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Usidame B, Meng G, Thrasher JF, Thompson ME, Fong GT, Fleischer NL. The Differential Impact of the 2000 Canadian Graphic Warning Label Policy on Smoking Prevalence by Sex and Education: A Difference-in-Difference-in-Difference Model. Nicotine Tob Res 2022; 24:1732-1740. [PMID: 35536724 PMCID: PMC9597072 DOI: 10.1093/ntr/ntac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Using a quasiexperimental design, we compared the impact of the 2000 Canadian introduction of graphic warning labels (GWLs) on differences in smoking prevalence by sex and education, to the United States, where no GWLs were introduced. METHODS We pooled 1999-2004 data from the Canadian Tobacco Use Monitoring Survey and the U.S. Behavioral Risk Factor Surveillance System. We used a difference-in-difference (DD) model to assess the impact of Canadian policy introduction on smoking prevalence, and a difference-in-difference-in-difference (DDD) model to examine differences in the policy impact by sex and education, comparing Canada (the treatment group) with the United States (the control group). RESULTS From 1999 to 2004, smoking prevalence decreased from 23.7% to 18.6% in Canada, and from 21.7% to 20.0% in the United States. Results from the DD regression models showed that Canadian respondents reported lower odds of being a current smoker compared to the U.S. respondents following the 2000 introduction of GWLs (OR = 0.84, 95% CI = 0.74-0.94). The DDD model showed that the impact of the Canadian GWLs versus the United States did not differ by sex or education. CONCLUSIONS The 2000 Canadian GWL policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status. IMPLICATIONS Existing evidence shows that GWL implementation is associated with reductions in smoking prevalence. But there is limited evidence from past evaluation studies on whether the impact of GWLs on smoking prevalence differs by sociodemographic subgroup. Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the United States. However, our study improves existing evidence by showing that the impact of the Canadian GWLs on smoking prevalence did not differ by sex or education, and thus did not reduce existing smoking disparities by educational levels.
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Affiliation(s)
- Bukola Usidame
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mary E Thompson
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Feliu A, Martinez C, Peruga A, Joossens L, Bianco E, Cornejo M, Nogueira SO, Fernández E. Tool to monitor tobacco control policy implementation: the Tobacco Control Scale in Latin America. Adaptation process and pilot study. Tob Control 2022; 31:642-648. [PMID: 34031228 DOI: 10.1136/tobaccocontrol-2020-056395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Monitoring tobacco control policy implementation is one of the keys for tobacco consumption reduction in Latin America (LA). This study reports on the adaptation of the Tobacco Control Scale (TCS) for use in LA countries and the level of tobacco control policy implementation in this region according to the scale. METHODS Ecological cross-sectional survey. The questionnaire to measure tobacco control policies was a translated (into Spanish and Portuguese) and adapted version of the last TCS as used in Europe. The resulting TCS-LA maintains the same structure as the original TCS, with eight policy domains and 100 points (pts) as maximum score; however, four policy domains were adapted because the exact same rationale could not be applied. At least two non-governmental tobacco control experts were contacted per country to answer the TCS-LA. RESULTS Informants from 17 out of 18 countries completed the questionnaire. Using the TCS-LA, Panama (70 pts), Uruguay (68 pts) and Ecuador (61 pts) exhibited the strongest tobacco control policies, while Guatemala (32 pts), Bolivia (30 pts) and Dominican Republic (29 pts) have implemented a lower number of tobacco control policies. Eight countries reached 50% of the TCS-LA total possible score, indicating a relatively good implementation level of tobacco control policies. CONCLUSIONS Panama, Uruguay and Ecuador are the tobacco control policy leaders in LA; however, tobacco control in the region has room for improvement since nine countries have a total score under 50 pts. The TCS is a feasible and adaptable tool to monitor tobacco control in other WHO regions beyond Europe.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Cristina Martinez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94118, USA
| | - Armando Peruga
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Center for Epidemiology and Health Policies, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana de Santiago, Chile
| | | | - Eduardo Bianco
- Regional Coordinator for the Americas, Framework Convention Alliance (FCA), Montevideo, Uruguay
| | - Marco Cornejo
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Sarah O Nogueira
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George W Thomson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the Global Youth Tobacco Surveys. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:245-255. [PMID: 33545071 DOI: 10.1016/s2352-4642(20)30390-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tobacco use is a leading preventable cause of morbidity and mortality worldwide. Little is known about recent prevalence and trends in tobacco use among adolescents globally. We aimed to assess the recent global prevalence of tobacco use in young adolescents and the secular trends in prevalence between 1999 and 2018. METHODS We used the most recent Global Youth Tobacco Surveys data on adolescents aged 13-15 years from 143 countries or territories that had done at least one survey between Jan 1, 2010, and Dec 31, 2018, to assess the recent prevalence of tobacco use; and data from 140 countries that had done two or more surveys between Jan 1, 1999, and Dec 31, 2018, to assess the trends in the prevalence of tobacco use. FINDINGS 530 234 adolescents were included from the 143 countries that had done at least one survey between 2010 and 2018. 1 192 312 adolescents were included from the 140 countries that had done two or more surveys between 1999 and 2018. The most recent global prevalence of cigarette smoking was 11·3% (95% CI 10·3-12·3) in boys and 6·1% (5·6-6·6) in girls, based on cigarette smoking on at least 1 day during the past 30 days, 6·0% (5·5-6·6) and 2·6% (2·4-2·9) based on smoking on at least 3 days, and 4·2% (3·8-4·6) and 1·6% (1·4-1·8) based on smoking on at least 6 days. The most recent prevalence of the use of tobacco products other than cigarettes (eg, chewing tobacco, snuff, dip, cigars, cigarillos, pipe, electronic cigarettes) on at least 1 day during the past 30 days was 11·2% (9·9-12·6) in boys and 7·0% (6·4-7·7) in girls. The most recent prevalence of any tobacco use on at least 1 day during the past 30 days was 17·9% (16·1-19·6) in boys and 11·5% (10·5-12·4) in girls. The prevalence of cigarette smoking on at least 1 day during the past 30 days decreased between the first and last surveys in 80 (57·1%) of 140 countries, was unchanged in 39 countries (27·9%), and increased in 21 countries (15·0%). However, the prevalence of the use of tobacco products other than cigarettes was unchanged or increased in 81 (59·1%) of 137 countries. INTERPRETATION The global prevalence of tobacco use among adolescents aged 13-15 years was substantial. Although the prevalence of cigarette smoking decreased over time in the majority of countries, the prevalence of the use of other tobacco products increased or did not change in the majority of countries during the past two decades. These findings re-emphasise the need to strengthen tobacco control efforts among young adolescents globally. FUNDING Shandong University.
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Ibarra-Salazar J, Romero-Rojas JC, Ayala-Gaytán E. The duration effect of pictorial health warnings on tobacco consumption in Mexico. Glob Public Health 2020; 16:1656-1674. [PMID: 33161839 DOI: 10.1080/17441692.2020.1839928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pictorial health warnings (PHW) were introduced in Mexico by the end of 2010. Different studies have assessed how PHW influence attitude or desire to renounce smoking, but they have not studied the actual effect on the demand of tobacco products. Our objective in this paper is to analyze the effect of duration of pictorial health warnings on consumption of tobacco in Mexico. We assess the influence of different consecutive rounds of pictorial warnings, taking into account their length and the use of repeated images. We use a Dynamic Least Squares model (DOLS) with quarterly data (1994-2015), to estimate the long run demand of cigarettes in Mexico, as a function of per-capita income, the relative price of tobacco, different regulatory measures and the different rounds of pictograms, its duration, and the use of repeated images. We find evidence indicating that the pictorial health warnings have reduced consumption of cigarettes, that the effect has decreased in the last rounds, and that the most effective duration of the rounds is six months. PHW regulation deters consumption; however, its effectiveness decreases over time, suggesting that consumers tend to adapt to images.
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Springer AE, Harrell MB, Martínez Gomensoro L, Traversa Fresco M, Rogers S, Florines M, Moreno V, Lee J, Perry CL, Bianco E, Estol D. ¡Activate Ya! Co-learning about school-based tobacco prevention and physical activity promotion in secondary school students in Uruguay. Glob Health Promot 2020; 27:63-73. [PMID: 30943128 DOI: 10.1177/1757975918813049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE ¡Activate Ya! was a group-randomized controlled intervention trial aimed at developing and evaluating the impact of a school-based intervention on preventing cigarette smoking and promoting physical activity (PA) in secondary school students in Uruguay. Secondary aims were to evaluate the program's impact on students' smoking- and PA-related psychosocial risk and protective factors. METHODS Sixteen schools and n = 654 students participated in the study. The one-year intervention included a classroom-based curriculum, an afterschool program, activity breaks, and final showcase event. A self-administered questionnaire measured outcomes at three time points. Fixed effects regression models tested for differences in outcomes by study condition. RESULTS While positive intervention effects were found for selected psychosocial-related smoking outcomes, no impact on past-year smoking or smoking susceptibility was detected. Past 7-day PA, measured by the PAQ-C, was significantly higher among intervention school students overall (p = .048) and for girls (p = .03) at posttest, and intervention girls reported significantly higher athletic identity PA competence, friend and teacher PA support at posttest, and PA enjoyment at follow-up (p < .05). CONCLUSION The positive short-term effects of ¡Activate Ya! on PA and related outcomes for girls support the utility of school-based health promotion in Uruguay. Additional research is needed to determine the most effective strategies to prevent tobacco use among students and promote PA among boys in this setting.
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Affiliation(s)
- Andrew E Springer
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, USA
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, USA
| | | | | | - Shannon Rogers
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, USA
| | - Martina Florines
- Centro de Investigación para la Epidemia del Tabaquismo (CIET), Montevideo, Uruguay
| | - Viviana Moreno
- Centro de Investigación para la Epidemia del Tabaquismo (CIET), Montevideo, Uruguay
| | - Joowon Lee
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, USA
| | - Cheryl L Perry
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, USA
| | - Eduardo Bianco
- Centro de Investigación para la Epidemia del Tabaquismo (CIET), Montevideo, Uruguay
| | - Diego Estol
- Centro de Investigación para la Epidemia del Tabaquismo (CIET), Montevideo, Uruguay
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Cosetti-Olivera ML, Cunha AR, Prass TS, Martins MA, Hugo FN, Martins MD. Trends of mortality due to oral and oropharyngeal cancers in Uruguay from 1997 to 2014. Med Oral Patol Oral Cir Bucal 2020; 25:e403-e409. [PMID: 32040460 PMCID: PMC7211375 DOI: 10.4317/medoral.23457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/27/2020] [Indexed: 12/09/2022] Open
Abstract
Background To analyze the trends of oral and oropharyngeal cancer mortality in Uruguay between 1997 and 2014 according to sex and age groups and its possible association with sociodemographic factors.
Material and Methods A time-series ecological study using secondary data was performed. The data about mortality due to oral and oropharyngeal cancers were obtained from the Statistics Vitals Department of the Public Health Ministry of Uruguay. To estimate the mortality trends of the historical series, by sex, anatomical site and age groups, linear regressions generated by the Prais-Winsten procedure were used.
Results The analysis of mortality trends for oral cavity and oropharyngeal cancers in Uruguay indicated that the global mortality rate was stable over the studied period. The women's mortality rate increased from 0.51 per 100,000 in 1997 to 0.65 per 100,000 in 2014 while for men, rates per 100,000 went from 3.22 in 1997 to 2.20 per 100,000 in 2014. Mortality from oral cancer in men decreased between 1997 and 2014. Mortality by oropharyngeal cancer, irrespective of sex, remained stable. Analysis by cancer site revealed decreasing trends tumors situated in the base of the tongue and gum. Years of education, unemployment, smoking and Gini index were not associated with mortality trends.
Conclusions The overall mortality from oral and oropharyngeal cancer in Uruguay has remained constant in the period between 1997 and 2014. Oral cancer mortality decreased in men and increased in women and decreased at the base of the tongue. It’s necessary to continue monitoring the behavior of these diseases. Key words:Mortality, oral cancer, oropharyngeal cancer, tongue cancer.
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Affiliation(s)
- M-L Cosetti-Olivera
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Odontologia, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre RS, Brazil
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Kalkonde YV, Alladi S, Kaul S, Hachinski V. Stroke Prevention Strategies in the Developing World. Stroke 2019; 49:3092-3097. [PMID: 30571438 DOI: 10.1161/strokeaha.118.017384] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yogeshwar V Kalkonde
- From the Society for Education, Action and Research in Community Health, Gadchiroli, India (Y.V.K.)
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India (S.A.)
| | - Subhash Kaul
- Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India (S.K.)
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, University of Western Ontario, Canada (V.H.)
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Santero M, Melendi S, Hernández-Vásquez A, Irazola V. Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013. PLoS One 2019; 14:e0217845. [PMID: 31173615 PMCID: PMC6555547 DOI: 10.1371/journal.pone.0217845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/20/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013. METHODS Data were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis. RESULTS Prevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES. CONCLUSIONS While overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.
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Affiliation(s)
- Marilina Santero
- Departmento de Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Santiago Melendi
- Departmento de Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru
| | - Vilma Irazola
- Departmento de Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
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Peterson E, Harrell M, Springer A, Medina J, Martinez L, Perry C, Estol D. Uruguayan secondary school students speak up about tobacco: results from focus group discussions in and around Montevideo. Glob Health Promot 2019; 26:15-24. [PMID: 28704137 PMCID: PMC5748367 DOI: 10.1177/1757975917703302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative research study investigated intrapersonal, interpersonal, and environmental factors that shape young adolescent tobacco use behaviors in Uruguay. Focus groups were conducted in the summer of 2012 and fall of 2013 in four secondary schools in Montevideo, Uruguay, including two private schools and two public schools. A total of four focus groups were led in each school, composed of 4-6 students each, 16 focus groups in total. Data analysis utilized NVivo software and included deductive and inductive content analysis. Overwhelmingly, students reported that the onset of smoking occurred in the second year of secondary school. The primary intrapersonal factors that were found to be universal among respondents identified that smoking was a performance in groups, to garner attention from their peers. Students interviewed most often stated that the greatest interpersonal factors for smoking were to look older, as a rite of passage, and for group membership. Environmental factors cited most often indicate that they smoked during unsupervised time, either at night or around the short Uruguayan school day. Focus group interviews revealed that adolescents had easy access to cigarettes for purchase through small family owned grocery stores, even though laws exist preventing the sale of cigarettes to minors. Few differences were cited between strata related to cigarette use in adolescents. The differences that do exist are most apparent across gender, though there were a few observed differences when stratified by public and private school. Findings from this study indicate that key factors across ecological levels (intrapersonal, interpersonal, and environmental) should be taken into consideration when designing tobacco prevention programs for youth in Uruguay. A multiple-component approach which addresses risk factors at all of these levels, implemented in schools, may be particularly well-suited to this setting.
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Affiliation(s)
- Erin Peterson
- University of Texas Health Science Center – School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - Melissa Harrell
- University of Texas Health Science Center – School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - Andrew Springer
- University of Texas Health Science Center – School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - José Medina
- University of Texas Health Science Center – School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - Lucía Martinez
- Centro de Investigación de la Epidemia de Tabaquismo, Montevideo, Uruguay
| | - Cheryl Perry
- University of Texas Health Science Center – School of Public Health, Austin Regional Campus, Austin, TX, USA
| | - Diego Estol
- Centro de Investigación de la Epidemia de Tabaquismo, Montevideo, Uruguay
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Francis DB, Mason N, Ross JC, Noar SM. Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies. Tob Induc Dis 2019; 17:41. [PMID: 31516484 PMCID: PMC6662785 DOI: 10.18332/tid/108614] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.
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Affiliation(s)
- Diane B Francis
- Department of Communication, University of Kentucky, Lexington, United States
| | - Nia Mason
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, United States
| | - Seth M Noar
- School of Media & Journalism, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Alonso R, Piñeros M, Laversanne M, Musetti C, Garau M, Barrios E, Bray F. Lung cancer incidence trends in Uruguay 1990-2014: An age-period-cohort analysis. Cancer Epidemiol 2018; 55:17-22. [PMID: 29758490 DOI: 10.1016/j.canep.2018.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Uruguay, a country with one of the highest lung cancer rates worldwide, initiated a series of comprehensive anti-smoking measures in 2005. We assess the tobacco control policies in the context of cohort-driven lung cancer incidence trends over a 25-year period, providing baseline predictions to 2035. METHODS Using data from the National Cancer Registry of Uruguay, an age-period-cohort analysis of trends 1990-2014 was performed. The NORDPRED package was used to predict the annual number of new cases of lung cancer and incidence rates up to 2035. RESULTS In men, age-standardised (world) rates declined from a peak of 165.6 in 1995 to 103.1 by 2014, translating to a 70% reduction in the risk of lung cancer in men born in 1970 relative to the early-1940s. In females, rates increased steadily from 18.3 in 1991 to 30.0 by 2014, with successive increases in risk among generations of women born 1940-1960. There is however evidence of a decline in observed rates in women born recently. Extrapolations of the trends indicate an 8% reduction in the mean number of new lung cancer cases in men by 2035, but a 69% increase in women. CONCLUSION Despite observed and predicted reductions in lung cancer incidence in Uruguayan men, rates among women are set to continue to increase, with a large rise in the annual number of female lung cancer diagnoses expected before 2035. There are signals of a diminishing risk among recent generations of women born after 1960. The current analysis provides important baseline information in assessing the future impact of the recent tobacco control initiatives in Uruguay.
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Affiliation(s)
- Rafael Alonso
- National Cancer Registry, CHLCC, Uruguay; Department of Quantitative Methods, Faculty of Medicine, Montevideo, Uruguay.
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mathieu Laversanne
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | | | - Mariela Garau
- National Cancer Registry, CHLCC, Uruguay; Department of Quantitative Methods, Faculty of Medicine, Montevideo, Uruguay
| | - Enrique Barrios
- National Cancer Registry, CHLCC, Uruguay; Department of Quantitative Methods, Faculty of Medicine, Montevideo, Uruguay
| | - Freddie Bray
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Shaheen K, Oyebode O, Masud H. Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study. BMC Public Health 2018; 18:466. [PMID: 29636043 PMCID: PMC5891956 DOI: 10.1186/s12889-018-5388-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is highly prevalent in Pakistan claiming the lives of over 100,000 individuals every year. A significant proportion of smokers (24.7%) make an attempt to quit each year but 97.4% fail to quit successfully. Little is known about the reasons for, and experiences of, failed quit attempts. This study was carried out to explore the experiences of young male smokers in quitting smoking in the twin cities of Pakistan METHOD: A qualitative study was carried out using a phenomenological approach in Rawalpindi and Islamabad. A total of 11 participants were interviewed. All study participants were male and had made at least one quit attempt. Study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert's (1991) method of phenomenology was followed during data analysis. RESULTS The experiences of smokers while smoking "the smoking phase" have major effects on their journey towards quitting smoking. The smoking phase consists of three major stages: contact with initial smoking stimuli, the journey from first puff to enjoying smoking and then finally smoking becoming part of life. However, the journey towards quitting smoking is not as simple as the journey towards becoming a smoker. Instead, smokers get trapped in three overlapping cycles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting. Breaking the cycle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these cycles which are strong will power, continuous peer support and avoidance of smokers' company. CONCLUSION A young smoker, during his experience of quitting smoking gets entrapped in several overlapping cycles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these cycles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan.
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Affiliation(s)
- Kanwal Shaheen
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Oyinlola Oyebode
- Warwick Medical School, the University of Warwick, Coventry, CV4 7AL UK
| | - Haleema Masud
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- Warwick Medical School, the University of Warwick, Coventry, CV4 7AL UK
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Harris JE, Ares G, Gerstenblüth M, Machin L, Triunfo P. Impact of plain packaging of cigarettes on the risk perception of Uruguayan smokers: an experimental study. Tob Control 2017; 27:513-518. [PMID: 28887428 DOI: 10.1136/tobaccocontrol-2017-053639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Uruguay, a South American country of 3.4 million inhabitants that has already banned tobacco advertising, prohibited such terms as light, mild and low-tar and required graphic warnings covering 80% of cigarette packs, is considering the imposition of plain, standardised packaging. METHODS We conducted an experimental choice-based conjoint analysis of the impact of alternative cigarette package designs on the risk perceptions of 180 adult current Uruguayan smokers. We compared plain packaging, with a standardised brand description and the dark brown background colour required on Australian cigarette packages, to two controls: the current package design with distinctive brand elements and colours; and a modified package design, with distinctive brand elements and the dark brown background colour. Graphic warnings were also varied. RESULTS Plain packaging significantly reduced the probability of perceiving the stimulus cigarettes as less harmful in comparison to the current package design (OR 0.398, 95% CI 0.333 to 0.476, p<0.001) and the modified package design (OR 0.729, 95% CI 0.626 to 0.849, p<0.001). CONCLUSIONS Plain packaging enhanced the perceived risk of cigarette products even in a highly regulated setting such as Uruguay. Both the elimination of distinctive brand elements and the use of Australia's dark brown background colour contributed to the observed effect.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gastón Ares
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Mariana Gerstenblüth
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Leandro Machin
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Patricia Triunfo
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la Republica Uruguay, Montevideo, Uruguay
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Rarau P, Vengiau G, Gouda H, Phuanukoonon S, Kevau IH, Bullen C, Scragg R, Riley I, Marks G, Umezaki M, Morita A, Oldenburg B, McPake B, Pulford J. Prevalence of non-communicable disease risk factors in three sites across Papua New Guinea: a cross-sectional study. BMJ Glob Health 2017; 2:e000221. [PMID: 29242751 PMCID: PMC5584489 DOI: 10.1136/bmjgh-2016-000221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 12/19/2022] Open
Abstract
Papua New Guinea (PNG) is a culturally, environmentally and ethnically diverse country of 7.3 million people experiencing rapid economic development and social change. Such development is typically associated with an increase in non-communicable disease (NCD) risk factors. AIM To establish the prevalence of NCD risk factors in three different regions across PNG in order to guide appropriate prevention and control measures. METHODS A cross-sectional survey was undertaken with randomly selected adults (15-65 years), stratified by age and sex recruited from the general population of integrated Health and Demographic Surveillance Sites in West Hiri (periurban), Asaro (rural highland) and Karkar Island (rural island), PNG. A modified WHO STEPS risk factor survey was administered along with anthropometric and biochemical measures on study participants. RESULTS The prevalence of NCD risk factors was markedly different across the three sites. For example, the prevalences of current alcohol consumption at 43% (95% CI 35 to 52), stress at 46% (95% CI 40 to 52), obesity at 22% (95% CI 18 to 28), hypertension at 22% (95% CI 17 to 28), elevated levels of cholesterol at 24% (95% CI 19 to 29) and haemoglobin A1c at 34% (95% CI 29 to 41) were highest in West Hiri relative to the rural areas. However, central obesity at 90% (95% CI 86 to 93) and prehypertension at 55% (95% CI 42 to 62) were most common in Asaro whereas prevalences of smoking, physical inactivity and low high-density lipoprotein-cholesterol levels at 52% (95% CI 45 to 59), 34% (95% CI 26 to 42) and 62% (95% CI 56 to 68), respectively, were highest in Karkar Island. CONCLUSION Adult residents in the three different communities are at high risk of developing NCDs, especially the West Hiri periurban population. There is an urgent need for appropriate multisectoral preventive interventions and improved health services. Improved monitoring and control of NCD risk factors is also needed in all regions across PNG.
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Affiliation(s)
- Patricia Rarau
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
- PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Gwendalyn Vengiau
- PNG Institute of Medical Research, Goroka, Papua New Guinea
- School of Public Health, The University of Queensland, Herston, Brisbane, Queensland, Australia
| | - Hebe Gouda
- PNG Institute of Medical Research, Goroka, Papua New Guinea
- School of Public Health, The University of Queensland, Herston, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Research and Education, Wacol, Queensland, Australia
| | - Suparat Phuanukoonon
- PNG Institute of Medical Research, Goroka, Papua New Guinea
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Isi H Kevau
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Chris Bullen
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Riley
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Herston, Brisbane, Queensland, Australia
| | - Geoffrey Marks
- School of Public Health, The University of Queensland, Herston, Brisbane, Queensland, Australia
| | - Masahiro Umezaki
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayako Morita
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Brian Oldenburg
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Pulford
- PNG Institute of Medical Research, Goroka, Papua New Guinea
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Noar SM, Francis DB, Bridges C, Sontag JM, Brewer NT, Ribisl KM. Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review. JOURNALISM & MASS COMMUNICATION QUARTERLY 2017; 94:416-442. [PMID: 29975497 PMCID: PMC5483339 DOI: 10.1177/1077699016674188] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.
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Affiliation(s)
- Seth M. Noar
- The University of North Carolina at Chapel Hill, USA
- Seth M. Noar, School of Media and Journalism, The University of North Carolina at Chapel Hill, 382 Carroll Hall, CB 3365, Chapel Hill, NC 27599-3365, USA.
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Abascal W, Lorenzo A. Impacto de la política de control de tabaco en población adolescente en Uruguay. ACTA ACUST UNITED AC 2017; 59Suppl 1:40-44. [DOI: 10.21149/8051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/22/2016] [Indexed: 11/06/2022]
Abstract
Objetivo. Analizar la evolución de la prevalencia del consumo de tabaco, comparando los datos obtenidos en la Encuesta Mundial de Tabaquismo en Jóvenes en sus ediciones 2007 y 2014. Material y métodos. Se compararon los datos de la Encuesta Mundial de Tabaquismo en Jóvenes 2007 y 2014. También se analizaron las medidas de control de tabaco adoptadas en el periodo considerado. Resultados. Los datos muestran un descenso en el consumo de cigarrillos a 30 días en población de 13 a 15 años: de 20.2% en 2007 a 8.2% en 2014. No se encontraron diferencias significativas entre los sexos. La susceptibilidad de convertirse en fumador en el próximo año se redujo de 25.8% en 2007 a 16.6% en 2014. Conclusiones. La implementación, en forma simultánea, de medidas contenidas en el Convenio Marco de la OMS para el Control del Tabaco es una estrategia eficaz para alcanzar los objetivos de reducción de la prevalencia del consumo.
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Blanco A, Sandoval RC, Martínez-López L, de Betânia Caixeta R. Diez años del Convenio Marco de la OMS para el Control del Tabaco: avances en las Américas. SALUD PUBLICA DE MEXICO 2017; 59Suppl 1:117-125. [DOI: 10.21149/8682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Amendola B, Quarneti A, Rosa AA, Sarria G, Amendola M. Perspectives on Patient Access to Radiation Oncology Services in South America. Semin Radiat Oncol 2016; 27:169-175. [PMID: 28325244 DOI: 10.1016/j.semradonc.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cancer represents a fast-growing challenge worldwide, and is being recognized as an emerging and critical issue in low- and middle-income countries, such most of South America. This subcontinent is unique for its geography, culture, and ethnical diversity. Most of its countries have large expanses of jungle and desert where underserved population groups including indigenous (native Indians), represent a challenge for cancer care. Many indigent patients have no access to preventive care nor early diagnosis. This results in late presentations with advanced disease and frequently incurable cancer. Prompt and coordinated action from local and international organizations is needed to support and guide local governments to avoid a global crisis. The critical role of education to improve awareness of the importance of radiation therapy, a cost-effective treatment modality, with the potential to help these patients at a relatively low cost is discussed.
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Affiliation(s)
| | - Aldo Quarneti
- Department of Radiation Oncology, School of Medicine of the University of the Republic of Uruguay, Montevideo, Uruguay
| | - Arthur Accioly Rosa
- Department of Radiation Oncology, Delfin Radioterapia Salvador, Bahía, Brazil
| | - Gustavo Sarria
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima Ica, Nazca, Peru
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Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Soc Sci Med 2016; 164:118-129. [PMID: 27423739 PMCID: PMC5026824 DOI: 10.1016/j.socscimed.2016.06.011] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings. METHODS We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior. RESULTS We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies. CONCLUSIONS Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.
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Affiliation(s)
- Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA.
| | - Diane B Francis
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA
| | - Christy Bridges
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Jennah M Sontag
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
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Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros M, de Vries E, Forman D. Cancer patterns and trends in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S23-S42. [PMID: 27678320 DOI: 10.1016/j.canep.2016.07.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVE Cancer burden is increasing in Central and South America (CSA). We describe the current burden of cancer in CSA. METHODS We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer mortality data from the WHO (18 countries). We estimated world population age-standardized incidence and mortality rates per 100,000 person-years. RESULTS The leading cancers diagnosed were prostate, lung, breast, cervix, colorectal, and stomach, which were also the primary causes of cancer mortality. Countries of high/very high human development index (HDI) in the region experienced a high burden of prostate and breast cancer while medium HDI countries had a high burden of stomach and cervical cancers. Between countries, incidence and mortality from all cancers combined varied by 2-3-fold. French Guyana, Brazil, Uruguay, and Argentina had the highest incidence of all cancers while Uruguay, Cuba, Argentina, and Chile had the highest mortality. Incidence of colorectum, prostate and thyroid cancers increased in Argentina, Brazil, Chile and Costa Rica from 1997 to 2008, while lung, stomach and cervical cancers decreased. CONCLUSION CSA carries a double-burden of cancer, with elevated rates of infection- and lifestyle-related cancers. Encountered variation in cancer rates between countries may reflect differences in registration practices, healthcare access, and public awareness. Resource-dependent interventions to prevent, early diagnose, and treat cancer remain an urgent priority. There is an overwhelming need to improve the quality and coverage of cancer registration to guide and evaluate future cancer control policies and programs.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | | | - Sébastien Antoni
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mathieu Laversanne
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Barrios E, Sierra MS, Musetti C, Forman D. The burden of oesophageal cancer in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S53-S61. [PMID: 27678323 DOI: 10.1016/j.canep.2016.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 01/28/2023]
Abstract
RATIONALE AND OBJECTIVE Oesophageal cancer shows marked geographic variations and is one of the leading causes of cancer death worldwide. We described the burden of this malignancy in Central and South America. METHODS Regional and national level incidence data were obtained from 48 population-based cancer registries in 13 countries. Mortality data were obtained from the WHO mortality database. Incidence of oesophageal cancer by histological subtype were available from high-quality population-based cancer registries. RESULTS Males had higher incidence and mortality rates than females (male-to-female ratios: 2-6:1 and 2-5:1). In 2003-2007, the highest rates were in Brazil, Uruguay, Argentina and Chile. Mortality rates followed the incidence patterns. Incidence of oesophageal squamous cell carcinoma (SCC) was higher than adenocarcinoma (AC), except in females from Cuenca (Ecuador). SCC and AC incidence were higher in males than females, except in the Region of Antofagasta and Valdivia (Chile), Manizales (Colombia) and Cuenca (Ecuador). Incidence and mortality rates tended to decline in Argentina, Chile, Brazil (incidence) and Costa Rica from 1997 to 2008. CONCLUSION The geographic variation and sex disparity in oesophageal cancer across Central and South America may reflect differences in the prevalence of tobacco smoking and alcohol consumption which highlights the need to implement and/or strengthen tobacco and alcohol control policies. Maté consumption, obesity, diet and Helicobacter pylori infection may also explain the variation in oesophageal cancer rates but these relationships should be evaluated. Continuous monitoring of oesophageal cancer rates is necessary to provide the basis for cancer prevention and control in the region.
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Affiliation(s)
- Enrique Barrios
- Registro Nacional de Cáncer, CHLCC, Uruguay; Dept. of Quantitative Methods, Faculty of Medicine, Montevideo, Uruguay.
| | - Monica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France.
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
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Piñeros M, Sierra MS, Forman D. Descriptive epidemiology of lung cancer and current status of tobacco control measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S90-S99. [PMID: 27678327 DOI: 10.1016/j.canep.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the world. In Central and South America lung cancer is now one of most frequent cancers and the leading cause of cancer-related death in both sexes. We describe patterns and trends in lung cancer incidence and mortality in Central and South America and give a brief overview of the current status of tobacco control measures based on the most recent MPOWER report. METHODS We obtained regional and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years. Incidence of lung cancer by histological subtype were only available from high-quality population-based cancer registries for the period 2003-2007. RESULTS The highest incidence and mortality rates in the region were seen among males in Argentina, Cuba, Chile and Uruguay. Adenocarcinoma was the most frequent histological type overall, though squamous carcinoma was more frequent in Antofagasta-Chile and Villa Clara-Cuba. Smoke-free policies and warnings are widely implemented tobacco control measures; cessation is offered but the costs are not covered by health systems in the majority of countries. CONCLUSION The high burden of lung cancer in the region highlights the need to improve long term information and strengthen current tobacco control policies including aggressive taxing measures and supporting smoking cessation in order to achieve the targeted reductions in smoking prevalence.
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Affiliation(s)
- Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Grainger Gasser A, Welch C, Arora M, Greenland R, Bhatti L, Sanda L, Moodie R, Bianco E. Reducing Cardiovascular Mortality Through Tobacco Control: A World Heart Federation Roadmap. Glob Heart 2016. [PMID: 26213299 DOI: 10.1016/j.gheart.2015.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | | | | | | | - Rob Moodie
- University of Melbourne, Melbourne, Victoria, Australia
| | - Eduardo Bianco
- Framework Convention Alliance (FCA), and The Center for Research on the Tobacco Epidemic (CIET), Montevideo, Uruguay
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Amendola B, Amendola M. Status of Radiation Therapy in Uruguay: Past, Present, and Future. Int J Radiat Oncol Biol Phys 2016; 94:428-34. [DOI: 10.1016/j.ijrobp.2015.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/29/2022]
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Kalkhoran S, Sebrié EM, Sandoya E, Glantz SA. Effect of Uruguay's National 100% Smokefree Law on Emergency Visits for Bronchospasm. Am J Prev Med 2015; 49:85-8. [PMID: 25997906 PMCID: PMC4476915 DOI: 10.1016/j.amepre.2014.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/08/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Implementation of smokefree laws is followed by drops in hospital admissions for cardiovascular diseases and asthma. The impact of smokefree laws on use of non-hospital medical services has not been assessed. The purpose of this study is to evaluate the impact of Uruguay's national 100% smokefree legislation on non-hospital emergency care visits, hospitalizations for bronchospasm, and bronchodilator use. METHODS The monthly number of non-hospital emergency care visits and hospitalizations for bronchospasm, as well as monthly puffs of bronchodilators (total and per person), from 3 years prior to the adoption of the 100% smokefree policy on March 1, 2006, through 5 years after the policy were assessed using interrupted time series negative binomial regression. Data analysis was conducted in 2014. RESULTS The incidence of non-hospital emergency visits for bronchospasm decreased by 15% (incidence rate ratio [IRR]=0.85, 95% CI=0.76, 0.94) following implementation of the law. Hospitalizations for bronchospasm did not change significantly (IRR=0.89, 95% CI=0.66, 1.21). Total monthly puffs of salbutamol and ipratropium administered in the non-hospital emergency setting decreased by 224 (95% CI=-372, -76) and 179 (95% CI=-340, -18.6), respectively, from means of 1,222 and 1,007 before the law. CONCLUSIONS Uruguay's 100% smokefree law was followed by fewer emergency visits for bronchospasm and less need for treatment, supporting adoption of such policies in low- and middle-income countries to reduce the disease burden and healthcare costs associated with smoking.
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Affiliation(s)
- Sara Kalkhoran
- Department of Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California
| | - Ernesto M Sebrié
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Edgardo Sandoya
- CIET, Centro para la Investigación de la Epidemia de Tabaquismo, Montevideo; CLAEH Medical School, Maldonado, Uruguay
| | - Stanton A Glantz
- Department of Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California; Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.
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Harris JE, Balsa AI, Triunfo P. Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight. JOURNAL OF HEALTH ECONOMICS 2015; 42:186-96. [PMID: 25985121 DOI: 10.1016/j.jhealeco.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 05/08/2023]
Abstract
We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2013 to assess the impact of three types of tobacco control policies: (1) provider-level interventions aimed at the treatment of nicotine dependence, (2) national-level increases in cigarette taxes, and (3) national-level non-price regulation of cigarette packaging and marketing. We estimated models of smoking cessation during pregnancy at the individual, provider and national levels. The rate of smoking cessation during pregnancy increased from 15.4% in 2007 to 42.7% in 2013. National-level non-price policies had the largest estimated impact on cessation. The price response of the tobacco industry attenuated the effects of tax increases. While provider-level interventions had a significant effect, they were adopted by relatively few health centers. Quitting during pregnancy increased birth weight by an estimated 188 g. Tobacco control measures had no effect on the birth weight of newborns of non-smoking women.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Ana Inés Balsa
- Departamento de Economía, Facultad de Ciencias Empresariales y Economía, Universidad de Montevideo, Montevideo 11500, Uruguay.
| | - Patricia Triunfo
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República, Montevideo 11200, Uruguay.
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Chiosi JJ, Andes L, Asma S, Palipudi K, McAfee T. Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey. Tob Control 2015; 25:393-401. [PMID: 25953532 DOI: 10.1136/tobaccocontrol-2014-052047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/20/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Knowledge about the harms of tobacco use deters initiation and is associated with cessation. Most studies on this knowledge in the general population have been in high-income countries, but the tobacco use burden is increasing in low-income and middle-income countries. We sought to estimate levels of knowledge about tobacco-related diseases in 22 countries and determine the factors associated with differences in knowledge. METHODS We used data from the Global Adult Tobacco Survey (GATS), a nationally representative survey of persons aged ≥15 years. GATSs were conducted from 2008 to 2013 in 22 low-income and middle-income countries. Information was gathered on tobacco-related knowledge and noticing of antismoking mass media messages and health warning labels on cigarette packages. We constructed a four-point knowledge scale and performed multivariate regression analyses. RESULTS Median country values for the proportion of adults who believed smoking causes a specific illness were 95.9% for lung cancer, 82.5% for heart attack and 74.0% for stroke. Knowledge scores ranged from 2.1 to 3.8. In multivariate regressions, adults scored significantly higher on the knowledge scale if they noticed antismoking media messages (22 countries) or health warning labels (17 countries). Significantly higher knowledge scores occurred in all 9 countries with pictorial health warning labels compared with only 8 out of 13 countries with text-only warning labels. CONCLUSIONS Antismoking media messages appear effective for warning the public about the harms from tobacco use in all 22 countries, while warning labels are effective in the majority of these countries. Our findings suggest opportunities to motivate smoking cessation globally.
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Affiliation(s)
- John J Chiosi
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Linda Andes
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samira Asma
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Krishna Palipudi
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim McAfee
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Sud SR, Brenner JE, Shaffer ER. Trading Away Health: The Influence of Trade Policy on Youth Tobacco Control. J Pediatr 2015; 166:1303-7. [PMID: 25681200 DOI: 10.1016/j.jpeds.2015.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/01/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Sohil R Sud
- Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
| | - Joseph E Brenner
- Center for Policy Analysis on Trade & Health (CPATH), San Francisco, CA
| | - Ellen R Shaffer
- Center for Policy Analysis on Trade & Health (CPATH), San Francisco, CA
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Beaglehole R, Bonita R, Yach D, Mackay J, Reddy KS. A tobacco-free world: a call to action to phase out the sale of tobacco products by 2040. Lancet 2015; 385:1011-8. [PMID: 25784348 DOI: 10.1016/s0140-6736(15)60133-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the sale (legal and illegal) of tobacco products. A tobacco-free world by 2040, where less than 5% of the world's adult population use tobacco, is socially desirable, technically feasible, and could become politically practical. Three possible ways forward exist: so-called business-as-usual, with most countries steadily implementing the WHO Framework Convention on Tobacco Control (FCTC) provisions; accelerated implementation of the FCTC by all countries; and a so-called turbo-charged approach that complements FCTC actions with strengthened UN leadership, full engagement of all sectors, and increased investment in tobacco control. Only the turbo-charged approach will achieve a tobacco-free world by 2040 where tobacco is out of sight, out of mind, and out of fashion--yet not prohibited. The first and most urgent priority is the inclusion of an ambitious tobacco target in the post-2015 sustainable development health goal. The second priority is accelerated implementation of the FCTC policies in all countries, with full engagement from all sectors including the private sector--from workplaces to pharmacies--and with increased national and global investment. The third priority is an amendment of the FCTC to include an ambitious global tobacco reduction goal. The fourth priority is a UN high-level meeting on tobacco use to galvanise global action towards the 2040 tobacco-free world goal on the basis of new strategies, new resources, and new players. Decisive and strategic action on this bold vision will prevent hundreds of millions of unnecessary deaths during the remainder of this century and safeguard future generations from the ravages of tobacco use.
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Affiliation(s)
| | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Derek Yach
- Vitality Institute (part of Discovery Holdings), New York, USA
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32
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Affiliation(s)
- John Britton
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham NG5 1PB, UK.
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Curti D, Shang C, Ridgeway W, Chaloupka FJ, Fong GT. The use of legal, illegal and roll-your-own cigarettes to increasing tobacco excise taxes and comprehensive tobacco control policies: findings from the ITC Uruguay Survey. Tob Control 2015; 24 Suppl 3:iii17-iii24. [PMID: 25740084 DOI: 10.1136/tobaccocontrol-2014-051890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/05/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little research has been done to examine whether smokers switch to illegal or roll-your-own (RYO) cigarettes in response to a change in their relative price. OBJECTIVE This paper explores how relative prices between three cigarette forms (manufactured legal, manufactured illegal and RYO cigarettes) are associated with the choice of one form over another after controlling for covariates, including sociodemographic characteristics, smokers' exposure to antismoking messaging, health warning labels and tobacco marketing. METHODS Generalised estimating equations were employed to analyse the association between the price ratio of two different cigarette forms and the usage of one form over the other. FINDINGS A 10% increase in the relative price ratio of legal to RYO cigarettes is associated with a 4.6% increase in the probability of consuming RYO cigarettes over manufactured legal cigarettes (p≤0.05). In addition, more exposure to antismoking messaging is associated with a lower odds of choosing RYO cigarettes over manufactured legal cigarettes (p≤0.05). Non-significant associations exist between the manufactured illegal to legal cigarette price ratios and choosing manufactured illegal cigarettes, suggesting that smokers do not switch to manufactured illegal cigarettes as prices of legal ones increase. However, these non-significant findings may be due to lack of variation in the price ratio measures. To improve the effectiveness of increased taxes and prices in reducing smoking, policymakers need to narrow price variability in the tobacco market. Moreover, increasing antismoking messaging reduces tax avoidance in the form of switching to cheaper RYO cigarettes in Uruguay.
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Affiliation(s)
- Dardo Curti
- Centro de Investigación de la Epidemia del Tabaquismo-CIET, Montevideo, Uruguay
| | - Ce Shang
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - William Ridgeway
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA WHO Collaborating Centre on the Economics of Tobacco and Tobacco Control
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
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De Maio FG, Konfino J, Ondarsuhu D, Goldberg L, Linetzky B, Ferrante D. Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS). Tob Control 2014; 24:562-7. [PMID: 24985731 DOI: 10.1136/tobaccocontrol-2013-051525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/08/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets. METHODS Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression. RESULTS Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance. CONCLUSIONS Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data.
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Affiliation(s)
- F G De Maio
- Department of Sociology, DePaul University, Chicago, Illinois, USA
| | - J Konfino
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - D Ondarsuhu
- Instituto Nacional de Estadística y Censos, Ministerio de Economía y Finanzas Públicas, Buenos Aires, Argentina
| | - L Goldberg
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - B Linetzky
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - D Ferrante
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
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35
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Affiliation(s)
- Prabhat Jha
- From the Center for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto (P.J.); and the Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Oxford, United Kingdom (R.P.)
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Abstract
There are complex legal and ethical tradeoffs involved in using intensified regulation to bring smoking prevalence to near-zero levels. The authors explore these tradeoffs through a lens of health justice, paying particular attention to the potential impact on vulnerable populations. The ethical tradeoffs explored include the charge that heavy regulation is paternalistic; the potentially regressive impact of heavily taxing a product consumed disproportionately by the poor; the simple loss of enjoyment to heavily addicted smokers; the health risks posed by, for example, regulating nicotine content in cigarettes—where doing so leads to increased consumption. Turning to legalistic concerns, the authors explore whether endgame strategies constitute a form of ‘regulatory taking’; whether endgame strategies can be squared with global trade/investment laws; whether free speech rights are infringed by aggressive restrictions on the advertisement and marketing of cigarettes.
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Affiliation(s)
- Bryan P Thomas
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, 600 New Jersey Avenue, NW, Washington, DC 20001, USA.
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37
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Huang SL, Lin IF, Chen CY, Tsai TI. Impact of tobacco control policies on adolescent smoking: findings from the Global Youth Tobacco Survey in Taiwan. Addiction 2013; 108:1829-35. [PMID: 23714267 DOI: 10.1111/add.12259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/04/2013] [Accepted: 05/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS To assess the impact of a set of comprehensive tobacco control policies implemented in Taiwan in 2009, including extensive smoke-free policy, advertisement ban, pictorial warning and price increase, on adolescent smoking prevalence. DESIGN Five waves of cross-sectional surveys. SETTING Taiwan, 2004-11. PARTICIPANTS Nationally representative sample of junior high schools aged 13-15 years, in a biennial survey, total sample size 101,100. MEASURES Core questionnaire of the Global Youth Tobacco Survey, including ever smoking, 30-day smoking and number of cigarettes smoked. The magnitude of prevalence change before and after the 2009 policy implementation was quantified by adjusted odds ratios estimated by piecewise logistic regression models. FINDINGS The 30-day smoking prevalence demonstrated an upward trend [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02-1.10] between 2004 and 2008. Significant decline in 30-day smoking prevalence after the 2009 law implementation was observed (OR = 0.84, 95% CI = 0.71-0.99). Those living in non-city areas demonstrated a greater magnitude of change. In addition to changes in prevalence, we observed some delay in the age starting smoking, reduction in smokers who smoke fewer than one cigarette per day, and decrease in smokers who did not buy cigarettes. The decline in smoking prevalence was contributed primarily by the reduction in experimenters. CONCLUSION The comprehensive tobacco control programme introduced in Taiwan in 2009 was associated with a reduction in adolescent smoking, particularly among those in earlier stages of smoking and those who resided in non-city areas.
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Affiliation(s)
- Song-Lih Huang
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
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38
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Collins R, Hammond M, Carry CL, Kinnon D, Killulark J, Nevala J. Distance education for tobacco reduction with Inuit frontline health workers. Int J Circumpolar Health 2013; 72:21078. [PMID: 23984270 PMCID: PMC3752291 DOI: 10.3402/ijch.v72i0.21078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tobacco reduction is a major priority in Canadian Inuit communities. However, many Inuit frontline health workers lacked the knowledge, confidence and support to address the tobacco epidemic. Given vast distances, high costs of face-to-face training and previous successful pilots using distance education, this method was chosen for a national tobacco reduction course. OBJECTIVE To provide distance education about tobacco reduction to at least 25 frontline health workers from all Inuit regions of Canada. DESIGN Promising practices globally were assessed in a literature survey. The National Inuit Tobacco Task Group guided the project. Participants were selected from across Inuit Nunangat. They chose a focus from a "menu" of 6 course options, completed a pre-test to assess individual learning needs and chose which community project(s) to complete. Course materials were mailed, and trainers provided intensive, individualized support through telephone, fax and e-mail. The course ended with an open-book post-test. Follow-up support continued for several months post-training. RESULTS Of the 30 participants, 27 (90%) completed the course. The mean pre-test score was 72% (range: 38-98%). As the post-test was done using open books, everyone scored 100%, with a mean improvement of 28% (range: 2-62%). CONCLUSIONS Although it was often challenging to contact participants through phone, a distance education approach was very practical in a northern context. Learning is more concrete when it happens in a real-life context. As long as adequate support is provided, we recommend individualized distance education to others working in circumpolar regions.
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Affiliation(s)
- Rob Collins
- Consultancy for Alternative Education, Montreal, Canada.
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Abstract
OBJECTIVE To estimate the long-term and short-term effects on cigarette demand in Argentina based on changes in cigarette price and income per person >14 years old. METHOD Public data from the Ministry of Economics and Production were analysed based on monthly time series data between 1994 and 2010. The econometric analysis used cigarette consumption per person >14 years of age as the dependent variable and the real income per person >14 years old and the real average price of cigarettes as independent variables. Empirical analyses were done to verify the order of integration of the variables, to test for cointegration to capture the long-term effects and to capture the short-term dynamics of the variables. RESULTS The demand for cigarettes in Argentina was affected by changes in real income and the real average price of cigarettes. The long-term income elasticity was equal to 0.43, while the own-price elasticity was equal to -0.31, indicating a 10% increase in the growth of real income led to an increase in cigarette consumption of 4.3% and a 10% increase in the price produced a fall of 3.1% in cigarette consumption. The vector error correction model estimated that the short-term income elasticity was 0.25 and the short-term own-price elasticity of cigarette demand was -0.15. A simulation exercise showed that increasing the price of cigarettes by 110% would maximise revenues and result in a potentially large decrease in total cigarette consumption. CONCLUSION Econometric analyses of cigarette consumption and their relationship with cigarette price and income can provide valuable information for developing cigarette price policy.
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Affiliation(s)
- Eugenio Martinez
- Instituto de Estudios Laborales y del Desarrollo Económico (IELDE) and Consejo de Investigaciones de la Universidad Nacional de Salta (CIUNSa), Facultad de Ciencias Económicas, Universidad Nacional de Salta, Salta, Argentina
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad and Programa de Medicina Interna General, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eliseo J Pérez-Stable
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
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Myers ML. The FCTC's evidence-based policies remain a key to ending the tobacco epidemic. Tob Control 2013; 22 Suppl 1:i45-6. [PMID: 23591509 PMCID: PMC3632993 DOI: 10.1136/tobaccocontrol-2012-050891] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/13/2013] [Indexed: 11/26/2022]
Abstract
With the dramatic reduction in tobacco use in developed nations, a growing number of public health leaders have called for what they describe as an 'endgame' strategy and the need for new policies to achieve that goal. In moving forward, it is important not to lose sight of the policies that have been the underpinnings of successful tobacco reduction efforts to date, nor should we allow any discussion of new strategies to decrease the emphasis on fully implementing the Framework Convention on Tobacco Control (FCTC). Any 'endgame' strategy should carefully build on the evidence-based strategies that have proven so effective and not be based on the false premise that the policies embraced by the FCTC are incapable of reducing tobacco use far below current levels or to a level where tobacco caused disease is no longer a major public health problem.
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Affiliation(s)
- Matthew L Myers
- Campaign for Tobacco-Free Kids, 1400 I Street, NW, Suite 1200, Washington, DC 20005, USA.
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41
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Christophi CA, Paisi M, Pampaka D, Kehagias M, Vardavas C, Connolly GN. The impact of the Cyprus comprehensive smoking ban on air quality and economic business of hospitality venues. BMC Public Health 2013; 13:76. [PMID: 23351838 PMCID: PMC3567943 DOI: 10.1186/1471-2458-13-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/16/2013] [Indexed: 11/30/2022] Open
Abstract
Background Several countries, including Cyprus, have passed smoke-free legislations in recent years. The goal of this study was to assess the indoor levels of particulate matter in hospitality venues in Cyprus before and after the implementation of the law on 1/1/2010, evaluate the role of enforcement, and examine the legislation’s effect on revenue and employment. Methods Several hospitality venues (n = 35) were sampled between April 2007 and January 2008, and 21 of those were re-sampled after the introduction of the smoking ban, between March and May 2010. Data on enforcement was provided by the Cyprus Police whereas data on revenue and employment within the hospitality industry of Cyprus were obtained from the Cyprus Statistical Service; comparisons were made between the corresponding figures before and after the implementation of the law. Results The median level of PM2.5 associated with secondhand smoking was 161 μg/m3 pre-ban and dropped to 3 μg/m3 post-ban (98% decrease, p < 0.0001). Furthermore, in the year following the ban, the hotel turnover rate increased by 4.1% and the restaurant revenue by 6.4%; employment increased that same year by 7.2% and 1.0%, respectively. Conclusion Smoke free legislations, when enforced, are highly effective in improving the air quality and reducing the levels of indoor PM2.5. Strict enforcement plays a key role in the successful implementation of smoking bans. Even in nations with high smoking prevalence comprehensive smoking laws can be effectively implemented and have no negative effect on accommodation, food, and beverage services.
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Affiliation(s)
- Costas A Christophi
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, 95 Eirinis Street, Rm 201, 3041, Limassol, CYPRUS.
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Stumberg R. Safeguards for tobacco control: options for the TPPA. AMERICAN JOURNAL OF LAW & MEDICINE 2013; 39:382-441. [PMID: 23815037 DOI: 10.1177/009885881303900210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
With tobacco trade, the past is prologue. In the 1980s, the U.S. government used domestic trade remedies (“Super 301”) to pry open markets for U.S. tobacco companies. The targets included Japan, South Korea, Taiwan, and Thailand. A grateful tobacco industry donated a renovation of the Treaty Room in the U.S. Department of State, declaring at the dedication: “Tobacco is intimately and historically associated with American diplomacy.”Thailand responded by banning imported cigarettes on grounds that the imports were more addictive and marketing of imports was driving up consumption. The United States then challenged Thailand for violating the General Agreement on Tariffs and Trade (GATT). The GATT panel ruled against Thailand, finding that the import ban failed to satisfy the health exception of GATT Article XX.
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Affiliation(s)
- Gulnar Azevedo e Silva
- Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janerio, ZC:20550-900, Brazil.
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Beaglehole R, Bonita R, Horton R, Ezzati M, Bhala N, Amuyunzu-Nyamongo M, Mwatsama M, Reddy KS. Measuring progress on NCDs: one goal and five targets. Lancet 2012; 380:1283-5. [PMID: 23063272 DOI: 10.1016/s0140-6736(12)61692-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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