smoking ban essay tagalog

Sanaysay Tungkol sa Nationwide Smoking Ban

Hindi dahil sa amoy nito o sa dating ng taong gumagamit, ngunit dahil sa nakababahalang epekto nito sa ating kalusugan — gumagamit ka man nito o hindi.

Napapanahon na ang nationwide smoking ban sapagkat lalong tumataas ang bilang ng mga Pilipinong nasasawi dahil sa mga sakit na may kinalaman sa baga, at ang isa sa mga sanhi nito ay ang sigarilyo.

Ang itinuturong dahilan, ang paninigarilyo. Dahil hindi agad nakikita ang komplikasyon ng paninigarilyo tulad ng unti-unting pagkasira ng baga, ay hindi naaagapan ang gamutan sa mga tinatamaan ng komplikasyon.

Kaya naman kung nais nating mapababa ang problema sa mga sakit na may kinalaman sa baga, dapat nang ipatupad ang nationwide smoking ban bago mas maraming baga pa ang maupos na parang sigarilyo.

Mga Karagdagang Sanaysay

• Sanaysay Tungkol Sa Saranggola
• Sanaysay Tungkol Sa Droga
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July 2021 — Volume 5, Issue 1 Back

“stop the puff tayo’y mag bagong baga, sigarilyo ay itigil”: a pilot community-based tobacco intervention project in an urban settlement.

Irene Salve D. Joson-Vergara, Julie T. Li-Yu

Jul 2021 DOI 10.35460/2546-1621.2020-0040

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Figures and Tables

Introduction.

Tobacco use continue to be one of the leading cause of death and disability worldwide. Around 8 million deaths worldwide each year are tobacco related, 7 million of which are attributed to direct tobacco use while around 1.2 million are due to exposure to secondhand smoke.    There are around 1.1 billion smokers worldwide and 80% of these live in low- and middle-income countries  [1]   .  The Philippines is one of the countries in the Western Pacific region with the highest prevalence of tobacco use  [2]     and seven out of the 10 leading cause of mortality in the country is tobacco related.  [3]    The Philippine government has intensified its efforts to curb smoking, focusing mainly on policies that target the wider determinants of health such as smoking bans, graphic health warnings and sin tax law. These efforts have resulted to a significant decrease in the prevalence of smoking from 17.3 million in 2009 to 15.9 million in 2015.  Also, the number of smokers who are interested in quitting increased by 16.3% from 2009 to 2015.  However, those interested in quitting that were seen by a health care provider did not increase significantly and only around half made a quit attempt. More importantly, the quit success rate did not increase.  [4]     This demonstrates a wide disparity between the number of smokers who want to quit and the number who are able to quit successfully.  This gap may be addressed by strengthening health care interventions especially among smokers that are heavily dependent on nicotine.  There may be a need to complement national policies with programs that target the specific needs of smokers.

Brief Tobacco Intervention (BTI), also known as brief advice, is a strategy that is proven to be effective, practical and doable in the community setting.  [5]    Unfortunately, cessation experts in the country are few and healthcare workers with training on tobacco interventions are limited. 

The primary objective of the project was to establish smoking cessation intervention in the community by empowering health workers and community volunteers on giving BTI and to improve access to cessation support by establishing a referral mechanism to smoking cessation services. The project also aimed to promote smoking cessation in the community through health education activities that promote smoke-free behavior and encourage smoking cessation among current smokers.

Review of Related Literature

Studies have shown that the outcome of quit attempt is related to various individual, socio-cultural and environmental factors.  [6-13]    Some factors were consistently shown to be related to quit success but there are certain factors that differ in every population.  Studies done among smokers in South Africa, USA and South Korea showed that higher educational level is related to quit success.  [6-8]     However, in a similar study done in Brazil, this was correlated with failure.  [9]    Being married was associated with quit success in the studies done in USA and in South Korea  [7,8]    however, this was not seen in the study done in South Africa.  [6-10]      It can be surmised therefore, that cultural, social and behavioral aspects of smoking that affect quit outcomes may be unique in each population or community (Table 1, Appendix A).

DiGiacomo et al  [14]    recommends a multi-faceted approach in smoking cessation, taking into consideration the individual and socio-cultural factors that are unique to each community.   These factors are usually not targeted by national policies that focus on the wider determinants of health. Community-based interventions, on the other hand, may better address these factors. There is also evidence that community-based interventions and those that are tailored to specific indigenous groups have greater retention and quit success rates compared to center-based interventions.  [14-20]    These suggest that establishing a community-based smoking cessation intervention is effective and feasible (Table 2, Appendix A). 

Methodology

The project was done in three phases as described in Table 3. A health needs assessment and situational analysis were done in the first phase. This involved an appraisal of the attributes of the community and an analysis of the specific needs of the community pertaining to tobacco control.  This was done primarily through review of secondary data, focus group discussions (FGDs) and informal interviews. The primary goals of the FGDs were to understand the general views of the community on tobacco, determine the level of awareness on its effects and identify misconceptions on tobacco use and smoking cessation. The findings were used to modify the design of the training and health education modules to better fit the needs and attributes of the community.

Phase 2 of the project involved the conduct of BTI training for health workers and volunteers in Munting Ilaw health center.  The training was done in two separate sessions to align with the health workers' schedule and minimize interruption in the delivery of services of the health center. The target number of participants was 30, in accordance with the WHO recommendations.  [5]    The general objective of the seminar and workshop is to capacitate the participants on the method of conducting brief tobacco intervention.  The module used was adopted from the BTI module of the Department of Health  [21]    and modified based on the result of the situational analysis. It consisted of 5 modules namely: 1. Building the Momentum; 2. Brief tobacco Intervention Essentials; 3. Not ready to quit; 4. Ready to quit; and 5. Staying quit or relapse.  The description, contents, methodology and resources of the modules are summarized in Table 5 (Appendix B). Gaps in knowledge, concerns and misconceptions identified during the FGDs were given emphasis during the training.  Possible referral mechanisms to smoking cessation services were discussed at the end of the session.

Phase 3 of the program involved health promotion activities such as information campaign on the dangers of smoking and promotion of smoking cessation services.  This was done in the form of a lay fora.

The actual schedule of the conduct of activities is presented in Table 4.

Observations and Results

A. Health Needs Assessment

1. Health Profile of the Community

The project was implemented in Phase 1-K Kasiglahan Village, Barangay San Jose, Rodriguez Rizal where a memorandum of agreement exists between Barangay San Jose and the University of Santo Tomas, Master in Public Health (International) program. Kasiglahan Village is situated in Barangay San Jose which is one of the eleven barangays in Rodriguez Rizal.  Although originally an agricultural land, the area has undergone massive development over the recent years and is now considered as an urban area.  It is the 6 th most populated barangay in Rodriguez with a population of 124,868 in 2015.  This population has grown quite rapidly over the past few decades largely due to the development of relocation sites that catered to displaced families from Quezon City and other cities surrounding the Pasig river.  Kasiglahan Village is one example of these developments, with residents mostly relocated from Quezon City areas.  [22]   There are several health facilities within Rodriguez Rizal. The Rural Health Unit is manned by the rural health officer, physicians, nurses, midwives, sanitary inspectors and malaria officers.  There is a 25-bed infirmary (Montalban Infirmary) that is located in Kasiglahan Village and a government health facility (Casimiro Ynares Sr. Memorial Hospital). Other private health providers likewise exist which include hospitals, lying-in clinics and multi-specialty clinics. Each barangay has at least one health center with some having satellite health centers.     Hospitals outside of the municipality are also easily accessible through jeepneys and other public utility vehicles. Based on the interviews with the residents and health workers from Kasiglahan Village, patients needing tertiary care are usually brought to hospitals in Metro Manila such as East Avenue Medical Center in Quezon City and Amang Rodriguez Memorial Medical Center in Marikina City.  These hospitals are what they deem as the most accessible and capable of providing higher level of healthcare. Munting Ilaw Health Center is a satellite health center of Barangay San Jose and is located in Kasiglahan Village.  It is tasked to provide basic health services to the residents of Kasiglahan Village such as maternal and child health, family planning, immunization, and nutrition.  It also houses a directly observed treatment short-course (DOTS) clinic for the management of tuberculosis. It is manned by nurses, midwives, barangay health workers, municipal health workers and volunteers. The leading causes of morbidity in Rodriguez Rizal in 2012 include: 1. Animal Bite; 2. Acute upper respiratory tract infection; 3. Pulmonary tuberculosis; 4. Dengue; 5. Asthma; 6. Acute rhinitis; 7. Acute gastroenteritis; 8. Hypertension; 9. Body injuries and 10. Pharyngitis.  Mortalities are mostly due to cardiac causes such as myocardial infarction.  Other causes of death include community acquired pneumonia, cancer (mostly of the lung), intra-cerebral hemorrhage, pulmonary tuberculosis and non-disease related deaths due to body injuries and gunshot wounds.  [22]    

2. Tobacco cessation services and policies in the community None of the existing health facilities within the municipality have an existing tobacco cessation service and there is no smoking cessation clinic anywhere in the municipality and in nearby areas.  The municipality has a newly drafted tobacco-free resolution; however, it has not been fully implemented at the time of the implementation of this project.  There is an existing ordinance prohibiting smoking in public spaces.  This is strictly implemented in the city proper and major establishments but not so much in the communities.  

3. Tobacco interventions from the perspective of health workers. The FGD was attended by 24 health workers. The goal of the discussion was to determine the general perception of the workers on smoking cessation interventions and the usual practices in the health center in order to identify possible strategies to integrate BTI in their existing programs. None of the health workers had attended any seminar on or related to BTI.   Advise on smoking cessation and inquiry regarding the smoking status is not customarily done in any of the existing programs of the health center, except in the TB Directly Observed Treatment Short-Course (TB-DOTS) clinic wherein the smoking status of each patient is included in the patient’s record. Even so, giving advice is done inconsistently.   Most did not know that BTI can be integrated in all of their programs and only a few recognized the relevance of  BTI in their particular line of work (i.e. family planning, nutrition). None were aware of the existence of the National Quitline and no referral mechanism to cessation providers exists.    

4. Understanding the perspective of current smokers. FGDs were done to better understand the predicament of smokers in the community.  FGDs were done instead of formal interviews with structured questionnaire to allow free flow of thoughts and ideas and thereby be able to capture aspects that are not obtained by the Philippine Global Adult Tobacco Survey (GATS).   Most of the participants initiated their smoking habit during their teen years and curiosity was the most common reason for trying.  Most had the initial intention to just satisfy their curiosity but eventually got hooked to habit.  One of the participants started using chewed tobacco at the age of five. Her parents were tobacco farmers and it was customary for them to chew tobacco leaves while farming. She transitioned to cigarette smoking during her teen years and maintained the smoking habit until adulthood. All of them agreed that it was easy to initiate and maintain the smoking habit because tobacco products were widely available, easily accessible and, at the time of their smoking initiation, very affordable.  They are aware of the ill-effects of tobacco on their health, however, there is a general perception that these ill-effects are unlikely to happen to them.  And if it does, they are resigned to accept it as an inevitable consequence of their smoking habit. Most are willing to quit “when it is absolutely necessary”, however, they do not foresee that they will be able to do so in the near future. This implies that the motivation to quit is generally low. When asked about possible motivations for them to quit, answers included: further price increase in tobacco products, development of health complications and total smoking ban. Tobacco products are also prioritized over other necessities such that they will go to the extent of borrowing money or forego one meal in order to sustain the smoking habit. There is a deep understanding of the current tobacco control policies and the intentions of such policies.  However, these did not seem to deter the smoking habit as they were able to adapt to these policies.  The smoking ban is not strictly enforced in the community; hence they are able to smoke freely while they are in the community.  When going to the city proper or while at work where smoking ban is strictly enforced, they are able to decrease their cigarette consumption.  The graphic health warnings on cigarette packages was likewise not enough to dissuade them from smoking because they usually buy individual sticks instead of packs.  Others cover graphic warnings in the packaging while some think that the pictures are not real and were only meant to scare them. None of the participants had ever received advice from health workers but most of them will likely avail of smoking cessation services if it is available in the community.  None were aware of the National Quitline and most are quite skeptic if it is functional.     

5. Lessons from the former smokers. Similar to the FGDs with smokers, the questions during the discussions with former smokers revolved around the initiation of the smoking habit, knowledge of the ill effects of tobacco and views on current national and local tobacco control policies and how it influenced their quit journey.  In addition to these, the discussion also focused on the motivation/s for quitting and the challenges encountered during their quit journey. The common motivation to quit was health reasons since all of the participants were diagnosed with a tobacco-related illness that led to the decision to quit.  Most of the participants were only given very brief advice by their physicians and all were able to quit completely, unassisted (“cold turkey” style), and without using any pharmacologic treatment for tobacco dependence.  The biggest challenge for most of them was seeing other people smoke, especially during gatherings and special occasions. The urge to relapse into the smoking habit was easier to resist after a few weeks of being tobacco-free. Although they fully support the existing tobacco control policies, most claim that it had little impact on their motivation to quit.  The graphic health warnings had some influence in their decision to quit, but seeing real patients with tobacco related illnesses on TV was a stronger motivation for them.  When asked about their views on providing cessation services in the health center, most deemed it unnecessary since smokers will quit unassisted for as long as they are motivated.   To encourage smokers to quit, they think that it is important to find the right motivation because it is easier to quit when the motivation is strong.  

6. Protecting the non-smokers. ​​​​​​The discussions with non-smokers, particularly the ones who are exposed to second-hand smoke in their homes, focused on questions about their feelings about the smoking behavior of their loved ones or household members and how they think it will affect them and the other members of the family.  The participants were also asked how they deal with the smoking behavior of the household member/s. Most of the participants were spouses of smokers.  All of the participants do not condone the smoking behavior of their spouses; however, they feel that their sentiments and objections to the smoking habit are being disregarded.  They are fearful of the ill-effects of smoking to the health of their spouses and their children as well.  As most of their spouses are breadwinners, the smoking habit is a source of anxiety and worry about the future of the family should their spouse develop a tobacco related illness.  Unfortunately, these feelings of fear, apprehension and anxiety are often invalidated.  Attempts to encourage the spouses to quit smoking are seldom done because discussions on the need to quit often leads to disagreement and tension in the household.  Most of the participants are aware of the ill-effects of second-hand smoke, but they are not aware of third- and fourth-hand smoke. They are receptive of the idea of having a cessation service in the community, however, they are not sure if their spouses will avail of the service or comply with the recommendations.  

B. Brief Tobacco Intervention Seminar And Workshop At the start of the training, each of the participants were asked to write their job designation, job description and their perceived role in tobacco control.  Most of the participants recognized their role as a source of information while a few recognized that they can be role models.  The other roles that they can assume in tobacco control were discussed during the training.  The first session consisted of modules 1 and 2 and was given mostly in a lecture format. This involved discussions on the mechanism of nicotine addiction, harms of tobacco, benefits of quitting, common misconceptions and the general approach to BTI. The second session consisted of Modules 3 to 5 and involved a discussion of the specific steps in giving brief tobacco intervention. An algorithm on how to approach each patient at various stages of quitting was presented in a workshop format wherein a video demonstration was presented after each lecture and the participants were asked to present a return demonstration. Feedback was given by the facilitator and also solicited from the rest of the audience.    At the end of the session, the importance of a referral system to smoking cessation providers and clinics was discussed. Since there is no existing referral mechanism yet in the community, the participants were asked to brainstorm on the possible referral mechanism specifically in Rodriguez Rizal. These mechanisms were presented to the whole group and they were made to choose the most feasible, efficient and plausible mechanism. A pre- and post-test was also done evaluate the effectiveness of the training in terms of improving knowledge. Out of the 34 attendees, only 25 were able to accomplish both the pre- and post-test. It was evident that after the workshop, the mean test scores of the participants significantly improved (p<0.001). At an average, their test score increased by 2.08 points which translates to a 20.8% increase in baseline knowledge (95% CI: 1.35 to 2.81).  To somehow ensure that the knowledge will be translated into practice, posters, guide cards and education materials were given to the health center and rural health unit (Appendix C).  

C. Community Health Promotion And Education The community health education and promotion was done in conjunction with the health education and promotion activity for non-communicable diseases in the community. The findings in the FGDs were taken into consideration and misconceptions identified were corrected in the lay fora. The activity consisted of short lectures interrupted by games to break monotony and to maximize attention span and retention of concepts. The National Quitline was promoted and participants were encouraged to urge the smokers in the community to utilize this service. Education on how to give very brief advice while avoiding conflicts in doing so was also given. A pre- and post-test was done to measure the effectiveness of the lecture in augmenting the participant’s knowledge.  Out of the 58 attendees, 37 completed the pre- and post-test.  It was evident that after the lecture, the mean test score of the participants significantly improved (p<0.001).  At an average, the test scores increased by 2.73 points which translates to a 27.3% increase in baseline knowledge (95% CI: 2.18 to 3.28).

The tobacco quit success rate in the Philippines continue to be dismal despite the government's efforts to curb smoking. Nearly half of smokers who are interested in quitting were not given proper advice by a health care provider.  [4]    In the community, several factors contribute to this (Figure 1).   There is an apparent lack of cessation services.  Health workers are not trained on brief tobacco intervention and a referral system to cessation support services is not in place.  Misconceptions on tobacco cessation is also rampant even among health workers.  Like in the rest of the country, tobacco products are widely available and easily accessible. On the contrary, access to nicotine replacement therapies is limited.  The prices of cigarettes, even with the surge due to the sin tax law, are still affordable.  There is an apparent lack of motivation for smokers to quit despite the graphic warnings and other policies that restrict access to tobacco products and decrease opportunity to smoke. Although a smoking ban exist, this is not uniformly enforced.  These factors all contribute to the problem which is a low quit success rate. This in turn result to a myriad of complications such as high prevalence of smoking, high mortality and morbidity from tobacco related illnesses, ultimately leading to greater economic cost.

The objective tree (Figure 3) represents the possible solutions to the problems identified.  The outcome that this project envisions is a high quit success rate in the community.  However, not all of the interventions identified can be accomplished by this project.  Restrictions to tobacco products, price increase and policies on the use of nicotine replacement therapies would need to be addressed by national and/or local government programs and policies. Instead, this project focused on community-based interventions such as the establishment of smoking cessation intervention and referral mechanism in the community health center and health education and promotion activities in the community.

In 2003, the Philippines, being a member of the WHO Western Pacific region, was required to implement the strategies in the WHO Framework Convention on Tobacco Control (FCTC). Bourne from this treaty, the Philippines drafted its National Tobacco Control Strategy (NTSC) for the years 2011-2016.  It’s three main strategies focused on: 1. Promotion and advocacy for the complete implementation of the FCTC; 2. Mobilization for public action; and 3. Strengthening the organization capacity.  [23]    This project is consistent with the activities specified under strategy 3 namely: human resource development, smoking cessation and tobacco dependence treatment, public awareness and education.  Likewise, it is consistent with one of the social sectoral objectives of the municipality which is "to implement sustainable preventive healthcare programs to lessen incidence of diseases caused by unhealthy lifestyle".   [22]  

Conclusion and Recommendations

The tobacco problem is centuries old and cannot be solved overnight.  It is indeed complex and full of challenges.  It was found in the situational analysis that the smoking habit can be initiated at the age of five.  This means that tobacco use is not freely chosen and therefore there is a need to alter the general environment through interventions that target the wider determinants of health. Such policies already exist; however, it is essential to strengthen these policies and complement it with clinical interventions. According to the European Society of Respirology  [24]   , in order to achieve a smoke-free society, tobacco cessation should be supported from policy to clinical perspective. Community based interventions have been consistently shown to be effective in improving quit success rates. Although establishing a formal smoking cessation clinic in the community is ideal, the task may be challenging in a low resource setting as it will entail additional resources.  Providing training to the existing health workforce and integrating brief tobacco intervention with the existing programs of the community health center may be more feasible. Likewise, creating a referral mechanism to smoking cessation providers and clinics may augment the efficiency of smoking cessation efforts in the community.  

The project aimed to address the clinical aspect of tobacco control by establishing tobacco cessation services in the community. This pilot project has shown that providing brief tobacco training among health workers is feasible. There is a need to assess whether this knowledge is translated into practice and whether the training created attitudinal change as well.

Recommendations

It is important that tobacco control remain a priority despite the countless other health problems that need attention. Especially because 5 out of the top 10 causes of mortality in the municipality are tobacco related and 4 out of the 5 causes of mortality are due to tobacco related diseases  [22]   . A local smoke-free policy is essential and its prompt implementation is encouraged. Stricter and consistent enforcement of the smoking ban is likewise encouraged. Continued health education is necessary to contradict misconceptions on tobacco cessation. BTI training should likewise be cascaded in other health centers, with priority given to at least the head nurse and TB-DOTS nurses. Regular updating of the seminar, on a yearly or every two years basis, is likewise necessary. Once smoking cessation services are fully integrated in the programs of the health centers and more cessation providers are available, smoking cessation clinics in key institutions in the municipality can be established. In the meantime, while smoking cessation clinics are not yet available in the municipality, it is recommended to promote the use of the National Quitline.

Limitations

Tobacco control is multi-faceted and this project mainly focused on the clinical aspect. Although an increase in the knowledge of the participants was documented, whether this knowledge was translated into practice was not assessed. Measuring the impact of the project in terms of increasing quit success rate is likewise ideal but beyond the scope of the project.   

Conflict of Interest Statement

The project was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethics Approval and Consent to Participate

Not applicable.

Acknowledgement

The authors would like to acknowledge the people and institutions that were instrumental in the accomplishment of this project.

• For their assistance, insights and valuable inputs:

Honorable Glenn Evangelista, Chairman of Barangay San Jose

Dr. Ma. Carmela V. Javier, Municipal Health Officer of Rodriguez Rizal 

Community leaders of Phase 1K, Barangay Kasiglahan, Rodriguez Rizal

Dr. Leilani B. Mercado-Asis, Program Head, Master in Public Health (International), UST Faculty of Medicine and Surgery

• For providing the module for Brief Tobacco Intervention Training and health promotion and education materials:

Philippine College of Chest Physicians, Council on Control for Tobacco and Air Pollution

Dr. Glynna Ong-Cabrera, Chairperson

Dr. Marie Charisma Dela Trinidad

Ms. Riza SJ San Juan, RN, Nurse Coordinator, Smoking Cessation Program, Lung    Center of the Philippines

Counselors and staff of the DOH National Quitline

• For their unwavering support throughout the conduct of this project from its conception to its realization:

UST FMS Master in Public Health (International) classmates and mentors

World Health Organization. WHO Tobacco Fact Sheet 2019. [Internet]. 2019 [cited 04 April 2019]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco

World Health Organization. WHO global report on trends in prevalence of tobacco smoking. [Internet]. 2015 [cited 04 April 2019]. Available from: https://apps.who.int/iris/bitstream/handle/10665/156262/9789241564922_eng.pdf;jsessionid=8FA5678C2197750E092EFFACF9FD0F0E?sequence=

Philippine Statistics Authority. Registered Deaths in the Philippines, 2017. [Internet]. 2019 [cited 08 January 2020]. Available from: https://psa.gov.ph/vital-statistics/id/138794

Department of Health Philippines. Global Adult Tobacco Survey: Philippine Country Report, 2015. [Internet]. 2015 [cited 08 April 2019]. Available from: https://www.who.int/tobacco/surveillance/survey/gats/phl_country_report.pdf

World Health Organization Tobacco Free Initiative. Strengthening health systems for treating tobacco dependence in primary care. Building capacity for tobacco control: training package. [Internet]. 2013 [cited 05 January 2020]. Available from: https://www.who.int/tobacco/publications/building_capacity/training_package/treatingtobaccodependence/en/

Ayo-Yusuf O, Szymanski B. Factors associated with smoking cessation in South Africa. South African Medical Journal [Internet]. 2010;100(3):175–9. Available from: http://www.samj.org.za/index.php/samj/article/view/3842

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Holm M, Schiöler L, Andersson E, Forsberg B, Gislason T, Janson C, et al. Predictors of smoking cessation: A longitudinal study in a large cohort of smokers. Respiratory Medicine [Internet]. 2017 Nov;132:164–9. Available from: http://dx.doi.org/10.1016/j.rmed.2017.10.013

DiGiacomo M, Davidson P, Abbott P, Davison J, Moore L, Thompson S. Smoking Cessation in Indigenous Populations of Australia, New Zealand, Canada, and the United States: Elements of Effective Interventions. IJERPH [Internet]. 2011 Jan 31;8(2):388–410. Available from: http://dx.doi.org/10.3390/ijerph8020388

Estreet A, Apata J, Kamangar F, Schutzman C, Buccheri J, O’Keefe A-M, et al. Improving participants’ retention in a smoking cessation intervention using a community-based participatory research approach. Int J Prev Med. 2017;8:106.

Asvat Y, Cao D, Africk JJ, Matthews A, King A. Feasibility and Effectiveness of a Community-Based Smoking Cessation Intervention in a Racially Diverse, Urban Smoker Cohort. Am J Public Health [Internet]. 2014 Sep;104(S4):S620–7. Available from: http://dx.doi.org/10.2105/AJPH.2014.302097

Levinson AH, Valverde P, Garrett K, Kimminau M, Burns EK, Albright K, et al. Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers. BMC Public Health [Internet]. 2015 Jul 9;15(1). Available from: http://dx.doi.org/10.1186/s12889-015-1962-4

Li WHC, Chan SSC, Wan ZSF, Wang MP, Ho KY, LAM TH. Development of a community-based network to promote smoking cessation among female smokers in Hong Kong. BMC Public Health [Internet]. 2017 Apr 11;17(1). Available from: http://dx.doi.org/10.1186/s12889-017-4213-z

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Fu D, Gratziou C, Jiménez-Ruiz C, Faure M, Ward B, Ravara S, et al. The WHO–ERS Smoking Cessation Training Project: the first year of experience. ERJ Open Res [Internet]. 2018 Jul;4(3):00070–2018. Available from: http://dx.doi.org/10.1183/23120541.00070-2018

Table 3: Project Design

Table 4: Actual Schedule of Activities

  ​​​​​

Figure1. Problem Tree

Figure 1 illustrates the problem tree wherein the low quit success rate is identified as the main problem that this project sought to address. The roots represent the factors that contribute to the problem while the branches represent the complications or effects of the main problem.    

Figure 2: Alternative Tree

The alternative tree shows the contrast of the problem tree wherein the problem is converted into a positive outcome. The roots represent the factors that can contribute to the realization of this positive outcome and therefore the cascade of negative effects is prevented.

Figure 3. Objective Tree

The objective tree represents the possible solutions to the problems identified.  The main objective of this project is to increase the quit success rate in the community.  The roots represent the interventions that can help realize the objective.

APPENDIX A: SUMMARY OF REVIEW OF RELATED LITERATURE

Table 1: Summary of Studies on Factors Associated with Quit Outcomes

 Table 2: Review of Articles on Community-based Smoking Cessation Services

APPENDIX B: BTI MODULE DESCRIPTION [21]

Table 5: Brief Tobacco Intervention Seminar and Workshop

APPENDIX C: POSTERS

Figure 4: The 5A’s in Brief Tobacco Intervention  [21]  

Figure 5: Readiness to change model  [21]  

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Persuasive essay about smoking(tagalog)

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Filipinos want national smoking ban in public places, survey says

4 February 2021

More can still be done to ensure the safety of Filipinos when it comes to the harmful effects of smoking and the results of a recent survey may lead policy-makers to the right direction.

According to a survey conducted by Pulse Asia in December 2020, there is overwhelming support for a national smoking ban in all public spaces (93 percent) and in all private spaces frequented by the public (91 percent).

“The survey clearly shows that there is a strong clamor for a smoke-free Philippines. People are more aware now of the health and environmental impacts of smoking, and are more health conscious,” said Atty. Jacky Sarita, Executive Director of Health Justice Philippines.

“We have nothing to lose by becoming smoke free. On the contrary, we have so much to gain—healthier citizenry and cleaner environment. We will even be able to contribute to poverty alleviation,” said Mardy Halcon, country lead of the Campaign for Tobacco-Free Kids.

Halcon added that people in the lower socio-economic demographic level will not be as “financially burdened because if they did not smoke, they wouldn’t have to choose between cigarette sticks and food.”

Halcon cited the case of Artemio Biernes who has been smoking since he was in high school. Like many others, his initiation into smoking was a result of peer pressure.

Artemio, now on his 50s recalled that his friends would not take no for an answer when they offered him a cigarette. He tried it and liked it. Since then, he has not stopped smoking. As he made more money, he periodically increased his allocation for cigarettes. At some point, he was spending 25 percent of his income on cigarettes alone.

Artemio has been smoking for decades when his wife noticed that he seemed unwell. A visit to the doctor confirmed their fears—he was diagnosed with emphysema, a lung disease characterized by difficulty in breathing and caused by many years of smoking.

“Seeing my X-ray results, the doctor asked if I smoked. I said yes. He told me to stop if I did not want my illness to worsen,” Artemio said.

Artemio heeded his doctor’s advice, but by then, the effects of his long years of smoking had taken its toll on his body.

“My body has considerably weakened. I can no longer do the things I used to do,” he said.

Because of Artemio’s condition, his wife Evelyn became the family’s breadwinner. To be able to put food on the table and buy Artemio’s medicines, Evelyn did laundry for their neighbors.

Artemio admitted that he was full of remorse saying, “I hope she can forgive me.”

Typical story

Artemio’s story mirrors those of many other smokers—starting young because of peer pressure, getting hooked, getting sick, and becoming cash-strapped because of the costs of the cigarettes, hospital bills and maintenance medicines when they get sick.

Numerous studies have consistently shown the link of smoking to various major diseases, among them lung cancer and heart disease.

Smoking has also been found to increase one’s risk of getting infected with Covid-19. Worse, when a smoker does get infected, they are more likely to have a severe case of infection—their lungs, the very target of Covid- 19, having considerably weakened by cigarette smoking.

To prevent Filipinos, especially the youth, from falling into the trap of smoking, anti-smoking regulations have been crafted and passed in the past years. In 2017, President Rodrigo R. Duterte signed Executive Order (EO) 26 which banned smoking in public areas except in designated smoking areas that follow guidelines set by the EO.

The EO also enjoined all cities and municipalities nationwide to form a local smoke-free task force with the goal of imposing its provisions.

In 2020, the President signed RA 11467 into law which raised the sin taxes for alcohol and cigarettes and issued EO 106 which regulates the sale, manufacture, marketing, distribution and importation of unregistered electronic nicotine devices and other novel tobacco products.

The directive also bans establishments from selling e-cigarettes and other tobacco products to a person aged 21 years old and below.

New Bill on the Block

In January 2021, Sen. Ronald Dela Rosa filed Senate Bill 1976 which aims to institutionalize the advocacy of the President to make the Philippines smoke free.

While he was still a city mayor, the President made Davao City known worldwide for strictly enforcing smoke-free policies that benefited the health of its constituents.

The new bill prohibits smoking in all public transportation vehicles and its terminals, workplaces, and other public places that may be identified by persons in authority.

It also prohibits indoor designated smoking areas which, according to the guidelines outlined by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), to which the Philippines is a signatory, are not sufficiently equipped to protect people from the harm of second-hand smoke.

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Make the Philippines smoke-free! Strictly enforce the nationwide smoking ban. Sama-sama tayo para sa #SmokeFreePH!

We are for a smoke-free Philippines, and we believe you are, too.

Make the Philippines smoke-free by enforcing a nationwide smoking ban now.

National law (including the WHO Framework Convention on Tobacco Control), local ordinances, and other government policies ban smoking in centers of youth activity, restaurants, food and beverage preparation areas, other public spaces (RA 9211), public vehicles and terminals (LTFRB Memorandum Circular 2009-036), and in government premises (CSC Memorandum Circular 17).

But these are not well-enforced.

At least 240 Filipinos die every day from smoking-related diseases. Exposure to secondhand smoke increases a non-smoker’s chance of developing lung cancer by 20% to 30%.

No amount of secondhand smoke will ever be safe, and no one should be permitted to irresponsibly place other people’s lives and health in peril by exposing them to secondhand smoke.

We must lose no time in providing a smoke-free environment for our children and families.

Enforce our smoke-free laws now. Protect public health now. Make the Philippines smoke-free now.

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The Philippines’ Nationwide Smoking Ban under Executive Order No. 26: Separating Fact from Fiction

The “action-packed” presidential issuance from President Rodrigo Duterte, signed on 16 May 2017, Executive Order No. 26 (EO 26) , otherwise known as the Nationwide Smoking Ban , takes effect sixty (60) days from its publication in a newspaper of general circulation. Thus, the smoking ban will be enforced throughout the Philippines beginning 23 July 2017 .  As smokers and non-smokers alike get ready for the inevitable, it is best to clarify what can and cannot be done under EO 26.

It must be clarified that this executive issuance is not entirely new. It takes off from where the not-so-new Republic Act No. 9211 has left.

EO 26 provides for the establishment of smoke-free environments in public and enclosed spaces . The presidential issuance made it very clear that it covers all public and enclosed places found within the territorial jurisdiction of the Philippines .

The issuance went further to define a public place as all places, fixed or mobile, that are accessible or open to the public or places for collective use , whether owned by the government or privately owned.

Included in the definition of a public place are schools, offices, workplaces, government facilities, establishments that provide food and drinks, accommodation, merchandise, professional services, entertainment or other services, and outdoor spaces, such as playgrounds, sports grounds, centers, church grounds, health/hospital compounds, transportation terminals, markets, parks, resorts, walkways, sidewalks, entrance ways, waiting areas , and the like, are covered in the prohibition.

Finally, in the executive order, public vehicles and conveyances refer to modes of transporting the general population, such as jeepneys, tricycles, taxicabs , and other similar vehicles .

It is obvious that there is a prohibition from smoking while inside public or private offices, buildings, or even public transport vehicles like taxicabs and buses. Of course, a smoker will not even dare smoke inside a church, school or hospital, lest he suffer the wrath of scores of angry parishioners, or complaining parents. Certainly, a person who insists on lighting up inside a non-smoking facility, like a mall or restaurant, is sure to be booted out by the next friendly security guard that sees him or her.

The question that everyone is asking is – does the nationwide smoking ban prohibit smoking in all of these public areas and public conveyances?

The answer is, no , the nationwide smoking ban does not absolutely prohibit smoking in all of these areas.

On the contrary, the prohibition is express towards smoking within enclosed public places and public conveyances. The operative word here is “enclosed”. EO 26 defines an enclosed place as a place that is covered by a roof or other structure serving the purpose of a roof, and having one or more walls or sides, wherein the openings on the walls or sides have an aggregate area that is less than half of the total wall space, regardless of the type of material used for the roof, wall or sides, and regardless of whether the structure is permanent or temporary.

Therefore, as a general rule, if the area is not enclosed, then is it not covered by the prohibition. However, note that EO 26 includes, as part of the term “enclosed public space”, all areas of a building or conveyance, including its open spaces, which are not covered by a roof or other similar structure.

Thus, a person who is caught lighting up a cigarette , at or near the entrance of a building, along the open hallways, or even in an open area, open quadrangle, or garden that is part of the building, can be said to be smoking in an enclosed public space , and consequently, violating the smoking ban, even if the area is not really enclosed.

Can you smoke in your car? Yes. The prohibition from smoking only applies to enclosed public places and public conveyances. The definition in EO 26 does not include private vehicles. While it may be argued that a person smoking inside the vehicle while traversing a public thoroughfare is no different than a person lighting up while walking along the street, penal laws and regulations, such as Executive Order No. 26, are to be interpreted strictly. For all intents and purposes, a private car is not an enclosed public space.

However, as to bars and restaurants that allow smoking inside the establishment through a legally obtained tobacco permit from the local government, the answer as to whether they may be affected and subject to the prohibition is not so clear.

The executive order includes in the definition of a public place “establishments that provide food and drinks”. As we clarified earlier, EO 26 prohibits “smoking within enclosed public places”. Thus, smoking inside a bar or restaurant may come within the prohibition since it is clearly an enclosed space. However, since Republic Act No. 9211 allows the owner, proprietor, operator, possessor or manager of such places to establish smoking and non-smoking areas, it can be argued that the owner of such bar or restaurant may legally segregate part of the establishment as a defined smoking area.

Additionally, there is nothing in the executive order that prevents these bars and restaurants from permitting smoking in the open or “unenclosed” portions of their establishment. After all, the prohibition is directed to “smoking within enclosed public places and public conveyances”.

Not only smokers taking a quick puff may be slapped by a violation of EO 26. Under the nationwide smoking ban, smokers and non-smokers alike may be liable .

EO 26 mandates the president of a company or business, the owner of a building or facility, or the administrator of property, to post or display written and graphic warnings of the prohibition all over the premises, in covered establishments, and in mandatory places under their control. These persons, referred to in the executive order as “persons-in-charge”, will be guilty of violating EO 26, if they fail to comply, even if the person-in-charge is a non-smoker.

Persons caught smoking in prohibited areas, persons-in-charge allowing, abetting or tolerating smoking in prohibited places, illegally selling, distributing or even purchasing tobacco products, sale of tobacco products to minors, the minors themselves when caught selling posting, distributing, promoting or advertising of tobacco products in prohibited places, are just some of the prohibitions found in Executive Order No. 26.

The issuance expressly orders the formation of a local Smoke-Free Task Force in each city and municipality, to apprehend violators, and institute criminal proceedings for violation of the executive issuance.

Does Executive Order No. 26 have teeth? Yes, it does. The executive order has bite.

Smokers and persons caught violating EO 26 will be punished under the penal clauses of existing laws, particularly Section 32 of Republic Act No. 9211.

For one, those caught smoking in prohibited places will be fined between Five Hundred Pesos (P500.00) to Ten Thousand Pesos (P10,000.00) , depending on the frequency of violations. Not only that, on the third offense, the owner of the business that tolerates or abets the violation may be penalized with cancellation of his or her business permit .

Those caught selling tobacco products to minors, those selling tobacco products without the required warnings, or otherwise violating the tobacco advertising or promotional guidelines in the executive order, will get slapped with fines ranging from Five Thousand Pesos (P5,000.00) up to Four Hundred Thousand Pesos (P400,000.00) , or imprisonment ranging from one (1) to three (3) years , or both, at the discretion of the court.

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Addressing the tobacco epidemic in the Philippines: progress since ratification of the WHO FCTC

1 International Union Against Tuberculosis and Lung Disease, Edinburgh Office,  Edinburgh, United Kingdom

2 Republic of the Philippines Department of Health, Manila, The Philippines

3 Framework Convention on Tobacco Control Alliance Philippines, Manila, The Philippines

4 Metropolitan Manila Development Authority, Manila, The Philippines

F. Trinidad

5 World Health Organization–Western Pacific Region, Manila, The Philippines

U. Dorotheo

6 South-East Asia Tobacco Control Alliance, Bangkok, Thailand

R. Yapchiongco

7 World Lung Foundation, New York, New York, USA

Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.

L’emploi de tabac est la principale cause évitable de décès et on estime qu’il tue chaque année plus de 5 millions de personnes au niveau mondial. L’utilisation de tabac et l’exposition à la fumée secondaire posent un problème majeur de santé publique aux Philippines. Les politiques efficientes de lutte contre le tabagisme sont garanties dans la Convention Cadre de Lutte contre la Tabagisme (FCTC) de l’Organisation Mondiale de la Santé (OMS), un traité international d’application légale obligatoire qui a été ratifié par les Philippines en 2005. Depuis 2007, Bloomberg Philanthropies a soutenu l’accélération de la réduction de l’utilisation de tabac dans beaucoup de pays, notamment les Philippines. On discute les progrès observés aux Philippines en insistant particulièrement sur la période faisant suite à la ratification de la FCTC de l’OMS et en se focalisant particulièrement sur le programme de dons financé par l’Initiative Bloomberg. En dépit de progrès significatifs, on identifie des défis majeurs auxquels il faut répondre à l’avenir, si l’on veut alléger le fardeau social économique et sanitaire provenant de l’épidémie de tabagisme.

El consumo de tabaco representa la principal causa prevenible de mortalidad y se calcula que provoca la muerte de más de 5 millones de personas cada año en todo el mundo. El tabaquismo y la exposición pasiva al humo del tabaco plantean un problema mayor de salud pública en las Filipinas. El Convenio Marco para el Control del Tabaco (FCTC) de la Organización Mundial de la Salud (OMS) consagra las políticas eficaces de control del tabaquismo; este tratado internacional jurídicamente vinculante fue ratificado por las Filipinas en el 2005. Desde el 2007, la iniciativa Bloomberg Philanthropies ha apoyado una disminución acelerada del tabaquismo en muchos países, incluidas las Filipinas. En el presente artículo se examinan los progresos alcanzados en este país, con especial interés en el período posterior a la ratificación del FCTC de la OMS y se hace hincapié en el programa de subsidios financiado por la Iniciativa Bloomberg. Pese a los considerables progresos alcanzados, se destacan retos importantes que exigen una respuesta en el futuro, si se busca aliviar la carga social, sanitaria y económica que representa la epidemia de tabaquismo.

Non-communicable diseases (NCDs) pose one of the main health challenges of the twenty-first century; of the estimated 57 million global deaths in 2008, 36 million (63%) were due to NCDs. 1 From the Global Burden of Disease projections, an estimated 2.6 million people died from NCDs in the 10 Association of South-East Asian Nations (ASEAN) countries, and the mortality rate adjusted to age per 100 000 population is high in low-income countries. 2 , 3 The largest proportion of NCD deaths is caused by cardiovascular disease (48%), followed by cancers (21%) and chronic respiratory diseases (12%).

Tobacco use is an important behavioural risk factor that is responsible for 12% of male deaths and 6% of female deaths in the world. 4 Exposure to second-hand smoke (SHS) is estimated to cause more than 600 000 premature deaths annually. These include 166 000 deaths from lower respiratory infections, 35 800 from asthma (1100 from asthma in children), 21 000 from lung cancer and 379 000 from ischaemic heart disease in adults. This disease burden amounts in total to about 10.9 million disability-adjusted life years. Of all deaths attributable to SHS, 28% occur in children and 47% in women. 5 Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million people each year worldwide; if current trends persist, tobacco will kill more than 8 million people worldwide each year by the year 2030, with 80% of these premature deaths in low- and middle-income countries. 6 , 7 In the Philippines, tobacco kills at least 87 600 Filipinos per year (240 deaths every day); one third of these are men in the most productive age of their lives. 8

The most effective tobacco control policies are contained in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), 9 which is the first global health treaty, and encapsulated in the corresponding MPOWER policy package. 10 In the Philippines, the FCTC was ratified in 2005 by the Senate and signed by the President, i.e., the ratification itself went through a legislative process. Parties to this legally binding international treaty must enact new laws or amend existing ones so that they are consistent with the FCTC. Progress in implementation of the FCTC is monitored and reported by the WHO. 6 , 7 , 11 The South-East Asia Tobacco Control Alliance also publishes reports on FCTC implementation ( http://www.seatca.org/ ). Since 2007, Bloomberg Philanthropies has supported the implementation of proven policies to accelerate the reduction of tobacco use worldwide; as of 2012, the total commitment confirmed under this initiative is more than US$600 million; 12 the Philippines has received some US$5 million through grants to government and civil society under this initiative. 13 Discussion in the peer-reviewed literature of tobacco control and related issues specifically with respect to the Philippines has been limited to date, with some noteworthy exceptions. 14 – 23 This article provides an overview of progress in the country since the 2005 ratification of the WHO FCTC to the end of 2012, and provides a particular focus on the grants programme funded under the Bloomberg Initiative.

TOBACCO USE IN THE PHILIPPINES

The Philippines is the world’s twelfth most popu-lous country, with projected population estimates of 101.8 million by 2015 and over 132.5 million by 2040. 24 Total health expenditure per capita is estimated at US$66. 1 The tobacco industry in the country has been described as ‘the strongest tobacco lobby in Asia’. 20 The Philippines has one of the highest per capita levels of cigarette consumption among the ASEAN countries, well above the ASEAN average (873 cigarettes). 25 Tobacco use, exposure to SHS and pervasive marketing of tobacco products pose a major public health problem in the country, according to recent data: 26 , 27

• 28.3% (17.3 million Filipinos) of the adult population currently smoke (males 47.6%, females 9.0%);
• 48.8% (29.8 million Filipinos) allow smoking in their homes;
• 36.9% of adult workers report exposure to tobacco smoke in enclosed areas at their workplace in the past month;
• exposure to SHS was 55.3% in public transport, 33.6% in restaurants, 25.5% in government buildings and 7.6% in health care facilities; and
• 96.2% of smokers bought their last cigarettes in a store and 53.7% of adults said they had noticed cigarette marketing in stores where cigarettes are sold.

PROGRESS IN TOBACCO CONTROL IN THE PHILIPPINES

The Philippines started to implement tobacco control efforts in 1987 and has intensified them over time. Since then, despite the strong lobbying of the tobacco industry, the country has successfully passed the Republic Act 9211 (Tobacco Regulation Act of 2003); despite several shortcomings, this Act was designed to promote a healthy environment and protect citizens from the hazards of tobacco smoke, inform the public of the health risks associated with cigarette smoking and tobacco use, regulate and subsequently ban all tobacco advertisement and sponsorships, except at point of sale, regulate labelling of tobacco products, and protect young people from being initiated to cigarette smoking and tobacco use through access restrictions.

The country ratified the WHO FCTC in 2005. 8 In 2009, the WHO Regional Office for the Western Pacific released a Regional Action Plan (RAP) for the Tobacco Free Initiative in the Western Pacific. The RAP had four overall indicators to be achieved by 2014: 1) all countries to have developed a national action plan and national coordinating mechanism, 2) all parties in the Region to have ratified all WHO FCTC protocols, 3) reliable data on adult and youth tobacco use to be available in all countries, and 4) the prevalence of adult and youth current tobacco use (smoking and smokeless) to be reduced by 10% from the most recent base-line. The RAP set out specific actions for countries and suggested country-level indicators; it was and remains an important influence on tobacco control activities within countries in the Region, including the Philippines. 28

The Bloomberg Initiative to Reduce Tobacco Use was designed to accelerate the reduction of tobacco use worldwide through the implementation in particular of WHO FCTC/MPOWER strategies. One important stream of investment under this initiative is the Grants Program, which is jointly managed on behalf of Bloomberg Philanthropies by the International Union Against Tuberculosis and Lung Disease (The Union) and the Campaign for Tobacco-Free Kids. Details about grants awarded, on the publicly available Program website, indicate that for the funding period commencing July 2007 and ending June 2014, some 23 grants were awarded to both non-governmental and governmental organisations in the Philippines, with a total investment in excess of US$4.9 million. 13 The key historical progression points of tobacco control in the country are illustrated in Figure 1 .

Philippines tobacco control timeline, 1987–2012. Adapted from the WHO Joint National Capacity Assessment Report. 8 DOH = Department of Health; WHO = World Health Organization; FCTC = Framework Convention on Tobacco Control; LTFRB = Land Transportation Franchising and Regulatory Board; PUVs = public utility vehicles; FDA = Food and Drug Administration; CSC = Civil Service Commission; JMC = Joint Memorandum Circular; NTCCO = National Tobacco Control Coordinating Office; NTCS = National Tobacco Control Strategy.

In mid-2011, a group of national, international and WHO health experts, in collaboration with a team from the Republic of the Philippines Department of Health (DOH), assessed the country’s tobacco control efforts in implementing the WHO FCTC. The assessment considered existing tobacco epidemiological data, as well as the status and present development efforts of key tobacco control measures undertaken by the government in collaboration with other sectors. The report of this Joint National Capacity Assessment on the Implementation of Effective Tobacco Control Policies identified some of the key achievements as well as significant challenges to the continued progress of tobacco control in the country. 8 Figure 1 , showing the Philippines tobacco control timeline 1987–2012, is adapted from the report of the Joint National Capacity Assessment. Points of progress since FCTC ratification include the 2009 Food and Drug Administration (FDA) law RA9711, which allowed for the FDA to regulate tobacco and tobacco products; the 2010 issuance of CSC-DOH No. 2010-01 ( Joint Memorandum Circular Civil Service Commission [CSC] and DOH, which promulgates the policy on protection of the bureaucracy from tobacco industry interference, covering all national and local government officials and employees); the 2011 issuance of DOH DO (Department Order) 2011–0029, which established the National Tobacco Control Coordinating Office (NTCCO) within the DOH, and the 2012 launch of the Philippines first National Tobacco Control Strategy (NTCS).

The achievements and challenges of tobacco control in the Philippines from the perspective of Joint National Capacity Assessment are presented in Table 1 . Note that the challenge of addressing tobacco industry interference in government policy through full implementation of Article 5.3 is in addition to those identified explicitly in the Joint National Capacity Assessment; the report does nonetheless point out (page 19) that it was ‘clearly stated by interviewed stakeholders that the tobacco industry’s ubiquitous presence in the decision-making process could be the main obstacle in taking effective tobacco control measures to protect the health of the Filipinos’. We agree with this perspective, and felt that the addition of a specific item on tobacco industry interference was justified. Another addition is the amendment of the national tobacco control act RA9211 to be consistent with WHO FCTC; central issues here are as follows: 1) the composition of the Interagency Committee on Tobacco (created by RA 9211) is inclusive of the Philippine Tobacco Institute and thus blatantly in conflict with WHO FCTC Article 5.3; 2) the current law allows the establishment of designated smoking areas, either indoors or outdoors, in public places, which not only creates a challenge for enforcement but also fails to protect public health effectively; 3) the definition of public places needs to be refined to include confined and open public places (the law has a definition for an enclosed area but none for a confined area); and 4) the current provisions on health warnings and advertising bans are not FCTC-consistent.

Key achievements to 2012 and challenges ahead for tobacco control in the Philippines

FCTC = Framework Convention on Tobacco Control; TAPS = tobacco advertising, promotion and sponsorship; MDG = Millennium Development Goals; DOH = Department of Health; WHO = World Health Organization.

Progress can also be considered in terms of the level of implementation of FCTC and MPOWER strategies ( http://www.who.int/tobacco/mpower/en/ ); data on the status of global tobacco control policy implementation and the countries’ level of attainment of the six MPOWER measures have been produced by the WHO in 2011, 11 with previous iterations in 2009 7 and 2008. 6 Based on these data and on the report of the Joint National Capacity Assessment, 8 it is our view that partial implementation has been achieved across all MPOWER components, except in O (offer help to quit tobacco use) and E (enforce bans on tobacco advertising, promotion and sponsorship), where implementation has been minimal. It is our view that full implementation has yet to be achieved in any one of the six components.

The framework of the NTCS ( Figure 2 ) and a summary description of the grants awarded under the Bloomberg Initiative to Reduce Tobacco Use ( Table 2 ) are shown here. More details on the specific grants and organisations are available online. 13

Framework of the Philippines National Tobacco Control Strategy to 2016. Source: Philippines Department of Health. 29 WHO = World Health Organization; FCTC = Framework Convention on Tobacco Control.

Overview of the main grants awarded to the governmental and non-governmental sectors in the Philippines under the Bloomberg Initiative to Reduce Tobacco Use 2007–2012

TAPS = tobacco advertising, promotion and sponsorship; DOH = Department of Health; FCTC = Framework Convention on Tobacco Control; WHO = World Health Organization.

Note that the purpose of one Bloomberg grant described in Figure 2 was to support the establishment of the NTCCO within the DOH and the development of an NTCS, both of which were achieved. In addition, the grant to Action for Economic Reforms had a specific focus on taxation reform which, with the consolidated efforts of the Filipino tobacco control constituency, was substantially achieved on 11 December 2012, when Congress ratified the so-called ‘Sin Tax’ bill. 30 President Aquino signed the Sin Tax reform bill into law on Thursday 20 December 2012, and it came into effect on 1 January 2013. For cigarettes (machine packed) the tax rate prescribed in the first year of implementation is 1) PHP12.00 (1 Philippine Peso [PHP] = US$0.024) per pack if the net retail price (excluding the excise tax and the value-added tax) is PHP11.50 and below per pack, and 2) PHP25.00 per pack if the net retail price (excluding the excise tax and the value-added tax) is more than PHP11.50 per pack. The Act stipulates higher tax rates in subsequent years, and also states that ‘the proper tax classification of cigarettes, whether registered before or after the effectivity of this Act, shall be determined every two (2) years’. 31

The Union has also, under the Bloomberg Initiative, recently negotiated a new grant with the CSC of the Philippines. Working to ensure protection of the civil service against tobacco industry interference (in line with Article 5.3 of the WHO-FCTC), the CSC will use a policy instrument known as CSC-DOH Joint Memorandum Circular 2010-01 as a cornerstone, drawing also on recently developed resources such as the FCTC Article 5.3 Toolkit: Guidance for Governments on Preventing Tobacco Industry Interference, published by The Union in 2012 and available online. 32 It should be noted that this Joint Memorandum Circular applies to elected officials as well as the rest of the civil service.

Tobacco use places an unacceptable burden on public health in the Philippines. In the 12 minutes or so taken to read this article, two Filipinos will have died from tobacco-related disease—the tobacco epidemic kills at least 87 600 Filipinos per year, or 10 every hour. 8 Efforts to tackle the epidemic have shown promise, especially since the ratification of the WHO FCTC in 2005. Although it is difficult to provide conclusive supporting evidence of cause and effect, it is arguable that the close to US$5 million in grants provided under the Bloomberg Initiative to Reduce Tobacco Use has made a contribution towards accelerating the implementation of effective tobacco control policies; it is now time to build on these successes in a sustainable way that does not rely so heavily on philanthropic donors. The launch of the country’s first NTCS and the progression of an improved taxation policy are recent and very encouraging signs of progress. Ensuring that the laws of the country are fully WHO FCTC-consistent must be given a higher priority, and the new NTCS appears to do just that. Recent robust efforts by the CSC and DOH to tackle tobacco industry interference in the civil service are also on the right track. Given the very strong tobacco industry presence in the Philippines, the daily challenges faced in advocating for WHO FCTC consistent policy measures are many and varied. A full account of these challenges is beyond the scope of this article; however, the cautionary observation by Alechnowicz and Chapman in 2004, 21 that the tobacco industry in the Philippines is ‘the strongest tobacco lobby in Asia’, still appears to be true. Tackling pervasive industry influence must be near the very top of all public policy makers’ lists of future actions, as are efforts to ensure the implementation of efficient and impactful public education and mass media campaigns.

Acknowledgments

The authors are grateful to the following people who provided comments or suggestions on earlier drafts of the manuscript: M Allen, M Balane, B del Rosario, M Derilo, I Escartin, S P Mercado, T Roda, F Santa Ana, L Tagunicar, P Ubial, X Yin.

Funding towards the writing of this paper was provided by Bloomberg Philanthropies under the Bloomberg Initiative and through the Initiative’s partner organisations.

The views expressed are those of the authors and not necessarily of the affiliated organisations.

Conflict of interest: none declared.

Cigarettes Should be Illegal – Argumentative Essay

One of the biggest and most challenging health concerns in our society is smoking. Smoking is not a new activity. This practice has been around for ages in different forms. Smoking is presently the foremost cause of death in the world, due to its damaging and addicting substances, such as nicotine and tobacco. Even though millions die from it each year, smoking is the single most avoidable cause of death as well. Without smoking, a great amount of money and lives will be saved. Bans on items like tobacco are difficult to implement, and usually, do not stop all activity. Illegal selling of cigarettes is likely to follow a ban, if not imposed correctly. Cigarette smoking is the source of several health issues, it also includes lethal cancers.  The habit-forming nature makes it a tough task to stay away from once it has been experienced. This is made particularly testing when smoking is attempted at a young age. Evolving and impressionable minds often form addictions faster.

Currently, a cigarette manufacturing machine can use up to 3.7 miles of paper an hour. Tobacco crop uses additional important nutrients than many other harvests, degrading the soil. Probably the most influence of a cigarette on the environment is the making of them. The land used to grow tobacco crops could be put to healthier use by planting more trees or food production. Huge quantities of pesticides, fertilizer and herbicides are used on tobacco crops. Cigarette butts also do a lot of damage as actually they are often made from a form of plastic. The polymer acetate filters consist of thousands of strands that can take up to 15-25 years to dissolve. The dregs from tobacco in the butts also discharge pollutants into the atmosphere. Trillions of butts are discarded each year. These cigarette butts then make their way inside the stomachs of birds and fishes. It is awful to know that some of the fishes that we have consumed may have been tainted by cigarette butts.

Main reasons why cigarette smoking should be banned Pollution Cigarettes add to pollutions every day as people smoke them and release toxins into the air. Our air is already wanting in good quality. This is only increasing the problem. Global warming has become the main problem because of the solid inflow of toxins into our air. We also want plants to help filter our air and produce purified clean air to breathe. The air around us is also needed by plants to breathe. Crops grown by farmers in contaminated air, do not give the top nourishment for our bodies. Polluted air and soil is the root cause of these issues.

Cancer Cancer is the usual result for those that smoke for many long years. Probabilities of escaping cancer are better instantly after giving up the habit. However, the damage to the lungs can be substantial. There are many losses that turn around advanced lung cancer. The lungs of these patients are frequently studied to understand how much damage has happened. They are mostly found to be totally black in colour, like the inside of a fireplace. The smoking of cigarettes can also lead to cancers of the mouth and throat. The smoke that constantly passes down the lungs harms the delicate tissues of the respiratory tract. There is, therefore, no purpose to permit the usage of a product that is killing people.

The rise of cancer is in many forms. Lung cancer can even happen after the habit of smoking ends. It takes time for the cells to heal themselves once they have been mutilated. Smokers very often regret the decision to try cigarettes when cancer is the diagnosis. Others may be angry after being exposed to unprotected second-hand smoke.

Children Children are at great danger from cigarette smoking. Those children whose Parents smokes regularly are susceptible to this poison, every day. Young kids that are still growing can be especially vulnerable to the bad effects of cigarette smoke. Children can also without difficulty become hooked when they live in the home with a smoker.

Children that are wide open to cigarette smoke before they are even born can have many problems right away. Pregnant women, who smoke cigarettes, put their newborn babies at danger for prematurity and low birth weight. Pregnant women smoking during and after pregnancy are at risk of Sudden Infant Death Syndrome. Smoking can expose a baby to harmful substances like nicotine, carbon monoxide and tar. Children with smoking parents are often ignorant of the concerns until they start school and learn about the dangers.

The recent laws forbid smoking in the car with children. This is a gigantic step towards shielding children from grown-ups with bad habits. Children that are open to cigarette smoke at an early stage in their life, often suffer from respiratory problems. This can include chronic disease like asthma. The pollutants from smoke settle down into the hair, clothes, and furniture of smokers. Even if a smoker selects to smoke only outside and away from children, the toxins from the cigarettes still make their way to children in the home.

Smoking is a nauseating habit that puts people’s lives at risk. The health concerns have been identified for many years, yet the habit-forming nature of cigarettes has stayed put. It may benefit to ban cigarettes since some people do not have the willpower to fight the problem on their own. A ban holds people responsible for their actions when it comes to illegal substances. Nicotine may not damage cognitive skills in the same way that drugs and alcohol do. However, they do affect vast long-term health matters. Smokers also suffer publicly, socially and not just physically. Cigarette smoking culminates to governing the lives of those who become addicted. Many residential complexes do not want smokers, as the cleaning is difficult when they move out. It is very difficult to totally eliminate the smell as the smell penetrates the walls and carpets deeply.

Unfortunately, smokers are at danger of losing their lives from huge health concerns. Smaller illnesses, like asthma, can also be challenging on the person. Lung cancer is often terminal and can lead to a heart-breaking loss for family and friends. Many people may try to support smoker mend, without any positive result. A ban on smoking may assist to curb pollution, keep children safe and healthy, and leave fewer people lonely. Any kind of addiction can inflict destruction in the lives of the addicts and those close to them.

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The Chinese Palace

There is nothing particularly Chinese about this charming building in the southern corner of the park at Oranienbaum. Built by Antonio Rinaldi between 1762 and 1768, it was the first major building project to be ordered by Catherine the Great, who planned for the building to serve as her private dacha. In fact the Empress spent only 48 days there during the 34 years of her reign. However, the building, which is currently undergoing full-scale renovation, is considered one of the finest examples of rococo in Russia, with has superbly ornate interiors featuring a range of late 18 th century styles, including Chinoiserie, a trend imported to St. Petersburg from England rather than from the East.

From the outside, the palace is a relatively simple building, single-storey except for the small central pavilion, painted in a mellow combination of ochre and yellow. The seventeen rooms inside, decorated by Rinaldi and other leading artists and craftsmen of the day, feature pink, blue and green scagliola, painted silks, and intricate stucco work. Rinaldi's parquet floors are wonderfully ornate, using several types of rare Russian and imported wood. Among the highlights of the Chinese Palace interiors are the Glass Beaded Salon, the walls of which are hung with 12 panels of richly coloured tapestries depicting exotic birds and fauna. The fine white glass beads that form the backdrop of the tapestries give the whole room a diaphanous, shimmering quality that was designed to be particularly effective in the glowing twighlight of the White Nights. The full influence of Chinoiserie is in evidence in the gaudy Large Chinese Salon, where the walls are covered with marquetry paneling of wood and walrus ivory depicting oriental landscapes, and large Chinese lanterns hanging in the corners. The room also contains an English-made billiard table with superb wood carving.

The interiors of the Chinese Palace are particularly prized because they have survived almost completely intact since Catherine's reign. Whereas most of the interiors of St. Petersburg's imperial palaces had to be completely reconstructed after the wanton destruction of the Nazi invaders, the decorations of the Chinese Palace were successfully evacuated, and re-installed in the early fifties. They are, however, in chronic need of restoration, and the process is finally underway in ernest, with several major Russian and international conservation agencies involved in the process. As yet, there is no date set for the completion of works.

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Tanzania Arrests 520 People in Mass Opposition Crackdown

The clampdown came after the police banned a youth rally and pointed to the anti-government protests that have swept neighboring Kenya in recent months.

By Abdi Latif Dahir

Reporting from Nairobi, Kenya

The Tanzanian police said on Tuesday they had arrested more than 500 people, including top opposition leaders, as they planned to attend a youth rally, a stunning development in the East African nation where a pathbreaking female president had once promised to restore political freedoms.

Some 520 people were arrested across the country ahead of a Monday rally in the southwestern city of Mbeya, Awadh J. Haji, the police commissioner for operations and training, said in a statement . The police, he said, also seized 25 vehicles that had been transporting people going to the rally and officials from different regions in the country.

The rally was organized by the opposition Chadema party, which said it wanted to mark International Youth Day. But the police banned the gathering before it was underway, and accused party members of making statements that showed their intention to carry out anti-government protests similar to those that swept across neighboring Kenya in recent months.

“Their goal is not to celebrate International Youth Day, but to initiate and commit violence to cause disruption of peace in the country,” Mr. Haji said.

The latest crackdown does not augur well for Tanzania, whose president promised to oversee a more open nation after coming to power in 2021. The country’s first female leader,  President Samia Suluhu Hassan,  reversed some of the measures put in place by her  populist predecessor , including by lifting a yearslong ban on political rallies, easing restrictions on the press and allowing pregnant girls to attend school.

Tanzania was one of three African nations that Vice President Kamala Harris visited last year in her efforts to bolster democratic governance and women’s empowerment in the continent.

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Visiting Sleeping Beauties: Reawakening Fashion?

You must join the virtual exhibition queue when you arrive. If capacity has been reached for the day, the queue will close early.

Heilbrunn Timeline of Art History Essays

Saint petersburg.

Ewer and basin (lavabo set)

Probably made at Chisinau Court Workshop

Andrei Nikiforovich Voronikhin

Alexander Danilovich Menshikov (1673–1729)

Unknown Artist, Swiss, Austrian, or German, active Russia ca. 1703–4

Samuel Margas Jr.

The Empress Elizabeth of Russia (1709–1762) on Horseback, Attended by a Page

Attributed to Georg Christoph Grooth

Table snuffbox

Niello scenes after a print entitled Naufrage (Shipwreck) by Jacques de Lajoüe , published in Paris 1736

Voltaire (François-Marie Arouet) (1694–1778)

Jean Antoine Houdon

Imperial Porcelain Manufactory, St. Petersburg

Cup with cover and saucer

Two bottle coolers

Zacharias Deichman the Elder

Catherine II The Great, Empress of Russia

Jean-Baptiste Nini

Coffee service

Johan Henrik Blom

Tureen with cover

Tureen with cover and stand

Jacques-Nicolas Roettiers

Possibly by Pierre-François-Mathis de Beaulieu (for Jean Georges)

Pair of scallop-shell dishes

Sugar bowl (from a tea service)

Workshop of David Roentgen

Beaker and saucer

David Roentgen and Company in Saint Petersburg

Johann Friedrich Anthing

Drop-front desk (secrétaire à abattant or secrétaire en cabinet)

Attributed to Martin Carlin

Pair of Flintlock Pistols of Empress Catherine the Great (1729–1796)

Johan Adolph Grecke

Gardner Manufactory

Center table

Imperial Armory, Tula (south of Moscow), Russia

Female Shaman

Pair of vases

Nikolai Stepanovich Vereshchagin

Jugate busts of Czarevitch Paul and Maria Feodorovna of Russia

James Tassie

Wolfram Koeppe Department of European Sculpture and Decorative Arts, The Metropolitan Museum of Art

October 2003

The Birth of Saint Petersburg Russia, or “Muscovy” as it was often called, had rarely been considered a part of Europe before the reign of Czar Peter I (Piotr Alexeievich), known as Peter the Great (r. 1682–1725). His supremacy marked the beginning of the country’s “Westernization,” whereby the political, economic, and cultural norms of the western European monarchies would become the basis for “civilizing” Russia. A radical transformation was needed to launch Russia into the modern world, a transformation later called the Petrine Revolution. The young czar, feeling oppressed by the medieval traditions and ecclesiastical patriarchy of seventeenth-century Moscow, wanted to Westernize Russia in a hurry, defying the sluggish pace of history.

Saint Petersburg was born on May 16, 1703 (May 5 by the old Julian Russian calendar). On that day, on a small island on the north bank of the Neva River, Peter cut two pieces of turf and placed them cross-wise. The setting was inauspicious. The area was a swamp that remained frozen from early November to March, with an annual average of 104 days of rain and 74 days of snow. The army, under the command of Alexander Menshikov ( 1996.7 ), had conquered the region shortly before. To show his gratitude, the czar later appointed Menshikov the first governor-general of Saint Petersburg. The fortification of the territory kept the Swedish enemy at bay and secured for Russia permanent access to the Baltic Sea. The partially ice-free harbor would be crucial to further economic development. All buildings on the site were erected on wooden poles driven into the marshy, unstable ground. Stones were a rare commodity in Russia, and about as valuable as precious metals.

The Dutch name “Piterburkh” (later changed to the German version, “Petersburg”) embodied the czar’s fascination with Holland and its small-scale urban architecture. He disliked patriarchal court ceremony and felt at ease in the bourgeois domestic life that he experienced during his travels throughout Europe on “the Great Embassy” (1697–98). However, the primary purpose of this voyage was to acquire firsthand knowledge of shipbuilding—his personal passion—and to learn about progressive techniques and Western ideas.

The victory over the Swedish army at Poltava in June 1709 elevated Russia to the rank of a European power, no longer to be ignored. Peter triumphed: “Now with God’s help the final stone in the foundation of Saint Petersburg has been laid.” By 1717, the city’s population of about 8,000 had tripled, and grew to around 40,000 by the time of Peter’s death in 1725. Saint Petersburg had become the commercial, industrial, administrative, and residential “metropolis” of Russia. By the 1790s, it had surpassed Moscow as the empire’s largest urban vicinity and was hailed as the “Venice of the North,” an allusion to the waterway system around the local “Grand Canal,” the Neva River.

Peter the Great’s Successors The short reign of Peter’s second wife, Empress Catherine I (r. 1725–27), who depended on her long-time favorite Menshikov, saw the reinstatement of the luxurious habits of the former imperial household. The archaic and ostentatious court display in the Byzantine tradition  that Peter had so despised was now to be restored under the pretext of glorifying his legacy. Enormous sums of money were lavished on foreign luxury items, demonstrating the court’s new international status and its observance of western European manners ( 68.141.133 ).

During the reigns of Empress Anna Ioannovna (r. 1730–40), niece of Peter I ( 1982.60.330a,b ), and her successor Elizabeth (Elizaveta Petrovna, r. 1741–62; 1978.554.2 ), Peter’s daughter, Saint Petersburg was transformed into a Baroque extravaganza through the talents of architect Bartolomeo Francesco Rastrelli (1700–1771) and other Western and Russian artisans. Foreign powers began to recognize Russia’s importance and competed for closer diplomatic relations. Foreign immigrants increased much faster than the local population, as scholars, craftsmen, artisans, and specialists of all kinds flocked to the country, and especially to Saint Petersburg ( 65.47 ; 1982.60.172,.173 ; 1995.327 ).

Catherine the Great (r. 1762–96) In a coup d’état assisted by the five Orloff brothers ( 33.165.2a–c ; 48.187.386,.387 ), Catherine II overthrew her husband, the ill-fated Peter III (r. 1762) and became empress. Catherine saw herself as the political heir of Peter the Great. A German-born princess of Anhalt-Zerbst who, after her marriage, became more Russian than any native, Catherine aimed at completing Peter’s legacy ( 52.189.11 ; 48.73.1 ). Having lived in isolation in the shadow of Elizabeth I since her marriage to the grand duke in 1745, the time had come to satisfy her thirst for life and her insatiable quest for culture and international recognition. An admirer of the Enlightenment and devoted aficionada of Voltaire’s writings, Catherine stimulated his cult in Russia ( 1972.61 ). In response, the French philosopher dedicated a poem to the czarina; her reply, dated October 15, 1763, initiated a correspondence that influenced the empress on many matters until Voltaire’s death in 1778. The hothouse cultural climate of Saint Petersburg during Catherine’s reign can be compared to the artistic and intellectual ferment in New York City in the second half of the twentieth century.

Catherine’s desire to enhance her fame and her claim to the throne was immortalized by her own witty play on words in Latin: “Petro Primo / Catharina Secunda” (To Peter the First / from Catherine the Second). This she had inscribed on the vast lump of granite in the form of a wave supporting the Bronze Horseman on the banks of the Neva in front of Saint Isaac’s Cathedral in Saint Petersburg. This triple-lifesize equestrian figure of Peter the Great took the French sculptor Falconet twelve years to complete, until it was finally cast—after three attempts—in 1782.

Catherine had military expansion plans for Russia and a cultural vision for its capital Saint Petersburg. Above all, she knew how to attract devoted supporters. Only nine days after the overthrow of her husband, Catherine wrote to Denis Diderot, offering to print his famous Encyclopédie , which had been banned in France. Catherine recognized the power of art to demonstrate political and social maturity. She acquired entire collections of painting ( Watteau , for example), sculpture, and objects. The empress avoided anything that could be called mediocre or small. With the help of sophisticated advisors, such as Prince Dmitrii Golitsyn, her ambassador in Paris, Denis Diderot, Falconet, and the illustrious Baron Friedrich Melchior von Grimm, the empress assembled the core of today’s State Hermitage Museum. Catherine favored luxury goods from all over Europe ( 33.165.2a–c ; 48.187.386,.387 ; 17.190.1158 ). She commissioned Sèvres porcelain and Wedgwood pottery as well as hundreds of pieces of ingeniously conceived furniture from the German manufactory of David Roentgen in Neuwied ( 48.73.1 ). Furthermore, she encouraged and supported Russian enterprises and craftsmen, like local silversmiths ( 47.51.1–.5 ; 1981.367.1,.2 ) and the Imperial Porcelain Manufactory ( 1982.60.171 ; 1982.60.177,.178 ; 1982.60.175 ), as well as privately owned manufactories ( 1982.60.158 ). Catherine especially liked the sparkling decorative products of the Tula armory steel workshop ( 2002.115 ), genuine Russian art forms with a fairy-tale-like appearance, and in 1775 merged her large collection of Tula objects with the imperial crown jewels in a newly constructed gallery at the Winter Palace in Saint Petersburg.

Catherine’s son and successor Paul I (Pavel Petrovich, r. 1796–1801) disliked his mother and her aesthetic sensibility ( 1998.13.1,.2 ). As grand duke, he had spent most of his time with his second wife Maria Feodorovna ( 1999.525 ) outside of Saint Petersburg, in Gatchina Palace and Pavlovsk Palace. These they transformed into the finest Neoclassical architectural gems in Europe ( 1976.155.110 ; 2002.115 ).

Koeppe, Wolfram. “Saint Petersburg.” In Heilbrunn Timeline of Art History . New York: The Metropolitan Museum of Art, 2000–. http://www.metmuseum.org/toah/hd/stpt/hd_stpt.htm (October 2003)

Further Reading

Cracraft, James. The Petrine Revolution in Russian Imagery . Chicago: University of Chicago Press, 1997.

Koeppe, Wolfram, and Marina Nudel. "An Unsuspected Bust of Alexander Menshikov." Metropolitan Museum Journal 35 (2000), pp. 161–77.

Shvidkovsky, Dmitri, and Alexander Orloff. St. Petersburg: Architecture of the Tsars . New York: Abbeville, 1995.

Additional Essays by Wolfram Koeppe

• Koeppe, Wolfram. “ Abraham and David Roentgen .” (June 2013)
• Koeppe, Wolfram. “ Hungarian Silver .” (February 2016)
• Koeppe, Wolfram. “ Collecting for the Kunstkammer .” (October 2002)

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• German and Austrian Porcelain in the Eighteenth Century
• James McNeill Whistler (1834–1903)
• James McNeill Whistler (1834–1903) as Etcher
• The Neoclassical Temple
• Neoclassicism
• Northwest Coast Indians Musical Instruments
• Venice in the Eighteenth Century

List of Rulers

• List of Rulers of Europe
• Central Europe (including Germany), 1600–1800 A.D.
• Eastern Europe and Scandinavia, 1600–1800 A.D.
• France, 1600–1800 A.D.
• Iran, 1600–1800 A.D.
• Low Countries, 1600–1800 A.D.
• 17th Century A.D.
• 18th Century A.D.
• Architecture
• Baroque Art
• Eastern Europe
• French Literature / Poetry
• Gilt Silver
• Scandinavia

Artist or Maker

• Anthing, Johann Friedrich
• Beaulieu, Pierre-François-Mathis de
• Blom, Johan Henrik
• Bouillat, Edme François, I
• Carlin, Martin
• Chisinau Court Workshop
• Deichman, Zacharias, the Elder
• Feodorovna, Maria
• Gardner Factory
• Grecke, Johan Adolph
• Grooth, Georg Christoph
• Houdon, Jean Antoine
• Imperial Armory, Tula
• Imperial Porcelain Manufactory
• Lajoüe, Jacques de
• Margas, Samuel, Jr.
• Nini, Jean-Baptiste
• Prudhomme, Elie
• Roentgen, David
• Roettiers, Jacques-Nicolas
• Rotari, Pietro
• Sèvres Manufactory
• Tassie, James
• Vereshchagin, Nikolai Stepanovich
• Voronikhin, Andrei N.
• Watteau, Antoine

Online Features

• 82nd & Fifth: “Curls” by Wolfram Koeppe