Tobacco Control Legislation Research Articles

Tobacco Control Policy in India: Progress and Challenges Quantified Using the Tobacco Control Scale.

One of the most vexing challenges to public health today is the menace of tobacco. Despite the large body of evidence indicating the vast scale of health hazards, tobacco use continues to be a major cause of preventable death. This study was conducted with the objective of quantifying the progress and challenges of the tobacco control policy of India. The Tobacco Control Scale (TCS) was used, which has a maximum score of 100 and assesses nine components including, price of cigarettes, smoke-free public and work places, spending on public information campaigns, comprehensive bans on advertising and promotion, large pictorial health warning labels, treatment to help smokers stop, illicit tobacco trade, tobacco industry interference and ratification of the WHO FCTC. The components of the TCS for India were scored based on data obtained from the WHO, Report on The Global Tobacco Epidemic, 2021 and the Cigarettes and Other Tobacco Products Act 2003 and their amendments and the Tobacco India 2023 country profile. The total score for the tobacco control scale placed India at 65 points, scoring highest with respect to 'large pictorial health warning labels', and lower with respect to 'spending on public information campaigns', 'illicit tobacco trade' and 'price of cigarettes'. Strong tobacco control legislation and its equally robust implementation is an affirmative step in achieving the vision of the WHO-FCTC and empowering the world towards being tobacco free.

New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic

For several decades, Aotearoa New Zealand has maintained a relatively strict regulatory approach towards tobacco. In response to the significant impact of tobacco-related illnesses, many countries worldwide have worked to enhance tobacco control measures. These efforts include introducing plain tobacco packaging with graphic health warnings, improving access to smoking cessation services and offering supportive treatments for tobacco dependence. In December 2022, New Zealand enacted world-leading tobacco control legislation aimed at leading the nation towards a 'smokefree' future by 2025, a future where the smoking prevalence falls below 5 percent across all population groups. To achieve this goal, revolutionary measures were needed. These measures included denicotinising cigarettes, reducing the number of tobacco retail outlets, and implementing a generational ban on smoked products. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government remained resolute in repealing the law and did so through parliamentary urgency on 27 February 2024. The reversal of this health policy is anticipated to result in thousands of lives lost and widen life expectancy gaps between indigenous and non-indigenous populations. This decision, driven by political agenda objectives and interference from the tobacco industry, has not only impeded New Zealand's progress but also weakened global efforts in tobacco control.

Increased taxes and regulation of Indian cigarillos (bidi) industry: Effects on revenue and years of life lost.

Indian cigarillos (bidi) are low-cost alternatives to cigarettes with only 22% imposed taxes, and turnover of upto INR 4 million per annum exempted from taxation. This paper estimates revenue implications and potential loss of life years (YLLs) averted, if bidi industry is subjected to increased regulations and taxation. Revenue estimated at 10% increased regulation and 100% regulation were calculated, followed by estimates at taxes equivalent to cigarettes and World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC) recommendation. Price elasticity was considered to assess demand. Price change in separate fractions (previously regulated and unregulated) were calculated to obtain potential YLLs averted. Current revenue of USD 59.25 million is projected to increase to USD 179.25 million with 695,159 averted YLLs at cigarette equivalent taxes and 10% increased regulation; USD 639.38 million with 4,527,597 averted YLLs with 100% regulation; USD 54.75 million, at WHO recommended taxes with 2,233,740 YLLs averted at 10% increased regulation, and 10,486,192 YLLs at 100% regulation. Proposed estimates are inline with WHO recommendations as they consider price elasticity and suggest substantial increase in revenue, while averting YLLs. A national action is needed to drive the policy decisions towards increased regulation and taxation and revision of India's tobacco control legislation. Our study presented empirical evidence of how the currently underutilized tool of taxation, as proposed in the WHO-FCTC, can be utilized to decrease bidi smoking prevalence and save measurable life years while generating government revenue simultaneously. While the revenue statistics counter the misleading tobacco industry narratives, the projected reduction in mortality will be seen as an irrefutable driving force for policy reforms, targeted at strategic increase in regulation and taxation of the traditional Indian cigarillos industry.

Mortality attributable to secondhand smoke exposure in the autonomous communities of Spain

Introduction and objectivesExposure to secondhand smoke (SHS) causes cardiovascular disease, respiratory disease, and cancer. The aim of this study was to estimate the mortality attributed to SHS in people aged ≥ 35 years in Spain and its autonomous communities (AC) by sex from 2016 to 2021. MethodsEstimates of SHS-attributable mortality were calculated by applying the prevalence-dependent method where SHS exposure was derived from the adjustment of small-area models and based on the calculation of population-attributed fractions. Sex, age group, AC, and cause of death (ischemic heart disease and lung cancer) were included. The estimates of attributed mortality are presented with their 95% confidence interval (95%CI). Crude and age-standardized rates were estimated for each sex and AC. ResultsFrom 2016 to 2021, SHS exposure caused 4,970 (95%CI, 4,787-5,387) deaths, representing 1.6% of total mortality for ischemic heart disease and lung cancer. The burden of attributed mortality differed widely among the AC, with Andalusia having the highest burden of attributed mortality (crude rate: 46.6 deaths per 100 000 population in men and 17.0/100 000 in women). In all the AC, the main cause of death in both sexes was ischemic heart disease. The highest burden of mortality was observed in nonsmokers. ConclusionsThe burden of SHS-attributable mortality was high and varied geographically. The results of this study should be considered to advance tobacco control legislation in Spain.

Blowing in the wind-Tobacco control legislation.

Blowing in the wind-Tobacco control legislation.

Mortalidad atribuida a la exposición al humo ambiental de tabaco en las comunidades autónomas de España

Introduction and objectivesExposure to secondhand smoke (SHS) causes cardiovascular disease, respiratory disease, and cancer. The aim of this study was to estimate the mortality attributed to SHS in people aged ≥ 35 years in Spain and its autonomous communities (AC) by sex from 2016 to 2021. MethodsEstimates of SHS-attributable mortality were calculated by applying the prevalence-dependent method where SHS exposure was derived from the adjustment of small-area models and based on the calculation of population-attributed fractions. Age group, sex, AC, and cause of death (lung cancer and ischemic heart disease) were included. The estimates of attributed mortality are presented with 95%CI. Crude and age-standardized rates were estimated for each sex and AC. ResultsFrom 2016 to 2021, SHS exposure caused 4970 (95%CI, 4787-5387) deaths, representing 1.6% of total mortality for lung cancer and ischemic heart disease. The burden of attributed mortality differed widely among the AC, with Andalusia having the highest burden of attributed mortality (crude rate: 46.6 deaths per 100 000 population in men and 17.0 in women). In all the AC, the main cause of death in both sexes was stroke. The highest burden of mortality was observed in nonsmokers. ConclusionsThe burden of SHS-attributable mortality was high and varied geographically. The results of this study should be considered to advance tobacco control legislation in Spain.

The impacts of tobacco control legislation on public view of e-cigarette usage in Macao—The co-word analysis of Macao daily

IntroductionMacao has been certified as a “Healthy City” by the World Health Organization, and has been adhering to the principle of combining prevention with proper medical care to build its medical system. As tobacco epidemic is a risk factor leading to a series of non-communicable diseases, the Macao SAR Government has continuously improved tobacco control measures.MethodsThe data for this study were derived from a news report on “e-cigarettes” published in Macao Daily. Co-word analysis and thematic analysis were conducted to analyze the development of tobacco control legislation against e-cigarettes. Co-word analysis examined the association and frequency of keywords, while thematic analysis identified prevalent themes within the data.ResultsThe study identified three stages of legislation against e-cigarettes: the pre-implementation stage, the early implementation stage, and the epidemic period. Each stage exhibited distinct characteristics and attention toward specific groups, particularly “teenagers” and “students,” increased significantly. Thematic analysis further highlighted the potential issues of drug use and smuggling associated with e-cigarettes.DiscussionThe findings suggest that the Macao SAR Government should prioritize the development of healthy behaviors among adolescents in the context of e-cigarette control. Additionally, considering regional cooperation to promote the “Healthy Bay Area” could be beneficial. Social media platforms and effective data management should be utilized as tools in these efforts.

A thematic content analysis of 2010–2015 state tobacco control legislation in the United States: Bill rationales and priority populations

ObjectiveTobacco use causes numerous types of cancers, heart diseases, and chronic illnesses, and is responsible for nearly 1 in every 5 deaths in the United States (U.S.) annually. This study assessed whether tobacco control laws introduced in state legislatures between 2010 and 2015 provided a rationale for the proposed bill and/or specified priority population groups, and we then examined emerging themes in the text that did so. MethodsUsing LexisNexis® State Net®, we identified tobacco control bills introduced in all states and coded their bill rationales and population category. We then conducted qualitative thematic analysis on a sample of bills with rationales or specified populations. ResultsOf the 2815 tobacco control bills introduced in state legislatures in the analysis period, 422 (15.0%) included a bill rationale, and 1309 (46.5%) specified at least one priority population. Four overarching themes emerged: 1) Addressing tobacco-related health harms and financial costs incurred to society; 2) Protecting the public from tobacco-related harms as a government responsibility; 3) Providing services to priority populations; 4) Exempting or preempting some population groups and localities. ConclusionsRationalizing tobacco control legislation by focusing on both health and cost implications was a key feature of tobacco policy bill text we analyzed; given the history of this approach, it is likely to remain so in the future. Our study may serve as a benchmark for tracking current and future tobacco control legislation to examine whether there is a growth in prioritizing populations experiencing unjust burdens of tobacco use and related disease.

Evaluación de los indicadores de control de Tabaco el MPOWER de la Organización Mundial de la Salud desde una perspectiva de género en Antioquia, Colombia.

Objective: To examine women’s perceptions of the implementation and enforcement of the Colombian national tobacco legislation in Antioquia, Colombia, through the lens of the MPOWER indicators, which is the World Health Organization Framework Convention on Tobacco Control guide.Methods: This was a cross-sectional study with a representative sample of women over 18 years of age in the nine subregions of Antioquia, using a multi-stage probabilistic sampling. Results: Out of 4,383 women who participated in the study, only 35% were aware of Law 1335, with awareness being the highest among white and married participants with college degrees, who have private health insurance, or residents in middle and high socioeconomic status. The degree of implementation varied across subregions, and participants percei-ved that monitoring tobacco consumption (M) and protecting the population from tobac-co smoke (P) have high levels of implementation in Antioquia, while warnings about the dangers of tobacco use (W) and enforcing the prohibitions on advertising, promotion, and sponsorship (E) are weak. In terms of offering help for quitting (O), only 8.5% of smokers or former smokers ever sought assistance from health professionals to quit smoking and, among those, only 2% received treatment covered by their health insurance plan. Conclusions: Even though tobacco control legislation is established at the national level, its enforcement relies heavily on local strategies. In Antioquia, efforts should be placed on educational strategies regarding warnings of the harms associated with tobacco use, enfor-cement of advertising and promotion of tobacco products, and provision of evidence-based tobacco cessation treatments.

Addressing the Issues and Approaches to Reduce Youth Smoking in Indonesia

This article examines prominent concerns regarding adolescent smoking in Indonesia and investigates diverse strategies targeted at mitigating this public health issue. Indonesia is confronted with an escalating epidemic of tobacco consumption among young people, which is worsened by inadequate legislation and assertive marketing strategies employed by tobacco corporations. This article addresses the difficulties associated with the cultural acceptability of smoking, the restricted availability of quitting resources, and the lack of comprehensive anti-smoking programs. The paper emphasizes the significance of enhancing more stringent tobacco control legislation and implementing cross-sector collaboration activities specifically designed for the Indonesian context to address the problem of individuals who start smoking for the first time. This article emphasizes the importance of protecting the health and future of Indonesia's youth population by tackling these challenges and applying different prevention techniques.

Decentralisation of the Compliance of Anti-tobacco Law in India: The Case of Higher Educational Institutions in New Delhi, India.

Introduction This paper studies the decentralised compliance responsibility of India's tobacco control legislation, called the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act of 2003, with its rules, which the government has outsourced to higher educational institutions, studied through an example of New Delhi. The study looks into the three most important parameters of decentralised compliance. Two of these require the installation of signboards by higher educational institutions, and the third involves imposing and collecting fines against persons found smoking within the educational institutions. Regarding the boards, the first board is about the warning prohibiting the sale within 100 yards of educational institutions, and the second one prohibits smoking in educational institutions. The study also checks with the educational institutions whether there is a presence of cigarette and tobacco product vendors within 100 yards of the institution, where the sale of such products has been banned by law. The study also found educational activities to create awareness in the institutions for tobacco control and cessation. Methods Thirty-six higher educational institutions, including universities, were randomly selected and studied through a unique methodology using India's transparency law, i.e., the Right to Information Act 2005. The portions of the law, which was direct compliance, or related compliance by the higher educational institution was included in the study. This justified the decentralised responsibility of these higher educational institutions. Applications for information under the transparency law were requested and supplied. Out of the 47 institutions, in which information requests were filed, 36 provided the information under the law. Credible information was provided by the higher educational institutions and this information was collated and interpreted to provide insights into the compliance by the higher educational institutions. Results Only 44.4% of the institutions had a board prohibiting the sale of cigarettes and other tobacco products. This was a non-universal compliance by the higher educational institutions. 88.9 per cent had boards prohibiting smoking in the higher educational institutions. Only one out of the 36 had an instance of smoking recorded and collection of fines. While 47.2% reported to not have any instance of smoking and fine collection. Fifty per cent of the institutions had no record of fine collection amounting to defiance of the law. 75 per cent of institutions did some kind of awareness activities which was not a direct statutory requirement, but a recommended guideline. Conclusion The results show that the intent to decentralise the compliance of the tobacco control law in New Delhi by the higher educational institutions has not been universally successful and requires much effort for its on-ground penetration. Such studies have a policy impact as they serve as an example for the generalisability of such statutes, which only work when there is implementation from the bottom-up and when the deterrent is also strong with incentivisation to the educational institutions to implement tobacco control with vigour.

The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

Background. Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021). Methods. The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings. Results. The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information. Conclusion. Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies.

Diverse e-cigarette regulations in the Asia Pacific: A health economic perspective.

Diverse e-cigarette regulations in the Asia Pacific: A health economic perspective.

The role of principled engagement in public health policymaking: the case of Zambia’s prolonged efforts to develop a comprehensive tobacco control policy

ABSTRACT Background The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade. Objective This study explores the role of ‘principled engagement’, a key element of the theoretical framework for collaborative governance, in Zambia’s delayed success to develop a comprehensive tobacco control policy. Methods This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis. Results Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia. Conclusion Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia.

Impact of the Spanish tobacco control legislation in mental health: a decade of progress in Catalonia

Impact of the Spanish tobacco control legislation in mental health: a decade of progress in Catalonia

Easter Eggs & ‘Easter Eggs’: Alcohol Branded Chocolate Eggs & Intoxigenic Environments in Ireland

Alcohol branded Easter Eggs were observed in a mainstream Irish supermarket. The Public Health (Alcohol) Act, 2018 fails to deal with such child-friendly marketing. An amendment to the current legislation to counter this deficit is urgently required. The absence of such legislation is particularly notable given the longstanding inclusion of clauses to this effect in tobacco control legislation in Ireland. Conflict of interests: None declared.

Multiple streams approach to tobacco control policymaking in the capital city of the world's largest tobacco consuming country.

The aim of this study was to analyse the policymaking process of Beijing tobacco control regulations based on a multiple streams framework to provide a reference for other cities, at the national level and for the international community to promote the development of tobacco control policy. Twenty-one documents related to tobacco control in Beijing were collected, nine informants were interviewed and the interview data were analysed by a thematic framework method. It was found that indicators, feedback and a focus event in the problem stream drew the attention of policymakers and the society for tobacco control. In 2011, Ying Songnian, a representative of the Beijing Municipal People's Congress, put forward tobacco control legislation, which was just in time for the legislative reform of the Congress. The proposal was studied by the Congress, and a strategy of 'social co-governance' was founded. In the political stream, the government actively promoted tobacco control and social organizations extensively participated in it. In 2013, the General Office of the Central Committee of the Chinese Communist Party and the General Office of the State Council issued a notice on matters related to leading cadres taking the lead in banning smoking in public places, which opened a policy window for decision-makers who were hesitatant. The issue of tobacco control was successfully put on the policy agenda and contributed to the introduction of the Beijing Municipal Regulations on Smoking Control. Development of the factors in problem stream, policy stream and political stream promoted the setting up of the tobacco control policy agenda in Beijing. It is suggested that more cities should learn from the experience of Beijing, seize the opportunity of the ideological change of the ruling party, actively identify the problems, mobilize and advocate for representatives and introduce the concept of 'social co-governance' to promote tobacco control legislation.

Assessment of Knowledge Gap on Cigarettes and Other Tobacco Products Act (COTPA) among Tobacco Vendors in Puducherry: A Mixed-Method Study.

Tobacco usage has been identified as a leading preventable cause of mortality and is responsible for six million fatalities per year globally. India had enacted COTPA in 2003. Tobacco vendors are one of the key stakeholders for Cigarettes and Other Tobacco Products Act (COTPA) implementation. To assess the knowledge gap on COTPA and to explore the perceived factors influencing implementation of COTPA among tobacco vendors in Puducherry. A mixed-method study was conducted among tobacco vendors from Point of Sale (PoS) around 230 educational institutions (schools and degree colleges) in Puducherry for three months. Simple random sampling was applied to select educational institutions and the tobacco vendors from PoS located around these institutions were included. Data capture was done using a pretested, face-validated questionnaire incorporated in Epicollect software 5 and data analysis by SPSSv24. Purposive sampling was employed to conduct in-depth interviews among tobacco vendors till the point of saturation and manual content analysis performed. Written informed consents were sought. Institutional Ethical Committee approval was obtained. Majority (95.7%) reported that they were aware of tobacco control legislation, but only one person had heard of COTPA. Awareness about the display of signage boards at PoS was observed in 75.7% vendors. Around 41.7% reported that they should not advertise any kind of tobacco products. Three major themes were identified: facilitators, barriers, and suggested measures for COTPA implementation. Tobacco vendors in Puducherry were aware of tobacco control legislations but not familiar with the COTPA and its provisions. It is necessary to put forth efforts to educate these important stakeholders to be more cognizant of COTPA and to effectively include them in anti-tobacco programs.

Tobacco Control Legislation in Small Island Nations: Adoption of WHO FCTC Article 13 in the Federated States of Micronesia.

Tobacco Control Legislation in Small Island Nations: Adoption of WHO FCTC Article 13 in the Federated States of Micronesia.

Evaluating the Effects of Denmark's New Tobacco Control Act on Young People's Use of Nicotine Products: A Study Protocol of the §SMOKE Study.

(1) Background: In December 2020, a broad majority of political parties in Denmark agreed on a new tobacco control act. In addition, price increases on tobacco in 2020 and 2022 became part of the Danish Finance Act. This study protocol describes the study “§SMOKE–A Study of Tobacco, Behavior, and Regulations” designed to monitor and evaluate the implementation and effect of the new strengthened tobacco control acts. The overall aim is to monitor tobacco use among young people before, during, and after implementation of the new tobacco control legislation, including an increased price on tobacco, a ban on point-of-sale tobacco displays, and plain packaging. Subgoals are to monitor overall use of nicotine products, attitudes, and norms. (2) Methods: This study is designed as a five-year impact evaluation with repeated cross-sectional survey data collections. The baseline survey was conducted before implementing an increased price on tobacco, the first step in the new legislation, initiated 1 April 2020. Study participants (n = 37,500) were a random sample of individuals living in Denmark aged 15 to 29 years. (3) Conclusions: This study examines the impact of the new strengthened tobacco control legislation in Denmark from 2020 to 2025. The findings of this study are relevant to other countries facing implementation of similar measures to explore intended and unintended consequences of the legislation and help to identify how the legislation could be further improved.