Framework Convention On Tobacco Control Research Articles

Awareness and Implementation Status of Tobacco Policy Provisions among Students of Public Schools in Budhanilkantha Municipality, Nepal

Background: The tobacco epidemic was responded globally with the enforcement of the WHO Framework Convention on Tobacco Control (WHO FCTC), a first public health treaty, on 27 February 2005. As a party and signatory country to FCTC, Nepal ratified the tobacco product (control and regulation) act in 2011. After endorsement of the act and other related tobacco policy documents, it is necessary to measure awareness level and the implementation status among different stakeholders including adolescent students. This study aimed to assess the awareness and implementation status of tobacco policy provisions in the students of Budhanilkantha Municipality of Kathmandu district, Nepal.
 Methods: This study was a school-based cross-sectional survey. A total of 378 students were recruited from five schools of Budhanilkantha municipality of Kathmandu, Nepal. The self-administered questionnaires were adapted from the Global Youth Tobacco Survey (GYTS) tool of the World Health Organization and youth-tobacco survey tool of the Center for Disease Control and Prevention (CDC) to collect the data.
 Results: The study showed that less than half of the participants (45.8%) knew that there is a tobacco product (control and regulatory) act in Nepal. Similarly, two-thirds (65.9%) of the participants responded that they were aware of the selling of tobacco products to a person below 18 years was legally prohibited in Nepal. In terms of tobacco laws enforcement, 66.2% of the participants were not prevented from buying tobacco products because of their age.
 Conclusions: More than half of the students were found unaware of tobacco control policies of Nepal, despite the students are the key target stakeholders of tobacco control policies. Additionally, implementation of policy provisions related to protecting the students from tobacco in school or home is not effectively enforced although Nepal has comprehensive tobacco control policies.

Implementing smokeless tobacco control policy in Pakistan: a qualitative study among Naswar supply chain actors

ObjectiveTo obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the...

Compliance of Oral Snuff (Naswar) Packaging and Sales Practices with National Tobacco Control Laws and the Relevant Articles of Framework Convention on Tobacco Control in Khyber Pakhtunkhwa Pakistan.

Smokeless tobacco (SLT) is a significant contributor to tobacco-related harm in Pakistan but its control has lags behind that of combustible tobacco. We assessed the compliance of Naswar's (a widely used SLT product in the Southeast Asia) packaging and sales practices with the national legislations and relevant articles of the WHO framework convention on tobacco control (FCTC). A cross-sectional observational audit was conducted in three districts of Pakistan. We recruited 286 general point of sale (GPOS) and exclusive Naswar sellers (ENS) through a multistage cluster sampling strategy. Data were gathered on packaging and labeling practices of Naswar and advertisement and promotion practices inside and outside the shops. Statistical tests for association between the dependent variable-advertisement practices, and independent variables-area and vendor types were conducted. We analyzed 133 and 49 unique Naswar products sold in 229 GPOS and by 57 ENS, respectively. None of the local products had any written or pictorial health warning. More than half of retailers used one or two methods of advertising Naswar inside the shops while only 9% advertised outside the shops. ENS were more likely to be noncompliant with tobacco advertisement and promotion compared with GPOS. The study presents first insights on the compliance of Naswar packaging and sale practices with local regulations and WHO FCTC provisions in Pakistan. Almost all products were on display in the shops and none of the local products had any health warning or contents disclosure on the packages. Naswar is a form of SLT used extensively in Pakistan, Central Asia, and Pashtun populations across the globe. This study provides an important insight into the Naswar retail environment in a geographical setting where the use of Naswar is endemic. The study brings to fore previously unreported issues like an urban-rural disparity, and differences between exclusive and nonENS, with regards to Naswar advertisement and promotion. These findings have potential implication on the implementation of tobacco control retail policies. The lack of health warnings and free display of Naswar brands call for alignment of tobacco control efforts with the FCTC.

Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries

BackgroundSmokeless tobacco (ST) is consumed by more than 300 million people worldwide. The distribution, determinants and health risks of ST differ from that of smoking; hence, there is a need to highlight its distinct health impact. We present the latest estimates of the global burden of disease due to ST use.MethodsThe ST-related disease burden was estimated for all countries reporting its use among adults. Using systematic searches, we first identified country-specific prevalence of ST use in men and women. We then revised our previously published disease risk estimates for oral, pharyngeal and oesophageal cancers and cardiovascular diseases by updating our systematic reviews and meta-analyses of observational studies. The updated country-specific prevalence of ST and disease risk estimates, including data up to 2019, allowed us to revise the population attributable fraction (PAF) for ST for each country. Finally, we estimated the disease burden attributable to ST for each country as a proportion of the DALYs lost and deaths reported in the 2017 Global Burden of Disease study.ResultsST use in adults was reported in 127 countries; the highest rates of consumption were in South and Southeast Asia. The risk estimates for cancers were also highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to ST. Based on risk estimates obtained from the INTERHEART study, over 6 million DALYs and 258,006 lives were lost from ischaemic heart disease that can be attributed to ST. Three-quarters of the ST-related disease burden was among men. Geographically, > 85% of the ST-related burden was in South and Southeast Asia, India accounting for 70%, Pakistan for 7% and Bangladesh for 5% DALYs lost.ConclusionsST is used across the globe and poses a major public health threat predominantly in South and Southeast Asia. While our disease risk estimates are based on a limited evidence of modest quality, the likely ST-related disease burden is substantial. In high-burden countries, ST use needs to be regulated through comprehensive implementation of the World Health Organization Framework Convention for Tobacco Control.

Gender, women, and the future of tobacco control

Purpose This paper aims to provide a gendered analysis of the WHO Framework Convention on Tobacco Control (FCTC) benchmarked upon the global commitments to women’s health and well-being in the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. It reviews evidence of the global consequences of neglecting women’s tobacco use and health, as well as analyzes persistent issues related to sex and gender that compromise the efficacy of tobacco control and science. Actionable recommendations are made to the Conference of the Parties to the FCTC and other key stakeholders. Design/methodology/approach This paper draws upon empirical studies, literature reviews and global health data at the varying intersections of gender, sex, tobacco and global health. Findings The global tobacco control framework and its implementation by state governments have been largely gender blind to date with dire health and economic consequences, including inequitable positive outcomes for men compared to women, and an increase in women’s smoking with associated morbidity and mortality. Gender equitable progress in combatting the tobacco epidemic will not be possible without resolving the gender bias, stigmatization, sexism and lack of intersectionality that plague tobacco control policy, research and interventions for cessation and harm reduction. Originality/value This paper provides an updated global overview of current trends in women’s tobacco use and comprehensively details the persistent structural barriers in tobacco control and science that limit their capacity to effectively analyze and address tobacco use and its impact on women.

Comparison of tobacco import and tobacco control in five countries: lessons learned for Indonesia

BackgroundWith a 264 million population and the second highest male smoking prevalence in the world, Indonesia hosted over 60 million smokers in 2018. However, the government still has not ratified the Framework Convention on Tobacco Control. In the meantime, tobacco import increases rapidly in Indonesia. These create a double, public health and economic burden for Indonesia’s welfare.ObjectiveOur study analyzed the trend of tobacco import in five countries: Indonesia, Pakistan, Bangladesh, Zimbabwe, and Mozambique. Also, we analyze the tobacco control policies implemented in these countries and determine some lessons learn for Indonesia.MethodsWe conducted quantitative analyses on tobacco production, consumption, export, and import during 1990–2016 in the five countries. Data were analyzed using simple ordinary least square regressions, correcting for time series autocorrelation. We also conducted a desk review on the tobacco control policies implemented in the five countries.ResultsWhile local production decreased by almost 20% during 1990–2016, the proportion of tobacco imports out of domestic production quadrupled from 17 to 65%. Similarly, the ratio of tobacco imports to exports reversed from 0.7 (i.e., exports were higher) to 2.9 (i.e., import were 2.9 times higher than export) in 1990 and 2016, respectively. This condition is quite different from the other four respective countries in the observation where their tobacco export is higher than the import. From the tobacco control point of view, the four other countries have ratified the Framework Convention on Tobacco Control (FCTC).ConclusionThe situation is unlikely for Indonesia to either reduce tobacco consumption or improve the local tobacco farmer’s welfare, considering that the number of imports continued to increase. Emulating from the four countries, Indonesia must ratify the FCTC and implement stricter tobacco control policies to decrease tobacco consumption and import.

Overcoming barriers to disseminate effective smoking cessation treatments globally

Purpose The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies. Design/methodology/approach A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally. Findings Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling. Originality/value Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.

Investing in Tobacco Control: Twelve Years of MPOWER Measures and Progress in the Western Pacific Region.

Tobacco use has detrimental effects in the Western Pacific Region. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) came into effect in 2005 to address the global tobacco epidemic, and WHO introduced the MPOWER measures to facilitate implementation of key demand-reduction measures of the WHO FCTC at the country level. This paper provides an overview of progress made by countries within the Region since the introduction of the MPOWER measures 12 years ago, and examines challenges and threats hindering their further implementation.

Methods of the International Tobacco Control (ITC) EUREST-PLUS ITC Europe Surveys.

The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union's Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.

An Empirical Study on the Transformation towards Domestic Law of the Framework Convention of Tobacco Control under the Perspective of the Right to Health

2020년 초 전 세계를 강타한 코로나19로 인하여 건강권의 중요성이 일반화 되었다. 이는 민족과 인종 또는 빈부를 불문하고 건강권은 세계 각국의 사람들 이 모두 마땅히 누리는 기본적인 권리로 인식되었다는 의미이다. 한편, 건강권 과 관련하여 지속적으로 논의가 되고 있는 것이 흡연의 위험성이다. 관련 연구 결과에 따르면, 담배는 연소로 인해 방출되는 가스 중 약 0.6%가 유해가스로 구성되어 있으며, 0.2%는 발암 또는 발암가능성이 있는 물질인 것으로 나타났 다. 이 수치는 에이즈, 심뇌혈관질환, 암 등 세계적인 건강문제와 비교하면 현격 한 차이가 있지만, WHO가 주최가 되어 성사시킨 첫 국제협약인 담배규제기본 협약(FCTC)을 보면 흡연의 위험성을 엿볼 수 있다. 담배규제기본협약은 건강권 을 고도로 중시하고, 예방의 관점에서 건강권 보호의 비용을 낮추는데 중점을 두어 흡연규제에 대하여 전 세계적으로 전례 없는 공감을 얻었다. 이로 인해 국 제적으로 당사국이 가장 많은 국제협약 중 하나로 현재 각국은 국내법으로의 전환을 모색하고 있다. 현재 전 세계의 90%가 넘는 국가가 동 협약에 가입한 상태이며, 협약의 이행에 있어서도 낙관적인 전망을 보인다. 새로운 시대적 맥 락에서 금연 환경의 조성과 미성년자의 금연에 중점을 두고 있다. 담배규제기본협약의 법적 효력은 사실상 각 당사국이 국내법으로 전환하여 일반적 의무를 적용할 때 발생한다. 건강권의 공동보호라는 기본적인 권리를 세 계 각국이 이행할 의지를 국내법으로 제정되어야 그 실질적 효력이 발생한다. 담배규제기본협약 제5조 제1항과 제2항(b)는 당사국의 담배규제에 관한 입법의 무를 규정하고 있지만, 담배규제기본협약의 원칙성과 개괄성으로 전면적 금연규제 이행과정에서 여전히 시간, 공간 및 효과 면에서 협약의 국내법 전환의 어려 움이 존재한다. 본 논문은 WHO의 담배규제기본협약 상의 ‘건강’을 분석하여 동 협약에서의 건강권이 기본적 권리임을 기초로 하여, 각 당사국의 국내법 전환을 위한 일반 적 의무를 어떻게 이행하고 있는지 검토한다. 유엔과 세계보건기구(WHO) 등 국제기구가 발표한 자료를 토대로 시기적, 공간적, 효과적 면에서 협약의 일반 적 의무 이행 현황을 분석하였다. 이러한 분석에 있어 약정시간, 국내발효시기, 국내입법시기 등에 대하여 비교 분석하였다. 공간적으로는 세계 6개 대륙의 발 효 현황, 미약정 상황, 이행을 하지 못한 이유 등을, 효과면에서는 담배규제에 대한 국내법의 효력 수준, 규제 형태, 구체적 내용을 분석하였다. 이를 통해 담 배규제기본협약 체결 이후 각국의 이행에 대한 회고와 각국이 이행의 차이 등 을 정리하여 향후 동 조약에 가입하는 국가를 위한 시사점을 제공하고, 국제 및 지역 간 흡역규제 협력을 강화하는데 도움이 될 것이라 본다.

The plain packaging of tobacco products and its recognition by the WTO as a legitimate policy measure for the protection of public health

Introduction: the adoption by the WTO DSB of the Panel Reports that resolved the disputes against the Australian tobacco plain packaging scheme unveil important aspects of international health law intertwined with international trade law. Objectives: this paper aims at understanding the concept of plain packaging and the scope of the WTO decision for countries envisaging the adoption of similar measures in policymaking. The research questions are descriptive and encompass how the position expressed by the WTO DSB affects the WHO FCTC and what legal reasoning the referred decision used. Methodology: a historical method is employed to identify the origins of plain packaging and the main concerns and challenges surrounding it, whilst a discursive analysis of the Panel Reports allows an interpretation of its basic principles and possible implications for public health policies. Results and discussion: from a microeconomic policy analysis, the standardization of tobacco packets is a reasonable regulatory approach at a government’s disposal for addressing welfare losses due to externalities and internalities. Although there is no consensus on the empirical evidence supporting plain packaging, its assessment by the WTO Panel played a vital role in the decision rendered, notably with respect to Article 2.2 of the TBT Agreement and Article 20 of the TRIPS Agreement. Conclusion: Honduras and Dominican Republic have appealed and consequently a final ruling is still pending. Nonetheless, the decision is so far a recognition under WTO law of a State’s regulatory autonomy to implement the necessary measures on behalf of public health.

Compliance of smokeless tobacco supply chain actors and products with tobacco control laws in Bangladesh, India and Pakistan: protocol for a multicentre sequential mixed-methods study

IntroductionSouth Asia is home to more than 300 million smokeless tobacco (ST) users. Bangladesh, India and Pakistan as signatories to the Framework Convention for Tobacco Control (FCTC) have developed policies...

Community voices to support smoke free regulation advocacy

The Smoke Free Regulation is a form of public regulation which indeed is needed in protecting the general community from the danger of smoking impacts. Currently, Indonesia was among those country which not ratifying the Framework Convention on Tobacco Control (FCTC), affecting on the less public advocacy regulating in people protection from tobacco smoke. The research was aimed to gain a public voices on regulation advocacy, specifically on smoke free regulation in Greater Yogyakarta. Involving 251 respondents reside in the same province, chosen through a random sampling technique. The result has been revealed a strong support for the importance of enacting such regulation to protect people from smoking. Thus, it is suggested that that the local stake holders could accommodate and following up these people voices.

An overview of tobacco control interventions in the Global South

Purpose The Framework Convention on Tobacco Control (FCTC) has been broadly successful but less so in the Global South. This paper aims to effectively design interventions that to mitigate tobacco-related harms in the Global South, further understanding of interventions in this environment will be helpful, in line with FCTC recommendations. The first objective was to locate and review all published literature relating to tobacco control interventions in the Global South. The second objective was to provide information on research trends within Global South tobacco control interventions. Design/methodology/approach A literature search was conducted across six databases. Findings Despite the FCTC detailing the significance of the research, studies are still lacking in the Global South. There are significant research gaps such as longitudinal studies, harm reduction and randomized controlled trials. Research limitations/implications Limitations arose from differences in study designs of reviewed studies, making it more complex to assess all studies under the same rubric. Practical implications Results indicate significant potential for tobacco control interventions in the Global South, potentially moving toward FCTC goals, but also highlight several areas of concern. Originality/value There is much evidence on the effectiveness of tobacco control in the Global North, especially in some parts of Europe and the USA. However, the evidence base in the Global South is far more limited. This paper provides an overview of Global South tobacco control interventions and suggests areas of concern, in line with the FCTC 15 years on.

Accelerating an end to smoking: a call to action on the eve of the FCTC’s COP9

Purpose The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. This study aims to describe progress toward the framework’s goals, setbacks and strategies to update its articles to optimize outcomes. Design/methodology/approach A review of relevant literature, including papers in this special issue, forms the basis for identifying steps necessary to amplify the impact of the FCTC. Findings The WHO suggests that there are 1.3 billion users of tobacco globally. The expected deaths associated with tobacco use could be dramatically reduced by hundreds of millions between now and 2060 through measures that improve cessation and harm reduction support among adults. Additional steps needed to achieve the goals of the FCTC include developing new initiatives to address areas of profound neglect (for example, women); investing in global research and innovation; addressing the needs of vulnerable populations; and establishing a mechanism to fund priority actions required by low- and middle-income countries, including support for alternative livelihoods for smallholder farmers. Practical implications In November 2020, the WHO FCTC Parties will host their next Conference of the Parties (COP9) in the Netherlands. This paper aims to contribute to the needed policy decisions related to this meeting. Since acceptance of this article, the WHO FCTC team announced that doe to the COVID-19 pandemic COP9 has been rescheduled till November 2021. Originality/value There exists a need to prioritize the goals of tobacco control and offer clear strategies for its execution. This paper fills this niche via a thorough and up-to-date analysis of how to amend and enforce the FCTC.

University students’ perspectives on tobacco control in the Asia-Pacific: a content analysis of a case competition

ABSTRACT The Asia-Pacific region has the highest number of active smokers in the world. Efforts to reduce tobacco use should implement evidence-based measures. The Association of Pacific Rim Universities is a non-profit network of more than 50 universities representing 18 economies. In 2017, it held a virtual global health case competition relating to the use of universities as platforms for tobacco control. This study is a content analysis of tobacco control proposals submitted by 24 teams from 10 economies. Content analysis of the 10-min videos examined (1) general tone and scope of videos; (2) contextual analysis; (3) intervention approaches; (4) theoretical framework; (5) primary versus secondary prevention; (6) individual versus structural approaches. Proposals were not comprehensive; most included some but not all elements recommended by the WHO FCTC. Smoking was often referred to as a ‘habit’ (instead of an addiction), which likely explains the predominance of individual-level behavior change interventions (smoking cessation) over structural interventions (tobacco ad or sales bans). The most common intervention was the enforcement of current bans on smoking (proposed in 78% of videos), perceived as a major barrier to tobacco control. While most proposals emphasized individual components (e.g. health education and peer support), some also proposed to create more supportive smoke-free environments through billboards, posters and cues to action, such as ‘no smoking’ reminders and signs with cessation hotline numbers. University faculty, students and campus-wide organizations are well positioned to lead tobacco control efforts. More work is needed to support the establishment of smoke-free campus environments.

Why is tobacco control progress in Indonesia stalled? - a qualitative analysis of interviews with tobacco control experts

BackgroundIndonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs).MethodWe conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas.ResultsThe multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption.ConclusionTobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and enforcing the World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC) would enable the Indonesian government to shift the power imbalance towards public health stakeholders. Tobacco control advocates must enhance their network cohesion and embrace other community groups to improve engagement and communication with policymakers.

A situational analysis of tobacco control in Ghana: progress, opportunities and challenges.

Tobacco use is the leading cause of preventable deaths in the world, with most of these deaths now occurring in low and middle-income countries (LMICs). Sub-Saharan Africa (SSA) is at an early stage of a tobacco epidemic and is, therefore, particularly vulnerable to rapid growth in tobacco consumption. More than a decade into the implementation of the World Health Organization’s Framework Convention on Tobacco Control (FCTC), State Parties in several countries in SSA, such as Ghana, have yet to fully fulfil their obligations. Despite early ratification of the FCTC in 2004, progress in implementing tobacco control measures in Ghana has been slow and much work remains to be done. The aim of this paper is to critically reflect on tobacco control implementation in Ghana, identify significant research priorities and make recommendations for future action to support tobacco control implementation. We emphasize the need for stronger implementation of the FCTC and its MPOWER policy package, particularly in the area of tobacco taxes, illicit trade and industry interference.

Organizational and Financial Analysis of Polish Tobacco Control Program in 2000-2018.

In accordance with the provisions of the WHO Framework Convention on Tobacco Control (FCTC), each country shall promote and strengthen public awareness of tobacco control issues (Article 12). Many parties to the FCTC have adopted national tobacco control programs to organize their tobacco control activities. The aim of our study was to analyze the organization and funding of the Polish Tobacco Control Program in years 2000–2018. Document analysis of The Program and reports from its implementation were performed in accordance to the Agency for Health Technology Assessment in Poland (AHTAPol) recommendations and the WHO FCTC guidelines for Article 12 implementation. Spending was also analyzed. The study showed both inadequate planning of and funding for Polish Tobacco Control Program. The Program was developed without use of best practices detailed in the WHO FCTC guidelines as well as in national guidelines prepared by AHTAPol. The experience of Poland shows that although earmarking tobacco taxes has existed in the law, it has been largely ineffective due to the poor Tobacco Control Program design and insufficient funding resulting from a poor execution of the earmarking law. This may be a warning to other countries to strive to create law, compliance with which can be verified and controlled.

Structural and Functional Features of the Cardiovascular System in Arterial Hypertension with Normal Spectrum of Transmitral Blood Flow

Objective: to assess the structural and functional features of the cardiovascular system in patients with arterial hypertension (AH) and normal spectrum of transmitral blood flow (NSTBF). Material and methods. An open prospective study of patients with essential hypertension (n=31) and healthy volunteers (n = 10) was organized at the state institution «Republican Research Center for Radiation Medicine and Human Ecology». The examined individuals were comparable in terms of sex and age features. All the participants of the study underwent transthoracic echocardiography (EchoCG) with the determination of the standard parameters, ultrasound of the extracranial part of the brachiocephalic arteries (BCA) with the determination of the thickness of the intima-media complex (CIM) and carotid plaques, duplex scanning of the arteries of the upper and lower extremities with the measurement of the ankle-brachial index (LPI) and endothelium-dependent vasodilation (EDVD). In addition, we assessed the global longitudinal deformation by the method of two-dimensional speckle tracking of the gray spots of the ultrasound image, the indicators of the movement of the fibrous ring of the atrioventricular valves into systole and diastole with the determination of the myocardial index by tissue dopplerography (TDG).Results. In comparison with the healthy volunteers, the patients with AH and NSTB have detected reliable changes in the anteroposterior size (38 mm versus 32.5 mm; p = 0.001) and volume (45 ml versus 31.5 ml; p = 0.002) of the left atrium (LP) and volume (37.5 ml versus 29.5 ml, p = 0.005) of the right atrium (PP), measured by means of standard transthoracic echocardiography. Using the method of two-dimensional tracking of the speckle spots of the gray scale of the ultrasound image we have recorded lower values of the global longitudinal strain (-17.5 versus -21.6; p < 0.001) in the study group compared with the control group, which indicates a violation of the biomechanics of the myocardial contractions of the left ventricle (LV). The study of the movement of the fibrous rings of the atrioventricular valves using tissue dopplerography (TDG) has showed that in the second group of the patients there are regional disorders of diastolic function, primarily this concerns the medial part of FC MK (1.3 versus 1.1; p = 0.05) and the lateral part of FC TC (1.3 versus 0.8; p = 0.028). In addition, in comparison with the healthy individuals we recorded higher values of the myocardial index for the lateral (0.51 versus 0.43; p = 0.001) and medial parts (0.59 versus 0.44; p = 0.001) FC MK, lateral part (0.58 versus 0.44; p = 0.001) FC TC. The patients of the study group, in comparison with the control one, have revealed signs of the pathological remodeling of the vascular wall. In the first group of the examined individuals, in comparison with the second one, the thickness of the intima-media complex (CIM) was slightly higher (p = 0.061 on the right, p = 0.08 on the left) and cases of the presence of atherosclerotic plaques (ASB) were recorded.Conclusion. The protocol research methods do not allow the comprehensive evaluation of the functional features of the heart in patients with AH, which requires additional diagnostic methods: TDH and speckle tracking.