World Health Organization Framework Convention Research Articles

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

BackgroundIn response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020.MethodsWe replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide.ResultsIdentical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries.ConclusionsConsiderable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries.

Smoking globally kills over half of long-term smokers and causes about 7 million annual deaths. The World Health Organization Framework Convention for Tobacco Control (FCTC) is the main global policy strategy to combat smoking, but its effectiveness is uncertain. Our interrupted time series analyses compared before- and after-FCTC trends in the numbers and prevalence of smokers below the age of 25 years (when smoking initiation occurs and during which response to interventions is greatest) and on cessation at 45-59 years (when quitting probably occurs) in 170 countries, excluding China. Contrasting the 10 years after FCTC ratification with the income-specific before-FCTC trends, we observed cumulative decreases of 15.5% (95% confidence interval = -33.2 to -0.7) for the numbers of current smokers and decreases of -7.5% (95% CI = -10.6 to -4.5) for the prevalence of smoking below age 25 years. The quit ratio (comparing the numbers of former and ever smokers) at 45-59 years increased by 1.8% (1.2 to 2.3) 10 years after FCTC ratification. Countries raising taxes by at least 10 percentage points concurrent with ratification observed steeper decreases in all three outcomes than countries that did not. Over a decade across 170 countries, the FCTC was associated with 24 million fewer young smokers and 2 million more quitters.

Bridging the gap in the implementation of the World Health Organization’s Framework Convention on Tobacco Control Article 5.3 in India: Insights from an opinion poll and stakeholder consultation

ABSTRACT Background: Article 5.3 of the World Health Organization Framework Convention on Tobacco Control (FCTC) outlines a roadmap for the parties to safeguard public health policies in compliance with the national law from the influence of commercial and other vested interests of the tobacco industry. Aim: The study was conducted with the aim to identify gaps and bring existing Indian policies in compliance with Article 5.3 of FCTC. Materials and Methods: A nationwide cross-sectional opinion poll involving respondents aged >18 years (n = 164) and a panel discussion (n = 31) were conducted. Results: The majority of stakeholders expressed (strongly agree = 65% and agree = 22.6%) the need for a nationwide policy to regulate interactions between public officials and the tobacco industry. About 56.7% felt the need to expand existing protocols and codes of conduct for public officials across India. Over 84% of the participants supported incorporating specific sections to implement Article 5.3 into the Cigarettes and Other Tobacco Products Act Amendment Bill 2020. The majority of participants supported the need for guidelines for medical bodies and prohibiting tobacco companies from participating in corporate social responsibility activities. Conclusion: The Government of India should comprehensively adopt Article 5.3, in all states and union territories, adopting a whole-of-government approach in partnership with the community and civil society under the “whole-of-society” approach for effective tobacco control measures.

Implementation Questions of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in Georgia

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is an international treaty established by WHO to address the global health issue of tobacco consumption, necessitating implementation at the national legislative level.
 The article explores the global problem of tobacco use and how it led to the creation of an international treaty to regulate it. It discusses how the FCTC was planned and Georgia's role in it. The analysis covers the legal side of the FCTC, including international and local rules for putting it into action. The article also talks about the challenges that have made it difficult to meet the FCTC's obligations from both legal and political viewpoints. This is the first attempt to explain the FCTC and the issues it faces in being adopted and carried out in Georgia.

Knowledge and attitude of adolescents regarding e-cigarettes: A scoping review

The World Health Organization Framework Convention on Tobacco Control has informed countries to ban or regulate electronic cigarettes (e-cigarettes) because of their health adverse effects. Although e-cigarettes are regulated, their popularity has increased among teens.

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.

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

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

Comparative Study on Tobacco Control in India and the United Kingdom: Analysis of Executive Policies

Context: In recent decades, the tobacco epidemic has spread worldwide. The impact of tobacco control policies has been different among countries. This paper aims to explain how two countries, the United Kingdom (UK) and India, with different political, social, and cultural contexts, implemented the World Health Organization (WHO) Framework Convention on Tobacco Control. Evidence Acquisition: A comparative study was done for tobacco control in UK and India in 2022. A review of literature in five databases, observational data and legal documents on tobacco use were undertaken. To identify and explain the factors that pose challenges to the implementation of tobacco control policies, country reports and health policy monitoring and research databases (in total, 27 papers and 16 reports) were reviewed. Results: Having different economic, social, and cultural backgrounds, a similar pathway to control the tobacco industry can be seen in UK and India. The factors that can explain the similar outcomes in two countries are the global pressure of WHO, increased awareness of people and policymakers, and a sense of urgency about the tobacco problem in both societies. Conclusions: At different stages of tobacco control in both countries, various interest groups with different routes of political influence used veto opportunities to overturn political decisions in the policy process. Continuous analysis of interest groups and their status quo is necessary to restrict the tobacco industry in favor of public health. Governments should carefully recognize the stakeholders and stake challengers in the policy domain and balance their interests.

Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature

BackgroundThere has been remarkable tobacco control progress in many places around the globe. Tobacco industry interference (TII) has been identified as the most significant barrier to further implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Civil society has been recognised as a key actor in countering TII. While TII has been extensively studied for several decades now, there is little research that focuses on counteractions to limit it and their effectiveness to do so. This scoping review seeks to map the peer-reviewed literature on civil society’s activities of countering TII in policymaking to identify common counterstrategies and assess their effectiveness.MethodsData sources: We searched Embase, IBSS, JSTOR, PubMed, Science Direct, Scopus and Web of Science using the following terms: (“Tobacco industry” OR “Tobacco compan*”) AND. (“corporate political activity” OR “CPA” OR “lobbying” OR “interference”) AND (“advoca*” OR “counter*” OR “activi*”), without time or language restrictions. Study selection: Our selection criteria included peer-reviewed studies that were written in English, German, or Spanish that drew on primary data and/or legal and policy documents and reported at least one specific example of civil society members or organisations countering tobacco industry action-based strategies. Data extraction: Advocates’ counterstrategies were analysed inductively and countered industry strategies were analysed using the Policy Dystopia Model (PDM). Perceptions of effectiveness of countering attempts were analysed descriptively.ResultsWe found five common counterstrategies among 30 included papers covering five WHO regions; 1. Exposing industry conduct and false claims; 2. Accessing decision-makers; 3. Generating and using evidence; 4. Filing a complaint or taking legal action; 5. Mobilising coalition and potential supporters. These counterstrategies were used to work against a wide range of industry strategies, which are captured by five action-based strategies described in the PDM (Coalition Management, Information Management, Direct Access and Influence, Litigation, Reputation Management). While some studies reported the outcome of the countering activities, their impact remained largely underexplored.ConclusionThe review shows that peer-reviewed literature documenting how civil society actors counter TII is scarce. It suggests that advocates employ a range of strategies to counter TII in its different forms and use them flexibly. More work is needed to better understand the effects of their actions. This could stimulate discussions about, and facilitate learning from, past experiences and help to further enhance advocates’ capacity.

Smoking: Quit to win.

The Winners of ‘Quit to Win’ Smoke-free Community Campaign organized by the Hong Kong Council on Smoking and Health. Translation of banner text: ‘13th Quit to Win Smoke-free Community Campaign Prize Presentation Ceremony’. (Image source: Hong Kong Council on Smoking and Health, with permission). In 2019, there were 1.14 billion current smokers globally, and they consumed 7.41 trillion cigarette-equivalents of tobacco (https://www.sciencedirect.com/science/article/pii/S0140673621011697). Smoking rates are high in some parts of Asia. China, India and Indonesia comprised 46% of the world's smokers in 2020 (https://www.statista.com/chart/24965/share-of-smokers-and-world-population-by-country/). Since early 1960, the detrimental impact of smoking on physical health and well-being has been reported worldwide. Smoking can damage nearly every human organ and lead to various diseases and disabilities, including cancer, heart disease, stroke, diabetes and chronic obstructive pulmonary disease. Smoking is harmful not only to the human body, but also the society and the economy. In 2012, the cost of diseases caused by smoking equated to 5.7% of global health expenditure and 1.8% of global gross domestic product (GPD; https://tobaccocontrol.bmj.com/content/27/1/58.long). Globally, 7.69 million deaths and 200 million disability-adjusted life-years (DALY) were related to smoking tobacco in 2019 (https://www.sciencedirect.com/science/article/pii/S0140673621011697). The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) opened for signature in 2003, and this treaty has been signed by 182 countries, covering more than 90% of the world population, making it one of the most widely embraced treaties in the United Nations' history. Various strategies have been advocated for tobacco control, and examples are price and tax measures to reduce the demand for tobacco and non-price measures, such as packaging and labelling of tobacco products; education, communication, training and public awareness; policies on tobacco advertising, promotion and sponsorship. Comprehensive tobacco control policies effectively reduce smoking prevalence, and the positive effects are amplified when multiple measures are implemented simultaneously at the same place (https://www.nature.com/articles/s41591-020-01210-8). With the substantial effort on tobacco control, from 1990 to 2019, there was a decline in the smoking-attributable mortality for both males and females in some countries such as China, Japan, the UK and the US (https://www.ssph-journal.org/articles/10.3389/ijph.2022.1605147/full). The effort to curtail the tobacco epidemic should be continued. At the regional level, the Asia Pacific Society of Respirology has recently added a new section on ‘Tobacco Control’ under the Environmental & Occupational Health and Epidemiology Assembly. It is anticipated that this can help to drive concerted efforts in the region on tobacco control. In my local community in Hong Kong, there is a recent 31% tax hike in tobacco smoking sales. It is gratifying to see the local effort for education and encouragement of smoking cessation. When attending the local campaign on tobacco control, I was touched by the stories shared by the quitters as their behavioural change positively impacts their community, family and personal life. None declared.

Policies regulating retail environment to reduce tobacco availability: A scoping review.

In 2005, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) entered into force. This treaty was developed in response to the global tobacco epidemic, and it includes measures to reduce both demand for and supply of tobacco. The measures related to demand reduction include raising tax, providing cessation services, promoting smoke free public places, banning advertising, and raising awareness. However, there are a limited number of measures for supply reduction, and these mainly include fighting illicit trade, banning sales to minors and providing alternatives to tobacco workers and growers. Unlike regulation of many other goods and services that have been subjected to retail restrictions, there is a lack of resources about restricting tobacco availability through regulation of tobacco retail environment. Considering the potential of retail environment regulations in reducing tobacco supply and consequently reducing tobacco use, this scoping review aims to identify relevant measures. This review examines interventions, policies, and legislations to regulate tobacco retail environment to reduce tobacco availability. This was done by searching the WHO FCTC and its Conference of Parties decisions, a gray literature search including tobacco control databases, a scoping communication with the Focal Points of the 182 WHO FCTC Parties, and a databases search in PubMed, EMBASE, Cochrane Library, Global Health, and Web of Science. Themes of policies were identified to reduce tobacco availability by regulating retail environment: four WHO FCTC and twelve non-WHO FCTC policies. The WHO FCTC policies included requiring a license to sell tobacco, banning tobacco sale via vending machines, promoting economically alternative activities to individual sellers, and banning ways of sale that constitute a way of advertising, promotion, and sponsorships. The Non-WHO FCTC policies included banning tobacco home delivery, tray sale, tobacco retail outlets in or within a minimum distance from specific facilities, sale in specific retail outlets, and sale of tobacco or one or more of its products, in addition to restricting tobacco retail outlets per density of population and per geographic area, capping the tobacco amount allowed per purchase, limiting the number of hours or days in which tobacco can be sold, requiring a minimum distance between tobacco retailers, reducing tobacco products availability and proximity within a retail outlet, and restricting sale to government controlled outlets. Studies show the effects of regulation of the retail environment in influencing overall tobacco purchases, and there is evidence that having fewer retails reduces the level of impulse purchasing of cigarettes and tobacco goods. The measures covered by WHO FCTC are much more implemented than ones not covered by it. Although not all widely implemented, many themes of limiting tobacco availability by regulating tobacco retail environment are available. Further studies to explore such measures and the adoption of the effective ones under the WHO FCTC decisions, could possibly increase their implementation globally to reduce tobacco availability.

Framework Convention on Tobacco Control 2030-A Program to Accelerate the Implementation of World Health Organization Framework Convention for Tobacco Control in Low- and Middle-Income Countries: A Mixed-Methods Evaluation.

Framework Convention on Tobacco Control (FCTC) 2030 Program (2017-2021) was launched to accelerate World Health Organization (WHO) FCTC implementation in 15 low- and middle-income countries (LMICs). We evaluated the Program in six domains: Governance; Smoke-Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising, Promotion, and Sponsorship (TAPS) bans; and International and Regional Cooperation. Following a mixed-methods design, we surveyed (June-September 2020) FCTC focal persons in 14 of the 15 countries, to understand the Program's financial and technical inputs and progress made in each of the six domains. The data were coded in terms of inputs (financial = 1, technical = 1, or both = 2) and progress (none = 1, some = 2, partial = 3, or strong = 4) and a correlation was computed between the inputs and progress scores for each domain. We conducted semi-structured interviews with key stakeholders in five countries. We triangulated between the survey and interview findings. FCTC 2030 offered substantial financial and technical inputs, responsive to country needs, across all six domains. There was a high positive correlation between technical inputs and progress in five of the six domains, ranging from r = 0.61 for taxation (p < .05) to r = 0.91 and for smoke-free policies (p < .001). The interviews indicated that the Program provided timely and relevant evidence and created opportunities for influencing tobacco control debates. The FCTC 2030 Program might have led to variable, but significant progress in advancing FCTC implementation in the 15 countries. As expected, much of the progress was in augmenting existing structures and resources for FCTC implementation. The resulting advances are likely to lead to further progress in FCTC policy implementation. What this study adds: In many LMICs, WHO FCTC policies are not in place; and even when enshrined in law, they are poorly enforced. It is not clear how financial and technical assistance to high tobacco-burden LMICs can most effectively accelerate the implementation of WHO FCTC policies and offer value for money. Bespoke and responsive assistance, both financial and technical, to LMICs aimed at accelerating the implementation of WHO FCTC policies are likely to lead to progress in tobacco control.

What is the Current Picture of Secondhand Smoke Exposure among Never-smoker Adolescents in Indonesia?

Introduction: Although Indonesia is not a signatory to the World Health Organization Framework Convention on Tobacco Control, 84% of local governments have adopted Smoke-Free Areas (SFAs) as a national policy. This study examines exposure to secondhand smoke (SHS) in adolescents who have never smoked after 8 years of SFA implementation. Methods: We used data from the 2019 Global Youth Tobacco Survey and a cross-sectional research design to find 6121 students from 148 schools in 30 provinces in Indonesia who met the research inclusion criteria. To identify risk factors regarding SHS exposure, multivariable logistic regression analysis was performed. Results: Although the local government had adopted an SFA policy, 61.1% of adolescents aged 11–17 years, especially middle and high school students, have relatively high exposure to SHS. School environments had the highest prevalence of SHS exposure (50.5%), followed by public places (49.9%) and at home (46.2%). A significant risk factor for exposure to SHS in the school environment is observed in teachers smoking inside school buildings (odds ratio [OR] =4.32, 95% confidence interval [CI]: 3.81–4.89); exposure to SHS at home and in public place (OR = 3.29, 95% CI: 2.93–3.70), and exposure to tobacco advertising, promotion, and sponsorship on offline and online media (OR = 2.07, 95% CI: 1.70–2.52). Conclusion: SFA policies must be evaluated and strengthened before they can be implemented to reduce smoking-related illnesses and economic losses. In addition, it is important to educate families and society about implementing SFA in school environments, public places, and at home.

Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study.

The Cigarette and Other Tobacco Products Act (COTPA) limits the sale of tobacco products, promotion and advertising and packaging of tobacco products in India. Periodic monitoring of the level of compliance with all sections of COTPA is obligatory to assess the effectiveness of the act. This pre-post study aimed to assess the change in the level of compliance with different sections of COTPA in selected States. A total of 3849 and 2176 samples were assessed during the study in November 2020 and October 2021, respectively; using the EpiData Software. Average compliance with section 4 of COTPA was highest in Puducherry during baseline [51.88%, prevalence ratio (PR)=0.72, 95% confidence interval (CI): 0.51-1.02] and in Telangana during endline assessment (66.1%, PR=0.6, 95% CI: 0.48-0.74). A visible change with section 5 of COTPA was observed in Telangana (40.08 to 93.12%, PR=0.04, 95% CI: 0.02-0.07). Compliance with section 6a of COTPA decreased in Puducherry (81.34 to 71.83%, PR=1.84, 95% CI: 1.14-2.95) and increased for Meghalaya and Telangana. The average compliance with sections 7, 8 and 9 (for Puducherry 51.09 vs . 48.8%, Meghalaya 54.94 vs . 46.18% and Telangana 73 vs . 51.91%, respectively) decreased in all States. An increase in average compliance was observed with sections 4 and 5 ( P =0.19 and 0.11, respectively) and a decrease with sections 7, 8 and 9 ( P =0.02) of COTPA in all three States. For sections 6a ( P =0.06) and 6b ( P =0.01), a mixed response was noted. The findings of this study suggest that the level of compliance with sections 4 and 5 of COTPA increased because they are strictly monitored compared to sections 7-9, which are less enforced by the States. There is a need to monitor sections 7-9 (pack warning) to fulfill the objectives related to the World Health Organization (WHO) Framework Convention on Tobacco Control.

Moving in the right direction: tobacco packaging and labeling in the Americas.

To assess the adoption of tobacco packaging and labeling policies based on the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC)'s Article 11 guidelines, in the WHO Region of the Americas (AMRO). We reviewed tobacco control laws in AMRO from the Campaign for Tobacco-Free Kids' Tobacco Control Laws database. We analyzed four sub-policy areas for smoked and smokeless tobacco products: 1) health warning labels (HWLs), 2) constituents and emissions (C&Es), 3) misleading tobacco packaging and labeling, and 4) standardized "plain" packaging. Of 35 countries in AMRO, 31 have tobacco packaging and labeling laws. Twenty-six countries require pictorial HWLs, 24 require warnings printed on at least 50% of the front and back of the packs, and 24 rotate a single or multiple (from 2 to 16) warnings within a specified period (from 5 up to 24 months). Only 21 countries require descriptive messages on toxic C&Es information. Twenty-seven countries ban brand descriptors with references to implied harm reduction (e.g., "light"), 24 ban figures, colors, and other signs, but only 13 prohibit emission yields printed on the packs. Only Canada and Uruguay have adopted standardized tobacco packaging while Uruguay also requires a single presentation (one brand variant) per brand family. Many countries in AMRO have made good progress in adopting multiple, rotating, large pictorial HWLs and banning misleading brand descriptors. However, there needs to be greater attention on other tobacco packaging and labeling provisions with a focus on implementing standardized tobacco packaging.

Tobacco control is integral to global COVID-19 response: an opportunity to accelerate toward SDGs

Abstract Issue Tobacco use intersects with the COVID-19 pandemic not only in terms of health consequences, but also on public health systems, economies, and the environment. Description of the problem The global tobacco supply contributes significantly to environmental pollution of the natural ecosystems. The damage is compounded by tobacco consumption and its resultant waste, which leaves a significant carbon footprint on the environment, undermining the planet’s ecological stability and intensifying climate change. Furthermore, tobacco use exacerbates inequalities and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic. Results he pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges and accelerate progress toward Sustainable Development Goals (SDGs). The MPOWER measures from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play an integral part to boost sustainable and equitable COVID-19 recovery — Monitor tobacco use (article 20); Protection from tobacco smoke (article 8); Offer help for tobacco cessation (article 14); Warn about the dangers of tobacco (article 11); Enforcing bans on tobacco advertising, promotion, and sponsorship (TAPS) (article13); and Raise tobacco taxes (article 6). Lessons To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and policy actions to emphasise tobacco control across equity, public health, climate actions, and counteract against the tobacco industry during and beyond COVID-19 as global authorities pledge to achieve the SDGs. Key messages • Global authorities must create better synergies on policies with a prime focus on reinforcing tobacco control to recover from the pandemic. • The WHO FCTC MPOWER measures can play an integral part in COVID-19 recovery to fight tobacco use and accelerate progress toward SDGs.

United States Food and Drug Administration's authorization of reduced exposure claims for IQOS®: implications for regulation in Latin America.

ABSTRACTPhilip Morris International has used the July 7, 2020 United States Food and Drug Administration’s (US FDA) modified risk tobacco product order for IQOS®, which authorized certain reduced exposure marketing claims, as a corporate strategy to promote and normalize its heated tobacco products in Latin America. The modified risk tobacco product orders are based on the US’s unique regulatory system that is not, and should not be, replicated anywhere else in the world. Philip Morris International’s global public relations campaign largely ignored the FDA’s rejection of reduced risk claims for IQOS and other key FDA findings that are important for policy-makers, regulators, and consumers – including tobacco users and Philip Morris International’s customers – to understand the risks associated with the product. In Latin America in particular, Philip Morris International has used media outlets to promote this misleading information to the public. This company has also used the FDA ruling to lobby regulators in Latin America to relax regulations on IQOS in the region. As tobacco companies rapidly introduce new tobacco products in low- and middle-income countries, public health advocates and Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) should take measures to prevent the promotion of misleading statements about heated tobacco products, including IQOS. As Latin American countries are at different stages in their regulation of heated tobacco products, governments should adhere to their WHO FCTC obligations and the recommendations of the Conference of the Parties by entirely prohibiting the sale of heated tobacco products or strictly applying to heated tobacco products all the relevant tobacco demand-reduction policies based on the WHO FCTC (making sure to capture both heated cigarettes and heating devices).

The 2018 public consultation on standardized packaging in Singapore: Analysis of policy actors' submissions

After a public consultation in 2018, Singapore implemented standardized tobacco packaging as part of its portfolio of tobacco control policies in 2020, in compliance with Article 11 guidelines for implementing the World Health Organization Framework Convention on Tobacco Control. This study analyzed policy actors in opposition to standardized packaging in Singapore and their submissions to the public consultation. Policy actors were profiled, and their arguments were then coded and compared across submissions. Descriptive results were then summarized in a narrative synthesis. In total, 79 submissions were considered for final analysis that opposed plain packaging in Singapore. Thematic analysis shows that transnational tobacco companies and their subsidiaries in Singapore, along with a variety of policy actors opposed to the standardized packaging policy, have significant similarities in arguments, often with identical statements. Industry tactics included framing tobacco as a trade and investment issue; utilizing trade barriers, intellectual property, and investment rights; pursuing litigation or threat of litigation; mobilizing third-party support and citing policy failure. This study provides evidence that further contributes to the growing literature on commercial determinants of health particularly industry tactics and, in this case, where the tobacco industry and its local and global allies, utilize to counter evidence-based tobacco control measures.

Could international human rights obligations motivate countries to implement tobacco cessation support?

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) seeks to realize the right to health through national tobacco control policies. However, few states have met their obligations under Article 14 of the FCTC to develop evidence-based policies to support tobacco cessation. This article examines how human rights obligations could provide a legal and moral basis for states to implement greater support for individualsto overcome their addiction to tobacco. The United Nations (UN) has a well-established legal framework for promoting human rights, looking to the right to health to realize health autonomy. Where addiction undermines autonomy, it is widely acknowledged that addiction presents a significant barrier to cessation for individuals who use tobacco, undermining the right to health. The UN human rights system could, therefore, provide a complementary basis for monitoring state obligations under Article 14 of the FCTC, identifying challenges to FCTC implementation and motivating states to support tobacco cessation. The United Nations' human rights system offers a mechanism that could be used to monitor Framework Convention on Tobacco Control implementation in national policy, facilitating accountability for the progressive realization of cessation support.

Towards Tobacco-Free Generation: implementation of preventive tobacco policies in the Nordic countries.

Europe's Beating Cancer Plan set a goal of creating a Tobacco-Free Generation in Europe by 2040. Prevention is important for achieving this goal. We compare the Nordic countries' preventive tobacco policies, discuss the possible determinants for similarities and differences in policy implementation, and provide strategies for strengthening tobacco prevention. We used the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to identify the key policies for this narrative review. We focused on Articles 6, 8, 9, 11, 13 and 16 of the WHO FCTC, and assessed the status of the required (core) and recommended (advanced) policies and their application to novel tobacco and nicotine products. Information on the implementation of strategies, acts and regulations were searched from global and national tobacco control databases, websites and scientific articles via PubMed and MEDLINE. The WHO FCTC and European regulations have ensured that the core policies are mostly in place, but also contributed to the shared deficiencies that are seen especially in the regulations on smokeless tobacco and novel products. Strong national tobacco control actors have facilitated countries to implement some advanced policies - even as the first countries in the world: point-of-sale display bans (Iceland), outdoor smoking bans (Sweden), flavour bans on electronic cigarettes (Finland), plain packaging (Norway), and plain packaging on electronic cigarettes (Denmark). Collaboration and participation in reinforcing the European regulations, resources for national networking between tobacco control actors, and national regulations to provide protection from the tobacco industry's interference are needed to strengthen comprehensive implementation of tobacco policies in the Nordic countries.