, anti-tobacco leaders and the media, while promoting global strategy and action by key anti-tobacco groups such as the American Cancer Society, American Heart Association and Campaign for Tobacco-Free Kids.  Since 1997, proposed U.S. legislation by CECHE has, among other things, fought to: bar U.S. government funds from being used to promote American tobacco industry interests abroad; establish an overseas code of conduct for U.S. tobacco companies, their subsidiaries, affiliates and licensees; impose strong anti-smuggling provisions; and establish an American nongovernmental organization (NGO) along the lines of CECHE to assist public health organizations combat the deleterious effects of tobacco in other countries.

In 1998, CECHE convened experts for “Women, Girls and the Threat of Tobacco: An Appeal for Global Action,” a co-sponsored and widely endorsed effort to prevent U.S. tobacco companies from marketing to females, especially in developing countries. CECHE Chairman Dr. Sushma Palmer and Vice Chairman Ambassador Mark Palmer also served as workshop hosts and members of the planning committee and several key subcommittees for the 11th World Conference on Tobacco or Health in 2000.  In addition, they participated in an international policy conference on children and tobacco in 1999, hosting a symposium on internet-based tobacco control that was attended by more than 4,500 tobacco-control advocates from around the globe. 


A Focus on Primary & Secondary Community-Based Intervention

The Partners in Health program aimed to curtail tobacco use and instill healthy lifestyle behaviors in the Czech Republic.

Facilitating mass awareness and change requires focus, interest and time, and CECHE’s very first tobacco-control program was a targeted, multi-faceted, multi-year collaboration in the Czech Republic initiated by CECHE and designed to lower the risks of cerebrovascular and cardiovascular disease (CVD).  Known as The Partners in Health Program, it emphasized community-based and high-risk initiatives to reduce tobacco use and improve the Czech diet and lifestyle.  Supported by USAID and conducted by CECHE and its U.S. partners from 1992 until the project’s Czech partners took over in 1998, the program also championed institutional development, program and policy reform, and intensive professional training and public education on a local, regional and national level.  To introduce healthy attitudinal and behavioral changes at the grass roots, the consortium initially established a total of four clinics for high-risk populations in Prague and Litomerice, and a community-intervention primary prevention program in Dubec, a rural area east of Prague; mass media was also used extensively, and included specially produced television series, as well as public service announcements (PSAs). 

Over the six years that CECHE oversaw it, The Partners in Health program generated strong commitments from the Czech population, health professionals and government, and had a positive impact on CVD risk factors, with the initial clinics reporting almost complete cessation of smoking within a year of therapy and a significant decrease in total and non-HDL cholesterol and triglycerides, as well as a measurable drop in the body mass index of patients.  Average reductions of 25 percent LDL cholesterol were found in the high-risk groups, and new or recurrent coronary events were estimated to be reduced by approximately 50 percent, with a 15 percent overall reduction in mortality and in patients’ coronary risk scores expected to be achieved in the long run.

A CECHE-supported program in South India helped transition the population of Pattur out of tobacco-related trades and into other professions, including
garment design and production.

Building on its experience in the Czech Republic, in September 2004, CECHE partnered with the Chennai-based NGO Roshni to implement a two-year Tobacco Control Communications Program in South India to create awareness of the health hazards of smoking and curtail the production and use of small, unfiltered cigarettes called beedis.  Centered in Pattur, the CECHE-Roshni initiative organized self-help groups, and offered vocational training, job placement, health classes/camps, and other incentives to refrain from tobacco-related activities. The program also facilitated enforcement of laws against smoking in public places, and it employed mass-media campaigns, competitions and health-education drives to reach its audience and achieve its goals.  By 2006, only 250 of the 2,500 families in Pattur were continuing to support themselves by rolling beedis; smoking rates in Pattur had plummeted 60 percent; and more than 220 individuals and 20 families had left beedi production for other professions, including garment design, tailoring and grocery businesses.

Using Mass Media to Broadcast the Message
CECHE has also made its mark on the tobacco-control landscape through a variety of effective and far-reaching mass media-based programs, including the television series A Family Year and Elixir of Life produced under the umbrella of The Partners in Health Program. 

(Source: CECHE)

A five-part multilingual series developed in 1995, A Family Year was among the first to use television for positive health impact in Central Europe and the Newly Independent States (CEE-NIS).  The series follows four families for six months, one each in Russia, Hungary, Poland and the Czech Republic, and shows them struggling to cope with personal health challenges, like cigarette smoking and alcohol abuse, in an effort to educate viewers and change attitudes and behaviors.  The 27-minute episodes were broadcast on national television channels in 17 countries in the CEE-NIS region and reached about 400 million viewers worldwide.  Data for viewer response in Hungary alone revealed that more than 1.5 million people tuned in to the series in the winter of 1996, representing roughly one-third of that country’s total viewing audience.  Meanwhile, analysis of audience interviews across a number of nations had 16 to 38 percent of viewers reporting a positive lifestyle change within six to 12 months of watching the series, noting that 40 percent and 50 percent of the Hungarian and Russian viewers, respectively, had quit smoking, and 85 percent of Russians claimed they were smoking less. 

CECHE's Media Fellows Program trained professionals around the world to create and use mass media focused
on public health.

An outgrowth of A Family Year, the popular 10-part American-style health-magazine show Elixir of Life, or “Heart of the Matter,” premiered in 1998.  Taking its cue from Western game shows, talk fora and music videos, it focuses on modern health issues, bringing them and their solutions to life through quiz segments, discussions with experts and celebrities, and dynamic field reports on a modern, interactive set with a lively studio audience.  A survey of Czech viewers, more than half of whom were health professionals, revealed that an overwhelming majority (95.6 percent) found the series to be stimulating or very stimulating educationally.  And about 30 percent said the series featured new and practical information – indicating that a high percentage of the respondents in non-health professions were exposed to useful and pertinent health data and tools.

A media-based substance-abuse program in Washington, D.C. worked with youth to create PSAs to deter unhealthy behaviors like smoking.

Educating tobacco-control advocates in the effective use of media has been another CECHE hallmark.  Its Media Fellows Program began training Central European and Russian media professionals in public-health PSA and other program production and broadcast in 1994.  By 1998, the program spanned seven countries, including India, and had trained more than 100 media professionals.  CECHE also implemented a Media-based Substance Abuse Prevention Program in the fall of 1998 at Garfield Elementary School, in one of Washington D.C.'s poorest wards.  The program trained 4th grade students to develop a series of PSAs focused on nutrition guidelines and smoking prevention and cessation for repeated broadcast on a local cable channel.

CECHE has been instrumental in creating and disseminating a host of anti-tobacco PSAs
across a number of high-use countries.

As early as 1992, CECHE’s multifaceted mass media effort was also instrumental in producing a host of tobacco-related PSAs in the Czech Republic, Russia, Ukraine and other high-use countries, including India, to warn of the dangers of tobacco and curtail consumption.  The TV spots contributed to a trend of free PSA broadcast and co-production with local partners, with multiple PSA series and national broadcasts taking place in collaboration with Czech TV, the IBS (Internews) Network and Ukrainian TV channels.  Evaluation showed tripling to quadrupling of knowledge and awareness among millions in 18 countries, many of them in the tobacco-plagued CEE-NIS region.

Making the Most of Information Technology
CECHE spearheaded the use of information technology to similar effect, launching a World Bank/InfoDev-funded Internet-Based Tobacco Control Program in the Czech Republic in 1999 with partners at the Prague-based Institute of Clinical and Experimental Medicine and National Institute of Public Health. The 18-month effort resulted in a self-sustaining Tobacco-Control Training and Communications Program, and an Internet-Based Tobacco Control Network, a coalition of trained public-health practitioners from Czech district hygiene stations and health-related NGOs using the Web for research and communications on tobacco-control issues. A Web site and Czech-language list-serve also were developed to issue monthly electronic bulletins with nationwide and international circulation, and a comprehensive data collection system was established to assess impact and support program operations.  Most importantly, the project led to the creation in 2000 of the Czech Heart Association, a Czech-run grassroots organization that is now a member of the European Heart Network helping to coordinate tobacco-control activities throughout Europe, including Czech ratification of the international convention on tobacco control in 2003.

Professional training in Russia and other countries has helped raise awareness and discourage tobacco use.

Professional Training, Communication Key to Public Behavior Modification
CECHE has focused on professional training as a way to foster understanding and encourage change in tobacco usage.  From 2003 through 2006, it partnered with the Russian Cancer Research Center (RCRC), Moscow Public Health Department and the Moscow Medical Academy to develop and administer a program to educate, motivate and train Russian physicians to champion smoking cessation among their patients. The comprehensive program included the development, implementation and dissemination of baseline surveys and seminars in smoking-cessation counseling.  Under it, nearly 2,000 health professionals participated in approximately 50 educational sessions in 32 outpatient clinics and 10 hospitals in and around Moscow and the Nizhny Novgorod and Altay regions.  Twelve one-day training workshops were also conducted, and approximately 1,000 copies of smoking-cessation guidelines for physicians were distributed via workshops and medical bookstores.  In addition, a Tobacco or Health educational training course, started at the Moscow Medical Academy in 2006 for post-graduate students devoted to treating tobacco use and dependence, continues to impact newcomers to the field.  Meanwhile, the number of smokers visiting RCRC’s smoking-cessation service following physicians’ recommendations has more than doubled, indicating that the program has helped expand the quantity of knowledgeable and skilled tobacco-control clinicians in the Moscow area.

For more than a decade, the MONITOR was a popular means of informing health professionals and policy-makers worldwide about tobacco-related topics.

CECHE also actively uses self-developed media and specially released articles and bulletins to communicate important messages and facilitate professional and public education; and its publications have reported on, and routinely continue to cover, tobacco-related topics.  Each issue of its online In Focus publication, launched in 2006 and aimed at analyzing key public health and lifestyle issues, including tobacco, is featured on CECHE’s Web site and electronically disseminated to more than 3,000 subscribing health professionals and policy-makers in approximately 50 countries.  Recent installments have focused on The Tobacco Atlas and America’s unprecedented 2009 Family Smoking Prevention and Tobacco Control Act.  Previously, from 1993 to 2006, CECHE’s biannual Global Health and Environment MONITOR reached more than 10,000 health professionals and policy-makers worldwide with expert-written articles on the global health crisis and programs implemented to combat it, with articles on tobacco and tobacco control often featured in its printed (and later, online) pages. 

Into the Future
CECHE continues to support and address tobacco-control issues and initiatives worldwide.  It provides seed grants and strategic assistance to catalyze projects (like the Tobacco Control Communications Program in South India and Russian physicians training), which are then managed by its program associates based on the partnership agenda it adopted a decade ago.  It also employs media – its own and other outlets – to report and comment on the topic. 

With the tobacco epidemic reaching pandemic proportions, CECHE will carry on the fight, building on its extensive experience as it works with cohorts around the world to curtail use and save lives. 

Read More:
Lead Article: New WHO Report Projects Hope and Help in Global Tobacco Offensive
Spotlight Article:
New Graphic Warnings Could Have Great Impact -- IF Enacted
Also Noted: E-Cigs Come Under Scrutiny

Copyright © 2011 Center for Communications, Health and the Environment (CECHE)
Dr. Sushma Palmer, Program Director
Valeska Stupak, Editor & Design Consultant
Shiraz Mahyera, Systems Manager
Daniel Hollingsworth, Website Consultant