Implementation Of Tobacco Control Policies Research Articles

How do industry and other actors undermine tobacco control policies post-adoption? A scoping review

Abstract Background Over recent decades, many countries have strengthened their tobacco control policies. To be effective, full implementation is needed. Tobacco industry interference is widely recognised as a key barrier to tobacco control progress and evidence-based models like the policy dystopia model (PDM) list industry strategies, focusing on those avoiding and undermining policy adoption. While prior research highlighted industry activities post-adoption, these have not been captured systematically. This review aimed to map the efforts of industry, front groups and other actors to undermine the implementation of policies, including marketing, packaging, smokefree and flavour measures. Methods We searched six literature databases, relevant bibliographies and grey literature, and consulted experts. We included articles describing one or more attempts to undermine adopted policies, including marketing, packaging, smokefree and flavour. The PDM served as starting point for coding; additional strategies were identified inductively. Strategies were charted against aims and policies. Results Several aims and strategies were identified which were similar across policies. Following policy adoption efforts to 1) overturn and 2) weaken measures, and 3) delay implementation continued. Legal strategies were utilised and there were attempts to influence stakeholders. In addition, tobacco industry and other actors sought to 4) undermine policy effectiveness by creating confusion, circumventing policies, and noncompliance, and 5) use implementation as an opportunity to enhance industry reputation. Conclusions Interference from tobacco industry and other actors threatens effective tobacco control policy implementation. The public health community must continue to monitor, expose and counter industry conduct after policy adoption. More research is needed to enhance our understanding of how industry interferes in policy implementation, and how this can be pre-empted and countered. Key messages • The interference from tobacco industry and other actors following policy adoption threatens effective tobacco control, and needs to be monitored, exposed and countered by the public health community. • Policymakers and civil servants need to be wary of efforts to undermine tobacco control policies and act to ensure effective policy implementation.

Crowding-out effect of tobacco consumption on household food expenditures in Cameroon

This study delves into the critical issue of household budgets in Cameroon, specifically focusing on the impact of tobacco expenditure. Tobacco use often represents a significant portion of a household’s financial resources, potentially leading to a phenomenon known as the “crowding-out effect.” This effect describes a situation where increased tobacco spending leads to a decrease in the budget allocated to other essential goods and services. To gain a deeper understanding of this phenomenon, this study employs a quantitative approach. The analysis utilizes data from a nationally representative household survey conducted in Cameroon during 2014 (ECAM4). A two-stage least squares (2SLS) technique is implemented to address a potential statistical issue known as endogeneity, which could otherwise skew the results. The study’s findings reveal a concerning trend: tobacco expenditure has a negative impact on the budget shares allocated to essential goods such as food, clothing, and household equipment. This negative impact appears to be particularly pronounced for male consumers within households. Based on these findings, the study suggested that implementing tobacco control policies could lead to significant improvements in household well-being and overall health status. These policies, by encouraging a reduction in tobacco use, could free up resources that could then be reallocated towards essential goods, ultimately improving household financial stability and health outcomes.

A realist evaluation of the implementation of a national tobacco control program and policy in India.

There is a growing interest in studying and unpacking implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate to policies and get implemented and understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) a comprehensive national tobacco control policy, and the National Tobacco Control Programme (NTCP), 2008 using realist evaluation. We developed an initial program theory (IPT) based on a realist literature review of tobacco control policies in Low- and Middle-Income Countries (LMICs). Three diverse states -Kerala, West Bengal, and Arunachal Pradesh- with varying degree of implementation of tobacco control law and program were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the program theory. A total of 300 Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurations were developed from the interview data, which were later synthesized into state-specific narrative program theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear, and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined program theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other LMICs.

Tobacco Control in Denmark: How the Ugly Duckling Turned into a Swan.

The implementation of tobacco control policies has been a neglected topic in tobacco research. A comprehensive Tobacco Action Plan including plain packaging, a point-of-sale display ban, a ban on characterizing flavors (in products other than cigarettes), a strengthening of the promotion and marketing ban, a ban on the sale of novel nicotine products to minors, smoke-and nicotine-free-school hours in all-schools with minors, and a significant increase in tobacco tax, was adopted in Denmark in 2019. Eleven people involved or very close to the advocacy process were invited, two did not respond and nine attended our research center. We used the nominal group technique, a consensus method, to identify the most important driving factors for passing the Tobacco Action Plan. The round-robin identified 39 driving factors merged into 13 in the clarification phase. In the ranking phase, participants agreed on seven factors that they perceived have strongly influenced the political will to strengthen national tobacco control comprehensively. The most important factors were national data and evidence, a nationwide alliance with broad partnerships, a strict focus on young people, continuous media coverage, intensive lobbying by many different advocates, making it a community agenda-not a political one, and effective professional campaigns. Our findings agree with experiences from other countries that significantly improved tobacco control. The Danish strategy, including a nationwide alliance with broad partnerships, had a high influence on the political agenda. In this study, there was a consensus that seven factors strongly influenced the political will to comprehensively strengthen the national tobacco control in Denmark in a short time: national data and evidence; a nationwide alliance with broad partnerships; a strict focus on children and young people; continuous media coverage; intensive lobbying by many different advocates; making it a community agenda-not a political one, and effective professional campaigns. This is consistent with findings from other countries.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis.

Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

A decade of tobacco control efforts: Implications for tobacco smoking prevalence in Eastern Mediterranean countries.

This study aimed to assess the association between the 10-year implementation of tobacco control policies, cigarette affordability index and changes in tobacco smoking prevalence across Eastern Mediterranean (EMR) countries. An ecologic study was conducted using EMR countries as the analytical unit. Data from three sources were utilized: the MPOWER scale to measure tobacco control policy implementation (2010-2020), the tobacco affordability index (expressed as a percentage of GDP per capita required to purchase 2000 cigarettes, from 2010 to 2020), and national tobacco smoking prevalence data for EMR countries (2010-2023). Linear Fixed-effect regression was employed to investigate associations between changes in MPOWER scores, the cigarette affordability index, and alterations in tobacco prevalence over a decade. Statistically significant inverse associations were observed between changes in MPOWER scores and tobacco smoking prevalence among both men and women in EMR countries (P-value<0.05). Each unit increase in MPOWER score corresponded to a 0.26% reduction in tobacco prevalence among men and a 0.12% reduction among women. The regression model revealed that each unit increase in the cigarette affordability index was linked to a 0.9% decrease in tobacco smoking prevalence across EMR countries (P-value<0.05). Furthermore, even after adjusting for multiple confounders, significant inverse associations were noted between tobacco monitoring (β = -0.41), health warning (β = -0.45), and changes in tobacco smoking prevalence (P-value<0.05). This study underscored the effectiveness of enhancing the implementation of tobacco control policies and increasing the cigarette affordability index as preventive measures to reduce tobacco smoking prevalence in EMR countries over the past decade.

Topic prediction for tobacco control based on COP9 tweets using machine learning techniques.

The prediction of tweets associated with specific topics offers the potential to automatically focus on and understand online discussions surrounding these issues. This paper introduces a comprehensive approach that centers on the topic of "harm reduction" within the broader context of tobacco control. The study leveraged tweets from the period surrounding the ninth Conference of the Parties to review the Framework Convention on Tobacco Control (COP9) as a case study to pilot this approach. By using Latent Dirichlet Allocation (LDA)-based topic modeling, the study successfully categorized tweets related to harm reduction. Subsequently, various machine learning techniques were employed to predict these topics, achieving a prediction accuracy of 91.87% using the Random Forest algorithm. Additionally, the study explored correlations between retweets and sentiment scores. It also conducted a toxicity analysis to understand the extent to which online conversations lacked neutrality. Understanding the topics, sentiment, and toxicity of Twitter data is crucial for identifying public opinion and its formation. By specifically focusing on the topic of "harm reduction" in tweets related to COP9, the findings offer valuable insights into online discussions surrounding tobacco control. This understanding can aid policymakers in effectively informing the public and garnering public support, ultimately contributing to the successful implementation of tobacco control policies.

Tobacco control in Qatar from 2002 to 2022: 20 years of progress and challenges.

Tobacco use and exposure has been known as one of the leading causes of premature mortality worldwide. Tobacco control measures have been considered one of the strategies for reducing the burden of NCDs, improving public health, and strengthening the health system's response to threats and pandemics. The State of Qatar has put tobacco control a national public health priority as it has adopted various tobacco control measures that the WHO classified as high-impact measures. This has resulted in achieving tobacco control milestones which led to constant monitoring of tobacco use and the provision of smoking cessation services at all healthcare levels. However, there is still much work to be done to fill the gaps and respond to the emergence of novel tobacco products and market strategies in an effective way. This review highlights the status of tobacco use and exposure in the State of Qatar, and focus on the progress, and challenges in the implementation of tobacco control policies and smoking cessation services between 2002 and 2022.

Comparative Study of Tobacco Control Policy in Smoking Behaviour Between Lithuania and Indonesia

Indonesia is one of the countries that have a large number of smokers in the world and it keeps increasing every year. Lithuania compared to other European Union countries, is slightly bigger than the European Union average of smoking prevalence. Both of these countries have implemented Tobacco Control Policies for quite a long time. Three research objectives in this research are to review and compare Lithuania and Indonesia’s Tobacco Control Policies; to analyze the situation of smoking behavior in Lithuania and Indonesia; and to analyze the implementation and its impact on smoking behavior of Tobacco Control Policy in Lithuania and Indonesia. Qualitative methods are used to analyze the document for the policy and literature analysis to acquire information about the situation of smoking cases and the implementation of the policy in both countries. This study aims to accomplish a comparative analysis of the Tobacco Control Policy between Lithuania and Indonesia and its impact on the rise of smoking cases. The Indonesian government has set a good Tobacco Control Policy but the implementation of the policy it’s not strict and there are a lot of tobacco product advertisements in Indonesia, this could be the reason why Indonesia has so many smokers and increasing every year. Lithuania has stricter regulations and implementation, and the smokers are decreasing every year, but they have a new group of smoker which is youth smoker that growing rapidly nowadays.

Association between tobacco control policies and smoking behaviour in Europe

Abstract Background Smoking is an important public health problem. The European Health Interview Survey (EHIS) provides regular data on prevalence and determinants of smoking for the populations of European countries, while the Tobacco Control Scale (TCS) quantifies the implementation of tobacco control measures. The aim is to examine the associations between tobacco control policies at country level and individual-level smoking prevalence. Methods Using multi-level regression modelling, individual data from EHIS 2019/2020 and country-level data from TCS 2019 were analysed. The outcome measure was self-reported current smoking (daily or occasional) at the individual level. Predictor variables were at the individual level: gender, age and education attainment level, and at country level: scores of TCS policy components ‘Price', ‘Public place bans', ‘Advertising bans', ‘Health warnings', ‘Treatment’ and ‘Illicit trade'. Microdata from the 3rd wave of EHIS for 28 European countries were used with a total of n = 66.934 individuals aged &amp;gt;15 years. A weighting factor was applied to consider each country proportionally according to its sample size in EHIS. Results There are large cross-national differences in current smoking prevalence ranged from 12.6% (95% confidence interval (CI) 11.9-13.3) in Sweden to 36.2% (95% CI 35.0-37.4) in Bulgaria. In the final multi-level model besides individual variables (female gender, age 60 years and over, medium or high education level), following variables at country level were significantly associated with lower prevalence of current smoking: ‘Price’ (Odds Ratio (OR)=0.96 (p &amp;lt; 0.05) and ‘Treatment’ OR = 0.88; (p &amp;lt; 0.01). For ‘Public place bans', ‘Advertising bans', ‘Health warnings’ and and ‘Illicit trade’ association were in same direction but without significance. Conclusions Tobacco control policies help to reduce the prevalence of smoking in population, although the different measures have differing impact. Key messages • Our study confirms the link between the implementation of tobacco control policies and smoking prevalence using recent data. • Policy components have different effects on smoking prevalence at population level.

Enhancing the legislation and implementation of tobacco control policies in Türkiye

Enhancing the legislation and implementation of tobacco control policies in Türkiye

Smoking-attributable mortality in Portugal and its regions in 2019

Introduction and objectivesTimely regional-specific estimates of smoking-attributable mortality (SAM) are crucial for healthcare planning and tobacco control advocacy. Currently, this information is lacking in Portugal. The aim of this study was to estimate SAM by region in 2019 among the Portuguese population aged ≥35 years. MethodsSAM was estimated using an independent-prevalence method. Observed mortality was obtained from Portugal Statistics; lung cancer mortality rates in smokers and never-smokers from the Cancer Prevention Study I-II and updated relative risks from five contemporary US cohort studies. SAM was estimated for each NUTS-II region by sex, age, and cause of death. Crude SAM rates, sex and age-specific rates, and age-adjusted rates were calculated using the direct method. ResultsIn 2019, tobacco consumption caused 13,847 deaths, representing 12.3% of total mortality among the Portuguese population aged ≥35 years. Of the total SAM, 71.2% occurred in men and 22.2% in those under 65 years; 42.5% was due to cancer, 35.4% to cardiovascular and metabolic diseases, and 22.2% to respiratory diseases. SAM greatly varied among regions from 2.1% in Madeira to 36.2% in the North region. In men, cancer was the leading cause of death in all regions, while in women it was cardiovascular and metabolic diseases. ConclusionIn Portugal, tobacco-mortality burden is high and varies significantly by region, sex and age. Therefore, estimates disaggregated by sociodemographic data and region may better support decision-makers while tailoring and implementing tobacco control policies addressing health population needs. The apparent lower tobacco burden among women and in some Portuguese regions may dramatically rise in the near future. This and the high SAM in Portugal, particularly in some regions, highlights the need to accelerate tobacco control both at national and regional levels.

Comparative Study on Tobacco Control in India and the United Kingdom: Analysis of Executive Policies

Context: In recent decades, the tobacco epidemic has spread worldwide. The impact of tobacco control policies has been different among countries. This paper aims to explain how two countries, the United Kingdom (UK) and India, with different political, social, and cultural contexts, implemented the World Health Organization (WHO) Framework Convention on Tobacco Control. Evidence Acquisition: A comparative study was done for tobacco control in UK and India in 2022. A review of literature in five databases, observational data and legal documents on tobacco use were undertaken. To identify and explain the factors that pose challenges to the implementation of tobacco control policies, country reports and health policy monitoring and research databases (in total, 27 papers and 16 reports) were reviewed. Results: Having different economic, social, and cultural backgrounds, a similar pathway to control the tobacco industry can be seen in UK and India. The factors that can explain the similar outcomes in two countries are the global pressure of WHO, increased awareness of people and policymakers, and a sense of urgency about the tobacco problem in both societies. Conclusions: At different stages of tobacco control in both countries, various interest groups with different routes of political influence used veto opportunities to overturn political decisions in the policy process. Continuous analysis of interest groups and their status quo is necessary to restrict the tobacco industry in favor of public health. Governments should carefully recognize the stakeholders and stake challengers in the policy domain and balance their interests.

Determinants of quit attempts among current Indian tobacco users: Findings from global Adult tobacco survey, 2016-17

Problem consideredTobacco use is the second most common preventable cause of death in the world and quitting tobacco is an important strategy to prevent premature morbidity and mortality. The objective of this study was to determine the correlates of quit attempts among tobacco users in India from GATS-2 data. MethodsComplex sample analysis was considered for logistic regression analysis to identify the correlates of quit attempts using Global Adult Tobacco Survey (GATS)- 2 (2016–17) data. Weighted estimates were calculated for sample statistics. ResultsA marked difference was observed in quit attempt rates across various states of India (p < 0.001). The quit attempt rate among current smokers and smokeless tobacco users was 33.7% [95% confidence interval (CI) = 32.8–34.7] and 28.9% [95% CI = 28.1–29.6] in India as per GATS 2. Individuals from scheduled caste and other backward classes had higher odds of making a quit attempt among current smokers. Among the smokeless tobacco users (SLT), factors namely age, belonging to other backward classes and having a belief that tobacco use is dangerous to health were independently associated with quit attempts. Majority of the users, 83.5% (95%CI = 82.2–84.8) of the smokers and 88%(95%CI = 87.0–88.9) of the SLT users made a quit attempt without any cessation aid. ConclusionFormulating tobacco control policies specific to the groups identified may bridge the gap between tobacco users and cessation services. The varying quit attempt rates reported across the country necessitates stringent implementation of tobacco control policies and programmes.

Status and Challenges of Implementing Tobacco Control Policies in Korea: Focus on WHO MPOWER Measures

Status and Challenges of Implementing Tobacco Control Policies in Korea: Focus on WHO MPOWER Measures

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.

From policy to practice: lessons learned from two regional consultations on strengthening the implementation of tobacco control policies in India.

From policy to practice: lessons learned from two regional consultations on strengthening the implementation of tobacco control policies in India.

From policy to practice: lessons learned from two regional consultations on strengthening the implementation of tobacco control policies in India.

From policy to practice: lessons learned from two regional consultations on strengthening the implementation of tobacco control policies in India.

Study on Tobacco Control-Related Stakeholders’ Perspective on Tobacco Control Policies and Practice Towards Teenagers and Children Under Sharia Law Setting in Aceh

Banda Aceh City Qanun Number 5 of 2016 concerning Smoking Free Areas and MPU Fatwa Number 18 of 2014 concerning Smoking in the Islamic view are two regional policies that have been issued and must be implemented optimally to limit and reduce smoking consumption, especially among adolescents and children in Aceh. This study aims to assess the perspectives of tobacco control-related stakeholders on tobacco control policies and practices in Aceh Province for children and adolescents. This study uses a qualitative study design by conducting Focus Group Discussions with twelve people as representatives of stakeholders related to tobacco control efforts in Aceh. The smoking culture of the Acehnese people which has integrated into their way of life has made teenagers and children vulnerable to exposure to cigarettes. But on the other hand, the Islamic view of smoking is in line with the principles of tobacco control where smoking can harm children and adolescents, so it is strictly prohibited in the Islamic view. Therefore, it is suggested that tobacco control interventions in Aceh for children and adolescents can focus on interventions that use a socio-cultural approach. This can guarantee the success of the tobacco control intervention program carried out in certain areas such as Aceh Province, which still has very clear socio-cultural values. In addition, a shared understanding of the dangers of smoking and making clear the law against smoking will strengthen tobacco control in Aceh, where so far the people have carried out everything based on sharia. Strict sanctions for youth and children who smoke and adequate resources are other keys to the success of the practice and implementation of tobacco control policies in Aceh Province.

Content analysis of Dutch newspaper coverage of three tobacco control policies, 2017–2019

ObjectivesNews media coverage can influence support for and implementation of tobacco control policies. This research aims to analyse and compare newspaper coverage of newly implemented policies: a substantial tobacco tax...