Area Of Tobacco Control Research Articles

Diffusion of smoke-free policies at outdoor sports clubs in the Netherlands

Abstract Background Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke-free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands, which may inform national strategies aimed at making all outdoor sports clubs smoke-free. Methods Using a retrospective, registry-based design, an inventory was made of football, field hockey, tennis, and korfball clubs that became smoke-free between 2016-2020. We determined the type of sports, number of members, and proportion of youth members. The degree of urbanization and density of smoke-free sports clubs were measured at the municipality level. The association between sports clubs’ characteristics, degree of urbanization, and SFP adoption was analysed using multilevel regression analysis. Horizontal diffusion was tested by analysing the association between the density and annual incidence of smoke-free sports clubs. Results Since 2016, the number of sports clubs with an outdoor SFP increased from 0.3% to 26.4%. Field hockey [OR compared to football 6.00 95% CI 4.46-8.07] and korfball clubs [OR 6.65 95% CI 4.98-8.87] and clubs with many (youth) members [OR 8.75 95% CI 6.20-2.35] were more likely to be smoke-free. SFPs spread from the most urbanized to less urbanized municipalities, which could mostly be attributed to sports clubs’ characteristics. A higher density of smoke-free sports clubs within municipalities was associated with an increased incidence of new SFPs in the following year. Conclusions Outdoor SFPs at sports clubs in the Netherlands diffused across horizontal and hierarchical lines. National strategies for smoke-free sports should monitor clubs that are more likely to stay behind, such as football and tennis clubs, smaller clubs, and clubs in less urbanized areas.

Diffusion of smoke-free policies at outdoor sports clubs in the Netherlands

BackgroundAlthough outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke free. This study aims to assess...

Smoke-Free Sports in The Netherlands: Why Most Sports Clubs Have Not Adopted an Outdoor Smoke-Free Policy

Background: Outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, as many people, including youth, spend a large portion of their free time participating in sports. Nevertheless, the majority of sports clubs worldwide still have not adopted an outdoor SFP. The aim of this study is to explore the perceptions of key stakeholders at different Dutch sports clubs concerning the adoption of an outdoor SFP. Methods: Semi-structured interviews were held with 41 key stakeholders at seven Dutch sports clubs (in field hockey, football, tennis, or korfball) without an outdoor SFP. A thematic approach was used to analyze the data. Results: The majority of respondents reported considerations that were favorable towards adoption of an outdoor SFP, including expected support from club members, changing social norms with regard to smoking, and few members who smoke. Most of all, respondents valued the protection of children from the harmful effects of smoking. However, they also foresaw a number of problems in case of adoption, including impaired social functioning of the sports club, problems with compliance and enforcement, conflict with smokers’ interest, and low priority in club management. Conclusions: Although stakeholders at sports clubs recognize the intrinsic value of an outdoor SFP, they foresee practical problems that are inherent to sports clubs. Adoption could be enhanced by articulating the importance of protecting children from the harmful effects of smoking, referring to ‘success stories’ at sports clubs that are already smoke-free, and actively involving smokers in the adoption process.

The impact of Brexit on oral health.

Introduction The United Kingdom (UK) left the European Union (EU) on 31 January 2020. Brexit will impact many sectors of the economy, including the dental sector.Methods and analysis This policy analysis evaluates UK and EU legislation and planning documents, as well as the published literature, to analyse the impact of two scenarios relating to the UK's exit from the EU on the dental sector: a free trade agreement based on the jointly agreed Political Declaration (the 'FTA') and a 'no-deal' scenario.Conclusion An FTA could cause price increases of medicines and medical devices, and cause some disruption to the ability of regulating authorities in this area, while a no-deal would additionally risk shortages of medicines and medical devices as well as more dramatic price increases. In both an FTA and a 'no-deal scenario', with EU law no longer applicable to the UK, more innovative policy in the area of tobacco control could be developed. An FTA could exacerbate existing workforce shortages and would likely cause a reduction in EU research funding, as well as posing issues with data transfers, with these all likely to be more severe under a no-deal scenario.

Corporations in global health: an investigation of food industry political activity at the WHO

Abstract Background With over ten million annual deaths now attributable to unhealthy diets, there is an urgent need for action, yet, political progress is too slow. Policy interference by major corporations is well documented in the area of tobacco control. Evidence shows similar behaviours by the food industry at country level, but global-level policymaking remains under-researched. Thus, this study explores how food industry actors seek to influence dietary non-communicable disease (NCD) policy at the World Health Organization (WHO). Methods We identified relevant industry documents from the Food Industry Documents Library and academic articles, using these initial findings and an existing model of corporate political activity as the basis for sixteen key informant interviews. Key industry strategies were identified in an iterative process of qualitative thematic coding. Additionally, food industry responses to five WHO consultations on NCD policy and governance (2015-2018) were analysed to explore how evidence was used. Results Food industry actors have substantial access to the WHO through formal routes. These interactions largely take place through business associations rather than individual companies, owing at least partly to the agency's own guidelines. Food industry actors can also access global-level policymaking indirectly, for example, by lobbying national political actors to adopt favourable positions in member state-led WHO decision-making, or by co-opting civil society. In consultation responses, the majority of evidence cited by commercial actors was either industry-linked or industry-funded, and less than half was peer-reviewed. Conclusions Focusing on the WHO's NCD agenda, we provide new insights into the ways food industry actors seek to influence global public health policy. Although their political behaviour bears similarities with that of the tobacco industry, multinational food companies are, in contrast, widely treated as part of the solution. Key messages By mapping how food industry actors seek to shape WHO policy, this research adds to evidence from national contexts and highlights a need for better safeguards across levels of governance. While the tobacco industry is prohibited from engagement with global NCD policy, multinational food corporations enjoy significant access and legitimacy, despite similarities in political behaviour.

Setting research priorities in tobacco control: a stakeholder engagement project.

Background and AimsThe Cochrane Tobacco Addiction Group (TAG) conducts systematic reviews of the evidence for tobacco cessation and prevention interventions. In 2016 TAG conducted a priority‐setting, stakeholder engagement project to identify where further research is needed in the areas of tobacco control and smoking cessation.DesignThe project comprised two surveys and a workshop. A range of stakeholders participated, including members of the public (smokers and ex‐smokers), clinicians, researchers, research funders, health‐care commissioners and public health organizations. The first survey phase identified unanswered research questions in the field of tobacco control. The second phase asked participants to rank these, with overall rankings calculated by combining scores across participants. The workshop allowed attendees to discuss prioritization of topics and questions in more depth. Workshop discussions were transcribed and analysed thematically, and a final voting activity at the close of the workshop allowed participants to choose topics to prioritize and to de‐prioritize.FindingsA total of 304 stakeholders (researchers, health professionals, smokers and ex‐smokers, guideline developers, research funders and policymakers, representing 28 countries) identified 183 unanswered research questions. These were categorized into 15 research categories. A total of 175 participants prioritized categories and questions in the second survey phase, with ‘electronic cigarettes’; ‘addressing inequalities’; and ‘mental health and other substance abuse’ prioritized as the top three categories. Forty‐three stakeholders attended the workshop and discussed reasons for and against category prioritization. Prioritized research categories largely mirrored those in the survey stage, although ‘treatment delivery’ also emerged as a key category. Five cross‐cutting themes emerged: efficacy; relative efficacy; cost effectiveness; addressing inequalities; and different types of evidence.ConclusionsThere are many unanswered questions in the field of tobacco control. Stakeholders highlighted electronic cigarettes, addressing inequalities and mental health and other substance abuse as key areas for further research, and efficacy, relative efficacy, cost‐effectiveness and use of non‐randomized studies as important themes cutting across research areas. Future prioritization work would benefit from targeting non‐US and non‐UK stakeholders explicitly and from examining where priorities may differ based on stakeholder group.

Network analysis of global tobacco control collaboration: data from the World Conference on Tobacco or Health (WCTOH)

BackgroundThe World Conference on Tobacco or Health (WCTOH) is held every three years to foster communication and collaboration on global tobacco control. Very little is known about the nature of interactions between WCTOH attendees and their linkages to tobacco control organizations, so knowing this information could help improve tobacco control efforts.MethodsAt the 2015 WCTOH, we implemented an online survey to assess barriers to global tobacco control activities, which information sources they use for tobacco control information, and with whom they interact regarding tobacco control.ResultsA total of 169 respondents completed the survey, with responses from all six World Health Organization (WHO) regions. Respondents worked in all areas of tobacco control; the most common were research (29.2%) and patient care/treatment (23.3%). The top barriers faced regarding tobacco control activities were: funding is weak (56.8%), government commitment (45.0%), tobacco industry interference (43.8%), and lack of coordination (34.3%). The network analysis identified Framework Convention Alliance (FCA) and Society for Research on Nicotine and Tobacco (SRNT) as the two most prominent groups that people belonged to and where they went to exchange information and best practices. Important regional and country specific groups also appear to be growing, such as the African Tobacco Control Alliance (ATCA) and the Argentinian Association of Tabacology (ASAT).DiscussionMapping and better understanding the global tobacco control network is important for informing knowledge exchange and best practices, particularly as increasing attention is being focused on global tobacco control efforts in low- and middle-income countries in particular.ConclusionsThe present study demonstrates that even a subsample of the WCTOH shows considerable collaboration. The full WCTOH network should be mapped in order to foster greater collaboration that has the the potential to improve global tobacco control efforts.

Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.

Tobacco-free but not tobacco industry free

In recent years a movement has spread across the USA to designate colleges 100% tobacco-free in an effort to reduce tobacco use and exposure to tobacco marketing among college students....

Economic policy - Public health linkage and the importance of a regional platform: The case of tobacco control.

Southeast Asia has been the source of some recent encouraging developments on the health front, particularly in the area of tobacco control. In December 2012, the Philippines passed a landmark sin tax legislation that restructures the decade-old tax system for tobacco and alcohol products, updates the tax rates and indexes them for automatic increases, and earmarks its incremental proceeds for universal health financing. In August 2013, Malaysia proposed to exclude tobacco from the Trans-Pacific Partnership Agreement (TPPA), a bid to protect tobacco control measures from any state-to-state or investor–state challenge. Earlier in July 2012, it was reported that Health Ministers of the Association of Southeast Asian Nations (ASEAN) agreed to withdraw tobacco from the ASEAN Free Trade Agreement (AFTA). While their actual Joint Statement made no mention of trade, the language referring to tobacco control was clear (ASEAN, 2012).

Public Support for Family Smoking Prevention and Tobacco Control Act Point-of-Sale Provisions: Results of a National Study.

We assessed public and smoker support for enacted and potential point-of-sale (POS) tobacco-control policies under the Family Smoking Prevention and Tobacco Control Act. We surveyed a US nationally representative sample of 17, 507 respondents (6595 smokers) in January through February 2013, and used linear regression to calculate weighted point estimates and identify factors associated with support for POS policies among adults and smokers. Overall, nonsmokers were more supportive than were smokers. Regardless of smoking status, African Americans, Hispanics, women, and those of older ages were more supportive than White, male, and younger respondents, respectively. Policy support varied by provision. More than 80% of respondents supported minors' access restrictions and more than 45% supported graphic warnings. Support was lowest for plain packaging (23%), black-and-white advertising (26%), and a ban on menthol cigarettes (36%). Public support for marketing and POS provisions is low relative to other areas of tobacco control. Tobacco-control advocates and the Food and Drug Administration should build on existing levels of public support to promote and maintain evidence-based, but controversial, policy changes in the retail environment.

Critical Ethnography: A Useful Methodology in Conducting Health Research in Different Resource Settings

Over the years, many policies have been implemented across nations to prevent, reduce and tighten enforcement on smoking and tobacco use. However, despite all of the major initiatives, smoking related deaths and diseases still remain high and present a major challenge for many nations of the world. In this paper we argue that conducting a critical ethnography study in different settings, as this research sets out to do (in Nigeria) is a first step to understanding the tobacco control policies that will work effectively in different resource settings. As the act of smoking becomes global, it is beneficial to study the effect of specific methods, methodology and policies in addressing smoking in the population. This paper is one of three on the study of public health challenge of smoking in Nigeria, and explains the method used in collecting and analyzing data. The research was undertaken and analyzed through a critical ethnography lens using critical realism as a philosophical underpinning. In the study we relied upon the following components: original field work in Nigeria which includes participant observation of smokers, in-depth interviews and focus groups with smokers, and in depth interviews with health professionals working in the area of tobacco control in Nigeria.

Tobacco and International Trade: Recent Activities of the FCTC Conference of the Parties

The article analyses three recent proposals made by the State-Parties to the Framework Convention on Tobacco Control (FCTC), which appears to be relevant for determining the relationship between trade and health rules in the area of tobacco control. In this context, it attempts to answer the following questions: (i) what is the legal status of decisions made by the Conference of the Parties (COP) to the FCTC?; (ii) how does a COP decision (or any applicable provision of the FCTC) affect the mandate of WTO dispute settlement bodies to hear and decide WTO cases?; and (iii) to what extent can a COP decision (or any applicable provision of the Convention) require FCTC State-Parties to exclude tobacco and tobacco products from their future Preferential Trade Agreements (PTAs). The article comes to the conclusion that COP decisions lack any binding character, while provisions of the Convention do not affect the jurisdiction of WTO panels to hear complaints concerning potential violations of WTO law nor require carving out tobacco products from PTAs.

Integration of tobacco control in Masters of Public Health curricula of India.

Tobacco is the single largest cause of preventable death among adults globally, as it is in India. Despite this alarming situation, there is very minimal inclusion of tobacco in formal education systems, including the medical discipline, in India. The present study analyzed the extent of integration of tobacco control related content in Masters of Public Health (MPH) curricula of various institutes in India. This cross-sectional study was conducted during January 2011 to May 2011 in all colleges of the country offering a MPH course. The colleges were enlisted using various internet search engines (Google Scholar, Pubmed, Medline), other published literature and snowball technique. A 50 items semi-structured questionnaire was designed, posted and e-mailed (followed by hard copy) to the Person-In-Charge of the MPH program. Descriptive statistics were used to profile the tobacco control content in respective institutions. All data entry and analysis was conducted using SPSS (version 16) for windows. The duration of the MPH course was two years in all institutes and had accreditation with some affiliated body. Tobacco related diseases were covered under 'non communicable diseases' section by every institute. However, a mere 41.4% of institute's had faculty who had received specialized training in tobacco control. More coverage was given to health risks and effects of smoking as compared to cessation interventions (5 A's), symptoms of withdrawal and pharmacological treatments. Only 25% of institutes were in process of introducing tobacco courses into their curricula. Lack of expertise and administrative barriers were cited as perceived major problems in inclusion of tobacco control in MPH curricula. It can be concluded that tobacco control is not receiving adequate attention in public health curricula in India. There is a need for coordinated efforts in the area of tobacco control so as to reduce morbidity and mortality from tobacco induced diseases.

Critical realism: a practical ontology to explain the complexities of smoking and tobacco control in different resource settings

BackgroundThis paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex.MethodsThe research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria.ResultsFindings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking.ConclusionThis paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.

Developing Leaders in Priority Populations to Address Tobacco Disparities

Few published evaluations documenting the results of community health leadership programs exist. Furthermore, few leadership programs specifically address cross-cultural issues or priority populations, and none have focused on the area of tobacco control. The goal of the evaluation was to determine the effectiveness of the Leadership and Advocacy Institute to Advance Minnesota's Parity for Priority Populations Institute. Institute Fellows were recruited from 5 priority populations, including African/African American, American Indian, Asian American, Chicano Latino and Lesbian, Gay, Bisexual, and Transgender. The Institute's impact on the acquisition and application of particular leadership skills was assessed, along with its impact in building priority population capacity to engage in tobacco control activities. DESIGN AND MEASURE: Findings are based on mixed methods, including Fellows' completion of paper surveys prior, during, and post-Institute, and telephone interviews conducted post-Institute. Perceived skills increased in all areas assessed. Fellows reported applying specific skills acquired 16 months after the Institute. Furthermore, a high number of Fellows were more intensely involved in tobacco control work compared to baseline and reported involvement in cross-cultural collaborations or initiatives post-Institute. The Institute achieved both short-term and intermediate outcomes; skills were acquired during the Institute and sustained and applied in areas of tobacco control over 1 year later.

Integrating Genetic Studies of Nicotine Addiction into Public Health Practice: Stakeholder Views on Challenges, Barriers and Opportunities

Objective: Will emerging genetic research strengthen tobacco control programs? In this empirical study, we interview stakeholders in tobacco control to illuminate debates about the role of genomics in public health. Methods: The authors performed open-ended interviews with 86 stakeholders from 5 areas of tobacco control: basic scientists, clinicians, tobacco prevention specialists, health payers, and pharmaceutical industry employees. Interviews were qualitatively analyzed using standard techniques. Results: The central tension is between the hope that an expanding genomic knowledge base will improve prevention and smoking cessation therapies and the fear that genetic research might siphon resources away from traditional and proven public health programs. While showing strong support for traditional public health approaches to tobacco control, stakeholders recognize weaknesses, specifically the difficulty of countering the powerful voice of the tobacco industry when mounting public campaigns and the problem of individuals who are resistant to treatment and continue smoking. Conclusions: In order for genetic research to be effectively translated into efforts to minimize the harm of smoking-related disease, the views of key stakeholders must be voiced and disagreements reconciled. Effective translation requires honest evaluation of both the strengths and limitations of genetic approaches.

Social, economic and legal dimensions of tobacco and its control in South-East Asia region

This paper examines the social, cultural, economic and legal dimensions of tobacco control in the South-East Asia Region in a holistic view through the review of findings from various studies on prevalence, tobacco economics, poverty alleviation, women and tobacco and tobacco control laws and regulations. Methods were Literature review of peer reviewed publications, country reports, WHO publications, and reports of national and international meetings on tobacco and findings from national level surveys and studies. Tobacco use has been a social and cultural part of the people of South-East Asia Region. Survey findings show that 30% to 60% of men and 1.8% to 15.6% of women in the Region use one or the other forms of tobacco products. The complex nature of tobacco use with both smoking and smokeless forms is a major challenge for implementing tobacco control measures. Prevalence of tobacco use is high among the poor and the illiterate. It is higher among males than females but studies show a rising trend among girls and women due to intensive marketing of tobacco products by the tobacco industry. Tobacco users spend a huge percent of their income on tobacco which deprives them and their families of proper nutrition, good education and health care. Some studies of the Region show that cost of treatment of diseases attributable to tobacco use was more than double the revenue that governments received from tobacco taxation. Another challenge the Region faces is the application of uniform tax to all forms of tobacco, which will reduce not only the availability of tobacco products in the market but also control people switching over to cheaper tobacco products. Ten out of eleven countries are Parties to the WHO Framework Convention on Tobacco Control and nine countries have tobacco control legislation. Enforcement of control measures is weak, particularly in areas such as smoke-free environments, advertisement at the point of sale and sale of tobacco to minors. Socio-cultural acceptance of tobacco use is still a major challenge in tobacco control efforts for the governments and stakeholders in the South-East Asia Region. The myth that chewing tobacco is less harmful than smoking tobacco needs to be addressed with public awareness campaigns. Advocacy on the integration of tobacco control with poverty alleviation campaigns and development programs is urgently required. Law enforcement is a critical area to be strengthened and supported by WHO and the civil society organizations working in the area of tobacco control.

A DISSENTING VIEW FROM ONE WHO HAS KNOWN BOTH NIDA AND NIAAA

A DISSENTING VIEW FROM ONE WHO HAS KNOWN BOTH NIDA AND NIAAA

El control del tabaquismo desde la perspectiva de la economía

This paper reviews the main arguments put forward from Economics in the area of tobacco control, and provides a detailed description of market failures from both the traditional perspective and recent literature advances. It concludes that smoking is a personal choice that can generate net welfare losses for the society, the smokers family and, above, all the smoker him(her)self. On these grounds there exists economic justification for correcting mechanisms. The article includes a discussion of two important preventive policies in the Spanish context: restrictions in bars and restaurants and tobacco tax hikes.