World Health Organization Framework Convention Research Articles

The Economic Geography of Kenyan Tobacco Farmers' Livelihood Decisions.

The narrative of prosperous economic livelihood of tobacco farmers in Kenya as alleged by the tobacco industry deserves challenge as evidence increasingly suggests that smallholder tobacco farmers are making little or no profits. Article 17 of the World Health Organization Framework Convention on Tobacco Control encourages viable alternative livelihoods for tobacco farmers. There is little evidence, however, on how tobacco farmers make livelihood choice decisions. A total of 527 purposefully selected smallholder tobacco farmers in Kenya from three main tobacco-growing regions participated in a 2017 economic livelihood survey. Geo-economic data were matched to surveyed farmers' Global Positioning System coordinates to estimate each farmer's access to nearby economic centers. Ownership of cell phones or radios was also used to estimate farmers' virtual access to nearby economic activities to understand better the role of information. Multivariate logistic regressions were used to control socioeconomic status and self-reported activity in nearby economic centers. Tobacco farmers rarely live within 10 km of an economic center. Results suggest that the further away farmers live from economic centers, the less likely they are to grow tobacco, but more likely to grow tobacco under contract. Also, farmers owning a cell phone or radio are not only less likely to grow tobacco, but also to not engage in farming under contract if they do grow tobacco. Physical and virtual access to nearby economic activities is significantly associated with tobacco farmers' livelihood choice decision and should be taken into consideration by decision makers while developing interventions for FCTC Article 17. Smallholder tobacco farmers in lower-income countries are making little or no profits, but few studies have been conducted to illuminate what perpetuates tobacco production, with such studies urgently needed to support governments to develop viable alternative livelihoods for tobacco farmers. This study suggests that geographic and technological factors that shape farmers' economic decisions can help policy makers tailor alternative livelihood policies to different regional contexts and should be a focus of future research in this area.

Протидія незаконному обігу тютюнових виробів через призму міжнародних нормативноправових актів

У статті здійснено огляд проблеми незаконного обігу тютюнових виробів. З’ясовано, що незаконне переміщення тютюнових виробів через митний кордон носить міжнародний характер. Проведено аналіз деяких міжнародних нормативно-правових актів щодо незаконного обігу тютюнових виробів (Віденської, Кіотської та Йоганнесбурзької конвенцій та Конвенції Найробі). Також розглянуто Рамкову конвенцію Всесвітньої організації охорони здоров’я із боротьби проти тютюну. Визначено місце і роль цих документів у протидії нелегальному переміщенню тютюнової продукції через митний кордон як однієї з ключових складових зазначеного обігу. Встановлено, що приєднання до згаданих конвенцій забезпечує не лише спільне прийняття та дотримання принципів, стандартів і норм міжнародного митного права, а й сприяє розвитку співробітництва між національними митними адміністраціями з питань протидії порушенням митного законодавства щодо незаконного обігу тютюнових виробів. Вказано на необхідність постійного ґрунтовного вивчення і глибокого аналізу міжнародних нормативно-правових актів та змін до них, особливостей інтеграційних процесів у галузі митної справи, наукових пошуків та системного дослідження пріоритетних тенденцій розвитку міжнародного та національного митного законодавства.

The SDGs and tobacco measures under the World Health Organization Framework Convention on Tobacco Control (FCTC)

The SDGs and tobacco measures under the World Health Organization Framework Convention on Tobacco Control (FCTC)

Tobacco control and sustainable development: shared challenges and future opportunities

INTRODUCTION – TOBACCO CONTROL AS A DEVELOPMENT PRIORITY In May 2017, just months before the end of her second term as Director-General of the World Health Organization (WHO), Margaret Chan spoke about championing the WHO’s mission to fight tobacco use as one of her proudest achievements in office. What was surprising was the justification that followed. Dr. Chan did not focus on the usual costs associated with smoking – the millions of premature deaths globally, the US$ 1.4 trillion wasted annually in healthcare expenditure and lost productivity, or the human suffering brought by the host of cancers, heart diseases, and respiratory diseases caused by tobacco use. Instead, she declared that ‘tobacco is a deadly threat to global development’, affecting ‘every country on every level and across many sectors – economic growth, health, education, poverty, and the environment’ [1]. The slogan ‘Tobacco – a threat to development’ became the theme of the 2017 World No Tobacco Day. This was not the first time that tobacco has been recognised by the public health community as posing a threat ‘to the cause of social and environmental justice’, rather than just being a matter of individual health [2]. In 2015, the magnitude of the tobacco epidemic was acknowledged in the 2030 Agenda for Sustainable Development [3]. The agenda, which encompasses 17 Sustainable Development Goals (SDGs), directly addresses the importance of tobacco control in SDG Target 3.a, calling for the strengthening of ‘the implementation of the World Health Organization Framework Convention on Tobacco Control [WHO FCTC] in all countries’. The FCTC, adopted in 2003, was the first legally binding multilateral international public health treaty. It covers the production, sale, distribution, advertisement, and taxation of tobacco, setting an evidence-based framework of minimum requirements for the signatory states in controlling tobacco products [4]. The FCTC – as of May 2019 – was legally binding in 181 ratifying countries. While in most high-income countries (HICs) the implementation of the FCTC has advanced markedly, in some low- and middle-income countries (LMICs) the progress has been much slower [5, 6]. This is particularly alarming given that in 2018 four out of five smokers (or 880 million out of 1.1 billion smokers) lived in LMICs [7]. Drawing on evidence and examples from LMICs, in this article we explore key synergies between the SDGs and tobacco control. We demonstrate that strengthening tobacco control is not only relevant for achieving SDG 3 (Good Health and Well-Being), but also for broader social, economic, and environmental dimensions of sustainable development encompassed in several other SDGs [8]. We also point to the agenda of the transnational tobacco companies (TTCs) as a fundamental obstacle to achieving the SDGs and, more widely, to continued public health progress. To conclude, we argue that in order to drive progress in sustainable development, especially given the interference of TTCs, international tobacco control networks need to be further strengthened in LMICs. These processes need to be accompanied by greater cross-disciplinary collaboration, especially between the fields of tobacco control and development studies.

Digital possibilities in the prevention and early detection of oral cancer in the WHO South-East Asia Region.

Cancers of the lip and oral cavity are the most common cancers among men in the World Health Organization (WHO) South-East Asia Region. Most cancers of the oral cavity are attributable to tobacco smoking, smokeless tobacco use and areca-nut product use, alone or in combination, and excessive consumption of alcohol. These risk factors are highly prevalent in parts of the region. This paper outlines an integrated framework for oral cancer prevention, which includes a strengthened primary health-care workforce, enhanced community engagement and a positive policy environment. Operationalizing this framework could be greatly facilitated by the application of digital technologies. Robust evidence exists for the effectiveness of using appropriately trained primary health-care workers to screen for oral cancer by oral visual examination; this can be combined with counselling for riskbehaviour modification as part of an overall strategy on noncommunicable diseases. This needs to be supported by greater overall community engagement, for example to tackle low levels of awareness of the harmful effects of smokeless tobacco and areca-nut products. A strong policy environment that supports and promotes these efforts is essential, along with the enforcement of the measures required by the WHO Framework Convention on Tobacco Control. Despite the burden of disease, oral cancer has been a neglected area of public health. This paper considers how the positively disruptive effects of digital technology may enable much-needed acceleration in prevention and control efforts.

Sustainable Healthy Food Choices: Dietary Guidelines and International Economic Law

Building on the companion piece by Christine Parker and Hope Johnson on international instruments supporting holistic dietary guidelines, this article examines potential concerns raised by such guidelines under international trade law and international investment law. Drawing lessons from the World Health Organization Framework Convention on Tobacco Control (‘WHO FCTC’) and its relevance to recent disputes in international economic law, this article examines the role of international instruments in supporting domestic dietary guidelines that could be challenged in the dispute settlement system of the World Trade Organization (‘WTO’) or under investor-state dispute settlement. The article includes an assessment of the potential impact of international economic laws on holistic dietary guidelines and related regulatory interventions, as well as a discussion of how a WHO treaty on healthy and sustainable diets could influence the interpretation and application of key trade and investment provisions. The article concludes that holistic dietary guidelines can be implemented in a manner consistent with international economic law, at least if local products are not prioritised.

From transit hub to major supplier of illicit cigarettes to Argentina and Brazil: the changing role of domestic production and transnational tobacco companies in Paraguay between 1960 and 2003

BackgroundParaguay has reportedly been a major transit hub for illicit tobacco products since the 1960s, initially to supply markets in Argentina and Brazil and, more recently, other regional markets and beyond. However, to date there has been no systematic analysis, notably independent of the tobacco industry, of this trade including the roles of domestic production and transnational tobacco companies (TTCs). This article fills that gap by detailing the history of Paraguay’s illicit cigarette trade to Brazil and Argentina of TTC products and Paraguayan production between 1960 and 2003. The effective control of illicit cigarette flows, under Article 15 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate the Illicit Trade in Tobacco Products, requires fuller understanding of the changing nature of the illicit trade.MethodsWe systematically searched internal industry documents to understand the activities and strategies of leading TTCs in Paraguay and subregion over time. We also mapped illicit trade volume and patterns using US government and UN data on the cigarette trade involving Paraguay. We then estimated Paraguay’s cigarette production from 1989 to 2003 using tobacco leaf flows from the United Nations Commodity Trade Statistics Database (UN Comtrade).ResultsWe identify four phases in the illicit tobacco trade involving Paraguay: 1) Paraguay as a transit hub to smuggle BAT and PMI cigarettes from the U.S. into Argentina and Brazil (from the 1960s to the mid-1970s); 2) BAT and PMI competing in north-east Argentina (1989–1994); 3) BAT and PMI competing in southern and southern-east Brazil (mid to late 1990s); and 4) the growth in the illicit trade of Paraguayan manufactured cigarettes (from the mid- 1990s onwards). These phases suggest the illicit trade was seeded by TTCs, and that the system of supply and demand on lower priced brands they developed in the 1990s created a business opportunity for manufacturing in Paraguay. Brazil’s efforts to fight this trade, with a 150% tax on exports to Latin American countries in 1999, further prompted supply of the illicit trade to shift from TTCs to Paraguayan manufacturers.ConclusionThis paper extends evidence of the longstanding complicity of TTCs in the illicit trade to this region and the consequent growth of Paraguayan production in the 1990s. Our findings confirm the need to better understand the factors influencing how the illicit tobacco trade has changed over time, in specific regional contexts, and amid tobacco industry globalization. In Paraguay, the changing roles of TTC and domestic production have been central to shifting patterns of illicit supply and distribution since the 1960s. Important questions are raised, in turn, about TTCs efforts to participate as legitimate partners in global efforts to combat the problem, including a leading role in data gathering and analysis.

Concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes in Mexico

BackgroundArticle 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers.MethodsParticipants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests.ResultsParticipants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p < 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p < 0.001), and N-nitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations.ConclusionCompared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry.

Country-specific costs of implementing the WHO FCTC tobacco control policies and potential financing sources.

BackgroundOne of the major obstacles to the full implementation of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC) tobacco control measures is the lack of sustainable financing resources.GoalTo update and simulate country-specific indicators that are highly relevant to the costs and financial resources of the treaty policy implementation. We also developed an Excel tool for simulation and assessed the aggregated-level indicators by the 2016 World Bank income groups.ApproachesUsing mostly 2016 data or 2014–15 data if 2016 one are not available, we updated five indicators relevant to the treaty implementation, which are the gap between current and desirable policy implementation, cigarette affordability, the costs of implementing best- buy tobacco control policies, the number of smoking-attributable deaths, and the simulated tax revenue resulting from a $1 tax increase. We also aggregated indicators and simulation results by the World Bank income groups, encompassing the five indicators and the reduction in smoking and in attributable deaths due to a hypothetical 1I$ tax increase. Finally, the policy implementation cost was compared with tax revenue and revenue increases.FindingsAs of 2016, smoking remains one of the leading causes of premature deaths worldwide while the implementation of best-buy tobacco control policies was below the recommended levels. Meanwhile, there was room to further increase cigarette taxes and prices, as cigarettes remained affordable in many countries. The total costs of implementing best-buy policies in the next 15 years merely account for 8.3% of the 2016 excise tax revenue, indicating that a small proportion of annual tax revenue could fund the implementation of tobacco control policies recommended by the WHO FCTC.ConclusionsIncreasing taxes could have a multiplier impact on curbing tobacco use through aiding the implementation of the WHO FCTC.

What is India's Position in Implementing the WHO Framework Convention on Tobacco Control? A Policy Analysis of the Tobacco Control Law and National Tobacco Control Program

Background and context: The Framework Convention on Tobacco Control (FCTC) is the world's first public health treaty enacted under the World Health Organization (WHO). It is the biggest global initiative in tobacco control. India is a signatory to this treaty since 2004. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. The country is also known for widespread production and consumption of many smokeless forms of tobacco. India's progress in complying with the Framework Convention treaty had been inconsistent. While few states (provinces) are making significant progress, larger parts of the country struggles with gaps in the law, weak regulatory surveillance and overall noncompliance. The protobacco lobbies in India argue against the legislation by forecasting that banning tobacco production would lead to huge loss of employment and significant negative impact on the economy. These issues act as big deterrents to the country's tobacco control initiatives. Aim: There are very few published policy analyses on compliance with the FCTC treaty and identifying gaps in Indian tobacco control laws. This paper looks at India's tobacco use behavior, the national tobacco control laws, and its gaps and barriers. Strategy/Tactics: Using a policy triangle framework developed by Walt and Gilson (1994), it analyzes the national tobacco control policies and laws against the current scenario to identify areas of improvement and policy reform. Program/Policy process: The Indian tobacco control regulations and the National Tobacco Control Plan is evaluated in light of the WHO FCTC treaty to identify gaps and barriers to its implementation using published evidence. Outcomes: The analysis revels significant gaps and legal complexities that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. There are also important ethical issues related to the use of child labor in tobacco trade in India. What was learned: This paper recommends to amend the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers. This also recognizes the political-economic aspects and reflects on the contextual variables and stakeholders that play a significant role in deciding the fate of tobacco production, use and control in India.

New tobacco products, a threat for tobacco control and public health of Mexico

The new tobacco products that include electronic cigarettes (called "E Cig", "e-hookahs", "mods", "vape-pens"), electronic nicotine delivery systems (SEAN, Spanish acronym), similar systems without nicotine (SSSN, Spanish acronym) and alternative nicotine consumption systems (SACN, Spanish acronym), are positioned in the global market with a discourse of harm reduction and risk minimization. This manuscript summarizes the scientific evidence and presents a regulatory proposal for this technological innovation, oriented to guide the decision making of legislators, government institutions and organized civil society. The scientific evidence concludes that there is no safe tobacco product for health. The addictive nature of nicotine and the health damages for children, adolescents and pregnant women is the fundamental argument. These new products promote the transition to conventional cigarettes and have not shown efficacy for smoking cessation, on the contrary, they promote dual use. High-level regulation must be formulated without the intervention of the manufacturers or institutions with a conflict of interest in the context of the complete and integral World Health Organization Framework Convention on Tobacco Control implementation.

Prevalence of Tobacco Use in Health Care Workers Worldwide: A Systematic Review and Meta-Analysis

Background: The World Health Organisation Framework Convention on Tobacco Control Article 14 guidelines stress that health care workers (HCW) should set an example by not using tobacco, however the overall prevalence among HCW worldwide is unknown. We present prevalence estimates of tobacco use among HCW by country income level, gender and occupation. Methods: We searched five electronic databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 1 January 2000 and 14 March 2016 that included HCW and tobacco use data from 2000 onward. We performed random effect meta-analyses to obtain estimates by World Bank income level, occupation, and gender (Prospero number CRD42016041231) Findings 282 studies met our inclusion criteria, including 157 studies from high-income countries (HIC), 92 from upper- middle- income countries (UMIC), and 33 from Lower Middle and low Income countries (LMLIC). The overall prevalence of tobacco use was 22% (95% CI 21-23). Smoking prevalence was highest in the UMIC 25% (95% CI 22-28%), higher in males compared to females (31% vs 17%) and highest in nurses, 25% (22-27%). Heterogeneity was high (I2 > 90%) in all sub-group analyses. There was borderline significant reduction in the overall tobacco use prevalence between 2000 and 2014 (p=0·06). Interpretation: HCW continue to use tobacco at high rates. Tackling tobacco use in these groups requires urgent action as they are at the front line for tackling tobacco use in their patients. Funding: UK Centre for Tobacco and Alcohol Studies. Declaration of interests: We declare no competing interests.

Two decades of tobacco use prevention and control policies in Cameroon: results from the analysis of non-communicable disease prevention policies in Africa

BackgroundTobacco use is the leading cause of preventable death in the world today. In 2010, the World Health Organization (WHO) proposed efficient and inexpensive “best buy” interventions for prevention of tobacco use including: tax increases, smoke-free indoor workplaces and public places, bans on tobacco advertising, promotion and sponsorship, and health information and warnings. This paper analyzes the extent to which tobacco use prevention policies in Cameroon align with the WHO tobacco “best buy” interventions. It further explores the context, content, formulation and implementation level of these policies.MethodsThis was a case study combining a structured review of 19 government policy documents related to tobacco use and prevention, in-depth interviews with 38 key stakeholders and field observations. The Walt and Gilson’s policy analysis triangle was used to describe and interpret the context, content, processes and actors during the formulation and implementation of tobacco prevention and control policies. Direct observations ascertained the level of implementation of some selected policies.ResultsTwelve out of 19 policies for tobacco use and prevention address the WHO “best buy” interventions. Cameroon policy formulation was driven locally by the social context of non-communicable diseases, and globally by the adoption of the WHO Framework Convention on Tobacco Control. These policies incorporated at a certain level all four domains of tobacco use “best buy” interventions. Formulating policy on smoke-free areas was single-sector oriented, while determining tobacco taxes and health warnings was more complex utilizing multisectoral approaches. The main actors involved were ministerial departments of Health, Education, Finances, Communication and Social Affairs. The level of implementation varied widely from one policy to another and from one region to another. Political will, personal motivation and the existence of formal exchange platforms facilitated policy formulation and implementation, while poor resource allocation and lack of synergy constituted barriers.ConclusionsDespite actions made by the Government, there is no real political will to control tobacco use in Cameroon. Significant shortcomings still exist in developing and/or implementing comprehensive tobacco use and prevention policies. These findings highlight major gaps as well as opportunities that can be harnessed to improve tobacco control in Cameroon.

Current strategies are inadequate to curb the rise of tobacco use in Africa.

Recently, there have been significant advances in the battle against tobacco use in Africa, with achievements including ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and the passing of tobacco control legislation in several countries. Many African countries have achieved measured success, while Uganda, South Africa and Mauritius have accomplished significantly more in their efforts to curb tobacco use. Nevertheless, few African countries meet the standards of the individual WHO FCTC articles with regard to comprehensive implementation. Africa has lower rates of tobacco taxation, weaker smoke-free policies and fewer restrictions on tobacco advertising compared with other world regions. These shortcomings have enabled the tobacco industry to expand its markets on the continent by capitalising on economic growth, changing social norms and population demographics. Consequently, tobacco use is increasing in Africa, with smoking prevalence having risen 57% between 1990 and 2009 compared with western Europe, where it decreased substantially during the same period. Rapid smoking uptake in Africa has led to tobacco-related conditions emerging as increasingly important public health problems. African nations are unlikely to meet the 2025 goal of a 30% relative reduction in tobacco use, as advocated by the World Health Assembly in 2013 and identified as the 'most urgent and immediate priority' intervention to reduce non-communicable diseases (NCDs). While there has been some progress, the current commitment of most African countries to the WHO FCTC has not translated into effective delivery of tobacco control policies and programmes. Strong tobacco control policies, which are among the most effective population-based strategies for NCD prevention, are needed. These include introducing higher tobacco excise taxes, stronger smoke-free policies, graphic warnings on cigarette packages, bans on tobacco advertising, promotion and sponsorship, and anti-smoking mass media campaigns. Furthermore, tobacco industry interference needs to be actively addressed by monitoring its activities and exposing misconducts, thereby changing attitudes to the industry. Technical support, capacity building and adequate financing are needed in Africa to enable countries to competently manage legal challenges to tobacco control and deal with the subversive tactics of the industry. Civil society and the media - major players in holding governments accountable for responsible stewardship - need to educate and pressurise African politicians and governments to implement and enforce effective tobacco control policies. Otherwise, if unchecked, the widespread uptake of tobacco use will be a threat not only to health but also to sustainable human development in Africa.

Downwards trends in adolescent risk-taking behaviours in New Zealand: Exploring driving forces for change.

Downwards trends in adolescent risk-taking behaviours in New Zealand: Exploring driving forces for change.

Tobacco control achievements and priority areas in the WHO Europe Region: A review.

INTRODUCTIONTobacco control efforts have been advancing globally, including the adoption and entry into force of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC), as well as the adoption of the European Union EU Tobacco Products Directive. With the present review, the European Network for Smoking and Tobacco Prevention (ENSP) and European Respiratory Society (ERS) aim to provide a comprehensive overview on the status of WHO FCTC implementation, policy achievements and priority areas across countries in the WHO Europe Region.METHODSThe review was conducted through a triangulation of data extracted from a survey administered to ENSP members, the WHO FCTC Implementation Database, Tobacco Control Laws and the Tobacco Control Scale 2016.RESULTSUsing the WHO MPOWER measures as a framework, we report on the implementation status of nine FCTC articles across 47 countries in the WHO Europe Region. The average number of articles fully implemented was 3.58. FCTC articles least fully implemented were: Article 5.3 on Tobacco Industry Interference (25.5%, n=12), Article 20 on Research (34.0%, n=16), and Article 15 on Illicit trade (40.4%, n=19). The most commonly fully implemented articles were: Article 8 on Smoke-free legislation (63.8%, n=30), Article 16 on Underage sales (57.4%, n=27), and Article 6 on Price and tax measures (51.2%, n=24). Policy achievements and recommended priority areas for future national tobacco control activities varied greatly among countries.CONCLUSIONSFindings highlight the multitude of successes in tobacco control efforts across the region in recent years, but point out the need to address gaps in FCTC implementation.

A survey of tobacco dependence treatment guidelines content in 61 countries.

AimsTo assess tobacco dependence treatment guidelines content in accordance with Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and its guidelines, and association between content and country income level.DesignCross‐sectional study.SettingOn‐line survey from March to July 2016.ParticipantsContacts in 77 countries, including 68 FCTC Parties, six Signatories and three non‐Parties which had indicated having guidelines in previous surveys, or had not been surveyed before.MeasurementsA nine‐item questionnaire on guidelines content, key recommendations, writing and dissemination.FindingsWe received responses from contacts in 63 countries (82%); 61 had guidelines. The majority are for doctors (93%), primary care (92%) and nurses (75%). All recommend brief advice, 82% recording tobacco use in medical notes, 98% nicotine replacement therapy (NRT), 61% quitlines, 31% text messaging and 87% intensive specialist support, and 54% stress the importance of health‐care workers not using tobacco. Only 57% have a dissemination strategy, and 62% have not been updated for 5 or more years. Compared with high‐income countries, quitlines are less likely to be recommended in upper middle‐income countries guidelines [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.04–0.61] and intensive specialist support in lower middle‐income countries guidelines (OR = 0.01, 95% CI = 0.00–0.20). Guidelines updating is associated positively with country income level (P = 0.027).ConclusionsAlthough most tobacco dependence treatment guidelines in the 61 countries assessed in 2016 follow the World Health Organization's Framework Convention on Tobacco Control Article 14 recommendations and do not differ significantly by income level, improvements are needed in keeping guidelines up‐to‐date, applying good writing practices and developing a dissemination strategy.

History of Brazil's tobacco control policy from 1986 to 2016

This study analyzes Brazil's tobacco control policy from 1986 to 2016, seeking to describe the policy's history and discuss its achievements, limits, and challenges. The study adopted a political economics approach and contributions from public policy analysis. Data were based on a search of the literature, documents, and secondary sources and semi-structured interviews with stakeholders involved in the policy. Factors related to the domestic and international contexts, the political process, and the policy's content influenced the institutional characteristics of tobacco control in the country. The study emphasizes the consolidation of Brazil's social rejection of smoking, government structuring of the policy, action by civil society, and Brazil's prestige in the international scenario. Inter-sector tobacco control measures like price and tax increases on cigarettes, the promotion of smoke-free environments, and the enforcement of health warnings contributed to the important reduction in prevalence of smoking. Implementation of the World Health Organization Framework Convention on Tobacco Control in Brazil, beginning in 2006, contributed to the expansion and consolidation of the national policy. However, tobacco-related economic interests limited the implementation of some strategic measures. The challenges feature the medium- and long-term sustainability of tobacco control and the solution to barriers involving crop diversification on current tobacco-growing areas, the fight against the illegal cigarette trade, and interference in the policy by the tobacco industry.

Implementation of Article 20 of the World Health Organization Framework Convention on Tobacco Control.

Background & objectives:Article 20 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) deals with surveillance and research on all tobacco products including smokeless tobacco (SLT). Here we describe the availability of indicators related to SLT among 180 Parties to the convention (countries ratifying the WHO FCTC are referred as Parties to the Convention).Methods:Data on SLT use among adults and adolescents and SLT-related economic and health indicators among Parties were obtained through rigorous literature search. Data analysis for high-burden parties was done using SPSS.Results:Nearly 92 per cent (166) of the Parties reported SLT use prevalence among adults or adolescents at national or subnational level, of these nearly one-fifth of the Parties (20.5%) were high-burden Parties. Comparable SLT tax incidence rate was available for 19.4 per cent (n=35) Parties, and SLT attributable morbidity and mortality risks of major diseases were available for only five per cent (n=10) of Parties.Interpretation & conclusions:SLT use is a global epidemic widespread among Parties to the Convention. There are a data gap and dearth of research on SLT-related issues. Parties need to monitor SLT use and related health and economic indicators regularly at periodic intervals.

Role of World Health Organization Framework Convention on Tobacco Control Global Knowledge Hub on Smokeless Tobacco.

Smokeless tobacco (SLT) is a recognized public health challenge, having over 350 million users globally, concentrated particularly in South-East Asia. A need for research on curbing major challenges in regulating SLT use has been long felt and subsequently highlighted in several sessions of the Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC). The sixth session of COP established a knowledge hub on SLT at the Indian Council of Medical Research- National Institute of Cancer Prevention and Research India, with a mandate to (i) generate and share expertise, information and knowledge; (ii) promote and facilitate communication among Parties, organizations and stakeholders; and (iii) support the Convention Secretariat in contributing to technical aspects of SLT control. The hub disseminates scientific evidence through an interactive website and publications and supports national and international partners in SLT research. The hub is a contributor to many events/conferences and has conducted several workshops on SLT control, including an inter-country meeting on SLT policy implementation status, which brought together representatives from across the globe, and framed recommendations for policy reform. The hub is dedicated to interaction and collaboration with relevant tobacco control organizations to generate evidence, support and policy orientation in line with its mandates and recommendations under the World Health Organization FCTC.