LLU trains tobacco control experts in Asia
From left: Richard Hart, MD, DrPH, LLU chancellor; Linda Hyder Ferry, MD, MPH, associate professor, SM and SPH; Khamphithoune Somsamouth, MD; Chhordaphea Chhea, MD; Maniphanh Vongphosy, MD, MPH; Souvankham Phommaseng, MD; Jayakaran Job, MD, DrPH, associate professor, SM and SPH; and Floyd Petersen, MPH, assistant professor, SM and SPH.
Loma Linda public health experts are concerned about the global tobacco epidemic, and their sense of responsibility extends beyond United States borders. They have turned their attention toward Southeast Asia, where tobacco use is a major growing health threat.
Consider Cambodia. In certain regions of the country in recent years, 35 percent of the people smoke (66 percent of males and 8 percent of females), according to Ministry of Health estimates.
Because of political unrest in past decades and its effect on the educational system, until recently, Cambodia had no tobacco control leaders highly qualified for research and scientific publishing. Neither did neighboring Lao People’s Democratic Republic.
Why does that matter? Because fighting big tobacco takes expertise and resources. To receive global anti-tobacco funding, developing countries must have trained health professionals who can write grants, conduct research, publish results, and network effectively with other world health leaders.
“There is very little in-country money for tobacco control projects in Laos and Cambodia because priorities in very low-income governments are not heavily health-focused,” says Linda Hyder Ferry, MD, MPH, associate professor in the School of Public Health and School of Medicine.
Furthermore, without the understanding that epidemiologic research provides, the severity of local tobacco prevalence, related diseases, and death rates are unknown.
“They had no reliable e
LLU Chancellor Richard Hart, MD, DrPH, offers LLU gift items to Souvankham Phommaseng, MD, during the group’s visit to Loma Linda University this summer.
stimate of how big a problem tobacco dependence was, and as a result, there were limited public health policies, such as clean indoor air laws, in these countries,” Dr. Ferry says.
So LLU researchers have been training health professionals in Cambodia and Laos to address tobacco use by improving their knowledge base about statistics, epidemiology, health behavior change, public health ethics, research skills, and grant writing.
Now, 14 health professionals are better armed to fight tobacco problems in their countries after completing LLU’s 28-unit graduate certificate program titled “Global Tobacco Control Methods” in 2005.
Professors from the LLU School of Public Health (and one from the Faculty of Religion) taught the courses, which were held periodically over the last two years in Phnom Penh, Cambodia. The six trainees from Laos would fly to Phnom Penh and join the trainees from Cambodia for the two-week sessions.
Chhordaphea Chhea, MD, of Cambodia, joined the program because of her self-described “hunger for knowledge and skills related to tobacco control.” She works in the tobacco control division of the National Center for Health Promotion of Cambodia’s Ministry of Health.
Souvankham Phommaseng, MD, who works with the department of hygiene and prevention for the Ministry of Health in Laos, says “This program is very important for my work, because in my country there is very poor knowledge about this.”
Like Drs. Chhordaphea and Phommaseng, most of the 14 trainees are physicians, several of whom work in government health positions.
“We have learned not only research methodology, but also how to write a proposal, how to publish the results, even how to be a good manager,” explains Maniphanh Vongphosy, MD, MPH, health program coordinator for the Laos branch of the nongovernment organization Adventist Development and Relief Agency (ADRA).
During their training, the participants helped create and implement two important research projects. One of these, a national prevalence study of tobacco use and health beliefs in Cambodia, was the first study to include all of the nation’s 22 provinces.
A similar study of Laos is planned. One reason this will be important is that policy makers in Laos are more impressed when they have local evidence of tobacco’s impact.
The LLU certificate course represented the first of two phases in a five-year program funded by the National Institutes of Health Fogarty International Centre. The program is a joint effort between LLU, ADRA, and the ministries of health in Laos and Cambodia. It is motivated in part by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), an international treaty and partnership that exists to lower deaths and disease caused by tobacco.
“Because the WHO FCTC was ratified last year, the timing was imperative for these countries to have leaders in their ministries of health who are highly skilled in developing tobacco control policies, giving advice on health issues, and conducting research surveys,” says Dr. Ferry.
The second and current phase of the Laos/Cambodia project further coaches the participants to develop tobacco-control leadership skills. It focuses on policy-making and additional independent research projects. The program’s culminating enterprise will require the trainees to develop five-year tobacco control research plans for Laos and Cambodia, including the capability to acquire outside funding.
A second supplemental three-year National Institutes of Health research grant for Laos began this year that will build on what was learned from the Cambodia prevalence study. The trainees will develop a revised questionnaire that can be used to assess the number of people who use various forms of tobacco in that diverse, multi-ethnic population, and their views about tobacco’s health effects.
The results will give these local government leaders the information about the health risks to their population that they need to implement effective anti-tobacco health messages and new policies appropriate for their culture. When they visited rural villages, they observed that a large number of women smoke pipe tobacco and chew. This new research project will give them the tools to describe these practices more accurately.
Some of the trainees have been able to attend and present at international tobacco control conferences during the last few years, including four who were awarded travel scholarships to attend the 13th World Conference on Tobacco OR Health (WCTOH), held this past July in Washington D.C. Three of the four were then guests at a Seventh-day Adventist tobacco control summit that followed on the WCTOH’s heels.
“This opportunity to meet other tobacco researchers from around the world was enriching and educational for them, and it was their first trip to the United States,” says Dr. Ferry.
Before returning to Southeast Asia, the four who attended WCTOH visited LLU for the first time, receiving four days of additional leadership training and research skill development. They were interviewed about their research on the Loma Linda Broadcasting Network on their final day on campus.
“We were glad and happy when we were there. It seemed we were visiting our own university,” says Dr. Vongphosy.
In addition to Dr. Ferry, the following LLU faculty participated in this program: Pramil Singh, DrPH; Emmanuel Rudatsikira, MD; Jayakaran Job, MD, DrPH; Susanne Mont-gomery, PhD; Jerry Lee, PhD; Floyd Petersen, MPH; Siroj Sorajjakool, PhD; and Synnove Knutsen, MD, PhD.
Editor’s note: Linda Hyder Ferry, MD, MPH, contributed to this article.
By Heather Reifsnyder