Tobacco Law Research Articles

Health promotion and tobacco control: a transatlantic perspective between Brazil and Portugal

Health promotion, a concept based on the Ottawa Charter, recognizes that health is influenced by economic, social and environmental factors, as well as individual practices. The fight against smoking is one of the most challenging fronts in this context, given its direct relationship with the global burden of chronic diseases and preventable deaths. The articulation of public policies that involve multiple sectors and civil society has proved fundamental in dealing with this problem. In both Brazil and Portugal, health promotion plays a crucial role in integrating tobacco prevention and control actions, reflecting the guidelines of Canada's Population Health Promotion Model. This Canadian model highlights the intersection between health, public policies and community action, emphasizing the need for healthy environments and structural interventions that shape behaviour. The influence of this paradigm is evident in global policies, including those adopted in Brazil and Portugal. It offers a theoretical framework that guides governments to create evidence-based strategies that are sensitive to cultural and social particularities. In Brazil, the National Health Promotion Policy (Política Nacional de Promoção da Saúde, PNPS) translates these principles into concrete actions, whereas in Portugal, the National Program for the Prevention and Control of Smoking reflects a progressive normative approach, especially in relation to tobacco consumption and electronic devices. Brazil and Portugal have different histories and cultural dynamics, but they share similar challenges in tackling smoking. In Brazil, robust policies have contributed to a significant reduction in the prevalence of adult smokers, from 34.8% in 1989 to 12.6% in 2019(1). These achievements are the result of educational campaigns, tax increases and the creation of smoke-free environments. In Portugal, legislative efforts, such as the Tobacco Law (Law No. 37/2007), have significantly limited smoking in public places and restricted advertising, but the country still faces worrying rates, with 17% of the population identified as smokers in 2019(2). [...]

The impact of the tobacco law on tobacco-related hospitalizations in Portugal - a natural experiment

Abstract Introduction Tobacco is responsible for approximately 8 million deaths annually worldwide, with 1.2 million resulting from passive exposure to smoke, as reported by the WHO. Comprehensive tobacco control policies have been enacted across Europe, yet their impacts are seldom assessed. This study evaluates the effects of the anti-tobacco legislation enacted in Portugal in 2007 on tobacco-related hospitalizations between 2002 and 2018. Methods Data from all in-patient admissions in public hospitals throughout the 2002-2018 period were utilized. A quasi-experimental interrupted time series design was employed, treating 2008 as an exogenous shock. The dependent variables include the municipality-based incidence of hospitalizations by year for tobacco-related diseases, namely, Acute Myocardial Infarction, stroke, lower respiratory tract infections, chronic obstructive pulmonary disease, and asthma. The analysis was adjusted for the percentage of women, the percentage of individuals aged over 65, and purchasing power in the municipality. Time trend graphs for each variable were generated, followed by an adjustment using the Poisson regression model to forecast their trends. A comparison was conducted between observed post-law implementation data and projected values from the regression model to ascertain the percentage difference between the two. Expected Results The 2007 tobacco law led to significant reductions in tobacco-related disease incidence, with the most notable effects immediately post-implementation. The impact varies across age groups, with younger individuals (30-49 years) showing a sharper decrease. The effect diminished over time, as indicated by negative coefficients in time:law interactions, such as -0.03. Conclusions The anti-tobacco laws implemented in Portugal have effectively decreased hospitalizations related to tobacco use, suggesting potential increases in life expectancy and reduction in health system burden. Key messages • Public health policies are crucial for the long-term improvement of people’s health. • Non-exposure to tobacco can bring health gains on several levels.

Tobacco industry corporate social responsibility activities and other interference after ratification of a strong tobacco law in Ethiopia

BackgroundSince strict new tobacco control laws were introduced in 2019 and 2020, the National Tobacco Enterprise (NTE), the main manufacturer and distributor of cigarettes in Ethiopia, strategically engaged in corporate...

Implementation of the polluter pay’s principle in tobacco control in the UK: a stakeholder analysis

BackgroundThe polluter’s pay principle (PPP) aims to internalise external costs and assign liability to the polluter for the harmful cost of their products to society. Tobacco companies continue to manufacture and sell harmful cigarettes, earning billions in profits each year from these products. Meanwhile, governments and their people are left to ‘clean up’ and deal with the detrimental health consequences. This paper explores with expert stakeholders how the PPP could be implemented within the context of tobacco control in the United Kingdom (UK).MethodsTwenty-four semi-structured interviews and two follow-up discussion groups were conducted with UK and international experts on tobacco control, public health, economics, or law from the academic, public, private and third sector. Participants considered the facilitators and barriers to implementing the PPP to tobacco control in the UK. Thematic analysis was employed, aided by NVivo 12, and data were compared to examine the views expressed by the different types of experts.ResultsStakeholders favoured the implementation of the PPP in the context of tobacco control and indicated that it could be acceptable and feasible to implement and that it would likely have support from policymakers and the public alike. Stakeholders unanimously agreed that any legislation and administration should be free from tobacco industry influence; however, differences arose concerning who should oversee the implementation.ConclusionThe PPP from environmental law was predominantly seen as an approach that could be usefully applied to the tobacco industry. However, there is no one size fits all template, therefore its implementation would need to be adapted to fit the UK context.

Impact of the tobacco law on hospitalizations for tobacco-related diseases in adults in Portugal

Abstract Introduction Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke, according to WHO data. Ambitious anti-tobacco policies have been implemented in European countries, but few have been evaluated. The present research measures the impact of the anti-tobacco laws implemented in Portugal in 2007, and reinforced in 2015, in the adult population residing in Portugal, between January 1, 2002 and December 31, 2018. Methods We used data for all in-patient stays at all public hospitals over the 2002-2018 period. A quasi-experimental interrupted time series study was applied, considering the years 2008 and 2016 as exogenous shocks. The dependent variables under study are the incidence of hospitalizations by municipality of residence and year for tobacco-related diseases, namely: AMS, stroke, lower respiratory tract infections, COPD and asthma. We adjusted the analysis by the percentage of women, percentage of people aged >65, and purchasing power. We produced time trend graphs for each variable, with subsequent adjustment to the Poisson regression model to predict its evolution. A comparison was made between the values observed after the implementation of the law and its reformulation and the values projected based on the regression model selected, to identify the percentage difference between the two. Expected Results In line with the international literature, a generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law. Likewise, after the changes added in its reformulation, the reduction in incidence was stronger, although not as sharply, compared to 2007. Conclusions Anti-tobacco laws in Portugal have been effective in reducing tobacco-related hospitalizations, with expected gains in life expectancy and reduced burden for the health system. Key messages • Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke. • Generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law.

Use of Tobacco Products and Compliance with Tobacco Law By A State Hospital Employees And Patients: A Comparative Research

Bu çalışmada sağlık çalışanları ile hastaların tütün ürünlerine ilişkin görüşlerinin değerlendirilmesi ve bu görüşlerin karşılaştırılması amaçlanmıştır. Tanımlayıcı ve kesitsel olarak hazırlanan çalışmanın örneklemini bir devlet hastanesinde görevli 124 sağlık çalışanı ile bu hastanede tedavi gören 276 hasta oluşturmaktadır. Veriler sosyo-demografik bilgileri içeren bilgi formu ve tütün kullanımına ilişkin soruların yer aldığı anket formu ile yüz yüze toplanmıştır. Çalışmanın veri analizinde SPSS 25 paket programı kullanılmıştır. Araştırma bulgularında sağlık çalışanlarının %33.1’inin her gün sürekli sigara kullandığı, hastaların ise %4.7’sinin hiç sigara kullanmadığı belirlenmiştir. Sigara içme / içmeme açısından toplum için rol model olma durumu incelendiğinde sağlık çalışanlarının %52.4’ü “evet” cevabını verirken, hastaların %50.4’ü “hayır” cevabını vermiştir. Türkiye’de uygulanan kapalı alanlarda sigara içme yasağının devamı konusunda ise sağlık çalışanlarının %66.9’u, hastaların ise %7.5’i “yasak aynen devam etmeli” cevabını vermiştir. Çalışma sonucuna göre erkeklerin kadınlara oranla; sağlık çalışanlarının da hastalara oranla daha fazla tütün ürünü kullandığı ifade edilebilir. Sağlık çalışanlarına ve hastalara yönelik tütün ürünlerinin zararları konusunda bilinçlendirme eğitimleri yapılmalıdır. Sigara bırakma teşvik programları ve kamu spotları artırılmalıdır.

O pojedinim prekršajnim odredbama iz Zakona o duvanu

Persons committing misdemeanors pursuant to the Tobacco Law are prosecuted pursuant to a misdemeanor notice. Should such person be found responsible in the ensuing procedure, the misdemeanor court may sentence him to the most severe fine foreseen in the Misdemeanor Law, as well as in the Tobacco Law. Apart from prescribing misdemeanors, the Tobacco Law also contains other provisions of importance for material and procedural misdemeanor law, as well as the enforcement of misdemeanor law. The subject of this paper are exactly these specific misdemeanor provisions from the Tobacco Law.

Compliance with national tobacco control legislation: a survey of tobacco vendors of Peshawar, Khyber Pakhtunkhwa

Introduction: Tobacco remains the world’s leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The Government of Pakistan 2002 Prohibition of Smoking in Enclosed Places and Protection of Non-smokers Health Ordinance comprehensively prohibits all kinds of tobacco advertisement, sponsorship, and ban of selling cigarettes to minors, near the vicinity of educational institutes and to sell tobacco without a license. However, it is a common observation that tobacco vendors do not comply with the policy.
 Objective: To assess the compliance with anti-tobacco laws by tobacco vendors in the city of Peshawar, Khyber Pakhtunkhwa, Pakistan.
 Material & Methods: A cross-sectional study was conducted in 145 shops across 2 jurisdictions (Hayatabad and Peshawar city) of Peshawar. The implementations of tobacco laws like advertisement, tobacco selling to minors (<18 years) and tobacco selling in the vicinity of educational institutes were assessed through a self-structured questionnaire. The data were transferred and analyzed through SPSS version 22 for descriptive statistics.
 Results: The most common method of advertisement of tobacco products was stickers (33.3%) followed by dangles (29.6%) and product showcasing (15.7%). The percentage of tobacco sold to minors was 63%; 42% vendors were near the educational institutes. The selected shops were selling smokeless tobacco (82.6% shops) as well, alongside cigarettes. Unlicensed shops were 97.9% which approximately makes the whole of the sample size.
 Conclusion: The compliance of tobacco vendors in Peshawar towards tobacco law is very poor. Also, the sale of tobacco to minors was found to be a routine occurrence.

Free toolkit to help programs with Ca. tobacco law

Under a new law signed by California Gov. Gavin Newsom, all alcohol and drug addiction treatment programs must assess for and treat tobacco problems.

Comparative Analysis of Agriculture Policies for Tobacco Planting and Processing, and the Correlation With the Illicit Production and Trade of Tobacco Products in Countries of the Western Balkans

Tobacco planting and processing has a long tradition in the Western Balkan region, including Albania, Kosovo, Montenegro and North Macedonia; over the last 20 years, however, farmers have faced a significant decrease in production. In Montenegro and Kosovo, for example, the surfaces planted with tobacco are almost inconsequential.Agricultural policies and legal and procedural frameworks regulate all related processes, such as tobacco seed distribution, registration of farmers, disclosure of land farmed for tobacco, production yield, and the various collecting and processing stages, as well as the enforcement capacities of the related law enforcement institutions. These factors have significantly impacted tobacco production and trade, including the levels of illicit production and trade.This paper is based on empirical analysis, evaluation of the statistical data of tobacco-related state policies and country interviews related to tobacco production costs in the region, which affect sector-related policies.Our findings indicate that Albania has a lack of clear and coordinated policies, procedures, and enforcement capacities to regulate and monitor all processes, from planting to the processing and trade of tobacco. North Macedonia is in a much better situation in this regard and a new draft tobacco law, associated with a series of implementation regulations is expected to result in further improvements. In the Albanian case, strong evidence suggests that there are considerable tracts of land planted with tobacco and many illegal tobacco-processing plants.

Public attitudes towards e-cigarette regulations and policies in Taiwan.

Background: There are various approaches to e-cigarette regulation globally. In Taiwan, the term “e-cigarette” is not found in existing regulations, but health authorities apply explanatory notes derived from standing laws to e-cigarette. Taiwan health authority is in the process of regulative reform to include “e-cigarette” in standing tobacco law. Our objective was to investigate the public’s attitudes towards potential policy options for e-cigarette regulations in Taiwan.Design and Methods: We conduct an anonymous online survey in the general public. A questionnaire in Mandarin was posted on the website Stop-tabac.ch between July and November 2017.Results: Participants (n=236) were mostly male, young, highly educated, employed, and smoked or had smoked cigarettes in the past. Half were e-cigarette users. Four measures banning ecigarettes, labelling content and nicotine level and establishing a maximum-allowable nicotine level were supported by more than 70% of participants. Vaping status was strongly associated with support for most measures after controlling for other factors in multivariate models.Conclusion: We documented attitudes of a self-selected sample of the general public in Taiwan regarding e-cigarette regulations and policies. These results may be useful to design studies in more representative samples and to inform e-cigarette regulations, policies and education campaigns.Significance for public healthThere are various approaches to e-cigarette regulation globally. The term “e-cigarette” is not found in existing regulations, but Taiwanese health authorities apply explanatory notes derived from standing laws to regulate e-cigarette. In Taiwan, there is no e-cigarette approved, but used. The Taiwanese health authorities face the challenge of how to best regulate it. Little is known about public attitudes toward current e-cigarette legislation. In addition, no literature is available about public attitudes to e-cigarette control measures that either applied already in other countries for e-cigarette or in Taiwan for tobacco control. This is the first study to examine the public attitudes towards e-cigarette legislations in Taiwan. Our findings on specific policy issues are useful in terms of identifying the need for information and education among policy makers, health professionals and the public, in Taiwan particularly, and in international community.

The impact of pictorial health warnings on tobacco products in smokers behaviours and knowledge: the first quasi-experimental field trial after the implementation of the tobacco law in Italy.

The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products. A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases. 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2). Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

Knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar.

ABSTRACTIn Myanmar, although the law prohibits the sale of tobacco products to and by those aged less than 18 years, the use of smoking and smokeless tobacco among high school students is a social problem. There has been no previous study on tobacco use or knowledge of tobacco law among students in Nay Pyi Taw. A survey was conducted to assess the knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar. The data were collected in three high schools, from 300 students of Grade 10 and 11, in September 2015, using anonymous self-administered questionnaires which included characteristics of students, knowledge, attitude, and usage pattern of tobacco. Of the 300 students, 104 (34.7%) were smokers and 85 (28.3%) were users of smokeless tobacco. The average age of first use of tobacco was 14 years. Although most students knew about the ill effects of tobacco, only 25% knew about the Tobacco Product Law. The most common source of tobacco was friends and male family members were main smokers in families. Most students had seen male teachers and headmasters smoking in schools. The usage of tobacco and smokeless tobacco was associated with sex and the students’ attitude towards tobacco. This study indicated that the high school students knew about the ill effects of tobacco, but not about the Tobacco Product Law. Schools need to educate students and teachers about tobacco and the Tobacco Product Law and the enforcement of the law is also needed.

Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda.

Introductionglobally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions.Methodsa cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking.Resultswe found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22).Conclusionthe prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.

The perspectives of politicians on tobacco control in Turkey.

BackgroundTobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians’ interpreted social problems that were prominent during the development and implementation of tobacco regulations.AimThis paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT).MethodsThis study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT—which is the Turkish parliament and unicameral Turkish legislature—1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption.Results and recommendationsTobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.

GENDER GAP IN SMOKING: A NONLINEAR DECOMPOSITION ANALYSIS FOR TURKEY

This paper aims to analyze the determinants of gender gap in smoking and compare the results between 2008 and 2012, the period of National Tobacco Control Action Plan. We apply the extended Blinder-Oaxaca decomposition using the Global Adult Tobacco Survey. We find that the percentage of the smoking differential explained is sensitive to the choice of the reference coefficients. Moreover, an inclusion of attitude toward tobacco law and tax variables increases the percentage of the explained differential when females and males differ only with respect to the differences in the observed characteristics. Results show that females and males respond differently to the changes in the factors of smoking. In addition, decomposition analysis reveals that contributions of the significant factors associated with gender gap in smoking differ between 2008 and 2012.

Re-habituating the lawscape of smoking

This article examines the law-conditioned transformation of smoking atmospheres through habitual smoking behaviour. Smoking experiences in Tallinn, Estonia were studied among high cultural capital smokers who have re-habituated their smoking milieus according to strengthened tobacco legislation. The study shows how in the context of the de-normalisation of smoking, certain groups of smokers will alter their smoking milieus by vigorous rearrangement of themselves and places within the legislated landscape, according to the social demands and personal subjective motivations. The study takes theoretical framework from two implications of habit: ‘forceful materialism’ and ‘performative practice’. These implications are analysed in the framework of materiality-oriented ‘lawscape’ and ‘five-event typology’, as they allow examine the extensive dimensions of re-habituation of place-based tobacco law and transformation of smoking atmospheres.

Secondhand smoke exposure, perceived risks and knowledge of the national tobacco law among non-smoking adults in outdoor motor parks in an urban area, Lagos, Nigeria

Secondhand smoke exposure, perceived risks and knowledge of the national tobacco law among non-smoking adults in outdoor motor parks in an urban area, Lagos, Nigeria

Development of a French-language online health policy course: an international collaboration

To present the process and challenges of developing an online competency-based course on public health policy using a collaborative international approach. Five public health experts, supported by an expert in educational technology, adopted a rigorous approach to the development of the course: a needs analysis, identification of objectives and competencies, development of a pedagogical scenario for each module and target, choice of teaching methods and learning activities, material to be identified or developed, and the responsibilities and tasks involved. The 2-credit (90-hour) graduate course consists of six modules including an integration module. The modules start with a variety of case studies: tobacco law (neutral packaging), supervised injection sites, housing, integrated services for the frail elderly, a prevention programme for mothers from disadvantaged backgrounds, and the obligatory use of bicycle helmets. In modules 1, 3, 4 and 5, students learn about different stages of the public policy development process: emergence, formulation and adoption, implementation and evaluation. Module 2 focuses on the importance of values and ideologies in public policy. The integration module allows the students to apply the knowledge learned and addresses the role of experts in public policy and ethical considerations. The course has been integrated into the graduate programmes of the participating universities and allows students to follow, at a distance, an innovative training programme.

Regulatory Chill: Learnings From New Zealand’s Plain Packaging Tobacco Law

Australia’s precedent-setting Tobacco Plain Packaging Act 2011 (Cth) took two and a half years from its public announcement to come into force. The fact that New Zealand’s almost identical legislation was still not in force six years after it was first mooted suggests it was subject to regulatory chill through both specific threats and systemic influences within the policy making process. This article examines the hypothesis that three elements associated with New Zealand’s free trade and investment treaties combined to chill a National government that was already luke-warm on a plain packaging law: perceived risks from litigation; associated arguments pressed by politically influential industry lobbyists; and the bias in the regulatory management regime that favours minimal intervention and empowers the tobacco industry, consistent with contemporary trade agreements. It concludes that these mutually reinforcing factors delayed the passage of New Zealand’s legislation, but did not see it abandoned. This suggests that health policies supported by public opinion, international health obligations, and precedents from other countries can withstand regulatory chill. But the difference from Australia also highlights the need to pay more attention to ways of neutralising those factors if a Smokefree Aotearoa New Zealand, and similarly ground-breaking public health policies, are to be achieved.