Bill & Melinda Gates Foundation Position Description

Title: Senior Program Officer, Tobacco

Summary:
The Senior Program Officer will take a leadership role on the scientific, research, policy and prevention strategies for global tobacco control within the Global Health Strategies Division. The foundation will work with a number of global partners to assist them in reducing consumption of tobacco in the poorest countries. This is an exciting opportunity to shape the foundation strategy and develop and manage a portfolio of grants for global tobacco control.

Responsibilities:
Research and analysis:
Identify new and promising areas of research targeted at filling key gaps in global tobacco control knowledge around key interventions.
Assist other team members in reviewing and creating grants and contracts that have a high level of research or analytics requiring special skills in this area.
Provide technical input into and actively participate in meetings, conferences, convenings that are technical in nature, and provide programmatic and policy expertise on global tobacco control strategies for developing world.
Take the lead in reviewing Letters of Inquiry (LOI) and proposals that have a research, economic analysis and policy orientation and work with grantees on developing country based strategies for tobacco control and prevention.
Perform literature reviews and analyses resulting in evidence-based recommendations on program design and methods.

Change agent functions:
Manage partnerships and relationships to achieve desired impact of grants, for example by conducting site visits, convening meetings of key stakeholders, and by developing and managing monitoring and evaluation components for grants.
Write and produce informative briefings and other materials on key issues for Global Health team members and foundation leadership.
Attend meetings, conferences and convenings that provide opportunities for shaping the tobacco control agenda at global and country levels.
Search for opportunities to disseminate the knowledge and products developed by grantees in order to leverage and expand their influence.

Grants and contracts management:
Conceptualize and articulate strategies for refining, researching or assessing promising areas for reducing morbidity and mortality from tobacco use in the developing world.
Manage a substantial portfolio of grants and contracts in global tobacco control and prevention.
Collaborate with team members to manage internal grant processes, portfolio progress, and grant budget planning and reporting.

Qualifications:
We are looking for an individual, with strong policy and programmatic experience including scientific data analysis and report writing skills. The successful candidate will have an MPH, MD or PhD in public health or health policy or a related field. The ideal candidate will also have lived and worked in developing countries of the world and have an appreciation for the complexities of implementing country based strategies for tobacco control in resource poor settings.
Over ten years of extensive research and field experience in the developing world or experience in domestic tobacco control programs is ideal.
Demonstrated excellence in policy analysis, scientific writing and data analysis, written and oral communication skills and experience communicating with a broad and diverse audience.
Experience in grant making is desirable.
Experience in a role requiring collaboration in complex internal and external organizations, as well as a demonstrated ability to work with efficiency and diplomacy, flexibility and a sense of humor, particularly as part of a team effort.
History of involvement and commitment to global tobacco issues.
Ability to travel up to 30% domestically and internationally.

Reports to: Deputy Director for Access and Delivery in Global Health Strategies To apply for this position, please visit
www.gatesfoundation.org/AboutUs/Jobs
and submit your resume online.
We are an equal opportunity employer dedicated and focused on diversity.

The association between exposure to environmental tobacco smoke and breast cancer: A review by the California Environmental Protection Agency.
Miller MD, Marty MA, Broadwin R, Johnson KC, Salmon AG, Winder B, Steinmaus C.
Prev Med. 2006 Oct 4; [Epub ahead of print]

BACKGROUND.: The California Environmental Protection Agency (Cal/EPA) recently completed a health effects assessment of exposure to environmental tobacco smoke (ETS) which resulted in California listing ETS as a Toxic Air Contaminant in January 2006. As part of the assessment, studies on the association between exposure to ETS and breast cancer were reviewed. METHODS.: Twenty-six published reports (including 3 meta-analyses) evaluating the association between ETS exposure and breast cancer were reviewed. A weight-of-evidence approach was applied to evaluate the data and draw conclusions about the association between breast cancer and ETS exposure. RESULTS.: The published data indicate an association between ETS and breast cancer in younger primarily premenopausal women. Thirteen of 14 studies (10 case-control and four cohort) that allowed analysis by menopausal status reported elevated risk estimates for breast cancer in premenopausal women, seven of which were statistically significant. Our meta-analyses indicated elevated summary relative risks ranging from OR 1.68 (95% C.I. 1.31, 2.15) for all 14 studies to 2.20 (95% C.I. 1.69, 2.87) for those with the best exposure assessment. CONCLUSIONS.: Cal/EPA concluded that regular ETS exposure is causally related to breast cancer diagnosed in younger, primarily premenopausal women and that the association is not likely explained by bias or confounding.

While most smokers are well aware that quitting can be an intense battle, many underestimate the severity of cravings and the role cravings play in putting them at risk for relapse.

A recent survey found that almost nine out of ten smokers (87 percent) who quit smoking started again because of everyday "situational cravings" and more than three quarters of smokers (80 percent) believe they could quit if they were able to get through their cravings.

"These survey findings are an important reminder that situational cravings can occur anytime and in any place a smoker associates with smoking," Dr. Raymond Niaura, professor of psychiatry and human behaviour at Brown Medical School said. "Situational cravings are triggered by events that the brain has associated with smoking and if left untreated, can cause a lapse to smoking in as quickly as 10-15 minutes."

According to Dr. Niaura, years of smoking cause an increase in the number of receptors in the brain which thrive on nicotine, essentially "re-wiring" a smoker's brain to crave nicotine. When the brain receptors stop getting nicotine they "call out" for it, something smokers then feel as a craving.

Many smokers may not fully understand their addiction and the effects of tobacco-delivered nicotine on the brain. The recent survey findings indicate that most smokers (67 percent) believe that sheer willpower is the way out of their smoking addiction with fewer than half aware of the brain chemistry behind it. Fifty-one percent admitted they were not sure or disagreed that smoking causes these changes in the brain that make it difficult to quit.

These attitudes may help to explain why among the smokers surveyed who have tried to quit smoking:

More than three-quarters (83 percent) have tried to quit by going "cold turkey," the least effective smoking cessation method

Less than half of smokers (47 percent) have tried therapeutic nicotine (gum, patch or lozenge), which has been shown to double chances of success versus cold turkey.

Studies have demonstrated that the administration of oral forms of therapeutic nicotine including Nicorette gum or Commit lozenge, can significantly reduce cravings within minutes and in those situations that remind someone of smoking.

Source: ASH Daily News and Medical News Today, 15 November 2006
Article link: http://tinyurl.com/yaqgjx

The role of smoking as a risk factor for rheumatoid arthritis was supported by several studies reported at the American College of Rheumatology's annual meeting.

Japanese researchers who undertook a meta-analysis of sixteen studies concluded that the strongest association between smoking history and Rheumatoid Arthritis (RA) occurred for Rheumatoid Factor positive men.

Swedish researchers found that current smokers had a higher risk of severe extra-articular manifestations of RA than non-smokers.

They speculate that smoking may have an impact on disease mechanisms in RA, including those leading to extra-articular disease.

Source: ASH Daily News + Medical News Today, 16 November 2006
Article link: http://tinyurl.com/scyxv

Columbia University Medical Center researchers are investigating whether common symptoms of attention deficit hyperactivity disorders (ADHD) could be causing people to smoke. If that is the case, will treatment for ADHD combined with the standard treatment to help people quit smoking -- the patch with counseling -- increase the quit rates for smokers trying to quit?

Lirio S. Covey, Ph.D., director of the Smoking Cessation Program at Columbia University Medical Center, is trying to find out.

Covey and her colleagues are recruiting smokers who have been diagnosed with ADHD or who may have symptoms of ADHD but have not yet been diagnosed, to be part of a study that will help them quit smoking. Approximately 7-8 million adults in the U.S. have ADHD. Smoking is twice as common in this population as in the general population.

Research has shown that most smoking in the U.S. occurs among people who have psychiatric conditions, such as alcohol or drug abuse, major depression, anxiety and ADHD. One line of research has shown that smokers with these conditions "self-medicate" their symptoms with nicotine, the primary addictive substance in tobacco.

Participants in the study will receive the nicotine patch, behavioral counseling, and a drug approved by the Food and Drug Administration for the treatment of ADHD called methylphenidate (brand name CONCERT|. Because methylphenidate and nicotine act on the brain in a similar way, the premise is that treatment with methylphenidate when trying to quit smoking may reduce symptoms of ADHD while also reducing tobacco withdrawal symptoms. These benefits together may lead to increased success in quitting.

"Nicotine seems to quell the symptoms for ADHD, but unfortunately the other ingredients in cigarettes and the act of taking in nicotine through the lungs makes it very bad for you," says Dr. Covey. Our hope is that we can affect some of the same receptors and transmitters activated by nicotine with this ADHD treatment so that smokers are relieved from their ADHD symptoms and are less likely to light up."

Sources: ASH Daily News and Medical New Today, 20 Nov 2006
http://www.medicalnewstoday.com/medicalnews.php?newsid=56822

NIH: State-of-the-Science Conference Statement: Tobacco Use: Prevention, Cessation, and Control

1. What Are the Effective Population- and Community-Based Interventions to Prevent Tobacco Use in Adolescents and Young Adults, Including among Diverse populations?

2. What Are the Effective Strategies for Increasing Consumer Demand for and Use of Proven, Individually Oriented Cessation Treatments, Including among Diverse Populations?

3. What Are the Effective Strategies for Increasing the Implementation of Proven, Population-Level Tobacco Use Cessation Strategies, Particularly by Health Care Systems and Communities?

Conclusions
Tobacco use remains a very serious public health problem. Coordinated national strategies for tobacco prevention, cessation, and control are essential if the United States is to achieve the Healthy People 2010 goals. Most adult smokers want to quit, and effective interventions exist. However, only a small proportion of tobacco users try treatment. This gap represents a major national quality-of-care problem. Many cities and states have implemented effective policies to reduce tobacco use; public health and government leaders should learn from these experiences.

Because smokeless tobacco use may increase in the United States, it will be increasingly important to understand net population harms related to use of smokeless tobacco. Prevention, especially among youth, and cessation are the cornerstones of strategies to reduce tobacco use. Tobacco use is a critical and chronic problem that requires close attention from health care providers, health care organizations, and research support organizations.

http://www.annals.org/cgi/content/full/0000605-200612050-00141v1