ࡱ> ]_\ ,jbjbt2t2 9SPP$ 1*v)))))))+I.)))))(()HvB()*01*(..()) :   Oral Presentation to Maori Affairs inquiry into tobacco 14th May 2010, 11.30 am Kia ora members of the committee. My name is Philip Pattemore, Associate Professor of Paediatrics at the Christchurch School of Medicine, University of Otago. I represent the Paediatric Society of New Zealand, including the doctors, nurses and other health professionals that look after children throughout the country. I also represent indirectly the children that these professionals look after. Every day of my working life as a paediatrician, I see the effects of smoking on children and on families, just like the children have just presented to you. I look after children with respiratory diseases. I would like to make three points to the committee. The disastrous effects of tobacco smoking by adults on the wellbeing and health of children who have no choice in the matter. Why addressing tobacco control in terms of adult choice of a legal drug and discouraging teenagers from smoking will not succeed, on its own. Why tobacco control must be multi-faceted. Effects of adult smoking on child health. Tobacco smoke exposure causes harm to the unborn infant, to children and to young people. The fetus and young child have no choice about this exposure. Tobacco smoke exposure causes fetal death, prematurity, poor growth and impaired growth of airways in the fetus. (15,000 exposed) Tobacco smoke exposure causes a 1.5 - 4-fold increase in infections of the nose, ears, sinuses, throat, airways and lungs in young children as well as an increased risk of meningitis. It increases the likelihood and severity of wheeze and asthma. (200,000 exposed) Tobacco smoke exposure decreases fitness and increases blood pressure in school-aged children. Smoking increases the disruption and grief of whanau, through death of parents and older family members, as you have just seen presented by the children. Smoking by parents and other adults is the biggest risk factor for young people trying and experimenting with smoking. Maori adults including pregnant women, parents, and Maori teenagers have a higher prevalence of smoking than other groups. Why smoking is not just a matter of adult choice and discouraging teenagers from smoking Prevention is better than cure. It may seem superficially that tobacco control should focus primarily on preventing the uptake of smoking by teenagers and young people. But this is not the case. Children have no choice in regards to exposure to adult smoking. Adult choices must be restricted in order to protect the health and future choices of our children. Adults who are addicted to smoke cannot be said to have full choice in their smoking. I had an example of this when a mother brought her child to my clinic for wheezing, which I felt was significantly due to smoke exposure. When I discussed this with her she thumped her fist on the table and said: If you get rid of my childs wheezing then Ill give up smoking. But the shoe was on the wrong foot. This demonstrates that smoking is an addiction which robs adults of insight and choice. Many parents are not aware of the effects their smoking is having on their own children. Our nation as a whole is addicted to the influence of the tobacco industry through monetary and retail connections. Very importantly, I would like to stress that teenagers do not buy into strategies where they are the target and adults continue to smoke. This was illustrated in the case of alcohol on the Close-Up program last night when a teenager being interviewed said: Why should we give up alcohol when thats how we see adults enjoying themselves? The same applies to tobacco. Children and teenagers smoke to emulate adult behaviour. Smoking has become a right of passage into adulthood for many young people. The first emphasis must therefore be to tackle adult smoking in order to limit the damage to the fetus and child; adult smoking must be eliminated to remove the attractiveness of smoking to children and teenagers. There is ample evidence that framing tobacco control in terms of adult choice, whether or not restrictions are put in place on youth access has the overall effect of increasing the desirability of smoking amongst young people. Tobacco control must be primarily directed to eliminate adult smoking, which directly impacts the fetus and child, and maintains the acceptability and uptake of smoking amongst youth. Young people will continue to take up smoking while smoking is seen as an adult choice. I would commend to the committee the WHO Western Pacific Region report: Seeing beneath the surface: The truth about the tobacco industry's youth smoking prevention programmes. WHO (2002). I will leave a copy with the committee. Prevention is better than cure. But the prevention needed is the removal of smoking as a desirable and normal adult behaviour. Why any approach to tobacco control must be multi-faceted. The tobacco industry maintains its grip on New Zealand through two major factors. One is the addictiveness of nicotine;the other is the corporate, legal and monetary power of the industry, affecting many workers and retail businesses. Are the people in the industry responsible for the 5000 deaths including 600 Maori, due to tobacco smoking in New Zealand each year? They are individuals like you and me. They have to decide and I would request, if I may, that the Committee ask their representatives at the hearing if they have any control over the use of tobacco in New Zealand or not. If they have control they must accept responsibility for the 5000 deaths, 600 of them Maori each year due to tobacco. It is then their moral responsibility to stop selling and distributing tobacco. If they do not have control over it then that is a clear mandate that the government must take control by regulating the industry and its products to eliminate these preventable deaths. The industry has a history of exploiting any and every loophole in tobacco control. A multi-faceted approach is essential. People who are addicted to smoking must be shown that the government is serious about eliminating smoking through a transparent and thoroughgoing process operating on multiple levels. Therefore tobacco control must include A regular scheduled increase in excise tax on manufactured cigarettes and roll-your-own tobacco Use of tobacco excise to fuel smoking cessation and tobacco control programs. The public will support taxation that is targeted to help the people that are taxed. It is a matter of transparency and honesty to smokers that the revenue they are charged is linked directly to assistance to them to stop smoking and for tobacco control. Tobacco retail display should be illegal. It influences choices, and it keeps tobacco products seen as desirable by children, who watch their parents shop for it amidst their normal shopping practices, Professor Pattemore said. Regulation of the product including nicotine, toxic ingredients, and flame-retardants. Progressive nicotine reduction will help smokers withdraw and make it easier to give up, while parallel reduction in toxins and increase in tax will avoid harm through compensatory increase in smoking. Removal of flame-retardants will reduce the fire-causing propensity of tobacco products. (HSC and Quitline) Graphic advertising through TV and printed media to smokers about the risk of smoking to adult and child health, and the possibility of giving up. Plain packaging for cigarettes, with removal of branding colours. Pressure on, or regulation of ,the film industry to prevent tobacco product placement in movies and TV. Further provision for inspection and penalties for those who display tobacco or sell to people under 18 years. Education of children from a young age about the harm due to tobacco smoking, and why strenuous efforts are being made to reduce it. (Smokefree Schools leadership) Consistent education, advice and assistance to quit from the medical profession in all encounters. This is now happening and all our paediatric health professionals are being trained to advise parents and teenagers about tobacco cessation. Removal of the right to smoke from vehicles. Tobacco control in areas where children frequent - parks, reserves and playgrounds should be addressed through policy development within local bodies. Increased subsidised access to smoking cessation programs for the people who find it difficult to quit through nicotine replacement and brief counselling alone. New Zealand society as a whole, must withdraw from its addictive affair with tobacco in order to protect those without choice. Thank you very much. Questions: What is the best way to help mothers in pregnancy give up smoking? Answer: Smokechange programmes in pregnancy are being applied around the country and are becoming more consistent in their approach. They have shown efficacy. However we see many mothers who give up smoking in pregnancy and start smoking again after birth, they say because of the stress of the baby. This is an area that needs urgent attention. 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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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