Tobacco Control Activities Research Articles

Mental health and support for rigorous tobacco control strategies in South Australia

IntroductionTobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control...

Flavor and Device Choices Among People Who Use ENDS: Results From the PATH Study

IntroductionIn guidance published in February 2020, the FDA described their intent to prioritize enforcement against the sale of flavored cartridge-based electronic nicotine delivery systems (ENDS) except tobacco and menthol flavors. This guidance was specific to cartridge-based ENDS and did not apply to other ENDS types or e-liquids sold in the United States (U.S.). It remains unknown if use of certain types of ENDS devices and flavors changed following the publication of this guidance. MethodsThis analysis includes PATH Study data from Wave 5 (W5, 2018-2019) and Wave 6 (W6, 2021) and examines cross-sectional estimates of 1) use of flavored ENDS and 2) use of different device types. All analyses in this study were stratified by self-reported age (youth – aged 12-17 years at W5 and aged 14-17 years at W6, and adults – aged 18-20, 21-24, and 25+). Analyses were conducted in 2023-2024. ResultsAmong adults aged 21 years and over, there were significant increases in the use of menthol or mint flavored ENDS. There were no substantial changes in flavors of ENDS used among youth or adults aged 18-20 years. Among all age groups, the use of cartridge-based ENDS was lower in 2021 than 2018–2019, with a notable shift to disposable-style ENDS. ConclusionsFederal-level tobacco control actions taken in the U.S. in early 2020 prioritized enforcement against “any flavored, cartridge-based ENDS product (other than a tobacco- or menthol-flavored ENDS product)”. Based on this analysis, there was a shift following the policy to menthol or mint-flavored ENDS and disposable-style ENDS.

Cigarette smoking decline among US young adults from 2000 to 2019, in relation to state-level cigarette price and tobacco control expenditure

ObjectiveTo investigate the association of state-level cigarette price and tobacco control expenditure with the large 2000–2019 decline in cigarette smoking among US 18–24 year-olds.MethodsSmoking behaviour was assessed in the 24...

Maternal smoking prevalence in Brazil in 2013 and 2019: not what we expected when they were expecting!

Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. We examined changes between 2013 and 2019 in the relative differences in smoking prevalence rates between pregnant and non-pregnant women aged 18-49 years. We used data from a nationally representative health survey conducted in Brazil in 2013 and 2019. A generalized linear model with binomial family and logarithmic link function was used to estimate, for each year of analysis, the crude and adjusted (by age-group, educational attainment, place of residence, and status of protection from passive smoking at home) relative differences. In 2013,the proportion point estimate of tobacco use among pregnant women was lower than that observed among non-pregnant women (4.7% vs. 9.6%). However, in 2019 proportion point estimates were virtually the same (8.5% vs. 8.4%). After adjustment for selected variables, in 2013, smoking prevalence among pregnant women was 42% (p-value≤0.05) lower than that observed among non-pregnant women. On the other hand, in 2019, maternal smoking prevalence was 13% (p-value>0.05) higher than that found among non-pregnant women. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations pose serious threats to public health and likely contributed to increasing maternal smoking prevalence. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and pre-natal tobacco prevention and cessation interventions as part of health professionals' routine consultation. The decline in smoking prevalence among non-pregnant women between 2013 and 2019 was accompanied by an increase in maternal smoking prevalence. Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations in Brazil pose serious threats to public health. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and primary healthcare professionals´ tobacco-related assistance during interaction with their patients.

Fuzzy-set qualitative comparative analysis of factors affecting the use of e-cigarettes among college students in Guangdong province.

In recent years, e-cigarettes as an emerging tobacco product have been favored by college students. Our study aims to explore the factors affecting the use of e-cigarettes among college students and to put forward feasible suggestions for effectively controlling the use of e-cigarettes among college students. The participating students were from three undergraduate and three specialized colleges in Guangdong Province, surveyed from January to March 2022. The Fuzzy-set Qualitative Comparative Analysis (fsQCA) method was used to analyze the influence mechanism and path of five antecedents: self-efficacy, social environment, cognition, sales environment, and negative outcome expectation, on the use of e-cigarettes. The fsQCA used in this study is a novel research methodology that combines the strengths of qualitative and quantitative analyses, through which we can determine which conditions are essential to the outcomes that lead to e-cigarette use among college students, and which combinations of conditions are more important than others. The interaction of self-efficacy, social environment, cognition, sales environment, and negative outcome expectation, affected college students' use of e-cigarettes. Through the fsQCA method, it was found that self-efficacy alone constitutes a necessary condition for college students not to use e-cigarettes. There are four possible pathways for college students not to use e-cigarettes, with higher self-efficacy, correct cognition, and a healthy social environment influencing the most important combination of conditions for college students to use e-cigarettes. The use of e-cigarettes by students in Guangdong Province is the result of the synergistic effect of multiple factors. Tobacco control action suggestions focus on improving students' self-efficacy and paying attention to the combination of different factors to achieve more effective tobacco control.

Adherence to the National Tobacco-Free School Policy in Selected Schools of Puducherry District in India: A Cross-Sectional Exploratory Study.

The objective of this study was to estimate the level of compliance and the factors associated with high adherence to the Tobacco-Free Educational Institutions (ToFEI) guidelines of the Government of India among schools in the district of Puducherry, India. This cross-sectional study was conducted among schools (N=50) in the Puducherry district in 2021-2022 using a "Self-Evaluation Scorecard" of the ToFEI guidelines. The assessment was done through in-person interviews with the schools' heads/representatives. The level of compliance to indicators was presented as proportions, and factors associated with high compliance were assessed using the chi-square test. No school met all the ToFEI indicators. The majority (88%) showed no evidence of the use of tobacco products inside the premises. More than half of the schools (58%) adhered to the criteria of not having tobacco shops within 100 yards and 56% reported the inclusion of the "No Use of Tobacco" norm in their guidelines. Schools located in rural areas (p-value <0.01) and those with teachers who attended any tobacco-related workshop were more likely to comply with the ToFEI indicators (p-value 0.05). After relaxing the criteria for 'High Adherence' to at least four indicators, we found that 20% of schools showed high adherence to the ToFEI indicators. Overall compliance of schools to the ToFEI guidelines is low in Puducherry. Sensitizing the relevant stakeholders in the district for implementing ToFEI guidelines and institutionalizing tobacco control activities in the school are the needs of the hour.

Marketing of nicotinamide as nicotine replacement in electronic cigarettes and smokeless tobacco.

In the United States, the Food and Drug Administration (FDA) requires tobacco product manufacturers to submit Premarket Tobacco Product Applications (PMTA) for new products, granting marketing approval only if deemed appropriate for the protection of public health. Historically, the tobacco industry has exploited loopholes in the Tobacco Control Act (TCA), especially related to the definitions of nicotine, tobacco product and characterizing flavors, to circumvent the PMTA requirement. In 2023, the industry introduced several 'PMTA-exempt' e-cigarette and smokeless products, including products containing 6-methyl nicotine, a synthetic nicotine analog that is pharmacologically more potent than nicotine. In late 2023 and early 2024, the major US e-cigarette suppliers Nicotine River and ECBlend introduced 'PMTA-exempt' products with the brand names 'Nixamide' or 'Nixodine' or 'Nixotine', with nicotinamide as the main active ingredient. Nicotinamide is a form of vitamin B3 with no known pharmacological activity at nicotinic receptors. Here, we report that the marketing claims for these products, suggesting them and be nicotine substitute products designed to target nicotinic receptors and provide the same experience as nicotine, is deceptive and misleading to consumers. We also inform that these products have evolved further to contain a combination of nicotinamide and 6-methyl nicotine. The regulatory implications of these newly introduced products are discussed.

Capacity building, national and international cooperation for enhancing tobacco control activities in Romania

Capacity building, national and international cooperation for enhancing tobacco control activities in Romania

Capacity of enforcers and level of enforcement of the Tobacco Control Act 2015 in Kampala, Uganda.

Tobacco use is a leading cause of preventable deaths worldwide. Uganda enacted the Tobacco Control Act (TCA) 2015 to domesticate implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) regulations. This study assessed the capacity to enforce the TCA and associated factors, as well as the level and barriers to its enforcement in Kampala, Uganda. A cross-sectional study using both quantitative and qualitative methods was employed. A structured questionnaire was used for quantitative data collection, and a WHO adapted capacity assessment open-ended guide was used for key informant interviews. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals for the independent predictors for capacity to enforce the TCA. A total of 162 respondents from 5 institutions and six key informants were involved in the study. Findings established that only 23% (37/162) of the enforcers had the capacity to enforce the TCA. Male enforcers [OR = 0.16, 95% CI (0.05-0.55)], those who did not know when the law was enacted [OR = 0.19, 95% CI (0.07-0.52)], those with no plans to enforce the law [OR = 0.22, 95% CI (0.05-0.93)], and older enforcers (aged 31-40 years) [OR = 0.27, 95% CI (0.09-0.81)] were less likely to have the capacity to enforce the TCA. The level of enforcement of the TCA was mainly low to moderate for most of the institutions mandated to enforce it. Lack of knowledge about the law amongst the enforcers and general public, and inadequate funds were reported as major barriers to enforcement of the TCA. The capacity to enforce the TCA in Kampala was low. There is potential to enhance the capacity of enforcers through further dissemination of the Act, as well as sensitization of enforcers, institutional managers, and the general public about the legislation.

Tobacco advertising ban discourse in online media coverage

Background and purpose: One industry that allocates quite a lot of budgets for advertising is the tobacco industries, which is still allowed with restrictions. Along with efforts to protect the public from negative exposure to tobacco products, tobacco control activists are discussing a total ban on tobacco advertisement in various media. The campaign to voice a total ban on tobacco advertisement has also reported in online media coverage. The purpose of this study is to determine the frame of online media coverage of the tobacco advertisement ban discourse. Methods: This research analyzed online media news stories in January – April 2022 period about the discourse on the tobacco advertising ban using framing analysis method with a qualitative approach. This study analyzes the frame of online media news stories related to the discourse of a total ban on tobacco advertisement. Results: This research found that there were two tones of news story in online media about the discourse of tobacco advertising ban, namely those that supported and those that rejected. News story with a supportive tone usually took source person from the civil society groups that support tobacco control, while news story with a rejection tone usually placed the tobacco industries as a disadvantaged party which in the end also harmed the workers and tobacco farmers. Conclusion: The discourse of tobacco advertisement ban was framed in different way by online media. There are at least two different tones in media coverage of the discourse, namely those that support the tobacco advertisement ban and those who reject the tobacco advertisement ban, although more news was found to be supportive.

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Deadly declines and diversity – understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence

Job demands-resources, job crafting and work engagement of tobacco retailers.

In recent years, the development of tobacco control actions in China and the changes in people's health concepts have slowed the development of the tobacco industry. As an important strategic partner of tobacco sales companies, tobacco retailers are the key link between tobacco commercial enterprises and consumers. How to improve the work engagement level of tobacco retailers is an urgent issue for tobacco business enterprises. On the basis of job demands–resources (JD–R) theory, the mechanisms of the effects of job resources and demands on tobacco retailers' work engagement were explored. Results showed that (1) The negative path of job demands influencing tobacco retailers' work engagement was supported, and job crafting played a mediating role in it. (2) The positive path of job resources influencing tobacco retailers' work engagement was supported, and job crafting played a mediating role in it. (3) Servant leadership moderated the influence of job resources and demands on job crafting. Higher level of servant leadership brings the stronger effect of job resources on job crafting and the weaker effect of job demands on job crafting. (4) The mediating effect of job crafting between JD–R and work engagement was moderated by servant leadership. The higher level of servant leadership strengthened the mediating role of job crafting between job demands and work engagement, whereas it weakened the mediating role of job crafting between job demands and work engagement. This study enriches the research on application fields and boundary conditions of JD–R theory and provides practical guidance for improving the work engagement level of tobacco retailers.

An observational study of compliance with tobacco-free school guidelines in Udupi district, Karnataka (India)

Background: National tobacco-free school guidelines were introduced in India in 2009. We assessed compliance with these guidelines across both government, government-aided, and private schools in Udupi district of Karnataka state in India. Methods: We visited 915 upper primary and high schools across Udupi district and used a standardized checklist for visual inspection of the school environment and interviews with a school representative to ascertain compliance with guidelines (display of a tobacco-free school/institution board, presence of no smoking signage, no tobacco sale within 100 yards, presence of a Tobacco Control Committee, integration of tobacco control activities into the school health program, and availability of a copy of Cigarettes and Other Tobacco Products Act). Results: A tobacco-free school board was displayed at the main entrance of 73% of schools, and there was no evidence of tobacco products on sale within 100 yards of 96% of schools. However, only 5% of the schools reported having the Committee; 4% reported having a copy of the Cigarettes and Other Tobacco Products Act, 2003 with the school, and no smoking signage was observed in &lt; 1%. Integration of tobacco control activities into the school health program was reported in 91% of schools. Conclusions: Compliance with tobacco-free school guidelines in Udupi was far from complete, indicating the need for enhanced implementation and monitoring.

Does tobacco use among adolescents come out of style in Czechia and Slovakia? Findings from the Global Youth Tobacco Survey between 2002 and 2016.

The aim of this study is to analyse Global Youth Tobacco Survey (GYTS) data on a prevalence of tobacco use, indicators of tobacco control and pro-tobacco activities in Czechia and Slovakia between 2002 and 2016. GYTS is a school-based survey of students aged 13-15 years carried out in Czechia and Slovakia in 2002/2003, 2007, 2011 and 2016. Standardized uniform questionnaires provided representative data. Between 2002 and 2016 the current cigarette smoking declined both in Czechia and Slovakia (from 34.6% and 26.4% to 15.2% and 17.1%, respectively). Indicators of tobacco control activities either did not change (access to buy cigarettes by minors) or decreased (school-based and mass media interventions). Indicators of pro-tobacco activities declined (being ever offered by a free tobacco product and having something with a tobacco product brand logo on it). Tobacco use is on decline and the situation becomes similar to the most of European countries. Preventive activities are only partially responsible for the process. Rather effect of global trends accelerated by widespread use of social media can play a role.

Innovative promotional strategies and diversification of flavoured mass merchandise cigar products: a case study of Swedish match

In 2009, the Family Smoking Prevention and Tobacco Control Act (TCA) granted the U.S. Food and Drug Administration (FDA) regulatory authority over tobacco products, although initially this only included cigarettes,...

Strengthening tobacco control policies during the COVID-19 pandemic in India

Problem consideredThe aim of this paper was to support policy makers to make informed decisions regarding public health response in general, and tobacco control interventions particularly, in the context of COVID-19. MethodsAn online cross-sectional survey using a semi-structured questionnaire was conducted in the year 2020 with stakeholders in tobacco control and public health experts from private and government organizations. Information pertaining to background characteristics of study participants and impact of pandemic on tobacco use and means to leverage tobacco control policy was collected. Data was analysed using Microsoft excel 2010 and results are presented as frequencies and percentages along with key responses from open ended questions. ResultsA total of 72 stakeholders were approached out of which, 46 (56.1%) responded and were included. About 32 (74.4%) of the participants thought that public health authorities had given advice on stopping tobacco use during COVID-19 pandemic. About 19 (43.2%) participants did not notice any change in level of interest in tobacco cessation during the pandemic while a majority 34(73.8%) agreed that COVID-19 pandemic had an impact on health seeking behaviour of patients with non-communicable diseases. Nearly half of participants, 21(48.8%) opined that tobacco industry was engaged in corporate social responsibilities during COVID-19. ConclusionThe stakeholders expressed that there is a good opportunity to further strengthen tobacco control activities during COVID-19 pandemic and also emphasized need to closely monitor tobacco industry interference during this time.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Smokeless Tobacco in Uganda: Perceptions among Tobacco Control Stakeholders.

The use and sale of smokeless tobacco (SLT) is prohibited in Uganda under the Tobacco Control Act (TCA), 2015. Nonetheless, SLT products remain available, and there are limited and inconsistent data on SLT users. Additionally, the perceptions of tobacco control stakeholders on SLT are unknown, making it difficult to determine barriers to enforcing the ban. This study examined perceptions of tobacco control stakeholders regarding SLT in Uganda. Qualitative semi-structured interviews were conducted with stakeholders who were purposively selected from ministries, semi-autonomous government agencies and Civil Society Organizations. Interviews explored knowledge, attitudes, perceptions of SLT appeal, and user demographics. Data were analysed using Nvivo V.12 software. Participants demonstrated a general lack of awareness of SLT product types and the extent of their use. They believed SLT use was increasing among females and minors and was as harmful to health and the economy as smoking. SLT products were thought to be cheaper than cigarettes and to appeal to minors. Discreet use was thought to help users overcome the cultural aversion towards tobacco use among women and youth in Uganda. There is an urgent need to strengthen the implementation of the SLT ban whilst also increasing efforts to reduce tobacco smoking.

Facing the challenges of smokeless tobacco epidemic in Bangladesh

AbstractBackgroundSmokeless tobacco (SLT) use in Bangladesh is one of the highest in the world. Despite having a tobacco control programme, the use of SLTs has increased in recent years. The objective of this paper is to report on the prevalence of SLTs and challenges faced during control measures in Bangladesh.MethodsA wide range of published reports on tobacco in general and SLT were reviewed. Websites of relevant organizations and national survey reports including PubMed were visited to identify national‐ or subnational‐level data. Legislations, policies and their implementation and programmes are reviewed. Additional data were captured by active surveys on SLT products, especially on graphic health warning. The authors’ perspectives on SLT control in Bangladesh were captured through a series of brainstorming sessions.FindingsThe reported prevalence of SLTs ranged from 21% to 26% among adults. SLT control measures are not adequately addressed despite the existence of several policies and programmes. It is based to the definition of Tobacco Control ACT in 2013. We propose inadequate prioritization and weak policy directives; unregulated industry leading to high production, marketing, violation of package warning and tax evasion; high level of cultural acceptance; and poor awareness of the people as challenges to the control efforts. In addition, a lenient attitude of the government towards the so‐called “cottage” industry made SLTs unabated. We propose prioritization of SLT control, strengthening industry monitoring and tax measures, countering cultural acceptability and public ignorance and cessation support engaging government and civil society organizations as the way forward.ConclusionThe control measures should be evidence‐based warranting operational research. Government and non‐government organizations’ collaborative efforts on an immediate, short‐and long‐term basis are recommended to meet the challenges of SLTs. These primarily include policy support for prioritization, enforcement of legislation, industry and marketing regulation, stringent tax measures, denormalizing societal acceptability and cessation support.

Agenda-setting of tobacco control policy in Iran: a retrospective policy analysis study

BackgroundThe prevalence of tobacco use, especially hookah, has increased in Iran In recent years, particularly among young people and women, and the age of onset of use has decreased. Tobacco use is the fourth leading risk factor for non-communicable diseases in Iran. These issues cause concerns in the country and led to the present study on tobacco control agenda-setting in Iran over a 30-year timeframe.MethodsWe conducted this retrospective analytical study to investigate process analysis in Iran using Kingdon’s multiple-streams framework (MSF). We collected the data using semi-structured interviews with key informants (n = 36) and reviewing policy documents (n > 100). Then, we analyzed the policy documents and in-depth interviews using the document and framework analysis method. We used MAXQDA 11 software to classify and analyze the data.ResultsIran’s accession to the Framework Convention on Tobacco Control (FCTC) opened a window of opportunity for tobacco control. The policy window opens when all three streams have already been developed. The adoption of the comprehensive law on the national control and campaign against tobacco in the Islamic Consultative Assembly in 2006 is a turning point in tobacco control activities in Iran.ConclusionsThe tobacco control agenda-setting process in Iran was broadly consistent with MSF. The FCTC strengthened the comprehensive plan for national control of tobacco as a policy stream. However, there are several challenges in developing effective policies for tobacco control in the Iranian setting.