Framework Convention On Tobacco Control Article 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.

Early assessment of tobacco excise sharing fund as policy for farmers’ viable alternatives in Indonesia: case study of four municipalities in Indonesia

Indonesia’s Tobacco Excise Sharing Fund (DBHCHT) policy mandates that part of the fund be allocated for tobacco crop diversification – reducing the farmers’ reliance on the tobacco industry as well as implementing Article 17 of the Framework Convention on Tobacco Control (FCTC). We collected primary data from key stakeholders in four main tobacco-producing municipalities. A number of challenges related to DBHCHT utilization remained at subnational levels. The suboptimal use of DBHCHT could be explained in part by (i) constantly changing central government regulations, (ii) farmers’ unawareness of DBHCHT regulations, (iii) delays in DBHCHT allocation, and (iv) supply and demand mismatches. Although Indonesia has not been a part of the FCTC ratification, the DBHCHT mandate is in line with the FCTC article 17, i.e., promoting economically viable alternatives for tobacco farmers. This study concluded that DBHCHT utilization needs to go further to void this mandate given the challenges at the subnational level. Therefore, this study recommends additional technical and practical regulations involving multisectoral stakeholders and the use of DBHCHT to meet the financial needs of crop diversification.

Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations

IntroductionThe Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products,...

Understanding the dynamics of notification and implementation of Article 5.3 across India’s states and union territories

IntroductionIn federal systems, state and local governments may offer opportunities for innovation in implementing the WHO Framework Convention on Tobacco Control (FCTC). This paper explores the implementation of WHO FCTC...

Taking Steps Toward Coherent Global Governance of Alcohol: The Challenge and Opportunity of Managing Conflict of Interest

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is increasingly seen as offering a template for advancing effective global health governance in other spheres, notably including alcohol. In thinking about lessons that can be transferred, there is a simplifying tendency to overstate the FCTC's transformative impacts and, more problematically, to neglect the significance of evolving policies, norms, and practices that collectively enabled its development. This can lead to underestimating the extent to which the FCTC's evolution was protracted and contested, while issues that need to be addressed as prerequisites for an international legal instrument for alcohol are viewed as only feasible after its achievement. This problem is examined here with reference to managing conflict of interest with unhealthy commodity industries. Although protection of policymaking from tobacco industry interference under FCTC Article 5.3 has been hugely significant, it was feasible because of wide-ranging developments in practices across diverse governance actors at national and international levels. This article illustrates the legitimating and enabling significance to the FCTC of measures including emergent internal practices within the WHO, the World Bank's decision to withdraw funding from tobacco projects, steps by host governments to restrict support for the overseas expansion of tobacco transnationals, and changes in civil society and researcher engagement with industry actors. Recent developments in seeking to manage conflicts of interest in nutrition policy in the WHO and at national levels highlight the scope for progress in the absence of an international legal instrument. The article concludes by considering implications of these varying innovations for the future development of effective global governance for alcohol.

Needs of LMIC-based tobacco control advocates to counter tobacco industry policy interference: insights from semi-structured interviews

IntroductionAdvocacy is vital for advancing tobacco control and there has been considerable investment in this area. While much is known about tobacco industry interference (TII), there is little research on...

Oral health and tobacco research in the Eastern Mediterranean Region in relation to the Framework Convention on Tobacco Control: a scoping review.

Tobacco use is associated with oral diseases. Evaluating research on tobacco use and oral health can provide insight into the prevailing situation and help engage dental personnel in tackling the tobacco problem. This study aimed to map knowledge gaps on tobacco and oral health research in the Eastern Mediterranean Region based on four articles of the Framework Convention on Tobacco Control (FCTC). These were: article 12 - use of communication tools to promote tobacco education and awareness; article 14 - promotion of tobacco cessation; article 20 - exchange of information on determinants and outcomes of tobacco use; and article 22 - international cooperation to transfer expertise to strengthen national tobacco control strategies. A scoping review was conducted that included publications on tobacco use and oral health in the Region. PubMed, Scopus, Web of Science, Google Scholar and Proquest theses were searched. Information extracted included: country, study type, whether more than one country was included and whether the publication addressed FCTC articles 12, 14, 20 or 22. In all, 322 publications were included, of which 82.0% were observational studies and 4.3% were clinical trials. Most publications (87.9%) were from the Islamic Republic of Iran, Jordan, Pakistan Saudi Arabia and Yemen. Only 32 (9.9%) publications included participants from more than one country. Of all the publications, 21.5% related to article 12 of the FCTC, 4.3% to article 14, 94.7% to article 20 and 6.5% article 22. Research on oral health and tobacco needs to be better aligned with the FCTC articles.

Memoranda of understanding: a tobacco industry strategy to undermine illicit tobacco trade policies

ObjectiveAnalyse the transnational tobacco companies’ (TTCs) memoranda of understanding (MoUs) on illicit trade and how they could undermine the WHO Framework Convention on Tobacco Control (FCTC) and the Protocol to...

Cigarette Package Health Warnings in Japan

TPS 641: Policies, interventions, communication, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM [Aim] The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires member countries to implement measures aimed at reducing the demand for tobacco products. FCTC article 11 recommends on large and pictorial health warnings. In 2001 Canada firstly implemented pictorial warning. By the end of 2016, 100 countries/jurisdictions had implemented pictorial warnings, and the number increased to 118 now. On Dec 2018, the Japanese Finance Ministry drew up a plan to enlarge the font of text warnings on tobacco packages, while rejecting graphical warnings, arguing that consumers must not be made excessively uncomfortable. Then we conducted an online survey to measure the impact of the change in health warnings. [Methods] A cross-sectional online survey was conducted from 26 January to 20 March in 2018. Participants were randomly sampled from a nationwide online panel. The age-gender balanced 8,140 effective sample was obtained. The number of never smoker, former smoker, and current smoker is 4,605, 2,076, and 1,459, respectively. We prepared 5 health warning designs, which include current text alone warning covering 30% of the front/back of the package, larger text warnings, picture warnings covering 50% or 75% of the packages. We observed the participants’ recognition of the health warnings, and label ranking for smoking cessation. [Results] The percentage of persons who know pictorial health warnings is 32.6%, 25.4%, 32.3%, 44.2% for total responders, never smoker, former smoker, and current smoker, respectively. The 52.8%, 60.9%, 61.2%, and 34.1% of total responders, never smoker, former smoker, and current smoker, respectively, ranked the large pictorial health warnings as most effective. [Conclusions] Text-only warnings are the least effective way to increase public awareness about the risk of tobacco use. We should introduce picture warnings that have the potential to help them better understand the harms of tobacco and encourage smoking cessation.

Tobacco control and prevention efforts in Ethiopia pre- and post-ratification of WHO FCTC: Current challenges and future directions.

INTRODUCTIONBeing the second most populous African country, Ethiopia represents a huge opportunity for the tobacco industry to recruit new smokers. Ethiopia signed the convention to ratify WHO Framework Convention on Tobacco Control (FCTC) in 2004 and ratified in 2014. We reviewed Ethiopia’s tobacco control legislative history pre- and post-ratification of the WHO FCTC and evaluated the level of compliance of the National Tobacco Control Directive (NTCD) with the WHO FCTC.METHODSWe reviewed Ethiopia’s tobacco legislative history, the NCTD, the National Tobacco Control Strategic Plan, and tobacco control related media stories from 2009 to 2018. The level of compliance of NTCD with WHO FCTC was compared and qualitatively analysed.RESULTSNTCD 2015 is Ethiopia’s first comprehensive tobacco control legislation, which for the most part is WHO FCTC compliant. The legislation prohibits, among other things, sale of flavoured tobacco products including menthol, sale of tobacco products to a person under the age of 18 years and bans all forms of tobacco advertising, promotion, and sponsorship. Yet, the current legislation allows smoking designated rooms in some prohibited places. Although a multi-sectoral National Tobacco Control Committee and a Strategic Plan were developed as per Article 5 of WHO FCTC, activities pertaining to the protection of such tobacco control policies from vested interests of the tobacco industry (WHO FCTC Article 5.3) are not addressed in NTCD 2015.CONCLUSIONSMajor gaps in the NTCD 2015 such as allowing smoking designated rooms should be addressed in order to stop the tobacco industry from using such loopholes to interfere with national tobacco control policies and/or maintain its tobacco market. Moreover, the tobacco control policies and efforts should be institutionalized across various sectors in order to ensure implementation of the NTCD.

\u201cWe think globally\u201d: the rise of Paraguay\u2019s Tabacalera del Este as a threat to global tobacco control

BackgroundLeading transnational tobacco companies (TTCs) began to expand their operations in Latin America in the 1960s. This included legally exporting their cigarettes to Paraguay during the 1960s which, in turn, were illegally re-exported to Argentina and Brazil. By the 1990s, competition between BAT and PMI for this lucrative illicit market, focusing on low-priced brands, prompted manufacturing in Paraguay. Paraguayan manufacturing rapidly grew after the introduction of a new cigarette export tax in Brazil in 1999.MethodsWe systematically searched Truth Tobacco Industry Documents (TTID) to understand the activities and strategies of leading TTCs in Paraguay and subregion over time. We applied the analytical framework of Lee and Eckhardt (2017) to understand Tabesa’s global business strategy. We searched the websites of TTCs and Tabesa for activities since the mid 2000s to understand how the companies publicly describe these strategies. We used the United Nations Commodity Trade Statistics Database (UN Comtrade) as an independent source to crosscheck statements by Tabesa executives about export markets. We contextualized and triangulated our findings with 42 key informant interviews.ResultsTabesa became the largest cigarette manufacturer in Paraguay, and one of the largest companies in the country, through complicity in the illicit trade. Enabled by market conditions created by leading TTCs, and a permissive regulatory environment in Paraguay, evidence suggests Tabesa had become a major source of illicit cigarettes across Latin America and beyond by the late 2000s. Although Brazil continues to account for the bulk of Tabesa’s revenues, findings suggest that the company is aspiring to compete with TTCs in markets worldwide through legal and illegal sales.ConclusionThere is a need for fuller understanding of the risks to global tobacco control from local companies aspiring to compete with TTCs. The rise of Tabesa is part of the changing nature of the illicit trade in tobacco products which must be taken into account in implementing the Framework Convention on Tobacco Control (FCTC) and its Protocol to Eliminate Illicit Trade in Tobacco Products. Potential conflicts of interest concerning Tabesa illustrate the importance of FCTC Article 5.3 on industry interference. There is also an urgent need to address the lack of independent and rigorous data on the illicit tobacco trade in the region.

Limited implementation of the framework convention on tobacco control’s tobacco tax provision: global comparison

ObjectiveTo quantify changes in tobacco tax rates and cigarette affordability after countries ratified the WHO Framework Convention on Tobacco Control (FCTC) using with the WHO MPOWER standards.MethodsWe used logistic regression...

Analysis of Article 6 (tax and price measures to reduce the demand for tobacco products) of the WHO Framework Convention on Tobacco Control

ObjectiveTo analyse the extent to which parties to the WHO Framework Convention on Tobacco Control (FCTC) have implemented Article 6 since the convention’s entry into force.MethodsCompliance was measured using nine...

Framework Convention on Tobacco Control Implementation in Nigeria: Lessons for Low- and Middle-Income Countries

Nigeria is a significant tobacco market and influential country in Africa. Nigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. We reviewed Nigeria's tobacco control legislation since 2000 and compliance of the National Tobacco Control Act (NTCA) 2015 with the FCTC. We reviewed the National Tobacco Control Bills 2011 (proposed by legislature) and 2014 (proposed by Executive), the NTCA 2015, and media stories on tobacco control from 2008 to 2017. The NTCA, despite being more comprehensive than Nigeria's first Tobacco Smoking (Control) law of 1990, maintained provisions promoted by the tobacco industry, for example: allowing designated smoking areas in hospitality venues, higher educational institutions, and transportation venues; a loophole in the advertising restrictions allowing communications with consenting adults; and having the Manufacturers Association of Nigeria (MAN) (which includes tobacco companies) on the National Tobacco Control Committee charged with working with the Ministry of Health to implement the law. The industry is also directly involved with the Standards Organisation of Nigeria (SON) in preparing regulations on cigarette constituents and emissions. In an unprecedented step globally, the law requires that implementing regulations be approved by the National Assembly, giving the industry another opportunity to weaken this law further by lobbying the legislators to favor the industry. As of January 2018, the law was still not being enforced. The NTCA can be strengthened through implementation guidelines still being developed. The industry should be prevented from interfering with through MAN and SON, as required by FCTC Article 5.3. The tobacco industry works to block Framework Convention on Tobacco Control implementation even after a country ratifies the treaty. The Nigerian case illustrates that it is essential for health authorities to remain vigilant and ensure that the tobacco industry does not play a decision-making role in the process of tobacco legislation and regulation either directly or indirectly. The unprecedented step of requiring approval of implementing regulations for the Nigerian law should not be allowed to become a precedent in other countries.

Using an Assessment Tool to Further Tobacco Control Accomplishment in Thailand.

Background:Because implementation of the Framework Convention on Tobacco Control (FCTC), a World Health Organization (WHO) treaty to reduce tobacco use, is an important goal of the 2015 United Nations Sustainable Development Goals (SDGs) and Thailand has sought to fully comply with all its articles, a multiperspective assessment was developed to ensure that any gaps in compliance with FCTC provisions were identified and addressed.Method:One assessment mechanism of this multicomponent assessment was the development by experts and use by stakeholders of a 3-tiered rating of all major provisions of the main articles of the FCTC. The results of the performance ratings on FCTC articles by a diverse group of stakeholders were used to spotlight areas of local and regional implementation and compliance with FCTC provisions.Results:Implementation ratings by stakeholders generally followed the chronology of WHO priorities as reflected in the development by WHO of guidelines for the various FCTC articles with highest ratings for articles 6, 8, 11, 12, 14, 15, and 16. However, only 5 articles (Articles 6, 11, 12, 15, and 16) reached level 2 (effectiveness) of the 3-level rating; articles 6, 8, 11, 13, and 14 are discussed because they are the WHO priority articles of the MPOWER tobacco control policy. Importantly, stakeholders cited problems with lack of completeness of present Thai law and processes for enforcement, as well as lack of public understanding regarding tobacco control strategies and provisions.Conclusions:Overall, the breadth and inclusiveness of the stakeholder approach devised for improving implementation by the Tobacco Control Research and Knowledge Management Center provided greater understanding about shortcomings of present policy and resource management which informed the Tobacco Products Control Act passed in 2017 and plans for advancing stronger Thai regulation by local and national government.

Progress in implementation of WHO FCTC Article 14 and its guidelines: a survey of tobacco dependence treatment provision in 142 countries.

AimsTo (1) estimate the number of Parties to the Framework Convention on Tobacco Control (FCTC) providing tobacco dependence treatment in accordance with the recommendations of Article 14 and its guidelines; (2) assess association between provision and countries’ income level; and (3) assess progress over time.DesignCross‐sectional study.SettingOnline survey from December 2014 to July 2015.ParticipantsContacts in 172 countries were surveyed, representing 169 of the 180 FCTC Parties at the time of the survey.MeasurementsA 26‐item questionnaire based on the Article 14 recommendations including tobacco treatment infrastructure and cessation support systems. Progress over time was assessed for those countries that also participated in our 2012 survey and did not change country income level classification.FindingsWe received responses from contacts in 142 countries, an 83% response rate. Overall, 54% of respondents reported that their country had an officially identified person responsible for tobacco dependence treatment, 32% an official national treatment strategy, 40% official national treatment guidelines, 25% a clearly identified budget for treatment, 17% text messaging, 23% free national quitlines and 26% specialized treatment services. Most measures were associated positively and significantly with countries’ income level (P < 0.001). Measures not associated significantly with income level included mandatory recording of tobacco use (30% of countries), offering help to health‐care workers (HCW) to stop using tobacco (44%), brief advice integrated into existing services (44%), and training HCW to give brief advice (81%). Reporting having an officially identified person responsible for tobacco cessation was the only measure with a statistically significant improvement over time (P = 0.0351).ConclusionFewer than half of countries that are Parties to the Framework Convention on Tobacco Control have implemented the recommendations of Article 14 and its guidelines, and for most measures, provision was greater the higher the country's income. There was little improvement in treatment provision between 2012 and 2015 in all countries.

Avoiding "A Massive Spin-Off Effect in West Africa and Beyond": The Tobacco Industry Stymies Tobacco Control in Nigeria.

Nigeria plays important economic and political roles in Africa and is a significant market for the tobacco industry. This study describes the tobacco industry's efforts to block Nigeria's early tobacco control attempts, especially the Tobacco Smoking (Control) Decree 20 of 1990, and efforts to strengthen the Decree in 1995. Analysis of documents from the Truth Tobacco Documents Library and other Internet resources related to Nigeria's Decree 20 and earlier tobacco control efforts. The World Conferences on Smoking and Health and World Health Organization in the late 1970s spurred the Nigerian government to take steps towards tobacco regulation. In response, the tobacco industry lobbied government ministries, used front groups and its trade group, the Tobacco Advisory Council of Nigeria, to block and weaken government efforts. The industry obtained a draft of Decree 20 two years before it was enacted, considered the Decree anti-business and proposed language that led to the passage of a weaker Decree in 1990. It also attempted to influence a potential review of the Decree in 1995. Decree 20 was a strong law for its time, but was weakened due to tobacco industry interference. Nigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005, and enacted a comprehensive National Tobacco Control Act (NTCA) in May 2015. Lessons learned from Decree 20's experience should be applied to protect NTCA 2015, and in compliance with WHO FCTC Article 5.3 which require parties to protect tobacco control policies from tobacco industry interference. This is the first detailed account of tobacco industry interference with tobacco legislation in Africa. The emergence of tobacco control in Nigeria threatened the tobacco industry, which believed that success in Nigeria would have a "domino effect" in Africa. The industry used lobbying and front groups to successfully block and weaken Nigeria's tobacco control, especially the Tobacco Smoking (Control) Decree 20 of 1990 and efforts to strengthen it in 1995. Nigeria and other African countries must learn from this history to protect tobacco control policies from the tobacco industry's vested interests and vigorously implement Article 5.3 of the WHO FCTC.

Tobacco industry interference: A review of three South East Asian countries.

The WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 requires governments to protect tobacco control policies from the commercial interest of the tobacco industry (TI). TI interference is the biggest barrier to implementing comprehensive tobacco control measures. This paper reviews the extent of the TI's interference in tobacco control policy development in three countries, Thailand, Myanmar, and Indonesia, and the governments' efforts to protect these policies. The paper draws on incidents of TI interference reported in the 2016 Tobacco Industry Interference Index: ASEAN Report on Implementation of the WHO FCTC Article 5.3. Base data were obtained through a questionnaire on twenty most commonly reported incidents of interference from the FCTC Article 5.3 Guidelines recommendations. A scoring system was developed. All three countries faced varying levels of TI interference. Thailand, though known for its stringent tobacco control measures, still faced interference while Myanmar remains vulnerable. Indonesia faced the highest industry interference which may explain why it is lagging behind in tobacco control and remains a nonparty to the WHO FCTC. The TI gains access to government officials through offers of technical assistance and its corporate social responsibility activities. Transparency in dealing with the TI is needed in all three countries. Most governments have not set up disclosure procedures when dealing with the TI. Outside the Department/Ministry of Health, other departments remain unaware of Article 5.3, not utilizing its strength to regulate the TI. More concerted effort is needed to implement Article 5.3 to achieve greater success in tobacco control.

FCTC followed by accelerated implementation of tobacco advertising bans

ObjectivesWe sought to evaluate changes in countries' enacting advertising bans after the effect of ratifying the WHO Framework Convention on Tobacco Control (FCTC).MethodsWe compared adoption of advertising bans on five...

Public opinions on disclosure of tobacco components: Results of a nationwide cross-sectional survey in Republic of Korea.

This study aimed to explore public views on disclosure of tobacco components in an effort to develop a comprehensive regulatory system facilitating implementation of the Framework Convention on Tobacco Control (FCTC) Articles 9 and 10 in Korea.In all, 1200 representative Koreans 19 years old or older were enrolled and information on their general characteristics, smoking status, awareness of the effects of smoking on health, and views on the public disclosure of tobacco components was collected by telephone using a structured questionnaire. Factors associated with acceptance of the need for public disclosure of tobacco components were identified via multivariate analysis.Most participants considered it necessary to publicly disclose tobacco components (95.9%) and were aware of the risk to health posed by smoking (76.0%). The prevalent view was that tobacco companies should be legally required to publicly disclose details of the components of cigarettes, their levels per cigarette, and their effects on health. The most effective means of disclosure were considered to be the mass media, printed materials, and labels on cigarette packs. Females and never-smokers (odds ratio [OR]: 4.39, 95% confidence interval [95% CI]: 1.76-10.94) more readily accepted the need for public disclosure, whereas those of lower educational level and/or who were less aware of the harm to health posed by smoking (OR: 0.05, 95% CI: 0.01-0.18) were less likely to be accepting.The attitude of the general population ensures that FCTC Articles 9 and 10 will be successfully implemented in Korea. Further public consultation on the details of disclosure would be useful for the development of a comprehensive regulatory system.