Tobacco Control Advocates Research Articles

WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations

The aim of this study was to analyze the barriers in the implementation of the Framework Convention on Tobacco Control (FCTC) in China and present recommendations on ways to address these challenges in tobacco control in China. We review the available literature on progress and explore the barriers and challenges that impede a speedier pace in the adoption of the effective tobacco control measures, and present recommendations based on in-depth knowledge of decision-making process on the implementation of FCTC in China. The pace of progress in China is too slow. China faces intractable political, structural, economic and social barriers in tobacco control, which make the whole-hearted implementation of FCTC measures a painstaking process. The authors recommend a comprehensive approach to speed up the implementation of tobacco control measures. This includes strong political leadership from the top, structural changes to the tobacco industry and government oversight of the tobacco industry, as well as advocacy and support for tobacco control from civil society at the grassroots level.

What are the sales practices of internet cigar vendors in China?

ObjectiveTo estimate the number of websites selling cigars in China and to examine their sales and marketing practices.MethodsComprehensive searches were conducted using three keyword terms and two popular internet search...

Tobacco Road Finland – How did an accepted pleasure turn into an avoidable risk behaviour?

Smoking was once defined as an appropriate recreational substance or life comfort, but is now understood as a serious health risk and a public health problem important enough to be controlled by society. In this article the changed social position and development of tobacco regulations in Finland are studied from a perspective of social constructionism. The emergence of recent tobacco controls can be seen as a process whereby tobacco came to be defined as a social problem. I will argue that there were three primary definitions which played a decisive role in this process. Put in historical order, these three definitions contained (1) claims about harms to smokers, (2) claims about harms to others, and (3) claims about tobacco as a highly addictive drug. These conceptions together drove a complementary and mutually reinforcing re-conception of tobacco harms. Consequently, the emergence of these definitions led to the founding of new institutions, practices, and treatments. The leading value in the claim-making process was public health, which transferred the state's interest away from fiscal revenues towards lowering the costs caused by tobacco diseases. Correspondingly, medical science and medical doctors gained a position as the leading authority in the defining the tobacco issue. The latest conceptual innovation is the idea of a tobacco-free Finland by 2040, representing a strategy of ‘de-normalising’ tobacco use. The reversal in the social and cultural position of tobacco, which in Finland went from one extreme to another, was not based on pressure created by any wider social movements or organised tobacco-specific citizens groups, as in some other countries, but rather by a state health administration supported by a relatively small network of tobacco control advocates.

Understanding the Influence of Evidence in Public Health Policy: What Can We Learn from the ‘Tobacco Wars’?

AbstractPublic health is overtly policy‐orientated and there is widespread support for the notion that health policies should be strongly informed by evidence. Despite this, studies consistently find that public health policies are not evidence‐based. This is often explained by reference to popular theories about research‐policy relations which highlight, amongst other things, the communicative gaps between academics and policymakers, the centrality of values (or politics) to decision‐making and the efforts by external interests to influence policy outcomes. Employing the ‘tobacco wars’ as a case study, with a particular focus on the UK, this article explores how tobacco control advocates and tobacco industry interests have attempted to influence policy and how, in so doing, each has sought to enrol evidence. Whilst accepting that evidence has played an important role in tobacco policy development, the article challenges claims that the implementation of tobacco control policies can be attributed to evidence. Turning to value‐orientated and network‐based approaches to conceptualizing policy development, the article demonstrates both the importance of values and the complex nature of coalitions. However, it argues that this approach needs to be supplemented by an ideational understanding of policy change, which pays attention to the ways in which arguments and evidence are constructed and framed. The article also suggests there are signs that the two ‘coalitions’ involved in the ‘tobacco wars’ may be unravelling. Overall, the ‘tobacco wars’ serve to highlight the complex relationship between evidence and policy, offering some insights for those interested in studying or improving the use of evidence in policy.

Reflections on the ‘endgame’ for tobacco control

The concept of an ‘endgame’ for tobacco control efforts is receiving increasing attention in advocacy, policy and academic circles. This may strike some as entirely premature in countries such as...

Where There's Smoke There's Fire: Outdoor Smoking Bans and Claims to Public Space

The Canadian city of Vancouver was very early to introduce extensive smokefree legislation. Smoking has been banned in all indoor locations for well over a decade and tobacco control advocates have also recently begun to push for the expansion of such legislation into outdoor spaces in the city. Drawing on a 6-month period of observation of smokers and “not-smokers” on their lunch breaks at office sites in downtown Vancouver, I examine the ways that smokers engage with outdoor public space. I show that while smokers continue to make material claims to such space, these claims have become increasingly tenuous. I argue that tobacco “denormalization” strategies provide essential context for understanding outdoor smoking bans and raise ethical questions about the form of de-facto prohibition they appear to encourage.

‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party

BackgroundThe Tea Party, which gained prominence in the USA in 2009, advocates limited government and low taxes. Tea Party organisations, particularly Americans for Prosperity and FreedomWorks, oppose smoke-free laws and...

The changing demographic of blunt smokers across birth cohorts

BackgroundIt has been suggested that African-American males, born in the 1970s, initiated the practice of smoking blunts during the rise of the hip-hop subculture in the 1990s. The objective of this study was to determine if other racial/ethnic groups from more recent birth cohorts adopted the practice as well. MethodsData from seven cross-sectional surveys, the 2004–2010 National Surveys on Drug Use and Health, were aggregated for constructing six five-year birth cohorts (n=297,478), starting with the 1970–1974 cohort. Age-stratified regression models were then developed to test the effect of the interaction between race/ethnicity and birth cohort on the past-year use of blunts. ResultsFewer differences in the prevalence of past-year blunt smoking were observed between African-Americans and other racial/ethnic groups from more recent birth cohorts. Statistically significant interaction terms in age-stratified models indicated that relative to African-Americans, the odds ratios of blunt smoking were greater in Caucasians and Hispanics born in the1980s compared to those born in the late 1970s. These results were replicated when the sample was limited to past-year cannabis users (n=61,038). ConclusionsAfrican-Americans, who likely initiated blunt smoking as adolescents/young adults in the 1990s, continued the practice into adulthood. As characterized by other drug eras, the drug became popular over time and expanded into other demographic groups. The additional exposure to tobacco should alert tobacco-control advocates about blunt smokers’ risk of developing nicotine dependence.

Experience of Smokers and Recent Quitters with Smokefree Regulations and Quitting

Bans on smoking in public areas have increased as knowledge of secondhand smoke dangers has grown. Restrictions on smoking in public areas may lead to less smoking and increased quitting. This study examines the experiences of smokers and recent quitters with local smokefree regulations to better understand the possible mechanisms by which smokefree regulations affect individual tobacco users' patterns of tobacco consumption and quitting. Fifteen in-depth interviews and thirteen focus groups were conducted with tobacco users and recent quitters formerly enrolled in cessation programs provided by ClearWay Minnesota(SM). Data were collected 3 months after smokefree legislation was adopted in the Minneapolis/St. Paul metropolitan area in 2006, and were stratified by tobacco use status and strength of regulation. Essential themes were extracted using NVivo 8 software in 2011. Study participants reported that smokefree legislation forced them to confront their addiction. They experienced apprehension, frustration, and panic anticipating smoking restrictions. This motivated some to attempt to quit, whereas others felt punished by and angry at government intrusion. Both current and former tobacco users felt smokefree regulations contributed to stigmatizing smokers. They also reported smokefree legislation reduced the temptation to smoke. The physical absence of cigarette smoke in bars and restaurants appeared to support quit attempts. The inconvenience of smoking outside was reported to have a similar effect. Essential mechanisms by which bans influenced patterns of tobacco use and quitting include confronting addiction, temptation, inconvenience, and social norms. These findings highlight the success of tobacco control advocates in denormalizing tobacco use, and suggest that some tobacco users may be internalizing negative messages about tobacco.

Tobacco control advocacy in the age of social media: using Facebook, Twitter and Change

The tobacco industry's use of social media sites, such as Facebook, is an emerging area of research; however, this is the first study of the potential for social media to...

Tips for managing a social networking site

Many public health organisations are making use of online social networking sites, such as Facebook, to disseminate information. The University of Kentucky's Kentucky Center for Smoke-free Policy (KCSP) has a...

Advocacy for tobacco control in India – A step forward

Tobacco use is the main cause of preventable death in the world today, accounting for nearly six million deaths each year. This is higher than the number of deaths due to tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome andmalaria combined. In the next two decades, the annual death toll from tobacco is expected to rise to over 8million, withmore than 80% of these deaths expected to occur in lowand middle-income countries. Tobacco poses a major public health challenge in India, being the second largest consumer of tobacco products and the second largest producer of tobacco in the world. The Global Adult Tobacco Survey 2010 estimated that there were 275 million users of tobacco, 163.7 million users of smokeless tobacco, 69.1 million smokers and 42.1 million users of both smoking and smokeless tobacco in India. The prevalence of overall tobacco use was 47.9% and 20.2% among men and women, respectively. Nearly two in five (38.4%) adults in rural areas and one in four (25.3%) adults in urban areas used tobacco in some form. Advocacy is an established strategy for tobacco control. The ultimate goal of any advocacy effort is to achieve effective, comprehensive, enforced tobacco control laws and policies. Prevention is clearly the most cost-effective measure for tobacco control. The role of public health advocacy in securing

Success Counteracting Tobacco Company Interference in Thailand: An Example of FCTC Implementation for Low- and Middle-income Countries

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face ‘how to’ challenges of implementation. For more than two decades, Thailand’s public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with ‘two faces’, (2) seeking to influence people in high places, (3) ‘buying’ advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

“Anti-Smoking Data Are Exaggerated” Versus “The Data Are Clear and Indisputable”: Examining Letters to the Editor About Tobacco

Media advocacy plays a unique role in tobacco control policy development. Letters to the editor in particular are an interesting form of media advocacy because they reflect community sentiment regarding the policy agenda and provide insight into the public debate. The authors used ethnographic context analysis to examine the techniques used by writers of 262 tobacco-related letters to the editor published in 61 newspapers across Missouri over a 2-year period when tobacco tax and smoke-free indoor air initiatives were occurring across the state. The authors found that pro–tobacco control letter writers often used didactic strategies, citing numbers and reports, to convey information and presented their training or experience as a health professional (e.g., M.D., Ph.D.) to add legitimacy to their arguments. Anti–tobacco control letter writers, in contrast, used narrative strategies to support their stance, claimed authority as a smoker or small business owner to legitimize their claims by relating to the audience, and used collectivity to capture the attention of policymakers. These results present the importance of strategic media advocacy in tobacco control. Tobacco control advocates should increase their use of narrative strategies and collectivity in order to better connect with the public and policymakers.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia.

IntroductionIn low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand's comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures.MethodWe used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand's tobacco control community, and an analysis of research productivity.FindingsIn Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support.ConclusionThe evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Generating news media interest in tobacco control; challenges in an advanced policy environment

To determine the efficacy of using media releases for tobacco control advocacy in Australia's advanced policy environment. Between February and August 2010, news releases that summarised either newly published but unpublicized research findings, or local developments in tobacco control, were sent to NSW media outlets. Reports arising from the releases were tracked using commercial services Media Monitors and Factiva, as well as Google and Google News. Other tobacco control related news items during the same period were also tracked and recorded. Twenty-one news releases generated 93 news items across all news media, with a quarter of these related to a story of porcine haemoglobin in cigarette filters. By comparison, 'live' policy issues (especially plain packaging and a significant tobacco tax increase) covered in this period attracted 1,033 news stories in the Australian media. Press releases describing recently published, but underpublicized research were issued in weeks where no major competing tobacco control news occurred. Results of this project indicate that in environments with advanced tobacco policy, media opportunities related to tobacco control advocacy are limited, as many objectives have been achieved. The media can still play a key advocacy role in such environments, and advocates need to be particularly vigilant for opportunities that do arise. The paper also highlights the increasingly important role of internet-based media, including opportunities presented by social media for tobacco control.

Making News: The Appearance of Tobacco Control Organizations in Newspaper Coverage of Tobacco Control Issues

To characterize the presence of advocacy groups in media coverage about tobacco issues. A content analysis of tobacco-related newspaper articles. Australia. All 12 national and state capital daily newspapers published in Australia between 2004 and 2007. We coded each article for explicit mentions of any of 16 major national or state tobacco control advocacy groups; for the article type, prominence, and topic; for the tone of the event; and for the author's opinion. A series of 2 × 2 χ(2) analyses assessed the extent to which advocacy groups were more or less likely to be mentioned in articles of each type, prominence, topic, event impact, and opinion orientation. Of the 4387 tobacco-related articles published over this period, 22% mentioned an advocacy group. There was a greater-than-expected proportion of advocacy groups mentioned in news articles with very high prominence (44%; χ(2) [1, N = 3118] = 27.4, p < .001), high prominence (34%; χ(2) [1, N = 3118] = 10.9, p < .001), and medium prominence (30%; χ(2) [1, N = 3118] = 7.3, p = .007), and in articles covering events with mixed (30%; χ(2) [1, N = 4387] = 10.0, p = .002) or positive (24%; χ(2) [1, N = 4387] = 26.1, p < .001) implications for tobacco control. Australian tobacco control advocacy groups have a reasonable presence within the news discourse on tobacco control issues and so are likely to contribute to generating and shaping this discourse, particularly in relation to evolving and controversial issues.

Addressing Tobacco Use in Homeless Populations

A diverse group of panelists met for one day on October 21, 2009, in Washington, DC, for the purpose of addressing the high tobacco use prevalence rates in homeless populations; identifying appropriate policy, cessation practices and models for implementation in this population; and providing targeted recommendations for researchers, homeless service providers, tobacco control advocates, and policy makers. The panel was convened by Break Free Alliance, one of six national networks funded by the Centers for Disease Control and Prevention, Office on Smoking and Health. The panelists worked through a process of problem identification, generation of responses, analysis and prioritization, development of recommendations, and arrival of final decisions reached by consensus. The resulting recommendations for addressing tobacco use in homeless populations focused on tobacco non-use policy implementation, cessation programming, and expansion of partnerships and collaborations between tobacco control advocates and social service providers. The panel also identified unanswered research questions that can serve to develop a framework for future initiatives to reduce tobacco use among homeless persons. The expert panel model serves as one approach for engaging nontraditional partners and building consensus among leaders from a variety of sectors to address tobacco use in special populations.

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry

BackgroundBuilding on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process.MethodsSeveral qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey.FindingsThe Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted.ConclusionThe state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.

Four Arguments against the Adult-Rating of Movies with Smoking Scenes

SC has over 30 years experience in tobacco control research and advocacy and has won several international and national awards, including the American Cancer Society's Luther Terry medal for outstanding international leadership. He was deputy editor then editor of Tobacco Control for 17 years and is now Editor Emeritus. He is committed to exposing tobacco industry marketing practices and supporting the WHO's Framework Convention on Tobacco Control's provisions on banning tobacco advertising. MCF has dedicated his 17-year research career to conducting objective research and evaluation of major tobacco control programs such as the American Legacy Foundation's truth® campaign and key policy interventions such as cigarette excise taxes and smoke-free air laws. No specific funding was received for writing this article. Provenance: Not commissioned; externally peer reviewed.