Tobacco Control Experience Research Articles

The WHO FCTC’s lessons for addressing the commercial determinants of health

SummaryThe tobacco, alcohol, beverage, processed food, firearms, gambling, fossil fuel and mining industries, inter alia, are implicated in fostering negative commercial determinants of health. They do this by shaping our environments, tastes, knowledge and politics in favour of the unlimited consumption and unencumbered promotion of their deadly and dangerous products. To shift the determinants of health, emphasis should be put on preventing industry actors whose profit lies in harming health from wielding influence over the institutions and actors of global and national governance. The tobacco control experience and the implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) provide a unique, comprehensive and fully substantiated guide for how this may be done. Just as the tobacco industry was a pathfinder for other harmful industries in developing tactics for expanding the depth and reach of the market for their deadly products, the WHO FCTC experience is the obvious pathfinder for countering the commercial determinants of health across all sectors and industries. Although they are desirable for countering negative commercial determinants of health, the WHO FCTC’s lesson is not that commercially driven epidemics must be tackled with legally binding treaties. Rather, given the challenges to treaty-making, the key lessons are those that show how it is possible to address the harms of other commodities, even in a treaty’s absence. What is needed is the national implementation of measures providing for intersectoral governance and protection from industry interference which will then assist in unlocking measures for reducing the supply of and demand for unhealthy commodities.

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

Science and Health Policies to Tackle Chronic Diseases in Chile

Chile has experienced rapid epidemiological transitions characterized by decreasing infant mortality, population aging, and a shift towards obesity with an increase in noncommunicable diseases (NCDs). Today, tobacco, alcohol, and ultraprocessed foods are the main risk factors for these diseases. Based on Chile's experience in tobacco control, we discuss paths to make progress in population evidence-based strategies to improve overall community health.

‘I’m not a smoker…yet’: a qualitative study on perceptions of tobacco control in Chinese high schools

ObjectiveChinese adolescents’ perceptions about tobacco control at schools are rarely researched. We explored how current antismoking strategies work in middle school environments, as well as the attitudes towards these strategies...

The role of the food industry in health: lessons from tobacco?

In this review, we highlight poor diet as the biggest risk factor for non-communicable diseases. We examine the denial tactics used by the food industry, how they reflect the tactics previously used by the tobacco industry, and how campaigners can use this knowledge to achieve future public health successes. Data sources are wide ranging, notably publications relating to public health, obesity and processed food, the effectiveness hierarchy and food industry denialism tactics. Global burden of disease analyses consistently demonstrate that poor diet produces a bigger burden of non-communicable disease than tobacco, alcohol and inactivity put together. The lessons learnt from the tobacco control experience of successfully fighting the tobacco industry can be applied to other industries including processed food and sugary drinks. Tackling obesity and poor diet is a more complex issue than tobacco. Food industries continue to promote weak or ineffective policies such as voluntary reformulation, and resist regulation and taxation. However, the UK food industry now faces increasing pressure from professionals, public and politicians to accept reformulation and taxes, or face more stringent measures. The rise in childhood and adult obesity needs to be arrested and then reversed. Unhealthy processed food and sugary drinks are a major contributing factor. There is increasing interest in the tactics being used by the food industry to resist change. Advocacy and activism will be essential to counter these denialism tactics and ensure that scientific evidence is translated into effective regulation and taxation.

Tobacco Control and Health Advocacy in the European Union: Understanding Effective Coalition-Building.

Introduction:Coalitions of supporters of comprehensive tobacco control policy have been crucial in achieving policy success nationally and internationally, but the dynamics of such alliances are not well understood.Methods:Qualitative semi-structured, narrative interviews with 35 stakeholders involved in developing the European Council Recommendation on smoke-free environments. These were thematically analyzed to examine the dynamics of coalition-building, collaboration and leadership in the alliance of organizations which successfully called for the development of comprehensive European Union (EU) smoke-free policy.Results:An alliance of tobacco control and public health advocacy organizations, scientific institutions, professional bodies, pharmaceutical companies, and other actors shared the goal of fighting the harms caused by second-hand smoke. Alliance members jointly called for comprehensive EU smoke-free policy and the protection of the political debates from tobacco industry interference. The alliance’s success was enabled by a core group of national and European actors with long-standing experience in tobacco control, who facilitated consensus-building, mobilized allies and synchronized the actions of policy supporters. Representatives of Brussels-based organizations emerged as crucial strategic leaders.Conclusions:The insights gained and identification of key enablers of successful tobacco control advocacy highlight the strategic importance of investing into tobacco control at European level. Those interested in effective health policy can apply lessons learned from EU smoke-free policy to build effective alliances in tobacco control and other areas of public health.

The case for stringent alcohol warning labels: Lessons from the tobacco control experience

Like cigarettes, alcohol is a social drug associated with considerable health and social costs. Relative to cigarettes, regulators worldwide have imposted very modest restrictions in its advertisements. Studies on alcohol health warnings show that they do not have a strong effect on influencing recall, perceptions, and behaviors. Poorly visible and ambiguous health warnings plus the absence of pictorial warnings muddy previous studies. This study takes a different approach, extracting lessons from cigarette health warnings literature for application to the alcohol health warnings' research and practice. I recommend the development of direct health warnings; increase in visibility of the warnings; incorporation of pictorial health warnings; and consideration of plain packaging for alcohol products. A toolkit of these best practices could advance the case for stringent alcohol health warnings policies.

Nicotine Yesterday, Today, and Tomorrow: A Global Review

This intentionally selective global review reflects the views and frustrations of a public health physician with 45 years of frontline experience in tobacco control. In particular, it focuses on the nexus between research and policy and the long periods between relevant discoveries and application as policy. Consideration is given to the relative neglect of the possibility of reducing the carcinogenicity and toxicity of the cigarette on the grounds that it is the preferred source of nicotine for the global majority of nicotine users. Although the outcome of such change is unquantifiable, there is much in cigarette smoke that can be changed to make it less carcinogenic and less toxic. It is difficult to think of excuses for accepting the status quo.

Shame, Blame, and the Emerging Law of Obesity Control

In using law as a tool to combat the obesity epidemic, legal scholars and policymakers are drawing heavily on the lessons of tobacco control. This Article describes the resulting emergence of “obesity control law” and argues for a radical reorientation of it from a “denormalization” strategy based on the tobacco control experience to a “destigmatization” strategy based on the HIV prevention experience. The war on obesity is nearing a political crossroads. Subsidies and food industry regulations aimed at making our environment more conducive to physical activity and healthy eating are in danger of losing out to cheaper and more politically palatable measures aimed at convincing obese individuals to lose weight without making it more feasible for them to do so. For example, recent legal reforms penalize obese employees and Medicaid recipients through higher out-of-pocket health-care costs, shame parents and kids by measuring and reporting students’ body mass index through the school system, and demoralize obese patients by promoting unsolicited and ineffective weight-loss counseling by physicians. These reforms are likely to further stigmatize obese people — and lead to worse health outcomes — by contributing to hostile work, school, and health-care environments. The tobacco control experience has provided a productive starting point for thinking about how to use labeling requirements, advertising restrictions, and taxes to make unhealthy food and beverage products less appealing. But tobacco control’s denormalization strategy for discouraging unhealthy behaviors and stigmatizing unhealthy people is not appropriate for preventing obesity-related health problems. In contrast, the destigmatization strategy proposed in this Article would emphasize that health, not thinness, is the proper objective of public health law. It would dictate that interventions targeting unhealthy products and environments must take precedence over interventions targeting obese individuals. And it would aim to revive interest in anti-discrimination, anti-bullying, and privacy laws as tools for preventing the health problems associated with obesity.

Bridging the gap between science and public health: taking advantage of tobacco control experience in Brazil to inform policies to counter risk factors for non-communicable diseases

The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control (TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies.

Interpersonal influence among public health leaders in the United States department of health and human services.

BackgroundIn public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS).Design and MethodsFifty-four tobacco control leaders across all 11 agencies in the DHHS were identified; 49 (91%) responded to a web-based survey. Participants were asked about communication with other tobacco control leaders, who influenced their work, and general job characteristics. Exponential random graph modeling was used to develop a network model of influence accounting for characteristics of individuals, their relationships, and global network structures.ResultsHigher job ranks, more experience in tobacco control, and more time devoted to tobacco control each week increased the likelihood of influence nomination, as did more frequent communication between network members. Being in the same agency and working the same number of hours per week were positively associated with mutual influence nominations. Controlling for these characteristics, the network also exhibited patterns associated with influential clusters of network members.ConclusionsFindings from this unique study provide a perspective on influence within a government agency that both helps to understand decision-making and also can serve to inform organizational efforts that allow for more effective structuring of leadership.

Tobacco control: Lessons learnt in Thailand

This review of legislation, obstacles faced, and challenges to be met, outlines present tobacco control lessons learnt in Thailand. A review of over twenty years of tobacco control experience in Thailand is provided in seven areas including policy formulation and the role of civil society, as well as in essential WHO Framework Convention on Tobacco Control areas. A descriptive, historical review shows how stakeholders, policies and resources were mobilized in Thailand, and what lessons resource-challenged countries might use from the Thai experience.

CONTROLLING GAMBLING: A POPULATION-BASED PERSPECTIVE TO MEASUREMENT AND MONITORING AS RESOURCE FOR EFFECTIVE INTERVENTIONS

CONTROLLING GAMBLING: A POPULATION-BASED PERSPECTIVE TO MEASUREMENT AND MONITORING AS RESOURCE FOR EFFECTIVE INTERVENTIONS

Le contrôle du tabac en Afrique du Sud

The aim of this paper is to briefly describe South Africa's experience in tobacco control, and to highlight some of the lessons that are applicable to other developing countries. South Africa's tobacco control strategy is based on two main pillars: (1) rapidly increasing excise taxes on tobacco, and (2) comprehensive legislation, of which the most important features are banning all tobacco advertising and sponsorship, and prohibition of smoking in public and work places. As a result of the increases in the excise tax, the real (inflation-adjusted) price of cigarettes has increased by 115% between 1993 and 2003. Aggregate cigarette consumption has decreased by about a third and per capita consumption has decreased by about 40% since 1993. Despite the decrease in cigarette consumption, real government revenue from tobacco excise taxes has increased by nearly 150% between 1993 and 2003. Some important lessons can be drawn from South Africa's experience in tobacco control. Firstly, strong and consistent lobbying was required to persuade the government to implement an effective tobacco control strategy. Country-specific research, drawn from a variety of disciplines, was used to back up and give credibility to the lobbyists' appeals. Secondly, rapid increases in the excise tax on cigarettes are particularly effective in reducing tobacco consumption. An increase in the excise tax increases the price of cigarettes, which in turn reduces cigarette consumption. In South Africa a 10% increase in the real price of cigarettes decreases cigarette consumption by between 6 and 8%. Similar results have been found for many other developing countries. Thirdly, while an increase in the excise tax is generally regarded as the most effective tobacco control measure, tobacco control legislation also plays an important role in a comprehensive tobacco control strategy. Bans on tobacco advertising and bans on smoking in public and work places denormalise and deglamorise smoking, and are likely to make other tobacco control interventions more effective. Fourthly, the industry would typically claim that they want to be constructive partners in drafting "reasonable and sensible" tobacco control legislation. In South Africa's experience, when they were involved in the drafting process in 1993, the role of the industry was to delay and water down the legislation. In drafting an amendment to the original legislation in 1998, the industry's views were largely ignored, and the result was a more comprehensive and effective piece of legislation. Fifthly, tobacco control legislation, particularly laws banning smoking in indoor public places, is largely self-enforcing. It does not require heavy-handed police intervention, as is typically claimed by the industry. The legislation clarifies and explains that the rights of non-smokers to clean air supersede the right of smokers to smoke. Smokers typically refrain from smoking where smoking is not allowed.

Medicaid coverage for tobacco-dependence treatments.

Update Health AffairsVol. 20, No. 1: Expanding Health Coverage STATE REPORTMedicaid Coverage For Tobacco-Dependence TreatmentsHelen Halpin Schauffler, Dianne C. Barker, and C. Tracy OrleansPUBLISHED:January/February 2001No Accesshttps://doi.org/10.1377/hlthaff.20.1.298AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSMedicaidState MedicaidSmokingSmoking cessationDiseasesGovernment programs and policiesCost-effectivenessMedicaid coverageFederal health plansDrug therapy Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 24 History Published online 1 January 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byThe Tobacco Control Experience: A Model for Substance Use Prevention?2 March 2019Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation TreatmentsAmerican Journal of Preventive Medicine, Vol. 54, No. 4Variation in Coverage for Progesterone to Prevent Preterm Birth: A Survey of Medicaid Managed Care OrganizationsWomen's Health Issues, Vol. 27, No. 5Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and MaineJournal of Public Health Management and Practice, Vol. 22, No. 1Impact of Broadened Coverage of Smoking Cessation Treatments on Cardiovascular Disease3 October 2012 | Current Cardiovascular Risk Reports, Vol. 6, No. 6Cancer-Related News from the CDC: State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 31, No. 23Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment SettingsAnnual Review of Clinical Psychology, Vol. 5, No. 1Identifying health disparities across the tobacco continuumAddiction, Vol. 102State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 29, No. 12Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsAnnals of Emergency Medicine, Vol. 48, No. 4Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsJournal of Emergency Nursing, Vol. 32, No. 5Prevalence and Trends in Smoking: A National Rural StudyThe Journal of Rural Health, Vol. 22, No. 2Medicaid Coverage For Tobacco-Dependence TreatmentsHealth Affairs, Vol. 25, No. 2Disparity in the Use of Smoking Cessation Pharmacotherapy Among Medicaid and General Population SmokersJournal of Public Health Management and Practice, Vol. 11, No. 4Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trialAddiction, Vol. 100, No. 7A randomized trial to promote pharmacotherapy use and smoking cessation in a Medicaid population (United States)Cancer Causes & Control, Vol. 16, No. 4IMPACT OF NICOTINE REPLACEMENT THERAPY ON SMOKING BEHAVIORAnnual Review of Public Health, Vol. 26, No. 1Effectiveness of a quit and win contest with a low-income populationPreventive Medicine, Vol. 39, No. 3Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatmentsAmerican Journal of Preventive Medicine, Vol. 26, No. 2Implementation of Evidence-Based Tobacco Use Cessation Guidelines in Managed Care OrganizationsAnnals of Behavioral Medicine, Vol. 27, No. 1Reversal of Misfortune: Viewing Tobacco as a Social Justice IssueAmerican Journal of Public Health, Vol. 94, No. 2Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer controlCancer Detection and Prevention, Vol. 28, No. 4Support for Smoking Cessation Interventions in Physician OrganizationsMedical Care, Vol. 41, No. 12Current strategies for cessation of smoking for head and neck cancer patientsCurrent Opinion in Otolaryngology & Head and Neck Surgery, Vol. 10, No. 2