Framework Convention On Tobacco Control Research Articles

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.

Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels

BackgroundThe WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes)....

Actor-agency and institutional complexity: multinational corporations’ strategies to combat the framework convention on tobacco control in Brazil

Purpose This study aims to analyse the strategic moves used by major tobacco corporations to thwart the ratification of the World Health Organization’s Framework Convention on Tobacco Control (FCTC) in Brazil. Design/methodology/approach The authors conducted a detailed historical case study spanning 1988–2005 and encompassing the period leading up to Brazil’s FCTC ratification. The authors collected qualitative data from various sources to triangulate and develop a comprehensive historical account. Findings The historical analysis identified three distinct phases. First, the acquisition of a Brazilian cigarette factory, Souza Cruz, by British American Tobacco dramatically altered power dynamics, strengthening the position of the tobacco industry. The second phase regards the era of dictatorship and the efforts of various actors advocating against smoking and the tobacco industry. The third phase involved Brazil’s re-democratisation and the challenges of securing FCTC ratification, during which fierce industry opposition had to be overcome. Throughout these phases, the authors identified four key strategies used by multinational corporations (MNCs) in Brazil to uphold unsustainable practices and products that contradicted public interests instead of reforming them: shaping collective memory, dissimulation, re-presentation and redirecting attention. Originality/value This study contributes to critical international business research on emerging economies by examining how Brazil’s position in the global capitalist system has influenced its dependency and how MNCs produce and maintain cycles of poverty and unsustainable practices through the exploitation of power dynamics within the country.

Legal Protection for Children Against the Threat of Addictive Cigarette Substances

Purpose: This research aims to find legal protection for children under the age of 18 from the threat of dangerous addictive substances contained in cigarette products.   Methode: The type of research is normative-juridical.   Result: The research results show that legal protection for children under the age of 18 from the threat of dangerous addictive substances contained in cigarette products from the perspective of child protection law and the Child Rights Covenant is in accordance with the basic principles of children's rights in the Child Protection Law and the Covenant Children's Rights, namely; the principle of non-discrimination, the principle of the best interests of children, the principle of child survival and development, and the principle of respect for children's opinions . The government should immediately ratify the Framework Convention on Tobacco Control (FCTC) or the Tobacco Control Framework Convention to strengthen regulations for protecting children from the dangers of smoking which threaten their health and growth and development.   Conclusion: The essence of legal protection for children under the age of 18 from the threat of dangerous addictive substances contained in cigarette products from the perspective of child protection law and the Child Rights Covenant is in accordance with the basic principles of children's rights in the Child Protection Law and the Child Rights Covenant, namely; the principle of non-discrimination, the principle of the best interests of children, the principle of child survival and development, and the principle of respect for children's opinions

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.

State of the literature discussing smoke-free policies globally: A narrative review.

Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

Association between Tobacco Industry Interference Index (TIII) and MPOWER measures and adult daily smoking prevalence rate in 30 countries

BackgroundThis study aimed to investigate the impact of tobacco industry interference on the implementation and management of tobacco control and the tobacco epidemic using the Tobacco Industry Interference Index (TIII) and MPOWER—a package of measures for tobacco control—and adult daily smoking prevalence in 30 countries.MethodsThe TIII was extracted from the Global Tobacco Industry Interference Index 2019 and Global Center for Good Governance in Tobacco Control (GGTC). MPOWER measures and adult daily smoking prevalence rate were extracted from the World Health Organization (WHO) report on the global tobacco epidemic in 2021. We assessed the ecological cross-lagged association between TIII and MPOWER scores and between TIII and age-standardized prevalence rates for adult daily tobacco users.ResultsTobacco industry interference was inversely correlated with a country’s package of tobacco control measures (β = -0.088, P = 0.035). The TIII was correlated with weaker warnings about the dangers of tobacco (β = -0.016, P = 0.078) and lack of enforcement of bans on tobacco advertising promotion and sponsorship (β = -0.023, P = 0.026). In turn, the higher the TIII, the higher the age-standardized prevalence of adult daily tobacco smokers for both sexes (β = 0.170, P = 0.036). Adult daily smoking prevalence in males (β = 0.417, P = 0.004) was higher in countries where the tobacco industry received incentives that benefited its business.ConclusionWhere the interference of the tobacco industries was high, national compliance with the Framework Convention on Tobacco Control (FCTC) was lower, and the prevalence of adult daily smokers higher. National governments and global society must work together to minimize the tobacco industry’s efforts to interfere with tobacco control policies.

Bridging the gap in the implementation of the World Health Organization’s Framework Convention on Tobacco Control Article 5.3 in India: Insights from an opinion poll and stakeholder consultation

ABSTRACT Background: Article 5.3 of the World Health Organization Framework Convention on Tobacco Control (FCTC) outlines a roadmap for the parties to safeguard public health policies in compliance with the national law from the influence of commercial and other vested interests of the tobacco industry. Aim: The study was conducted with the aim to identify gaps and bring existing Indian policies in compliance with Article 5.3 of FCTC. Materials and Methods: A nationwide cross-sectional opinion poll involving respondents aged &gt;18 years (n = 164) and a panel discussion (n = 31) were conducted. Results: The majority of stakeholders expressed (strongly agree = 65% and agree = 22.6%) the need for a nationwide policy to regulate interactions between public officials and the tobacco industry. About 56.7% felt the need to expand existing protocols and codes of conduct for public officials across India. Over 84% of the participants supported incorporating specific sections to implement Article 5.3 into the Cigarettes and Other Tobacco Products Act Amendment Bill 2020. The majority of participants supported the need for guidelines for medical bodies and prohibiting tobacco companies from participating in corporate social responsibility activities. Conclusion: The Government of India should comprehensively adopt Article 5.3, in all states and union territories, adopting a whole-of-government approach in partnership with the community and civil society under the “whole-of-society” approach for effective tobacco control measures.

CLUSTERING NEGARA BERDASARKAN SKOR PENGENDALIAN KONSUMSI TEMBAKAU MENGGUNAKAN ALGORITMA DBSCAN

Smoking is an activity that has a detrimental impact on the health of individuals, families, communities and the environment, both directly and indirectly. Therefore, it is necessary to control global tobacco consumption. The World Health Organization (WHO) in the Framework Convention on Tobacco Control (FTCT) developed the MPOWER strategy: a which countries can use to control tobacco consumption. In this study a clustering analysis of tobacco use control will be carried out based on the MPOWER score: a from WHO for each country using the Density Based Spatial Clustering of Applications with Noise (DBScan) algorithm. DBSCAN is a cluster formation algorithm based on the level of distance density between objects in a dataset. Using a density radius of 1.72 with a minimum point of 4 objects obtained from the kNNdisplot function on Rstudio produces 4 clusters, 75 data as noise, and the Davies Bouldin-Index value as the best cluster validity is 1.08118.