Framework Convention On Tobacco Control Research Articles

Tobacco Industry Engagement in the House of Commons Science and Technology Select Committee E-cigarettes Inquiry

Background: A now extensive literature has documented political strategies of healthharming industries (HHIs), but little is known about their engagement with Parliamentary select committees. Recent investments by trans-national tobacco corporations (TTCs) in electronic nicotine delivery systems (ENDS) has raised concerns that industry actors may be using these to re-engage policymakers in ways precluded by the Framework Convention on Tobacco Control (FCTC) Article 5.3. Methods: This article examines tobacco industry engagement with the House of Commons Science and Technology Committee (STC) inquiry into electronic cigarettes. It draws on a qualitative analysis of semi-structured interviews with committee members and support staff (n=4) triangulated against written and oral evidence submissions. Results: TTCs featured prominently in the STC inquiry via written and oral submissions. Opportunities existed for industry engagement, and potential influence, at each stage of the process. There was an absence of oral testimony from those sceptical about the potential health benefits of ENDS. The governance mechanisms in place for select committees appear inadequate for protecting committee work from industry influence. As it relates to TTCs, this has implications for the UK’s commitments under FCTC Article 5.3, yet understanding of the FCTC and the requirements of Article 5.3 compliance within the committee were limited. Conclusion: The governance of select committees requires urgent reform in order to balance norms of openness and participation with the need to protect their work from power of economic actors with conflicts of interest. This is particularly the case in relation to TTCs and adherence to FCTC Article 5.3. These findings are of relevance to other select committees whose work affects the interests of HHIs. Further research is needed on other committees and sectors.

Evaluation of Tobacco Tax Funding to Eradicate Illicit Cigarettes in Indonesia: A Qualitative Approach.

The illicit cigarette trade endangers public health because it increases access to cheaper tobacco products, hence fueling the tobacco epidemic and undermining tobacco control policies. The objective of this study was to evaluate the execution of an illicit cigarette eradication program under the jurisdiction of the local government in Indonesia. We sought to provide insights into the effectiveness of current policies and their impact on the illicit cigarette trade in line with the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) protocol to eliminate illicit trade in tobacco products. We conducted semistructured interviews with key policy-makers and semistructured FGDs with consumers and small- to medium-scale cigarette manufacturers at the district level. We indentified Pasuruan and Kudus as the districts or cities with the highest proportion of DBH CHT, and Jepara and Malang as a district with a highest illicit cigarette incident. We used reflective thematic analysis to identify the important opportunities and challenges facing illicit cigarette eradication programs in the three districts. We identified four opportunities and four challenges related to illicit cigarette eradication program implementation under the local government. The opportunities for illicit cigarette eradication lie in strong central government regulatory and multisectoral authority support, consumer awareness, and local governments' commitment to tobacco supply chain control. The key challenges facing illicit cigarette eradication include ineffective public dissemination programs, rapidly changing regulatory designs, consumers' preferences for illicit products, and a lack of industrial involvement in tobacco supply chain control programs. In addition to significant budget allocation and increasing consumer awareness, local programs to eradicate illicit cigarette production require considerable evaluation to rethink the program's design and external stakeholders' engagement within the local government's scope.

The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico.

The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

Exposure to second-hand smoke and risk of lung cancer among Iranian population: A multicenter case-control study.

Despite the implementation of the WHO Framework Convention on Tobacco Control (FCTC) program in Iran, the regulation of second-hand smoke (SHS) exposure-an often-overlooked hazard-, still requires improvement. We employed a multi-center case-control study to investigate the association between exposure to secondhand smoke (SHS) from various tobacco products (cigarettes, water-pipes, pipes, and chopogh), opium use, and the risk of lung cancer. We included 627 lung cancer cases and 3477 controls. Exposure to SHS tobacco and SHS opium was collected through a questionnaire. We used mixed-model logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CI). Among the overall population exposed to second-hand tobacco smoke (SHTS), the odds ratio (OR) compared to those never exposed was 1.35 (95% CI: 1.08-1.71). Never smokers who were ever exposed to second-hand tobacco smoke (SHTS) had 1.69-fold risk of lung cancer compared to those who were never exposed (95% CI: 1.13-2.52). Exposure to SHTS between 2-3 per day (OR = 2.27, 95% CI: 1.13-4.53) and more than three hours per day (OR = 2.29, 95% CI: 1.20-4.37) can increase the risk of lung cancer compared with the no exposure group (P-trend <0.01). We did not observe any association between exposure to second-hand opium smoke (SHOS) and the risk of lung cancer, either in the overall population or among never-smokers. Our study estimates the impact of second-hand tobacco smoke (SHTS) on lung cancer risk in both the overall population and never-smokers. Additional studies are required to evaluate the association between exposure to second-hand smoke from opium and other type of tobacco, including water-pipe and the risk of lung cancer.

Are Tobacco Companies in Nigeria Complying With Health Warning Label Regulations on Cigarettes and Other Tobacco Products?

BACKGROUND: Nigeria has approved 50% coverage of text and images of pictorial health warning labels (PHWLs) on packages of cigarettes and other tobacco products such as cigars, smokeless tobacco, and loose tobacco. While there is knowledge on the extent to which LMICs like Nigeria adopt the WHO Framework Convention of Tobacco Control (FCTC), there is need to examine the compliance with adopted packaging and labeling policies to generate knowledge for strengthening existing policies and efforts at enforcement. We assessed agreement with FCTC regulations as well as compliance with Nigerian requirements which are not adequate and do not effectively capture all FCTC requirements to identify the gaps being explored by these companies in an environment of poor regulation in Lagos, Nigeria. METHODS: This descriptive study was conducted in Lagos State, Nigeria, from October 2022 to January 2023. A multistage random sampling method was utilized. Four local government areas (LGAs) with a combined population of 16 million, accounting for 70% of the population in Lagos, Nigeria were selected while three points‑of‑sale were randomly picked from two selected wards in each LGA. Empty discarded packs of cigarette and other tobacco products were collected from these outlets. The pack dimensions were measured and assessed for PHWLs, health warning manipulations and cessation assistance. Findings were assessed for compliance with the FCTC and national legislation. For each compliance feature, we calculated the frequencies and percentages of the packs that were compliant. RESULTS: 704 packs: 434 packs of 22 cigarette brands and 270 packs of 17 different tobacco products including cigars, snuff and loose tobacco were included in the study. Of 434 cigarette packs assessed, 50.3% were compliant with 9 indicators measured. These ranged from 48.8% to 55.5% for individual brands. For cessation assistance, image variability and image manipulation, compliance was 0% across all cigarette packs. Out of 270 tobacco product packs assessed, 10.6% were compliant with the 9 indicators assessed. Of the 12 multinational parent companies and product distributors assessed, the overall level of compliance among them was 24.9%. Level of compliance was noted to very low for companies involved in marketing other tobacco products, ranging from 0% to 20% but moderate for those marketing cigarettes, ranging from 37% to 55.5%. Companies that had no presence or subsidiaries in Nigeria but only export their products were highly non-compliant. CONCLUSIONS: Tobacco companies had low compliance with PHWL on cigarettes and negligible compliance on other tobacco products like cigars, loose and smokeless tobacco. The government should expand and strictly enforce all regulations applying to health warnings, especially on non-cigarette tobacco products and closely monitor companies that merely export their products to the country.

Increased taxes and regulation of Indian cigarillos (bidi) industry: Effects on revenue and years of life lost.

Indian cigarillos (bidi) are low-cost alternatives to cigarettes with only 22% imposed taxes, and turnover of upto INR 4 million per annum exempted from taxation. This paper estimates revenue implications and potential loss of life years (YLLs) averted, if bidi industry is subjected to increased regulations and taxation. Revenue estimated at 10% increased regulation and 100% regulation were calculated, followed by estimates at taxes equivalent to cigarettes and World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC) recommendation. Price elasticity was considered to assess demand. Price change in separate fractions (previously regulated and unregulated) were calculated to obtain potential YLLs averted. Current revenue of USD 59.25 million is projected to increase to USD 179.25 million with 695,159 averted YLLs at cigarette equivalent taxes and 10% increased regulation; USD 639.38 million with 4,527,597 averted YLLs with 100% regulation; USD 54.75 million, at WHO recommended taxes with 2,233,740 YLLs averted at 10% increased regulation, and 10,486,192 YLLs at 100% regulation. Proposed estimates are inline with WHO recommendations as they consider price elasticity and suggest substantial increase in revenue, while averting YLLs. A national action is needed to drive the policy decisions towards increased regulation and taxation and revision of India's tobacco control legislation. Our study presented empirical evidence of how the currently underutilized tool of taxation, as proposed in the WHO-FCTC, can be utilized to decrease bidi smoking prevalence and save measurable life years while generating government revenue simultaneously. While the revenue statistics counter the misleading tobacco industry narratives, the projected reduction in mortality will be seen as an irrefutable driving force for policy reforms, targeted at strategic increase in regulation and taxation of the traditional Indian cigarillos industry.

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

BackgroundIn response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020.MethodsWe replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide.ResultsIdentical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries.ConclusionsConsiderable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

The power of WHO epistemic communities: The “tobacco epidemic” as construct

AbstractThe aim of this article is to present the idea that the tobacco epidemic, included in the World Health Organization's (WHO) documents, may have contributed to the success of the Framework Convention on Tobacco Control (FCTC). The tobacco epidemic as a construct was present in internal and official WHO documentation as well as in scientific publications of the tobacco control‐oriented scientists who constituted the anti‐tobacco epistemic community. Using a qualitative approach, I analyzed three sets of texts to describe the features of the tobacco epidemic and how it may have contributed to the success of the FCTC. The methodology of the analysis was based on the sociological concept of medicalization. I argue that by virtue of medicalized framing in the case of the FCTC, the WHO was able to influence the debate on tobacco control.Related ArticlesLuján José, Luis. 2023. “Evidence‐Based Policies: Lessons from Regulatory Science.” Politics &amp; Policy 51(4): 524–37. https://doi.org/10.1111/polp.12543.Newman, Joshua. 2019. “The Role of Uncertainty in Regulating E‐Cigarettes: The Emergence of a Regulatory Regime, 2005‐15.” Politics &amp; Policy 47(2): 407–29. https://doi.org/10.1111/polp.12294.Roberts, Alex N. 2023. “The Scientization of Public Policy and Politics: A New Approach to Conceptualizing and Identifying the Phenomenon.” Politics &amp; Policy 51(5): 726–54. https://doi.org/10.1111/polp.12548.

Advancing progress on tobacco control in low-income and middle-income countries through economic analysis

BackgroundMore than 80% of the world’s 1.3 billion tobacco users live in low-income and middle-income countries (LMICs), where progress to address tobacco and its harms has been slow. The perception...

Interpreting results, impacts and implications from WHO FCTC tobacco control investment cases in 21 low-income and middle-income countries

BackgroundTobacco control investment cases analyse the health and socioeconomic costs of tobacco use and the benefits that can be achieved from implementing measures outlined in the WHO Framework Convention on...

Evolving methodology of national tobacco control investment cases

BackgroundThis article describes an investment case methodology for tobacco control that was applied in 36 countries between 2017 and 2022.MethodsThe WHO Framework Convention on Tobacco Control (FCTC) investment cases compared...

Equity implications of tobacco taxation: results from WHO FCTC investment cases

BackgroundAcross time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum...

Tracking the Variations in Trace and Heavy Elements in Smoking Products Marketed in Oman and Egypt: Risk Assessment After Implementation of Constraining Protocols.

Tobacco smoking is becoming one of the major worldwide concerns regarding environmental pollution as well as health threats. In 2005, the World Health Organization (WHO) released the Framework Convention On Tobacco Control (FCTC), which outlined protocols for controlling tobacco products. Oman was one of the leading countries to follow these protocols; however, Egypt has only followed these protocols recently in 2020. One of the main challenges in tobacco product control is the variation in their trace element's types and amounts from country to country owing to differences in agriculture techniques and used chemical additives. Smoking releases different toxic metal ions found in them into the air, and hence, analyzing trace amounts of metals in tobacco smoking products is becoming more critical. The proposed research aims to evaluate the current levels of 11 heavy metals (namely, As, Pb, Cd, Co, Cr, Be, Ba, Mn, Ni, Fe, and Hg) in 22 tobacco products available in Egypt and Oman using inductively coupled plasma optical emission spectroscopy and a direct mercury analyzer. Although some elements such as Be, Co, and Cd were absent, the positive detection of As and Pb and the levels of Ba, Cr, and Ni are still alarming, especially for heavy smokers. The obtained results were then statistically related to previously published data in 2017 to explore the effectiveness of implementing the FCTC protocols within the Egyptian market. The outcomes suggested a positive impact of FCTC protocol implementation in Egypt, besides the lower levels of elemental content for Omani products compared to the Egyptian market.

Tobacco packaging and labeling policies in the WHO African Region: Progress 15 years after adoption of the WHO Framework Convention on Tobacco Control Article 11 Implementation Guidelines.

Article 11 of the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) requires Parties to adopt and implement effective tobacco packaging and labeling policies to communicate health risks and reduce tobacco consumption. The goal of this study was to assess adoption of these policies in the WHO African Region (AFRO). We reviewed tobacco packaging and labeling policies adopted in AFRO from the Campaign for Tobacco-Free Kids' Tobacco Control Laws database (w w w.tobaccocontrollaws.org). We assessed these policies based on WHO FCTC Article 11 and its Implementation Guidelines examining three sub-policy areas (health warning labels [HWLs], descriptive constituents and emissions information, and misleading packaging and labeling). We developed a scoring system to rank AFRO countries individually and by World Bank's income-level groups and documented the progress during 1985-2023. Forty (of 47) AFRO countries adopted national laws, of which a majority adopted large rotating pictorial HWLs and banned misleading descriptors; only Cote d'Ivoire and Mauritius adopted standardized packaging. The higher a country is in the World Bank's income-level group, the stronger their packaging and labeling policies are. This observation was not present in the sub-policy area of HWLs. Prior to approving the WHO FCTC Article 11 Implementation Guidelines, only 23 countries adopted text-only HWLs whereas 26 countries adopted pictorial HWLs after the approval. Several AFRO countries have adopted tobacco packaging and labeling policies that align with the WHO FCTC Article 11 Implementation Guidelines. More efforts could be directed toward the low-income group and disseminating standardized packaging throughout AFRO. In the WHO African Region (AFRO), the number of tobacco users is increasing, highlighting the need for tobacco packaging and labeling policies aligned with WHO FCTC Article 11 and its Implementation Guidelines as these are proven tobacco control strategies. This study provides a country-level and income-level group ranking of tobacco packaging and labeling policies and documents the evolution of health warning labels adopted in AFRO. It also identifies regional and income-level group successes and gaps in tobacco product packaging and labeling policies and provides recommendations to further align with WHO FCTC Article 11 and its Implementation Guidelines.

Are Tobacco Companies in Nigeria Complying With Health Warning Label Regulations on Cigarettes and Other Tobacco Products?

BACKGROUND: Nigeria has approved 50% coverage of text and images of pictorial health warning labels (PHWLs) on packages of cigarettes and other tobacco products such as cigars, smokeless tobacco, and loose tobacco. While there is knowledge on the extent to which LMICs like Nigeria adopt the WHO Framework Convention of Tobacco Control (FCTC), there is need to examine the compliance with adopted packaging and labeling policies to generate knowledge for strengthening existing policies and efforts at enforcement. We assessed agreement with FCTC regulations as well as compliance with Nigerian requirements which are not adequate and do not effectively capture all FCTC requirements to identify the gaps being explored by these companies in an environment of poor regulation in Lagos, Nigeria. METHODS: This descriptive study was conducted in Lagos State, Nigeria, from October 2022 to January 2023. A multistage random sampling method was utilized. Four local government areas (LGAs) with a combined population of 16 million, accounting for 70% of the population in Lagos, Nigeria were selected while three points‑of‑sale were randomly picked from two selected wards in each LGA. Empty discarded packs of cigarette and other tobacco products were collected from these outlets. The pack dimensions were measured and assessed for PHWLs, health warning manipulations and cessation assistance. Findings were assessed for compliance with the FCTC and national legislation. For each compliance feature, we calculated the frequencies and percentages of the packs that were compliant. RESULTS: 704 packs: 434 packs of 22 cigarette brands and 270 packs of 17 different tobacco products including cigars, snuff and loose tobacco were included in the study. Of 434 cigarette packs assessed, 50.3% were compliant with 9 indicators measured. These ranged from 48.8% to 55.5% for individual brands. For cessation assistance, image variability and image manipulation, compliance was 0% across all cigarette packs. Out of 270 tobacco product packs assessed, 10.6% were compliant with the 9 indicators assessed. Of the 12 multinational parent companies and product distributors assessed, the overall level of compliance among them was 24.9%. Level of compliance was noted to very low for companies involved in marketing other tobacco products, ranging from 0% to 20% but moderate for those marketing cigarettes, ranging from 37% to 55.5%. Companies that had no presence or subsidiaries in Nigeria but only export their products were highly non-compliant. CONCLUSIONS: Tobacco companies had low compliance with PHWL on cigarettes and negligible compliance on other tobacco products like cigars, loose and smokeless tobacco. The government should expand and strictly enforce all regulations applying to health warnings, especially on non-cigarette tobacco products and closely monitor companies that merely export their products to the country.

Survey from 61,748 schools in four States of India on sale of tobacco products near schools.

Children form the most vulnerable strata of the society and the tobacco industry is known to target them. Article 16 of the Framework Convention of Tobacco Control (FCTC) calls for prohibition of tobacco sales to and by minors. Although interventions to stop such sales are based on sound science, it is widely acknowledged that many countries find implementation, full of challenges. In India, sales near educational institutions are banned by law, Section 6b of the Cigarettes & Other Tobacco Products Act (COTPA). We conducted a survey of violations in four states [Andhra Pradesh (AP), Karnataka (KA), Meghalaya (ML), Uttar Pradesh (UP)] of India to report the number of violations and to assess if there was an association between the schools with violations and variables such as gender, size, category, location of schools. Schools in these States were asked to report the number of shops selling tobacco within 100 yards on an App circulated to all schools (289,392 in number). Chi-square tests, univariate and multivariate logistic regression performed to find association between schools with violations by Category of School, Size of School, Gender of students and location (Urban/Rural). Responses were received from 61,748 (21.3%) schools of which 16,193 (26.2%) reported violations. It was observed that the percentages of the schools with violations were similar to the prevalence of tobacco usage in the state. Four states AP, KA, ML, UP reported violations 22.2%, 17.5%, 42.9% and 31.4% respectively. On chi-square tests, there was a significant association for the states of KA and ML with regards to variables like size, category, location of schools (p-value <0.001). For AP, all variables were significantly different (p-value <0.001) while for UP variables like size and gender were significant. On logistic regression, there was significant association between the variables like size (>100), category (Upper Primary) and location (urban) for tobacco shops violations in both KA and ML except for the school category that was secondary in ML. While for AP and UP, only size (>100), location (urban) of schools have a significant association with the violations of tobacco shops. Logistic regression of pooled data of four states school size (>100) and school category (primary) and location (urban) had significantly higher association of violation of tobacco shops. This is the first large survey with responses from almost all parts of the four states in India. This study shows significant association with the size, category and location of schools. We anticipate that the lists of schools which have such violations can be used by enforcement agencies to take focused action. Such models will help develop effective tobacco control policies in developing countries with large populations where implementation remains a big challenge.

Prevalence of and Influential Factors for Waterpipe Smoking among School-Attending Adolescents in Bissau, Guinea-Bissau

The marketing of sweetened and flavoured tobacco in the early 1990s resulted in an upsurge in waterpipe smoking (WPS), mainly among young people and women. Here, we estimate prevalence rates among school-attending adolescents aged 14–19 (girls 52%) for a lifetime experience of WPS and within the last 30 days (WPS &lt; 30 days) and identify influential factors for such smoking in Bissau, Guinea-Bissau. A random sample (N = 2039) was drawn from a class-based register created for 16 schools in Bissau; attending students in June 2017 were invited to respond to a locally adapted Planet Youth questionnaire. Descriptive statistics, odds ratio with 95% confidence interval, and multinomial logistic regression analysis were used to identify influential factors for WPS. The prevalence rates for a lifetime experience of WPS and within &lt; 30 days were high, 17.7% and 15.0%, respectively, with no significant gender difference. For both groups, a multinomial logistic regression analysis identified attending higher grades in school, use of alcohol and being a victim of sexual violence as significant, influential factors. The overlapping of influential factors suggests preventive work against substance abuse should focus on less stigmatising behaviour, such as WPS and firmer implementation of the Framework Convention of Tobacco Control (FCTC).

Adopting a WHO Framework Convention on Tobacco Control-Based Tobacco Control Law in Ethiopia: Sustained Transnational Health Advocacy and Multi-Sectoral Institutionalized Support.

The objective of this study was to document how Ethiopia adopted a WHO Framework Convention on Tobacco Control (FCTC)-based tobacco control law. We analyzed publicly available documents, including news media articles, advocacy reports, and government documents. We triangulated these findings by interviewing nine key stakeholders. Data were analyzed to construct a historical and thematic narrative and analyzed through a retrospective policy analysis. Local and international health advocacy efforts helped introduce and support WHO FCTC-based legislation by (1) educating policymakers about the WHO FCTC, (2) providing legal assistance in drafting legislation, (3) generating local data to counter industry claims, and (4) producing media advocacy to expose industry activity. Health advocates worked closely with government officials to create a multi-sectoral tobacco committee to institutionalize efforts and insulate tobacco companies from the policymaking process. Japan Tobacco International bought majority shares of the government-owned tobacco company and attempted to participate in the process, using standard industry tactics to undermine legislative efforts. However, with health advocacy assistance, government officials were able to reject these attempts and adopt a WHO FCTC-based law in 2019 that included 100% smoke-free indoor places, a comprehensive ban on tobacco advertising, and large pictorial health warning labels, among other provisions. Sustained local health advocacy efforts supported by international technical and financial assistance can help establish WHO FCTC-based tobacco control laws. Applying a standardized multi-sectoral approach can establish coordinating mechanisms to further institutionalize the WHO FCTC as a legal tool to build support with other government sectors and insulate the tobacco industry from the policymaking process.

Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives.

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries.

Smoking globally kills over half of long-term smokers and causes about 7 million annual deaths. The World Health Organization Framework Convention for Tobacco Control (FCTC) is the main global policy strategy to combat smoking, but its effectiveness is uncertain. Our interrupted time series analyses compared before- and after-FCTC trends in the numbers and prevalence of smokers below the age of 25 years (when smoking initiation occurs and during which response to interventions is greatest) and on cessation at 45-59 years (when quitting probably occurs) in 170 countries, excluding China. Contrasting the 10 years after FCTC ratification with the income-specific before-FCTC trends, we observed cumulative decreases of 15.5% (95% confidence interval = -33.2 to -0.7) for the numbers of current smokers and decreases of -7.5% (95% CI = -10.6 to -4.5) for the prevalence of smoking below age 25 years. The quit ratio (comparing the numbers of former and ever smokers) at 45-59 years increased by 1.8% (1.2 to 2.3) 10 years after FCTC ratification. Countries raising taxes by at least 10 percentage points concurrent with ratification observed steeper decreases in all three outcomes than countries that did not. Over a decade across 170 countries, the FCTC was associated with 24 million fewer young smokers and 2 million more quitters.