Focus on Primary Prevention: A European Example of Prevention Strategies in the Digital Era

The era of communication we’re living has shrunk the world to a global village: digital reality is characterized by a constant stream of knowledge, and Internet articles are predominating over newspapers, radio and television. Therefore, for non-professionals, building a robust expertise on the access to information technologies and knowing how to discern between real and fake news, are contemporary and controversial issues. In this confusing scenario, the importance of educating general public to prevention is unequivocal and can be considered an ethical mission at all levels: either as primary prevention initiatives on healthy lifestyles or as secondary ones as well, promoting adherence to the screening programs. For Patient Organizations, communication facilities represent a golden opportunity to become promulgators of correct information: a beacon of positivism in the darkness of a new digital middle ages.


Introduction
The era of communication we're living has shrunk the world to a global village: digital reality is characterized by a constant stream of knowledge, and Internet articles are predominating over newspapers, radio and television. Therefore, for non-professionals, building a robust expertise on the access to information technologies and knowing how to discern between real and fake news, are contemporary and controversial issues. In this confusing scenario, the importance of educating general public to prevention is unequivocal and can be considered an ethical mission at all levels: either as primary prevention initiatives on healthy lifestyles or as secondary ones as well, promoting adherence to the screening programs. For Patient Organizations, communication facilities represent a golden opportunity to become promulgators of correct information: a beacon of positivism in the darkness of a new digital middle ages.
According to this purpose, WALCE (Women Against Lung Cancer in Europe) aims at promoting communication strategies to raise public opinion awareness on smoking damages. WALCE is a no profit Organization based in Italy but networking at European level, founded in 2006 with the primary objective to increase women's awareness about the rising incidence and mortality of lung cancer in female population and to support patients affected by this disease, as well as their families. WALCE currently provides accurate and updated information on lung cancer in terms of prevention, diagnosis and treatment.
Lung cancer remains one of most lethal cancer. It has been reported that in 2012 around 270,000 people died from this disease in Europe and over one million die every year worldwide with an incidence still growing. Approximately 85% of lung cancer patients are smokers or former smokers: therefore, it is appropriate to state to not light the first cigarette (or tobacco cessation) is a valid and unexceptionable form of primary prevention. Consistent with those evidences, WALCE is promoting different awareness initiatives, targeted and tailored depending on recipients' age. Aimed at 9 to 11 year-old pupils, "I do not smoke it-We shall try to see things clearly in the smoky speeches" is an information campaign on smoking damages endorsed by the National Institute of Health, addressed by WALCE (for free) to the Italian Primary Schools, since 2011 ( Figure  1).

Figure 1
Using an educational kit (composed by entertaining and useful contents), teachers may promote, through this project, positive attitudes that deviate from the smoking habit and encourage a healthy lifestyle. In Italy, at the moment, over 20,000 pupils have joined the campaign. The book entitled "Ash of stars-Cinema, smoking habit and adolescents" has been conceived for teenagers (the most vulnerable part of society), analyzing the link between cigarette smoke scenes in recent movies and smoking habit. In opposition with other European countries, Italy lacks any legislation concerning the regulation of movies containing these type of scenes: WALCE advocates for introducing stricter rules to limit the access of young people to film containing unjustified smoke scenes and to counteract the improper use of cinema to advertise tobacco products.
This manual is a useful tool for teachers to set up prevention and awareness programs on cinematography, stimulating debates among students (Figure 2). WALCE pursues the approach to primary prevention "in the field" through "Go out of the Tunnel. Don't burn away your future", a smoking prevention campaign addressed to general public, media and political institutions, and endorsed by the Italian Parliament (Figure 3). This program consists of a structure shaped as a giant cigarette committing Pulmonologists and Oncologists for performing counselling, displaying educational materials on smoking cessation and providing a basic spirometry test to attending people (Figure 4). In Italy "Go out of the Tunnel" has been organized as a roadshow and during 2015, 2016 and 2017 (from the period of the World No-Tobacco Day, in May, until November, Lung Cancer Awareness Month) has toured 9 major Italian cities (Turin, Bari, Milan, Padua, Lecce, Messina, Palermo, Ravenna and Rome) ( Figure 5). Over 15,000 people visited the Tunnel, involving groups of heterogeneous ages: young people, adults and elderly; more than 3,000 spirometries have been made. In addition, the former Italian Minister of Health, Hon. Beatrice Lorenzin, attended the event in Rome, in 2015.    At European level, in occasion of the World No-Tobacco Day 2017, a 2-day Tunnel exhibition, focused on primary prevention and smoking cessation, took place in Place de la Monnaie in Brussels. As a result, 450 spirometries have been performed and 600 people of any age, mainly smokers, joined the Tunnel asking for information on smoke-related diseases and smoking cessation programs. There is a lack of knowledge in the general population about respiratory functionality tests or concerning different diseases related to smoking attitude: most people entering in the big tunnel did not know that every day 3.1 million people die due to Chronic Obstructive Pulmonary Disease, being smoke the major cause. The campaign also captured the attention of local television broadcaster and journalists. In November 2017, in concomitance with the Lung Cancer Awareness Month, WALCE organized a smoking cessation campaign addressed to pregnant women, entitled "Hope it's the last one", supported by a useful tool dedicated to the newborn child: "Ector the Protector Bear", a teddy bear that coughs when exposed to cigarette smoke ( Figure 6). In parallel, a counseling service was offered by Gynecologists and Pulmonologists, to promote smoking cessation and healthy lifestyles.
Despite several improvements in the diagnostic workup and in therapeutic strategies for lung cancer, this disease remains one of the big killers in oncology mainly because of its correlation with smoking habit. Investments in designing and performing primary prevention campaigns across Europe are urgently needed and Advocacies are among the main actors in this scenario. In the personalized medicine era a personalized prevention approach is also needed taking into account that awareness advertisings could not be the same in adolescents, young people, adult smokers, male and female and WALCE aims to promote the proper message to the proper population subgroup.

Journal of Tumor Medicine & Prevention
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