Comprehensive Tobacco Control Law Research Articles

An ecological study on MPOWER and smoking prevalence rate by Tobacco control law

Objectives: The Framework Convention on Tobacco Control (FCTC) is the first international convention in the public health field. This study examines whether countries have maximized the effectiveness of tobacco regulation by appropriately utilizing measures to reduce tobacco consumption and smoking rates. It studies the effectiveness of Tobacco control law policies in various countries. Methods: Using ecological and descriptive correlation, this study attempted to verify the correlation between the Tobacco control law, the measures that help countries reduce the demand for tobacco (MPOWER) and the smoking rate. Results: It was found that the Tobacco control law was related to lower smoking rates and higher levels of implementation of the MPOWER policy. The results showed that the performance of related MPOWER policies increased according to the category of the Tobacco control law. Conclusion: FCTC measures to reduce tobacco use are effective. Enacting and strengthening comprehensive Tobacco control laws is necessary for implementing more effective tobacco control policies.

Tobacco Control in Bolivia: Transnational Civil Society Efforts in Securing a Comprehensive Law.

To document the adoption of a comprehensive tobacco control law in Bolivia, a low-income country in South America. Analysis of the Bolivian case study by reviewing news sources, tobacco control legislation, industry websites, and advocacy reports. Application of the Policy Dystopia Model to analyze tobacco industry and health advocacy arguments and action-based strategies. For decades tobacco control progress in Bolivia remained relatively stagnant due to industry interference. In the 2000s and 2010s, Bolivia ratified the WHO Framework Convention on Tobacco Control (FCTC) and implemented a couple of laws that began restricting smoking in public places and tobacco advertising. In 2015, tobacco control civil society emerged with the creation of Fundación InterAmericana del Corazón (FIC) Bolivia, which began coordinating efforts to counter industry interference. Between 2016 and 2020, FIC Bolivia with financial and technical support from international health groups proactively coordinated interministerial meetings, identified and met with key policymakers, and held public educational socialization events to introduce and support a FCTC-based tobacco control bill. Tobacco companies argued to policymakers and the media the bill would result in lost sales/jobs, increase illicit trade and help smugglers profit but only secured minimal changes. In February 2020, Bolivia passed Law 1280, which established 100% smoke-free environments, banned tobacco advertising (except at the point-of-sale), required 60% pictorial health warnings, among others. International financial and technical support combined with proactive advocacy strategies, including identifying and engaging key policymakers, coordinating interministerial meetings, and educating the public can help pass strong tobacco control laws, especially in low-income countries. Low- and middle-income countries struggle to adopt comprehensive tobacco control legislation due to weak state capacity, limited resources, and aggressive tobacco industry interference. This is one of a handful of studies to examine the adoption of a comprehensive tobacco control law in a low-income country, Bolivia. Proactive health advocacy strategies, including identifying and engaging key political allies, helping coordinate interministerial meetings, and aggressively educating and engaging the public can help pass strong tobacco control laws, especially in low-income countries.

Legislation Related to E-Cigarettes in The Gulf Cooperation Council Countries

Even though 90% of the world’s population is covered by the World Health Organization’s Framework Convention on Tobacco Control, it is estimated that only one-fifth (21%) and half (49%) of the countries that ratified this convention will achieve the target of reducing tobacco use by 30 % among men and women respectively in 2025. Over the past decade, there has been an increasing trend in the use of electronic cigarettes or e-cigarettes for recreational use as well as smoking cessation. In concurrence with the increasing use of e-cigarettes among smokers of different age groups, nations have developed relevant national regulations on its sale, advertisement, packaging, product regulation, taxation, and surveillance. The countries of the Gulf Cooperation Council (GCC) region have also witnessed several legislations, at varying extent, related to the use of electronic cigarettes. However, the evidence on the use of electronic nicotine delivery systems remains scarce in the GCC region. Thus, further research on this emerging public health issue is warranted to generate the evidence necessary for the formulation of comprehensive tobacco control laws and effective prevention strategies.

Defending Comprehensive Tobacco Control Policy Implementation in Nepal From Tobacco Industry Interference (2011-2018).

Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law. Policy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM). The TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition. Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it. The PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.

Exceeding WHO Framework Convention on Tobacco Control (FCTC) Obligations: Nepal Overcoming Tobacco Industry Interference to Enact a Comprehensive Tobacco Control Policy.

The tobacco industry works to block, delay, and weaken national tobacco control legislation to implement the WHO Framework Convention on Tobacco Control (FCTC). This article reviews how Nepal overcame industry opposition and to a comprehensive tobacco control law implementing the FCTC. We triangulated newspaper articles and policy documents with key informant interviews. With the support of international health groups, local tobacco control advocates worked with policymakers in Nepal to pass a comprehensive tobacco control law that exceeded FCTC obligations. The tobacco industry exploited a time of political transition to block consideration by Parliament, arranged and sponsored foreign tours for legislators, made death threats to tobacco control advocates and their families, and argued for the economic importance of tobacco farms. Despite strong interference from Health, and Law and Justice ministers, a 2009 Supreme Court ruling helped tobacco control advocates secure a comprehensive tobacco control law in 2011 that included rotating pictorial health warning labels covering 75% of both sides of cigarette packages, 100% smoke free public places and workplaces, private homes and vehicles, and a tobacco advertising, promotion, and sponsorship ban. Advocates in developing countries should utilize Nepal's experience to reject tobacco industry offers of compromise and continue educating politicians and legislators to generate political support to pass a comprehensive tobacco control law. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak (the abstract in Nepali is available as a Supplementary Material). The tobacco industry exploited a time of political transition in Nepal in its effort to block comprehensive tobacco control policy in Parliament by sponsoring foreign tours of legislatures, making death threats to tobacco control advocates and their families, and arguing for the economic importance of tobacco farms. Tobacco control advocates used litigation to raise awareness and educate legislators and promote strong legislation with the involvement of international health groups. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak.

Effects of tobacco control policy on cardiovascular morbidity and mortality in Russia.

BackgroundAccording to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality.MethodThe study evaluated the TCL as an intervention in a natural experiment during the period 2003–2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes – hospital discharge rates (HDRs) and standardized death rates (SDRs) – were then compared to test for an impact associated with the TCL.ResultsPre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear.ConclusionThis study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable.

Frequency and duration of smoking scenes in Turkish movies

BACKGROUND: Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by the tobacco industry. Advertisement of tobacco products was banned on television, billboards and press media, but not on movie films. METHODS: To evaluate the frequency and duration of smoking in the movies, 60 most watched Turkish films which were on the vision during the second half of 2016 were determined for this descriptive study. Two young males having a university degree were trained on the aim and methodology of the study. Then the two observers viewed the films independently and recorded smoking scenes or direct appearance of tobacco products on a standard form. RESULTS: There were tobacco products or smoking views in 36 (60%) out of total 60 movies. In these movies there were 4.75 times tobacco occurrences as an average (median 3). Average duration of smoking occurrences was almost 3.5 min (198 s). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. DISCUSSION: In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies are considered as kind of tobacco advertisement and promotion, which influences smoking behavior particularly the young people. Therefore, control and prevention of smoking occurrences in movies are important for the protection of children and young people to start smoking. Some health warnings and anti-tobacco messages may be placed in the movies, to reduce tobacco views in the movies.

ED12.02 Tobacco Control: The Turkish Experience

ED12.02 Tobacco Control: The Turkish Experience

OA17.06 Make the World Beautiful and Healthy by Making Your Country Smoke Free: Case Study between Iceland and Thailand?

Globally, 600,000 non-smokers die due to tobacco related diseases and health care cost for tobacco related diseases are soaring especially in developing countries.Cigarette smoke contains 69 known carcinogens out of 7000 chemicals causing various health problems in children and infants including ear infections, bronchitis, pneumonia, frequent and severe asthma attacks, sudden infant death syndrome and cancer. Secondhand smoke can cause coronary heart disease, stroke and various kinds of cancer including lung cancer in adult. 2006 U.S. Surgeon General Report clearly confirmed that there is no safe level of exposure to secondhand smoke. Therefore, there is a strong need for comprehensive smoke free law in reducing the burden of tobacco use in the world. Section not applicable. Iceland is a high income country with a long history of tobacco control. The comprehensive tobacco control law was passed in 1984 which included restriction on smoking in service areas of public and private buildings, premises of health care facilities, schools, workplaces, and in public transport whereas Thailand is an upper middle income country and once had a very high smoking rate (70 percent for male and around 5 percent for female) in early 1970. Smoking ban in movie theaters and buses ordinance was issued by Bangkok Metropolitan Administration I n 1976 followed by the comprehensive interventions including smoke-free areas by the royal Thai government in 1991. As a result, the smoking prevalence went down to 32 percent in Thailand but this still demonstrated that one in three adults in 1991. It was found that the role of government and different civil society organizations in implementing smoke free policies was significant in both countries in this review paper. Although both countries issued smoke free policies, there are still challenges on implementation. Iceland try to overcome the challenges by developing comprehensive system including investigation after complaint and allocating budget for enforcement. Thailand also implemented 100% Smoke-Free Hospitals with the compliance rate of 86.4 percent according to a research in 2010. Thailand established the Thai Health Promotion Foundation (ThaiHealth) in 2001 which allowed Thailand to implement comprehensive tobacco control measures in a sustainable way. ThaiHealth used knowledge generation, social mobilization and policy advocacy called tri-power strategy in achieving the success. This paper concluded that civil society initiative and continuing efforts on tobacco control which leads to adoption of comprehensive tobacco control law is the heart of the success of tobacco control in both countries.

The Development and Piloting of a Mobile Data Collection Protocol to Assess Compliance With a National Tobacco Advertising, Promotion, and Product Display Ban at Retail Venues in the Russian Federation.

BackgroundTobacco control policies that lead to a significant reduction in tobacco industry marketing can improve public health by reducing consumption of tobacco and preventing initiation of tobacco use. Laws that ban or restrict advertising and promotion in point-of-sale (POS) environments, in the moment when consumers decide whether or not to purchase a tobacco product, must be correctly implemented to achieve the desired public health benefits. POS policy compliance assessments can support implementation; however, there are challenges to conducting evaluations that are rigorous, cost-effective, and timely. Data collection must be discreet, accurate, and systematic, and ideally collected both before and after policies take effect. The use of mobile phones and other mobile technology provide opportunities to efficiently collect data and support effective tobacco control policies. The Russian Federation (Russia) passed a comprehensive national tobacco control law that included a ban on most forms of tobacco advertising and promotion, effective November 15, 2013. The legislation further prohibited the display of tobacco products at retail trade sites and eliminated kiosks as a legal trade site, effective June 1, 2014.ObjectiveThe objective of the study was to develop and test a mobile data collection protocol including: (1) retailer sampling, (2) adaptation of survey instruments for mobile phones, and (3) data management protocols.MethodsTwo waves of observations were conducted; wave 1 took place during April-May 2014, after the advertising and promotion bans were effective, and again in August-September 2014, after the product display ban and elimination of tobacco sales in kiosks came into effect. Sampling took place in 5 Russian cities: Moscow, St. Petersburg, Novosibirsk, Yekaterinburg, and Kazan. Lack of access to a comprehensive list of licensed tobacco retailers necessitated a sampling approach that included the development of a walking protocol to identify tobacco retailers to observe. Observation instruments were optimized for use on mobile devices and included the collection of images/photos and the geographic location of retailers. Data were uploaded in real-time to a remote (“cloud-based”) server accessible via Internet and verified with the use of a data management protocol that included submission of daily field notes from the research team for review by project managers.ResultsThe walking protocol was a practical means of identifying 780 relevant retail venues in Russia, in the absence of reliable sampling resources. Mobile phones were convenient tools for completing observation checklists discretely and accurately. Daily field notes and meticulous oversight of collected data were critical to ensuring data quality.ConclusionsMobile technology can support timely and accurate data collection and also help monitor data quality through the use of real-time uploads. These protocols can be adapted to assess compliance with other types of public health policies.

A qualitative study on a 30-year trend of tobacco use and tobacco control programmes in Islamic Republic of Iran.

We conducted in-depth interviews with key tobacco control policy-makers to explore their views and opinions of trends in tobacco use and the effectiveness of tobacco control programmes over the past 3 decades. A qualitative interview study was conducted in 2014 using a grounded theory approach. In-depth interviews were conducted with 86 key tobacco control policy-makers and data collection was based on principles of saturation. The core code "tobacco consumption and its control programme" was extracted and its related themes were listed. After review and classification by an expert panel, 9 categorized codes emerged. The final 31 codes were ordered according to their conceptual differentiations. Overall, tobacco consumption was constant over the past 3 decades; however it was increasing in females and young people and decreasing in older people; hookah consumption was increasing. A positive outcome is that tobacco use is now viewed negatively in the Islamic Republic of Iran, largely due to tobacco control programmes but the current situation is still not ideal and a comprehensive tobacco control law is needed.

Moving away from the comfort zone of tobacco control policies to the highest level of implementation

The year 2015 marked the 10th anniversary of the entry into force of the WHO Framework Convention on Tobacco Control (FCTC). Following this, in the same year, the 18th comprehensive national tobacco control law(s) was adopted in the WHO Eastern Mediterranean Region (EMR). Member countries of the EMR have come a long way in tobacco control legislation since the entry into force of the WHO FCTC, with 19 of the 22 countries now party to it (except Morocco, Palestine and Somalia). But has this legal movement really succeeded in changing the prevalence of tobacco use in the Region?

Opinions of Coffee-House Clients Two Years after Comprehensive Tobacco Control Law of Turkey (Ankara, 2011)

Opinions of Coffee-House Clients Two Years after Comprehensive Tobacco Control Law of Turkey (Ankara, 2011)

Effective smoke-free policies in achieving a high level of compliance with smoke-free law: experiences from a district of North India

BackgroundCompliance survey of smoke-free law is an effective means of measuring progress towards a smoke-free society. They also help policy makers to take action where strengthening measures are required. India...

Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India

Background:India enacted a comprehensive tobacco control law known as cigarettes and other tobacco products act (COTPA) in 2003. However, enforcement of the provisions under the law is still a matter of concern. Compliance survey is an effective tool to measure the status of implementation of the law at various public places. Smoke-free hospital campus demonstrates commitment to good health and sends a pro-healthy signal to the community.Objective:The objective of this study was to assess the compliance to the prohibition of smoking at public places (under section-4 of COTPA) in a tertiary health-care institution in a smoke-free city of India.Materials and Methods:An observational cross-sectional study was conducted at 40 different venues within a tertiary health-care institution in a smoke-free city of India. These places were observed for certain parameters of assessment by a structured checklist, which included evidence of active smoking, evidence of recent smoking, display of signages, presence of smoking aids, cigarette butts and bidi ends.Results:Overall compliance rate for section-4 of COTPA was found to be mere 23%. Evidence of active smoking was observed in 21 (52.5%) venues. Signages were seen at only 8 places (20%). Butt ends and other smoking aids were seen in 37 (92.5%) and 26 (65%) places respectively.Conclusion:These dismal findings suggest non-compliance to the provisions under COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

Tobacco smoking using Midwakh is an emerging health problem--evidence from a large cross-sectional survey in the United Arab Emirates.

IntroductionAccurate information about the prevalence and types of tobacco use is essential to deliver effective public health policy. We aimed to study the prevalence and modes of tobacco consumption in the United Arab Emirates (UAE), particularly focusing on the use of Midwakh (Arabic traditional pipe).MethodsWe studied 170,430 UAE nationals aged ≥18 years (44% males and 56% females) in the Weqaya population-based screening program in Abu Dhabi residents during the period April 2008–June 2010. Self-reported smoking status, type, quantity and duration of tobacco smoked were recorded. Descriptive statistics were used to describe the study findings; prevalence rates used the screened sample as the denominator.ResultThe prevalence of smoking overall was 24.3% in males and 0.8% in females and highest in males aged 20–39. Mean age (SD) of smokers was 32.8 (11.1) years, 32.7 (11.1) in males and 35.7 (12.1) in females. Cigarette smoking was the commonest form of tobacco use (77.4% of smokers), followed by Midwakh (15.0%), shisha (waterpipe) (6.8%), and cigar (0.66%). The mean durations of smoking for cigarettes, Midwakh, shisha and cigars were 11.4, 9.3, 7.6 and 11.0 years, respectively.ConclusionsSmoking is most common among younger UAE national men. The use of Midwakh and the relatively young age of onset of Midwakh smokers is of particular concern as is the possibility of the habit spreading to other countries. Comprehensive tobacco control laws targeting the young and the use of Midwakh are needed.

P1-170 Tobacco use among UAE nationals

IntroductionTobacco use is a major public health problem worldwide yet it is not well-studied in the UAE. We aimed to study the prevalence and patterns of tobacco consumption among UAE...

WHO framework convention on tobacco control and its implementation in South-East Asia region

The birth of the WHO Framework Convention on Tobacco Control (WHO FCTC) took place in response to the global tobacco epidemic and it became the most important global tobacco control instrument. Duly recognizing tobacco use as an important public health problem and in the wake of rising prevalence of and mortality related to tobacco use, almost all Member States of the South-East Asia Region signed and ratified the WHO FCTC. Following the ratification, Member countries have enacted comprehensive national tobacco control laws and regulations. Most countries have covered some important provisions, such as tax and price measures, smoke-free places, health warnings, a ban on tobacco advertising and promotion, and a ban on tobacco sales to minors. In spite of innumerable constraints and challenges, particularly human, infrastructural and financial resources, Member countries have been doing their best to enforce those legislations and regulations as effectively as possible. In order to educate the general public on the harmful effects of tobacco, mass health campaigns have been organized which are being continued and sustained. However, some of the important areas that need attention in due course of time are tax raises, illicit trade, tobacco industry interference and alternate cropping systems. All Member States in the Region are striving harder to achieving the goals and provisions of the Framework Convention through actively engaging all relevant sectors and addressing the tobacco issue holistically, and thus protecting the present and future generations from the devastating health, social, economic and environmental consequences of tobacco consumption and exposure to tobacco smoke.

Prevalence and Psychosocial Correlates of Current Smoking Among Adolescent Students in Thailand, 2005

This article examines the prevalence of current smoking and associated psychosocial correlates and whether these correlates differ by sex among adolescent students in Thailand. Data were analyzed from the Thailand Global Youth Tobacco Survey (GYTS), a school-based, cross-sectional survey conducted in 2005 and completed by Mathayom 1, 2, and 3 (U.S. seventh through ninth grades) students. Weighted prevalence estimates of the percentage of students who were current smokers (smoked on ≥ 1 day during the past 30 days) and noncurrent smokers were calculated for the sample and for each psychosocial variable. Separate logistic regression models were calculated for males and females to examine the independent association of the psychosocial correlates of current smoking. Significant correlates for both males and females included close peer smoking, secondhand smoke exposure, being offered a free cigarette by a tobacco industry representative, and belief that smoking is not harmful. These correlates are examined in the context of comprehensive tobacco control laws in Thailand.