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APACT & WCC 2018: Tobacco Control, Oral Cancer and the Sustainable Development Goals in the Asia-Pacific

, by Kalina Duncan, Elizabeth Orlan & Mark Parascandola

Drs. Prakash Gupta, Rahmi Amtha, Rosnah Binti Zain, Mark Parascandola, and Krishna Palipudi (left to right) participate in the APACT session: Strategies for Research and Developing Policy Interventions on Betel Quid and Areca Nut (BQ/AN) to Prevent Oral Cancers.

Credit: National Cancer Institute

From September 12-15, 2018, the 12th Asia Pacific Conference on Tobacco or Health (APACT) brought together 1000 policymakers, researchers, advocates and practitioners from 23 countries in Nusa Dua, Indonesia. This was the first time that Indonesia - one of the few countries that has not yet ratified the Framework Convention on Tobacco Control (FCTC) - has hosted the meeting. This international conference raised attention toward Indonesia’s tobacco epidemic among government officials and national media, and the urgent need to strengthen tobacco control efforts in the country.

According to the latest data (2013), Indonesia has a national smoking prevalence rate of 36.3%, one of the highest national smoking prevalence rates in the world, and has a current male smoking rate of 64.9%. Indonesia also has high rates of betel quid and areca nut (BQ/AN) use, with or without tobacco, particularly in the Eastern regions of the country. The conference theme was “Tobacco Control for Sustainable Development Goals: Ensuring a Healthy Generation.” The conference program largely discussed how tobacco use and production may impede with Asia-Pacific countries’ efforts to achieve the United Nations’ Sustainable Development Goals (or SDGs), and how the SDG goals, beyond goal 3 about good health and wellbeing, are dependent on implementing and enforcing evidence-based tobacco control strategies.

When the APACT program was released, NCI recognized a gap in the program with regards to BQ/AN use, even though an estimated 600 million people use these products worldwide and use rates are the highest in the Asia-Pacific region. NCI’s CGH has worked on addressing the issue of BQ/AN over the past several years, co-hosting an international meeting of researchers in Malaysia that resulted in a paper, “Defining the policy agenda for betel quid and areca nut,” published in Lancet Oncology last year.

Dr. Mark Parascandola, Division of Cancer Control and Population Sciences, NCI, presents at APACT.

For APACT, NCI organized a special session: ‘Strategies for Research and Developing Policy Interventions on Betel Quid and Areca Nut (BQ/AN) to Prevent Oral Cancers', held on the final day of the conference. Dr. Parascandola kicked off the session with a talk on the epidemiology of the BQ/AN problem. The session featured experts on BQ/AN from three countries—India (Dr. Prakash Gupta, Healis Institute), Indonesia (Dr. Rahmi Amtha, Universitas Trisakti) and Malaysia (Dr. Rosnah Zain, MAHSA University). Each of the expert speakers discussed the burden in their country, the products used, and their own research on either the epidemiology of the problem and/or recent studies and interventions.

Dr. Krishna Palipudi from the U.S. Centers for Disease Control and Prevention (CDC) served as the discussant, highlighting how the CDC has measured the use of smokeless tobacco products through their Global Tobacco Surveillance System.  The presentations will be available soon through the APACT website. Following the session, the audience had a lively discussion about what can be done about BQ/AN use and how to distinguish cultural use of these products from regular use. Speakers and participants called for cessation trials, adding questions about interventions to the Global Adult Tobacco Survey (GATS), and applying proven WHO FCTC strategies from cigarettes to BQ/AN control.

The 2018 World Cancer Congress convenes researchers and subject matter experts to engage in discussions on oral cancer research and ongoing tobacco control efforts in the region.

The conversations on oral cancer and associated risk factors continued in a similar session held at the World Cancer Congress (WCC) in October in Kuala Lumpur, which attracted more than 75 participants and was co-organized with Prof. Ravi Mehrotra from the Indian Council of Medical Research, National Institute of Cancer Prevention & Research. At WCC, NCI also partnered with Malaysian Oral Cancer researchers to host a side meeting to the conference that will result in a report that will be distributed to participants which outlines scientific updates and identified next steps and remaining research gaps.

At APACT, Dr. Parascandola also spoke in another session on tuberculosis (TB) and tobacco, organized with the Ministry of Health of Indonesia. Dr. Parascandola’s talk was focused on mHealth interventions for tobacco cessation and their application in the TB treatment setting. Elizabeth Orlan gave an oral presentation ‘Attitudes surrounding e-cigarette policies in ASEAN countries’ mainstream media,’ and presented an e-poster from her doctoral program research titled, “Characteristics of Vape shops in Jakarta, Indonesia.” In addition, several NCI grantees presented findings from research projects in the Southeast Asia region.

The conference concluded with resolutions developed by conference participants and the resolutions committee. The resolutions are available here and match Sustainable Development Goals (SDGs) with the FCTC articles to show the synergies between the two international frameworks, and how governments can implement both simultaneously.

Many thanks to Indonesia’s National Committee on Tobacco Control (Komnas Pengendalian Tembakau) and all organizers of the conference. You can watch video recaps and find out more about the conference here.

Kalina Duncan is the Lead Public Health Analyst for the NCI Center for Global Health (CGH). Elizabeth Orlan is a Cancer Research Training Award fellow at NCI's CGH and the Division of Cancer Control and Population Sciences (DCCPS) Tobacco Control Research Branch (TCRB). Dr. Mark Parascandola is a NCI/DCCPS, TCRB Program Director.

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