Implementing Tobacco Control Research Articles

Efforts made for Tobacco Control (NTCP) implementation in all health institution, Govt. offices and Districts Basti Tobacco Free State of Uttar Pradesh

Efforts made for Tobacco Control (NTCP) implementation in all health institution, Govt. offices and Districts Basti Tobacco Free State of Uttar Pradesh

Paving way for tobacco free schools towards building leadership and broader alliances for implementing tobacco control policy

Paving way for tobacco free schools towards building leadership and broader alliances for implementing tobacco control policy

Cigarillo sales in legalized marijuana markets in the U.S.

BackgroundNearly half of marijuana users in the United States also smoke cigarillos, with many using the products as marijuana “blunts.” The relationship between marijuana legalization and tobacco retail has not yet been examined. This study uses tobacco sales data to compare the cigarillo marketplace in states with legalized recreational marijuana to the overall U.S. marketplace in 2016. MethodsCigarillo sales data from 2016 were obtained from the Nielsen Research Company in the following market regions: Denver, CO; Seattle, WA; Portland, OR; and the overall U.S. Descriptive statistics highlighted differences in the market share of various product features (e.g., flavors, brand, pack size) across regions. ResultsCharacteristics such as fruit flavors, single sticks, and 2–3 packs were more popular in legal marijuana regions compared to the overall U.S. Black & Mild, a brand not traditionally used for blunts, was the top brand nationally (32.8% market share), but Swisher was the top brand in legal marijuana regions. In Seattle and Portland, for example, over half of cigarillo sales were for Swisher products (59.1% and 52.1%, respectively). Cigarillo wraps (i.e., no tobacco filler) were particularly popular in Denver, constituting 11.4% all cigarillo sales versus 2.8% nationally. ConclusionsCigarillo product characteristics traditionally associated with blunt use may shape the tobacco market in legal marijuana regions. As more states continue to legalize recreational marijuana, state and local governments should anticipate the potential impact on the tobacco marketplace and implement tobacco control policies (e.g., flavor bans, minimum pack sizes) that discourage product use.

International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark

Smoking habits early in life are known to have important implications for lifetime smoking behaviors and efforts that discourage smoking among young people are essential for national tobacco control. In Denmark, various approaches have been taken to prevent or stop smoking in youth. This paper provides an overview of approaches to tobacco control policies and smoking cessation programs targeting adolescents and young adults in Denmark and presents current evidence of their effectiveness. Extensive research documents the effect of tobacco control policies on youth smoking behavior, especially that of increasing prices on tobacco. Further, it has been suggested that strategies addressing the social aspect of smoking should be emphasized. This paper highlights that Denmark has an untapped potential within national tobacco control. Denmark should prioritize a comprehensive approach including enactment of tobacco control policies and implementation of interventions shown to be effective to prevent smoking initiation and encourage quitting among Danish youth.

The State of Tobacco Control in ASEAN: Framing the Implementation of the FCTC from a Health Systems Perspective

AbstractUsing a tobacco control framework that combines demand‐reduction and selected supply‐reduction measures according to a health system's building blocks, this article aims to assess the state of Framework Convention on Tobacco Control implementation in ASEAN countries from a health systems perspective. Results show that more ASEAN member states are showing leadership in adopting effective policies in the MPOWER suite of interventions such as raising taxes on tobacco, establishing smoke‐free areas and implementing graphic health warnings. However, effective enforcement of these policies is hampered by the lack of policies to protect public health measures from tobacco industry interference. ASEAN faces three challenges to control and reduce tobacco use: tackling the increasing burden of disease from tobacco use, tobacco industry interference and the need for better governance based on stronger political will and commitment. ASEAN member states need to further invest and innovate on tobacco control and promoting healthy lifestyles in order to achieve the SDG target on tobacco control.

Progress in Tobacco Control in Singapore: Lessons and Challenges in the Implementation of the Framework Convention on Tobacco Control

AbstractSingapore has implemented tobacco control policies since the 1970s, more than three decades before it became party to the World Health Organization (WHO) Framework Convention on Tobacco Control—the first evidence‐based global health treaty in 2005. The country's stringent policies have resulted in a 13 per cent adult smoking prevalence rate, one of the lowest in the world. This article reviews how a mix of demand‐ and supply‐reduction measures with extensive regulation and stringent enforcement has contributed to Singapore's reputation as the ‘most hostile environment’ for tobacco companies. Its tobacco control policies can offer lessons for more effective tobacco control among its neighbouring countries.

Implementing Tobacco Control Assistance in Pediatric Departments of Chinese Hospitals: A Feasibility Study.

Evidence-based tobacco control strategies delivered through pediatric settings could encourage parental smoking cessation and reduce children's exposure to second hand smoke (SHS) in the United States. The extent to which these tobacco control strategies could be routinely implemented in the pediatric setting of a developing country is not known. We tested the feasibility and efficacy of implementing an evidence-based intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE), in a Chinese hospital to address the second hand smoke exposure of children in the home and car and to address parental smoking. We conducted a quasi-experimental trial of CEASE implementation in the pediatric inpatient departments of 2 Chinese hospitals, 1 assigned as the intervention hospital and another assigned as the control hospital. Data were collected through pre- and postsurveys of parents and clinicians, implementation process surveys, and chart review. In the intervention hospital, pediatricians' rates of delivering different types of tobacco control assistance to smoking parents were all significantly (P < .0001) higher during the post-CEASE implementation period than in the pre-CEASE implementation period. During the post-CEASE implementation period, pediatricians' rates of delivery for all aspects of tobacco control assistance were significantly higher (all P < .0001) in the intervention hospital than in the control hospital, whereas there was no difference during the pre-CEASE period. The findings of this study suggest that it is feasible to implement a system-level intervention of CEASE in the pediatric inpatient department of a major hospital in southern China. A large-scale trial incorporating measures to increase quit rates and including a long-term follow-up is needed to examine the effectiveness of CEASE implementation in China.

English

Tobacco smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander Australians. Reducing tobacco use in this population is a public health priority. Precise monitoring of smoking prevalence trends is central to implementation and evaluation of effective tobacco control. The way in which trends are reported influences understanding of the extent of progress, with potential implications for policy. Our objective was to quantify absolute changes in Aboriginal and Torres Strait Islander adult (≥18 years old) daily tobacco smoking prevalence from 2004 to 2015, including comparisons with the total Australian population, and by age, sex and remoteness. We analysed multiple nationally representative surveys of the Aboriginal and Torres Strait Islander, and total Australian, population conducted from 2004 to 2015. Aligned with strength-based approaches, we applied a progress frame, focusing on absolute differences in smoking prevalence within the Aboriginal and Torres Strait Islander population. The prevalence of current daily smoking among Aboriginal and Torres Strait Islander adults nationally was 50.0% (95% confidence interval [CI] 47.9, 52.2) in 2004-05 and 41.4% (95% CI 39.1, 43.6) in 2014-15, representing an absolute prevalence decrease of 8.6 percentage points (95% CI 5.5, 11.8) over the past decade. This is comparable with the 6.8 percentage point (95% CI 5.6, 7.9) decrease in smoking prevalence in the total Australian population over the same period, from 21.3% in 2004-05 (95% CI 20.5, 22.0) to 14.5% in 2014-15 (95% CI 13.6, 15.4). Particular success in reducing Aboriginal and Torres Strait Islander daily smoking was observed among younger age groups, with a decrease of 13.2 percentage points for 18-24-year-olds (95% CI 5.9, 20.4), 9.0 percentage points for 25-34-year-olds (95% CI 2.7, 15.3) and 8.7 percentage points for 35-44-year-olds (95% CI 2.6, 14.8). Smoking prevalence in those living in urban/regional areas decreased by 10.2 percentage points (95% CI 6.2, 14.1). Substantial progress has been made in reducing smoking, with an estimated 35 000 fewer Aboriginal and Torres Strait Islander adults smoking every day in 2014-15 compared with if daily smoking remained at 2004-05 prevalence. This will lead to thousands of lives saved. The observed success in the younger age groups is encouraging. Continued resourcing and comprehensive tobacco control efforts are required to ensure positive trends continue.

Solving the problem of smoking in the Polish enterprises during 2003-2015.

Tobacco smoking is a major organizational, economical, and public relations-related (PR-related) problem for the company. Moreover, it is an important health determinant of the working population. The paper reports the results of the research which analyzed the current state and the tobacco control activities' transformations undertaken by Polish employers between 2003 and 2015. Data comes from the research performed in 2006, 2010 and 2015, involving random- selected representative samples of Polish enterprises, employing no fewer than 50 employees. The sampling pattern covered location and classification of activities (excluding public administration, national defense, social security, education, health care and social assistance sectors). Consecutive interviews were conducted with representatives of 611, 1002 and 1000 companies, respectively. The companies improved their compliance with the national regulations on smoking in the workplace. The strategy for limiting smoking in public places resulted in a steady increase in the number of companies (11%, 23%, 38%, respectively) that introduced smoking ban. Approximately in every second company, smoking was allowed only in the smoking room or outdoors. Voluntary activities (e.g., education and support for employees wishing to cease smoking) were very rarely undertaken by medium and large companies (several percent) and since 2010, when the law had become more restrictive, such tendency reinforced. Employers also were seldom interested in the prevalence of tobacco smoking among their personnel, its consequences for the company's functioning and the effectiveness of the implemented tobacco control measures. National anti-smoking policy caused that companies were more focused on smoking-bans at the expense of education and support for those who wanted to cease smoking. Although this contributes to reducing secondary smoking in the workplace, the companies' potential to become a major agent for tobacco control policies is neglected while the downward trend of smoking in the Polish society has slowed down. Int J Occup Med Environ Health 2018;31(3):261-280.

Institutions and the implementation of tobacco control in Brazil.

This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.

German EstSmoke: estimating adult smoking-related costs and consequences of smoking cessation for Germany.

We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. Germany. German population of prevalent current, never and ex-smokers in 2009. Life-time cost and outcomes in current, never and ex-smokers. If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%.

Tobacco control law implementation in a middle-income country: Transnational tobacco control network overcoming tobacco industry opposition in Colombia

ABSTRACTThe objective of this paper is to examine the implementation of Colombia's tobacco control law. Methods involved are triangulated government legislation, news sources, and interviews with policy-makers and health advocates in Colombia. Colombia, a middle-income country, passed a tobacco control law in 2009 that included a prohibition on tobacco advertising, promotion, and sponsorship; and required pictorial health warning labels, ingredients disclosure, and a prohibition on individual cigarette sales. Tobacco companies challenged the implementation through litigation, tested government enforcement of advertising provisions and regulations on ingredients disclosure, and lobbied local governments to deprioritise policy responses to single cigarette sales. A transnational network including international health groups and funders helped strengthen domestic capacity to implement the law by; promoting public awareness of Ley [Law] 1335; training local health department staff on enforcement; facilitating health agencies’ sharing of educational strategies; and providing legal defence assistance. This network included vigilant efforts by local health groups, which continuously monitored and alerted the media to noncompliance, engaged government officials and policy-makers on implementation, and raised public awareness. Support from international health NGOs and funders and continuous engagement by local health groups enhanced implementation capacities to counter continued tobacco industry interference and ensure effective tobacco control implementation.

Prevalence and determinants of current and secondhand smoking in Greece: results from the Global Adult Tobacco Survey (GATS) study

ObjectivesGreece is one of the leading tobacco-producing countries in European Union, and every year over 19 000 Greeks die from tobacco-attributable diseases. The aim of the present study was to...

Youth tobacco use in South-East Asia: Implications for tobacco epidemic and options for its control in the region.

Nearly half of all male population and two in every five females in the WHO South-East Asia Region (SEAR) consume some form of tobacco. Preventing initiation among adolescents is critical for overall tobacco control. We assessed the trends in youth tobacco use and policies in SEAR. Data are used from school-based youth (Global Youth Tobacco Survey and global school student-based health survey) and adult (Global Adult Tobacco Survey, STEPS) tobacco surveys and the WHO Framework of Convention of Tobacco Control (FCTC) implementation database. More than 10% of 13-15-year-old adolescent students reported tobacco use in 8 out of 11 countries. The prevalence of smokeless tobacco exceeded that of cigarettes except in Indonesia, Thailand, and Timor-Leste. No consistent declining trends in tobacco use were observed in any of the countries with 3 or more data points. More than half of all daily smokers aged 20-34 years initiated "daily" smoking before 20 years of age. 19% (Bangladesh) to 55% (Timor-Leste) of 13-17-year old students tried their first cigarette before their 14th birthday. Majority of adolescent students in most of the SEAR countries reported purchasing their cigarettes from store/shop/vendor and as single sticks, with few exceptions and purchased them as "single" cigarette. There is a limited change in affordability of cigarettes in SEAR over time. Tobacco use remains high among youth in SEAR. Efforts should be strengthened to fully implement/enforce recommended policy measures (legal minimum age, fiscal measures to reduce tobacco affordability; prohibiting sale of single cigarettes, etc.) and to explore new measures (e.g., tobacco-free generation).

MTE01.01 Strategies to Improve Tobacco Control in Central European Countries

Tobacco use is the single most preventable cause of death and disease, especially of lung cancer. Approximately 1.6 million people in the WHO European Region die of tobacco-related diseases every year and the Region has the highest proportion of deaths (16%) attributable to tobacco use. Globally, Europe also has the highest prevalence of tobacco smoking among adults (28%), including one of the highest smoking prevalence rates among women (19%). In the meantime it is well-known that a wide range of political decisions can stop the tobacco epidemic and reduce substantially smoking. According to the first health treaty in history, the WHO Framework Convention on Tobacco Control, following strategies are the most effective: raising cigarette prices through higher cigarette tax and combating illicit trade of cigarettes, protecting from secondhand smoke through comprehensive smoke-free air laws, enforcing bans on advertising, promotion and sponsorship, placing warnings (pictures and text as big as possible) on tobacco packages and communicate the warnings through media/educational programs and finally offering greater access to smoking cessation services. WHO Europe has established a database on countries of the WHO European region showing the effects of the reduction in smoking prevalence as a result of implementing tobacco control policies. This presentation will analyze the current situation in this Region and showing the lessons learnt from past years with regards to future prevention of smoking. Strategies for effective tobacco control, WHO European region, especially Central Europe, Tobacco prevention

Prevalence of smoking among doctors and paramedical staff in Hospital University Center Mohammed VI, Marrakech

Le tabagisme est un problème majeur de santé publique. Le personnel médical et paramédical n'est pas épargné par ce fléau. L'interdiction de fumer à l'hôpital est née d'une volonté gouvernementale de réduire le tabagisme passif. L'objectif de cette étude était d'évaluer les habitudes tabagiques chez le personnel soignant médical et paramédical, afin d'élaborer une stratégie de lutte contre le tabagisme au sein de cette population, et de les adresser éventuellement à la consultation d'aide au sevrage tabagique. L'étude transversale descriptive concernant l'ensemble du personnel soignant du CHU de Marrakech en se basant sur la distribution des questionnaires anonymes. Nous avons distribué 530 questionnaires dont 380 ont été récupérés, soit un taux de réponse de 71,7%. La population d'étude était constituée de 58,2% de femmes (n= 221) et de 41,8% d'hommes (n=159). Le personnel médical (n=220) était la catégorie professionnelle la plus représentée (57,9%) suivie des infirmiers (31,8%). Les fumeurs (n = 62) représentaient 16,3% de notre population d'étude; les ex-fumeurs (n=31) 8,1% et les non-fumeurs (n= 287) 75,5%. La moyenne d'âge des fumeurs était de 31,1 ans avec des extrêmes de 22 à 56 ans. La prévalence du tabagisme était de 16,3% (n=62) de la population d'étude dont 32,7% (n=52) chez les hommes contre 4,5 % (n=10) chez les femmes. L'âge moyen de début du tabagisme était de 19 ans avec des extrêmes de 11 à 29 ans avec une consommation moyenne de 9 cigarettes/jour. 13% (n=50) des personnes fumaient aussi le narguilé, 9% (n=34) consommaient de l'alcool et 3% (n=21) des personnes consommaient du Cannabis. 67,7% des fumeurs (n=42) se projetaient d'arrêter de fumer, dont 30,9% (n=13) dans les 3 prochains mois, 52,4% (n=22) dans les prochains 6mois et 16,7% (n=16) se projetaient d'arrêter dans l'année. Plusieurs activités incitaient les fumeurs à fumer davantage dont la garde, la pause-café, et les repas dans respectivement 90,3% (n=56), 64,3% (n=40) et 61,3% (n=38) des cas. A la suite de cette enquête, une réflexion doit être menée sur la nécessité de mener des actions de sensibilisation pour renforcer la motivation de ceux qui désirent arrêter et les aider dans leur démarche de sevrage.

Using public interest litigation for tobacco control: Insights from India.

The Indian notion of "Public Interest Litigation (PIL)" represents a moral and humane process for providing justice to an individual or a group in matters relating to infringement of fundamental rights or denial of civil privileges. The goal of PIL in India is to counter governmental lawlessness, administrative deviance, and exploitation of disadvantaged groups by denying them their rights and entitlements. Although this paper selectively describes the use of the PIL mechanism for ensuring implementation of large graphic health warnings on packages of tobacco products in India, there is a sufficient published literature to corroborate the successful use of this mechanism in India in different tobacco control settings. In fact, over the years, this legal tool has allowed the tobacco control community in India, to extensively promote human rights approach to tobacco control. In the wake of growing interference of tobacco industry worldwide, this paper explores PIL as a potent and effective tool for claiming public health rights related to tobacco control. The PIL has considerable potential to be used for enforcement of tobacco control measures and for stopping tobacco industry from engaging in activities which are detrimental to the health of the people at large. It is important to continuously identify potential avenues through which lessons and recommendations pertaining to PIL could be incorporated into the WHO Framework Convention on Tobacco Control implementation plans and guidelines, with special focus on different intercessional mechanisms that are available from time to time. To set the ball rolling, the authors suggest two such avenues.

ED12.01 Tobacco Control Policies in Eastern Europe

ED12.01 Tobacco Control Policies in Eastern Europe

P1.01-001 Reduction of Cigarette Consumption through a National Policy for Tobacco Control in Brazil

According to WHO, “approximately one person dies every six seconds due to tobacco, accounting for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease”, which can be lung cancer (87%), pulmonary disease (61%) and coronary heart disease (32%), considering secondhand smoke exposure too as says the Surgeon General's Report. To protect the health of the Brazilian population, the government has been applying measures, since the 90 years, to reduce the harm caused by tobacco use. Brazil is also committed to reduce the premature mortality from tobacco use in 30% from 2013 to 2025, to achieve one of the nine voluntary WHO Global NCD's Targets. Quantitative secondary data analysis confronting the cigarette prevalence rates found in Risk and Protective Factors Surveillance for Chronic Diseases Telephone Survey (VIGITEL) and the National Policy for Tobacco Control measures. Before ratifying the WHO Framework Convention on Tobacco Control, in 1996 the government started promoting smoke-free places, banning the advertising, promotion and sponsorship, that were finally regulated in 2014. In 2011, the Secretariat of Federal Revenue developed a new system for cigarette taxation to establish a minimum price for a pack of twenty cigarettes and raise the cigarette's excise tax gradually. In May, 2016 the total taxation represents 76% of the cigarette price and will bring to 81% after December 2016. This is one of the measures of the Framework Convention for Tobacco Control/WHO more cost-effective in the country: Article 6, which deals with the rising prices and taxes on tobacco products to reduce demand. Several surveys and studies point to a reduction in smoking prevalence. Every year, since 2006, the VIGITEL report has shown prevalence rates collected in the entire adult population of the 27 state capitals. In 2015 the frequency of smokers decreased to 10.4%, compared to 2006 which were 15.7% for both sexes. The report also reiterated the effectiveness of the prices and taxes measure, when you compare the frequency of former smokers with lower education, those representing people with lower income. In 2006 they were 25.6%, and in 2015 they increased to 29.1%. The present study shows a prevalence decline as a positive result coming from the National Policy for Tobacco Control implementation between the years of 2006 and 2015. To achieve the WHO Global NCD’s Target we still have too much work to do, especially protect the National Policy from the tobacco industry interference.

Social characteristics associated with disparities in smoking rates in Israel.

BackgroundCigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel.MethodsThis is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models.ResultsCurrent smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well.ConclusionsAmong several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13584-016-0095-2) contains supplementary material, which is available to authorized users.