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Gannon J, Bach K, Cattaruzza MS, Bar-Zeev Y, Forberger S, Kilibarda B, Azari R, Okwor U, Lomazzi M, Borisch B. Big tobacco's dirty tricks: Seven key tactics of the tobacco industry. Tob Prev Cessat 2023; 9:39. [PMID: 38124801 PMCID: PMC10731746 DOI: 10.18332/tpc/176336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Affiliation(s)
- John Gannon
- World Federation of Public Health Associations
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Sheikh ZD, Branston JR, Llorente BA, Maldonado N, Gilmore AB. Tobacco industry pricing strategies for single cigarettes and multistick packs after excise tax increases in Colombia. Tob Control 2023; 33:59-66. [PMID: 35641118 PMCID: PMC10803973 DOI: 10.1136/tobaccocontrol-2022-057333] [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] [Received: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Taxes on tobacco products are an efficient way of reducing consumption. However, they are only effective if passed on to consumers with higher prices. This study aims to examine tobacco industry (TI) pricing strategies in response to tax increases, and whether they differ by price segments or presentation (packs or individual sticks) in Colombia. This is the first such academic study in Latin America and the first anywhere to include the market for single sticks. METHODS Using data on cigarette pricing/taxation from a survey of smokers (2016-2017) and official government data on pricing (2007-2019), the TI's pricing strategies were examined, split by brand, price segments, different sized packs and single cigarettes. RESULTS The TI employed targeted pricing strategies in Colombia: differentially shifting taxes; and launching new brands/brand variants. The industry overshifted taxes when increases were smaller and predictable, but used undershifting more when there was a larger increase in 2017, after which it mostly overshifted on budget and premium (but undershifted mid-priced) brands. The prices for single sticks increased more than the tax increase in 2017 when their consumption also increased. CONCLUSION The pricing strategies identified suggest excise taxes can be increased further, particularly the specific component, to reduce the price gap between brand segments. Brands should be restricted to a single variant along with prohibitions on launching new brands/brand variants. Lastly, since the pricing of single sticks does not match the pattern of packs, more monitoring of their sales and distribution is required, especially since they promote consumption and hinder effective implementation of tobacco tax policies.
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Affiliation(s)
- Zaineb Danish Sheikh
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, UK
| | - J Robert Branston
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, UK
- School of Management, University of Bath, Bath, UK
| | | | - Norman Maldonado
- PROESA - Research Center on Health Economics and Social Protection, Department of Economics, Universidad Icesi, Cali, Colombia
| | - Anna B Gilmore
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, UK
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Argefa TG, Carnegie T, Kassa SA, Kitonyo-Devotsu R, Mdege ND. Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia: a scoping review and narrative synthesis. JOURNAL OF GLOBAL HEALTH REPORTS 2023. [DOI: 10.29392/001c.57372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Tobacco advertising, promotion and sponsorship (TAPS) has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognised as a top priority for the government, and all tobacco advertising, promotion, and sponsorship forms are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed at understanding the extent and nature of the evidence gaps on TAPS in Ethiopia and identifying primary research priorities to inform future research direction. Methods Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarised descriptively and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. Results 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socio-economic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. Conclusions There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, compliance monitoring, and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring.
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Affiliation(s)
- Terefe G. Argefa
- ICAP at Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Tyryn Carnegie
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Selam A. Kassa
- Development Gateway: an IREX Venture, Washington, DC, United States
| | | | - Noreen D. Mdege
- Development Gateway: an IREX Venture, Washington, DC, United States
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, Amos Drive, York, United Kingdom
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Hebbar PB, Dsouza V, Bhojani U, Prashanth NS, van Schayck OC, Babu GR, Nagelhout GE. How do tobacco control policies work in low-income and middle-income countries? A realist synthesis. BMJ Glob Health 2022; 7:e008859. [PMID: 36351683 PMCID: PMC9644319 DOI: 10.1136/bmjgh-2022-008859] [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] [Received: 02/18/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs. METHODS We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs. RESULTS We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process. CONCLUSIONS The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs. PROSPERO REGISTRATION NUMBER CRD42020191541.
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Affiliation(s)
- Pragati Bhaskar Hebbar
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Vivek Dsouza
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Upendra Bhojani
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | | | - Onno Cp van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Netherlands
| | - Giridhara R Babu
- Epidemiology, Public Health Foundation of India, Bangalore, India
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Singh PK, Jain R, Tyagi A, Yadav A, Singh S. Smokeless tobacco industry's brand stretching through FM radio: A study from Delhi National Capital Region, India. Front Public Health 2022; 10:999552. [PMID: 36311609 PMCID: PMC9616108 DOI: 10.3389/fpubh.2022.999552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/25/2022] [Indexed: 01/26/2023] Open
Abstract
Smokeless tobacco (SLT) consumption is associated with multiple adverse health effects and mortality, with the highest burden in India. The WHO FCTC has banned tobacco advertisement, promotion and sponsorship via Article 13. Indian laws also prohibit any kind of direct or indirect advertisements in all forms of audio, visual, and print media; brand promotion; and sponsorship of tobacco products. However, the tobacco industry continues to find aggressive marketing ways to advertise their products. This study aims to assess the extent of surrogate advertisement of smokeless tobacco products through frequency modulation (FM) radio stations in the city of Delhi (National Capital Territory of India). In this study, the advertisements broadcasted over FM radio across different channels (private and government owned) in total 162 h were analyzed. The time duration was spread evenly over morning peak hours, off hours, and evening peak hours. It was found that multiple brands including Vimal, Kamla Pasand, and Rajshree have used surrogate advertising to market their brands that are commonly associated with smokeless tobacco products. However, no such advertisement was found to be aired on government-owned FM channels. The total surrogate advertisements broadcasted were over 286 times, where no significant difference was found in distribution among peak and non-peak hours. The study indicated that the tobacco industry is making its way to sell the products through indirect advertisements. The need of the hour is to not only enforce tobacco advertising ban laws in all forms of advertising media but also to strictly regulate smokeless tobacco products.
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Affiliation(s)
- Prashant Kumar Singh
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India,*Correspondence: Prashant Kumar Singh
| | - Rupal Jain
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Akansha Tyagi
- Guru Jambheshwar University of Science and Technology, Hisar, India
| | - Amit Yadav
- The International Union Against Tuberculosis and Lung Disease (The Union) South East Asia Office, New Delhi, India
| | - Shalini Singh
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Crosbie E, Gutkowski P, Severini G, Pizarro ME, Perez S, Albuquerque de Figueiredo B, Rodríguez D, Sebrié EM. Progress in adopting bans on tobacco advertising, promotion, and sponsorship in the Americas: lessons from Uruguay and Argentina. Rev Panam Salud Publica 2022; 46:e102. [PMID: 36211239 PMCID: PMC9534354 DOI: 10.26633/rpsp.2022.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective. To assess progress in and barriers to implementing bans on tobacco advertising, promotion and sponsorship (TAPS) in Uruguay, which has a complete ban, and Argentina, with a partial ban. Methods. Legislation on TAPS bans in Uruguay and Argentina was reviewed and relevant published literature, news stories, civil society reports and tobacco industry reports retrieved to analyze progress in implementing TAPS bans. Results. In Uruguay, the complete TAPS ban, which includes standardized tobacco packaging, maintains high compliance and severely limits exposure of TAPS, despite a few problems with corporate social responsibility, social media, and transnational advertising. In Argentina, the partial TAPS ban has more problems with compliance and exposure to TAPS. The most important barriers to implementing TAPS bans in both countries are the tobacco companies. In Uruguay, tobacco companies do not comply in a few areas but the complete ban greatly minimizes this. In Argentina, however, tobacco companies can more easily exploit gaps in the partial TAPS ban, such as advertising at the points of sale, promoting contests, and using influencers on social media. Conclusions. The partial TAPS ban in Argentina illustrates the problems with enforcement and the tobacco industry’s ability to exploit loopholes and continue to market their products, especially to young people. A complete TAPS ban, including standardized tobacco packaging, as in Uruguay, is easier to implement and enforce and is effective in reducing exposure to tobacco advertising. Nevertheless, governments should prioritize implementing TAPS bans on social media, which remains a difficult sphere to monitor and allows tobacco companies to continue recruiting and targeting young people.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, United States of America
| | - Patricia Gutkowski
- Campaign for Tobacco-Free Kids, Washington, DC, United States of America
| | - Gianella Severini
- Campaign for Tobacco-Free Kids, Washington, DC, United States of America
| | | | - Sara Perez
- School of Public Health, University of Nevada Reno, Reno, NV, United States of America
| | | | - Diego Rodríguez
- Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay
| | - Ernesto M. Sebrié
- Campaign for Tobacco-Free Kids, Washington, DC, United States of America
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Crosbie E, Hartman J, Tran B, Bialous S. Promoting healthier options? Inside the branding of light cigarettes and targeting youth in Brazil. Glob Public Health 2022; 17:1913-1923. [PMID: 34852728 DOI: 10.1080/17441692.2021.2003840] [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: 05/16/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to understand how the internal strategies of British American Tobacco (BAT) selling 'light' cigarettes to young people in Brazil may inform current global efforts to promote new tobacco and nicotine products. We reviewed industry documents in the Truth Tobacco Industry Documents (TTID) Library. In 1976, Philip Morris and BAT introduced 'low tar' or 'light' cigarettes in Brazil to maintain and attract new young smokers. At the time it was a novel tobacco product that implied lower health risks. While an initial push for 'light' cigarettes in Brazil did not materialise in the 1970s, BAT launched a new 'light' cigarette, Free, in 1984, with a marketing campaign consisting of symbols of personal freedom and choice to attract young people. In the mid-1990s, BAT used the success in Brazil to expand the lights segment throughout Latin America. BAT drove the lights segment through brand marketing and claims of a healthier alternative. As tobacco companies introduce and market new tobacco and nicotine products, mixing health and imagery messages, governments should recognise aggressive brand marketing messaging to attract new tobacco users and ensure that marketing regulations are enforced.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
| | - Johnny Hartman
- School of Public Health, University of Nevada Reno, Reno, NV, USA
| | - Brian Tran
- School of Public Health, University of Nevada Reno, Reno, NV, USA
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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Adu AO, Ismail N, Noor SM. Motivators of impulsivity to smoke waterpipe tobacco among Nigerian youth who smoke waterpipe tobacco: the moderating role of social media normalisation of waterpipe tobacco. BMC Public Health 2022; 22:1057. [PMID: 35619059 PMCID: PMC9135596 DOI: 10.1186/s12889-022-13386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Impulsivity is a formidable cause of waterpipe tobacco smoking among youth, however, it is understudied among African youth. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco, specifically among youth in Nigeria who smoke waterpipe tobacco. Methods Data were drawn from 695 respondents who smoke waterpipe tobacco across six Nigerian universities in the South-West zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3. Results Among Nigerian youth who smoke waterpipe tobacco, intention (β = 0.442, P < 0.001) was the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β = 0.302, P < 0.001). In addition, social media normalisation of waterpipe tobacco acted as a moderator that strengthened the relationship between intention and impulsivity (β = 0.287, P < 0.01), as well as, between positive evaluations and impulsivity (β = 0.186, P < 0.01) among youth. Conclusion Intention greatly instigates Nigerian youth’s impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educational waterpipe tobacco cessation-oriented programmes that utilise diverse constructive-based learning approaches like illustrative learning and counselling, can help to enlighten and encourage Nigerian youth on the importance of shunning the desirability to smoke waterpipe tobacco.
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Affiliation(s)
| | - Nurzali Ismail
- School of Communication, Universiti Sains Malaysia, Penang, Malaysia.
| | - Shuhaida Md Noor
- School of Communication, Universiti Sains Malaysia, Penang, Malaysia
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Mertens AEJ, Kunst AE, Lorant V, Alves J, Rimpelä A, Clancy L, Kuipers MAG. Smoking cessation among adolescents in Europe: The role of school policy and programmes. Drug Alcohol Depend 2021; 227:108945. [PMID: 34333281 DOI: 10.1016/j.drugalcdep.2021.108945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION European estimates of adolescent smoking cessation are lacking and studies on the role of schools in quit behaviour are scarce. We aimed to describe smoking cessation attempts and success among adolescents in Europe and explored the association with school policy and programmes. METHODS We used cross-sectional data from the 2013 and 2016-2017 surveys of the European SILNE and SILNE-R projects. We included 4,509 12-19-year-old current or ex-smokers in 67 secondary schools in seven countries (Belgium, Germany, Finland, Ireland, Italy, the Netherlands, and Portugal). School staff reported strength of smoke-free school policies (SFSPs), proportion of grades in which anti-tobacco education was offered, and whether the school offered any form of cessation support programme. Multilevel logistic regression analysis determined school-level variation and the association of school-level and individual-level variables with self-reported and self-defined quit attempts and quit success. RESULTS Over three quarters (77.3%) of students reported a quit attempt and half of them (50.1%) reported quit success. Prevalence rates of quit success and quit attempts, showed relatively small variations between schools within countries. Associations of smoke-free school policy, tobacco educational programmes and cessation programmes with quit attempts and quit success could not be demonstrated with statistical significance. Quit attempts and quit success were inversely associated with alcohol use, parental smoking, and friend smoking. CONCLUSION This study demonstrates that adolescence is an important time to encourage quitting and to support quit attempts. We did not find evidence for a contribution of school policies and programmes to quit behaviour of adolescent smokers.
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Affiliation(s)
- Aukje E J Mertens
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Arja Rimpelä
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Tampere, Finland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, Dublin, Ireland
| | - Mirte A G Kuipers
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Kapoor S, Kumar S, Sharma R, Pandey A, Singh R. Compliance assessment with tobacco control regulations at wheelchair-based tobacco Point of sale in Delhi, India. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2021. [DOI: 10.4103/jncd.jncd_76_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Uznay F, Gumus S. Uncovering TAPS strategies of the tobacco industry at PoS in low- and middle-income countries: the case of Turkey. Eur J Public Health 2020; 30:996-1001. [PMID: 32388567 DOI: 10.1093/eurpub/ckaa067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to uncover strategies executed by the tobacco industry against tobacco advertising, promotion and sponsorship (TAPS) bans at points of sale (PoS) in Turkey. METHODS The data are based on a field study conducted in the city of Izmir. There are 10 750 PoS in all of Izmir; the 6200 PoS in the 11 central districts were considered as potential subjects. Using a proportional sampling method (95% confidence interval, 5% margin of error), it was calculated that 384 PoS could adequately represent the whole. Face-to-face interviews were conducted with PoS administrators, using survey form consisting of 53 questions. Descriptive statistics methods have been used to analyze the data. RESULTS Of a total of 384 PoS visited; 96.4% featured at least one type of display/TAPS ban violation, 94.5% featured display settings creating brand dominance on display units, 76.7% received promotional payments and 14.8% received free tobacco products for featured display settings. Additionally, 29.2% of PoS had tobacco product displays visible from outside, 26.8% sold tobacco products on the counter, 24.7% featured advertising items on display units, 19.3% sold tobacco products as single stick and 11.7% had price tags with fonts larger than the legally fixed 20 pt. CONCLUSIONS An official institution specializing in tobacco control must be established to continually inspect the tobacco market. Tobacco products must stay hidden, in closed cupboards or under the counter, and communication between PoS and tobacco industry must be limited. In addition, tobacco products must be distributed by government institutions rather than the industry.
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Affiliation(s)
- Fatih Uznay
- Department of Agricultural Economics, Faculty of Agriculture, Ege University, Bornova, Izmir, Turkey
| | - Sevtap Gumus
- Department of Agricultural Economics, Faculty of Agriculture, Ege University, Bornova, Izmir, Turkey
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Hassounah MM, Al-Zalabani AH, AlAhmari MD, Murriky AA, Makeen AM, Alanazi AM. Implementation of Cigarette Plain Packaging: Triadic Reactions of Consumers, State Officials, and Tobacco Companies-The Case of Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2668. [PMID: 32295009 PMCID: PMC7215406 DOI: 10.3390/ijerph17082668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In August 2019, Saudi Arabia started implementing plain packaging for cigarettes. Three months later, an opposing campaign on twitter using an Arabic hashtag "the new smoke" gained momentum amongst smokers. The purpose of this study is to document this opposing campaign's timeline and describe consumers, government, and tobacco industry rhetoric. METHODS We created a timeline of the campaign events then performed online social listening of Arabic twitter hashtags related to the campaign. RESULTS Campaigners mainly complained of an unfavorable new taste in cigarette packs with plain packaging. The messaging developed to accusations to government entities and neighboring countries, and then after threats to boycott tobacco companies. The campaign received a significant amount of media coverage and elicited an official response from a number of Saudi government bodies, such as the Saudi Food and Drug Authority and Ministry of Commerce and Investment. CONCLUSION This case points at a need for risk communication training, possible tobacco industry manipulation, and a need to gain consumer trust with evidence-based messaging techniques. The case of cigarette plain packaging adoption in Saudi Arabia serves as an example to other countries of potential consumer interaction, tobacco industry interference, and state official counter-reactions.
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Affiliation(s)
- Marwah M. Hassounah
- Community Medicine Unit, Family and Community Medicine Department, King Saud University, Riyadh 11564, Saudi Arabia;
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah 42353, Saudi Arabia;
| | - Mohammed D. AlAhmari
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran 34464, Saudi Arabia;
| | - Afraa A. Murriky
- Department of Restorative Dentistry, Riyadh Elm University, Riyadh 11564, Saudi Arabia;
| | - Anwar M. Makeen
- Department of Family and Community Medicine, Jazan University, Jazan 88723, Saudi Arabia;
| | - Abdullah M.M. Alanazi
- Department of Respiratory Therapy, King Saud bin Abdulaziz University For Health Sciences, Riyadh 11564, Saudi Arabia
- Sparkman Center for Global Health, The University of Alabama at Birmingham, Birmingham, AL 35205, USA
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Isip U, Calvert J. Analyzing big tobacco's global youth marketing strategies and factors influencing smoking initiation by Nigeria youths using the theory of triadic influence. BMC Public Health 2020; 20:377. [PMID: 32197659 PMCID: PMC7085134 DOI: 10.1186/s12889-020-8451-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background Major transnational tobacco companies (TTCs) have identified Nigeria, the seventh most populous country in the world, as a market with a significant revenue potential, given its high youth population and growing gross domestic product (GDP). This research analyses tobacco industry-related strategies and activities targeting youth (aged 15 to 24 years) in Nigeria involving existing, but most importantly, future tobacco users. Nigeria is the focus of this study because the tobacco industry has viewed it as a major emerging market since the 1990s. Successful marketing in Nigeria could provide the industry with a template for similar initiatives in other emerging markets in low- and middle-income countries. Methods The research began with a systematic review of secondary literature to determine how the tobacco industry has targeted youth globally and factors contributing to youth smoking initiation. It then used the theory of triadic influence as a heuristic framework to categorize the various factors influencing youth smoking initiation and industry strategies related to increasing tobacco use among youths. Quotations from internal tobacco industry documents were organized into the three streams of the theory of triadic influence: biology/personality, social and cultural/environmental streams. A total of 12 interviews were conducted with 6 policymakers and governmental officials, 2 civil society organization representatives, a high school principal, a journalist and 2 researchers to investigate how the tobacco industry had targeted youth in Nigeria. Results The findings indicate that TTCs have actively targeted youth in Nigeria since the 1990s, focusing on changing behaviour through the biology/personality, social and environmental/ cultural streams. Conclusion The study suggests that Nigeria implement and vigorously enforce its 2015 National Tobacco Control Bill as well as a package of other measures to prevent tobacco companies targeting youth.
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Affiliation(s)
- Ukoabasi Isip
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - John Calvert
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Williams R, Aithal G, Alexander GJ, Allison M, Armstrong I, Aspinall R, Baker A, Batterham R, Brown K, Burton R, Cramp ME, Day N, Dhawan A, Drummond C, Ferguson J, Foster G, Gilmore I, Greenberg J, Henn C, Jarvis H, Kelly D, Mathews M, McCloud A, MacGilchrist A, McKee M, Moriarty K, Morling J, Newsome P, Rice P, Roberts S, Rutter H, Samyn M, Severi K, Sheron N, Thorburn D, Verne J, Vohra J, Williams J, Yeoman A. Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK. Lancet 2020; 395:226-239. [PMID: 31791690 DOI: 10.1016/s0140-6736(19)32908-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.
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Affiliation(s)
- Roger Williams
- Institute of Hepatology, Foundation for Liver Research, London, UK.
| | - Guruprasad Aithal
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK; Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Graeme J Alexander
- UCL Institute for Liver & Digestive Health, University College London, London, UK
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Richard Aspinall
- Portsmouth Liver Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Alastair Baker
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Rachel Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Katrina Brown
- Cancer Intelligence Team, Cancer Research UK, London
| | | | - Matthew E Cramp
- Faculty of Health: Medicine, Dentistry and Human Sciences Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Natalie Day
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College Hospital, London, UK; National Addiction Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham Foster
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Ian Gilmore
- Liver Centre for Alcohol Research, University of Liverpool, UK
| | | | | | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle, UK; The Royal College of General Practitioners, London, UK
| | - Deirdre Kelly
- The Liver Unit Birmingham Women's and Children's Hospital, Birmingham, UK
| | | | - Annie McCloud
- Kent & Medway NHS and Social Care Partnership Trust, Gillingham, UK
| | | | - Martin McKee
- The London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philip Newsome
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Peter Rice
- Scottish Health Action on Alcohol Problems, Edinburgh, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | | | - Nick Sheron
- European Public Health Alliance, Brussels, Belgium
| | | | | | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London
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Kuijpers TG, Kunst AE, Willemsen MC. Policies that limit youth access and exposure to tobacco: a scientific neglect of the first stages of the policy process. BMC Public Health 2019; 19:825. [PMID: 31242893 PMCID: PMC6595563 DOI: 10.1186/s12889-019-7073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets, or banning the display of tobacco products. Many studies have assessed the impact of these policies, while less is known about the preceding policy process. The aim of our review was to assess the available evidence on the preceding process of agenda setting, policy formulation, and policy legitimation. METHODS A systematic literature search was conducted using the PubMed and the Social Sciences Citation Index databases. After selection, 200 international peer-reviewed articles were identified and analyzed. Through a process of close reading, evidence based on scientific enquiry and anecdotal evidence on agenda setting, policy formulation and policy legitimation was abstracted from each article. RESULTS Scientific evidence on the policy process is scarce for these policies, as most of the evidence found was anecdotal. Only one study provided evidence based on a scientific analysis of data on the agenda setting and legitimation phases of policy processes that led to the adoption of display bans in two Australian jurisdictions. CONCLUSION The processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy.
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Affiliation(s)
- Thomas G Kuijpers
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands.
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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16
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Mbulo L, Kruger J, Hsia J, Yin S, Salandy S, Orlan E, Agaku I, Ribisl KM. Cigarettes point of purchase patterns in 19 low-income and middle-income countries: Global Adult Tobacco Survey, 2008-2012. Tob Control 2019; 28:117-120. [PMID: 29622603 PMCID: PMC6173657 DOI: 10.1136/tobaccocontrol-2017-054180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is little information on cigarette-purchasing behaviour among smokers globally. Understanding cigarette purchase and point-of-sale patterns can help guide the development and implementation of tobacco-control strategies in retail environments. OBJECTIVE The purpose of this study was to identify where adults in 19 countries last purchased cigarettes. METHODS Data were from 19 low-income and middle-income countries that conducted the Global Adult Tobacco Survey (GATS) during 2008-2012. GATS is a nationally representative household survey of adults aged 15 years or older using a standardised protocol to measure tobacco-related behaviours. Data were weighted to yield nationally representative estimates within each country and summarised by using descriptive statistics. RESULTS Overall prevalence of current cigarette smoking ranged from 3.7% in Nigeria to 38.5% in the Russian Federation. Among current cigarette smokers, locations of last purchase were as follows: stores, from 14.6% in Argentina to 98.7% in Bangladesh (median=66.8%); street vendors, from 0% in Thailand to 35.7% in Vietnam (median=3.0%); kiosks, from 0.1% in Thailand to 77.3% in Argentina (median=16.1%); other locations, from 0.3% in China and Egypt to 57.5% in Brazil (median=2.6%). CONCLUSION Cigarettes are purchased at various retail locations globally. However, stores and kiosks were the main cigarette purchase locations in 18 of the 19 countries assessed. Knowledge of where cigarette purchases occur could help guide interventions to reduce cigarette accessibility and use.
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Affiliation(s)
- Lazarous Mbulo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judy Kruger
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason Hsia
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaoman Yin
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simone Salandy
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Israel Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt M. Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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McCloud RF, Kohler RE, Viswanath K. Cancer Risk-Promoting Information: The Communication Environment of Young Adults. Am J Prev Med 2017; 53:S63-S72. [PMID: 28818248 DOI: 10.1016/j.amepre.2017.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/07/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
Young adulthood represents a time of myriad transitions, which leave young adults (YAs) more susceptible to the influences of cancer risk-promoting information. The tobacco, alcohol, indoor tanning, and food and beverage industries engage in aggressive marketing strategies through both traditional and social media to target this age group to consume their products, which have known links to cancer. Despite this barrage of messaging, detailed data are lacking on the communication behaviors of subgroups of this diverse age group, particularly those from low SES. This paper explores the available data on media usage among YAs and describes the cancer risk-promoting information environment, with a focus on communication inequalities and their implications for cancer research and control. Nationally representative data on media consumption patterns indicate that the majority of YAs access a diverse range of traditional and social media platforms, but these data do not fully describe differences at the intersection of age and important factors such as SES, gender, race/ethnicity, or urban/rural residence. Meanwhile, risk-promoting information is heavily marketed to YAs across media, with an increasing focus on using social media sites to normalize products and evade marketing restrictions. Gaps in the available data on YAs' media consumption behaviors, coupled with aggressive risk-promoting marketing strategies toward YAs, may impede cancer control efforts. Relationships between exposure to various cancer risk-promoting information, concurrent risk behaviors, SES disparities, and communication inequalities should be investigated to develop innovative and effective control programs and policies to promote cancer control in this important group.
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Affiliation(s)
- Rachel F McCloud
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Racquel E Kohler
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - K Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Banks C, Rawaf S, Hassounah S. Factors influencing the tobacco control policy process in Egypt and Iran: a scoping review. Glob Health Res Policy 2017; 2:19. [PMID: 29202087 PMCID: PMC5683450 DOI: 10.1186/s41256-017-0039-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/05/2017] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Tobacco control policy is essential for addressing the growing tobacco consumption seen in the Eastern Mediterranean Region, the single greatest preventable contributor to the non-communicable disease epidemic. Egypt and Iran have had varied success in using policy to combat this issue. The study aims to identify and compare the factors which have influenced different stages of the policy process - evidence generation, development and implementation. METHODS A scoping review was conducted with a systematic search of 7 databases which was conducted along with searches of Google Scholar, and the World Health Organisation and Eastern Mediterranean Regional Office websites to identify influencing factors at each stage of the policy process. RESULTS Twenty-seven relevant articles were identified from the literature search. Factors identified as influencing tobacco control policy in these countries were lobbying by the tobacco industry, the rise of water-pipe smoking, lack of political commitment and the lack of resources to for policy implementation. Iran was found to be leading Egypt on all three areas of the policy process. Implementation was found to be the most pivotal part of the policy process and the area in which Egypt was weakest compared to Iran. CONCLUSION This study addresses a gap in knowledge concerning tobacco control in the Middle East and has identified multiple factors which are potentially slowing the process of enforcing policy to address tobacco consumption. Iran is the regional leader for tobacco control and it is important for Egypt to assess the transferability of its tactics and immediately start implementing measures to control tobacco use.
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Affiliation(s)
- C. Banks
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
| | - S. Rawaf
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
| | - S. Hassounah
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
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Arrazola RA, Ahluwalia IB, Pun E, Garcia de Quevedo I, Babb S, Armour BS. Current Tobacco Smoking and Desire to Quit Smoking Among Students Aged 13-15 Years - Global Youth Tobacco Survey, 61 Countries, 2012-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:533-537. [PMID: 28542119 PMCID: PMC5657874 DOI: 10.15585/mmwr.mm6620a3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Tobacco use is the world's leading cause of preventable morbidity and mortality, resulting in nearly 6 million deaths each year (1). Smoked tobacco products, such as cigarettes and cigars, are the most common form of tobacco consumed worldwide (2), and most tobacco smokers begin smoking during adolescence (3). The health benefits of quitting are greater for persons who stop smoking at earlier ages; however, quitting smoking at any age has health benefits (4). CDC used the Global Youth Tobacco Survey (GYTS) data from 61 countries across the six World Health Organization (WHO) regions from 2012 to 2015 to examine the prevalence of current tobacco smoking and desire to quit smoking among students aged 13-15 years. Across all 61 countries, the median current tobacco smoking prevalence among students aged 13-15 years was 10.7% (range = 1.7%, Sri Lanka to 35.0%, Timor-Leste). By sex, the median current tobacco smoking prevalence was 14.6% among males (range = 2.9%, Tajikistan to 61.4%, Timor-Leste) and 7.5% among females (range = 1.6%, Tajikistan to 29.0%, Bulgaria). In the majority of countries assessed, the proportion of current tobacco smokers who desired to quit smoking exceeded 50%. These findings could be used by country level tobacco control programs to inform strategies to prevent and reduce youth tobacco use (1,4).
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20
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Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017; 389:1885-1906. [PMID: 28390697 PMCID: PMC5439023 DOI: 10.1016/s0140-6736(17)30819-x] [Citation(s) in RCA: 1093] [Impact Index Per Article: 156.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. METHODS We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). FINDINGS Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. INTERPRETATION The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years. FUNDING Bill & Melinda Gates Foundation and Bloomberg Philanthropies.
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21
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Cigarette graphic health warning labels and information avoidance among individuals from low socioeconomic position in the U.S. Cancer Causes Control 2017; 28:351-360. [PMID: 28255678 DOI: 10.1007/s10552-017-0875-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Although graphic health warning labels (GHWs) on cigarette packs have influenced cessation behaviors in other countries, no U.S. studies have explored the impact of avoidance of GHW content among individuals from low socioeconomic position (SEP). The purpose of this study was to determine the predictors of intention to avoid GHWs, and how avoidance impacts cessation intention, in a low SEP sample in the U.S. METHODS Data come from low SEP smokers (n = 541) involved in a field experiment. The participants responded to questions pre- and post viewing of GHWs assessing SEP, intention to avoid them, emotional reactions, and intention to seek health information or quit smoking. Backwards stepwise logistic regression determined the predictors for intention to avoid GHWs. Simple and adjusted logistic regression analyzed the association between avoidance and its main predictors and outcomes of intentions to seek information or quit smoking. RESULTS Predictors for avoidance included being somewhat addicted to cigarettes (OR 2.3, p = 0.002), younger than 25 (OR 2.6, p = 0.008), and having medium (OR 3.4, p < 0.001) or high (OR 4.7, p < 0.001) levels of negative emotional reaction to the labels. Intention to avoid GHWs was positively associated with the intent to look for health information about smoking (OR 2.2, p = 0.002). Higher levels of negative emotional reaction were positively associated with cessation behaviors, with high negative emotional reaction associated with nine times the odds of quitting (p < 0.001). CONCLUSIONS Results indicate avoidance of GHWs does not detract from the labels' benefit and that GHWs are an effective means of communicating smoking risk information among low SEP groups.
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Owusu D, Mamudu HM, John RM, Ibrahim A, Ouma AEO, Veeranki SP. Never-Smoking Adolescents' Exposure to Secondhand Smoke in Africa. Am J Prev Med 2016; 51:983-998. [PMID: 27866598 DOI: 10.1016/j.amepre.2016.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/26/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons. METHODS Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006-2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues. RESULTS About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure. CONCLUSIONS A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Daniel Owusu
- Departments of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Hadii M Mamudu
- Departments of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Rijo M John
- Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - Abdallah Ibrahim
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
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Carroll AJ, Labarthe DR, Huffman MD, Hitsman B. Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review. Prev Med 2016; 93:189-197. [PMID: 27717667 PMCID: PMC5125629 DOI: 10.1016/j.ypmed.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/18/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States.
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Anderson CL, Becher H, Winkler V. Tobacco Control Progress in Low and Middle Income Countries in Comparison to High Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1039. [PMID: 27783060 PMCID: PMC5086778 DOI: 10.3390/ijerph13101039] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022]
Abstract
The study aimed to describe worldwide levels and trends of tobacco control policy by comparing low and middle income countries with other income categories from 2007 to 2014 and to analyze the corresponding relation to recent changes in smoking prevalence. Policy measure data representing years 2007 to 2014 were collected from all available World Health Organization (WHO) reports on the global tobacco epidemic. Corresponding policy percentage scores (PS) were calculated based on MPOWER measures. Age-standardized smoking prevalence data for years 2010 and 2015 were collected from the WHO Global Health Observatory Data Repository. Trends of PS were analysed with respect to WHO region and OECD country income category. Scatter plots and regression analysis were used to depict the relationship between tobacco control policy of 2010 and change in smoking prevalence between 2015 and 2010 by sex and income category. Combined PS for all countries increased significantly from 47% in 2007 to 61% by 2014 (p < 0.001). When grouped by income category and region, policies were strengthened in all categories, albeit with varying progression. By 2014, tobacco control policy legislation had reached 45% in the Least Developed Countries (LDCs), 59% in Low Middle Income Countries (LMICs), 66% in Upper Middle Income Countries (UMICs) and 70% in High Income Countries (HICs). Overall, there was a negative relationship between higher policy scores and change in smoking prevalence. Although policy strengthening had been conducted between 2007 and 2014, room for considerable global improvement remains, particularly in LDCs.
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Affiliation(s)
- Carrie L Anderson
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Volker Winkler
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany.
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Soong A, Navas-Acien A, Pang Y, Lopez MJ, Garcia-Esquinas E, Stillman FA. A Cross-Sectional Study of Tobacco Advertising, Promotion, and Sponsorship in Airports across Europe and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100959. [PMID: 27690072 PMCID: PMC5086698 DOI: 10.3390/ijerph13100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/19/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
Tobacco advertising, promotion, and sponsorship (TAPS) bans are effective and are increasingly being implemented in a number of venues and countries, yet the state of TAPS in airports and their effect on airport smoking behavior is unknown. The objective of this study was to evaluate the presence of TAPS in airports across Europe and the US, and to begin to examine the relationship between TAPS and smoking behaviors in airports. We used a cross-sectional study design to observe 21 airports in Europe (11) and the US (10). Data collectors observed points of sale for tobacco products, types of products sold, advertisements and promotions, and branding or logos that appeared in the airport. Tobacco products were sold in 95% of all airports, with significantly more sales in Europe than the US. Advertisements appeared mostly in post-security areas; however, airports with advertisements in pre-security areas had significantly more smokers observed outdoors than airports without advertisements in pre-security areas. Tobacco branding appeared in designated smoking rooms as well as on non-tobacco products in duty free shops. TAPS are widespread in airports in Europe and the US and might be associated with outdoor smoking, though further research is needed to better understand any relationship between the two. This study adds to a growing body of research on tobacco control in air transit and related issues. As smoke-free policies advance, they should include comprehensive TAPS bans that extend to airport facilities.
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Affiliation(s)
- Andrea Soong
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 20742, USA.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 20742, USA.
| | - Yuanjie Pang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 20742, USA.
| | - Maria Jose Lopez
- Public Health Agency of Barcelona, Barcelona 08023, Spain.
- Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona 08025, Spain.
| | - Esther Garcia-Esquinas
- Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid 28220, Spain.
| | - Frances A Stillman
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 20742, USA.
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D'Angelo D, Ahluwalia IB, Pun E, Yin S, Palipudi K, Mbulo L. Current Cigarette Smoking, Access, and Purchases from Retail Outlets Among Students Aged 13-15 Years - Global Youth Tobacco Survey, 45 Countries, 2013 and 2014. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:898-901. [PMID: 27584595 DOI: 10.15585/mmwr.mm6534a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Tobacco use is a leading preventable cause of morbidity and mortality, with nearly 6 million deaths caused by tobacco use worldwide every year (1). Cigarette smoking is the most common form of tobacco use in most countries, and the majority of adult smokers initiate smoking before age 18 years (2,3). Limiting access to cigarettes among youths is an effective strategy to curb the tobacco epidemic by preventing smoking initiation and reducing the number of new smokers (3,4). CDC used the Global Youth Tobacco Survey (GYTS) data from 45 countries to examine the prevalence of current cigarette smoking, purchase of cigarettes from retail outlets, and type of cigarette purchases made among school students aged 13-15 years. The results are presented by the six World Health Organization (WHO) regions: African Region (AFR); Eastern Mediterranean Region (EMR); European Region (EUR); Region of the Americas (AMR); South-East Asian Region (SEAR); and Western Pacific Region (WPR). Across all 45 countries, the median overall current cigarette smoking prevalence among students aged 13-15 years was 6.8% (range = 1.7% [Kazakhstan]-28.9% [Timor-Leste]); the median prevalence among boys was 9.7% (2.0% [Kazakhstan]-53.5% [Timor-Leste]), and among girls was 3.5% (0.0% [Bangladesh]-26.3% [Italy]). The proportion of current cigarette smokers aged 13-15 years who reported purchasing cigarettes from a retail outlet such as a store, street vendor, or kiosk during the past 30 days ranged from 14.9% [Latvia] to 95.1% [Montenegro], and in approximately half the countries, exceeded 50%. In the majority of countries assessed in AFR and SEAR, approximately 40% of cigarette smokers aged 13-15 years reported purchasing individual cigarettes. Approximately half of smokers in all but one country assessed in EUR reported purchasing cigarettes in packs. These findings could be used by countries to inform tobacco control strategies in the retail environment to reduce and prevent marketing and sales of tobacco products to youths (5).
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Hiilamo H, Glantz S. FCTC followed by accelerated implementation of tobacco advertising bans. Tob Control 2016; 26:428-433. [PMID: 27471111 DOI: 10.1136/tobaccocontrol-2016-053007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/01/2016] [Accepted: 07/09/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We sought to evaluate changes in countries' enacting advertising bans after the effect of ratifying the WHO Framework Convention on Tobacco Control (FCTC). METHODS We compared adoption of advertising bans on five areas (TV and radio, print media, billboards, point-of-sale, sponsorship) in countries that did versus did not ratify the FCTC, accounting for years since the ratification of the Convention. RESULTS On average, passage of complete advertising bans accelerated after FCTC ratification. The development was strongest among lower middle-income countries. Lack of state capacity was associated with lower likelihood of countries implementing complete advertising bans. Implementation of complete advertising bans slowed after 2007. CONCLUSIONS Implementation of FCTC Article 13 was followed by increased progress towards complete advertising bans, but progress is incomplete, especially among low-income countries. Low-income countries need comprehensive support to implement FCTC as part of a broad effort to reinvigorate progress on global implementation of the FCTC. Enforcing complete bans requires constant monitoring and attacking of tobacco industry efforts to circumvent them.
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Affiliation(s)
- Heikki Hiilamo
- Social and Public Policy, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies.,Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
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Lee JGL, Gregory KR, Baker HM, Ranney LM, Goldstein AO. "May I Buy a Pack of Marlboros, Please?" A Systematic Review of Evidence to Improve the Validity and Impact of Youth Undercover Buy Inspections. PLoS One 2016; 11:e0153152. [PMID: 27050671 PMCID: PMC4822877 DOI: 10.1371/journal.pone.0153152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/23/2016] [Indexed: 11/19/2022] Open
Abstract
Most smokers become addicted to tobacco products before they are legally able to purchase these products. We systematically reviewed the literature on protocols to assess underage purchase and their ecological validity. We conducted a systematic search in May 2015 in PubMed and PsycINFO. We independently screened records for inclusion. We conducted a narrative review and examined implications of two types of legal authority for protocols that govern underage buy enforcement in the United States: criminal (state-level laws prohibiting sales to youth) and administrative (federal regulations prohibiting sales to youth). Ten studies experimentally assessed underage buy protocols and 44 studies assessed the association between youth characteristics and tobacco sales. Protocols that mimicked real-world youth behaviors were consistently associated with substantially greater likelihood of a sale to a youth. Many of the tested protocols appear to be designed for compliance with criminal law rather than administrative enforcement in ways that limited ecological validity. This may be due to concerns about entrapment. For administrative enforcement in particular, entrapment may be less of an issue than commonly thought. Commonly used underage buy protocols poorly represent the reality of youths' access to tobacco from retailers. Compliance check programs should allow youth to present themselves naturally and attempt to match the community's demographic makeup.
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Affiliation(s)
- Joseph G. L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States of America
- * E-mail:
| | - Kyle R. Gregory
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Hannah M. Baker
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Leah M. Ranney
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Adam O. Goldstein
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Savell E, Gilmore AB, Sims M, Mony PK, Koon T, Yusoff K, Lear SA, Seron P, Ismail N, Calik KBT, Rosengren A, Bahonar A, Kumar R, Vijayakumar K, Kruger A, Swidan H, Gupta R, Igumbor E, Afridi A, Rahman O, Chifamba J, Zatonska K, Mohan V, Mohan D, Lopez-Jaramillo P, Avezum A, Poirier P, Orlandini A, Li W, McKee M, Rangarajan S, Yusuf S, Chow CK. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bull World Health Organ 2015; 93:851-61G. [PMID: 26668437 PMCID: PMC4669733 DOI: 10.2471/blt.15.155846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. METHODS Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. FINDINGS Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. CONCLUSION Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.
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Affiliation(s)
- Emily Savell
- Department for Health, University of Bath, Bath, England
| | - Anna B Gilmore
- Department for Health, University of Bath, Bath, England
| | - Michelle Sims
- Department for Health, University of Bath, Bath, England
| | - Prem K Mony
- Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pamela Seron
- Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
| | - Noorhassim Ismail
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ahmad Bahonar
- Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
| | - Rajesh Kumar
- School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Hany Swidan
- Primary Health Care Sector, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Ehimario Igumbor
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Asad Afridi
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omar Rahman
- Independent University Bangladesh, Dhaka, Bangladesh
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Alvaro Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | | | - Wei Li
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Martin McKee
- ECOHOST, London School of Hygiene & Tropical Medicine, London, England
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Clara K Chow
- The George Institute for Global Health, Sydney Medical School (Westmead Campus), University of Sydney, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
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Golden SD, Smith MH, Feighery EC, Roeseler A, Rogers T, Ribisl KM. Beyond excise taxes: a systematic review of literature on non-tax policy approaches to raising tobacco product prices. Tob Control 2015; 25:377-85. [PMID: 26391905 PMCID: PMC4941206 DOI: 10.1136/tobaccocontrol-2015-052294] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/02/2015] [Indexed: 11/04/2022]
Abstract
Objective Raising the price of tobacco products is considered one of the most effective ways to reduce tobacco use. In addition to excise taxes, governments are exploring other policies to raise tobacco prices and minimise price dispersion, both within and across price tiers. We conducted a systematic review to determine how these policies are described, recommended and evaluated in the literature. Data sources We systematically searched six databases and the California Tobacco Control library for English language studies or reports, indexed on or before 18 December 2013, that included a tobacco keyword (eg, cigarette), policy keyword (eg, legislation) and a price keyword (eg, promotion). We identified 3067 abstracts. Study selection Two coders independently reviewed all abstracts and identified 56 studies or reports that explicitly described a public policy likely to impact the retail price of tobacco products through non-tax means. Data extraction Two coders independently identified tobacco products targeted by policies described, recommendations for implementing policies and empirical assessments of policy impacts. Data synthesis The most prevalent non-tax price policies were price promotion restrictions and minimum price laws. Few studies measured the impact of non-tax policies on average prices, price dispersion or disparities in tobacco consumption, but the literature includes suggestions for crafting policies and preparing for legal challenges or tobacco industry opposition. Conclusions Price-focused evaluations of well-implemented non-tax price policies are needed to determine whether they can deliver on their promise to raise prices, reduce price dispersion and serve as an important complement to excise taxes.
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Affiliation(s)
- Shelley D Golden
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Margaret Holt Smith
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen C Feighery
- International Research, Campaign for Tobacco Free Kids, Washington DC, USA
| | - April Roeseler
- California Department of Public Health, California Tobacco Control Program, Sacramento, California, USA
| | - Todd Rogers
- Public Health Research Division, RTI International, San Francisco, California, USA
| | - Kurt M Ribisl
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Fallin A, Goodin A, Rayens MK, Morris S, Hahn EJ. Smoke-free policy implementation: theoretical and practical considerations. Policy Polit Nurs Pract 2015; 15:81-92. [PMID: 25573743 DOI: 10.1177/1527154414562301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Secondhand smoke exposure is a major public health issue, increasing the risk of cardiovascular and respiratory diseases and cancer. Although best practices for adopting smoke-free policy are well understood, there is limited research on the effective implementation of smoke-free policy. This article presents theoretical and practical considerations for smoke-free policy implementation in three Kentucky communities guided by the Institutional Analysis and Development (IAD) Framework. Although both Danville and Lexington-Fayette County, Kentucky have comprehensive smoke-free policies, Danville had more effective implementation, as well as better outcomes. Further study is needed to understand the critical elements of smoke-free policy implementation and their association with population outcomes. The IAD is a promising model to guide the study of both policy adoption and implementation.
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Affiliation(s)
- Amanda Fallin
- Tobacco Policy Research Program, University of Kentucky, Lexington, KY, USA
| | - Amie Goodin
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- Tobacco Policy Research Program, University of Kentucky, Lexington, KY, USA
| | - Sarah Morris
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Belt O, Stamatakos K, Ayers AJ, Fryer VA, Jernigan DH, Siegel M. Vested interests in addiction research and policy. Alcohol brand sponsorship of events, organizations and causes in the United States, 2010-2013. Addiction 2014; 109:1977-85. [PMID: 25384933 PMCID: PMC4228795 DOI: 10.1111/add.12727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/14/2014] [Accepted: 08/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS There has been insufficient research attention to the alcohol industry's use of corporate sponsorship as a marketing tool. This paper provides a systematic investigation of the nature and extent of alcohol sponsorship-at the brand level-in the United States. METHODS The study examined sponsorship of organizations and events in the United States by alcohol brands from 2010 to 2013. The top 75 brands of alcohol consumed by underage drinkers were identified based on a previously conducted national internet-based survey. For each of these brands, a systematic search for sponsorships was conducted using Google. The sponsorships were coded by category and type of sponsorship. RESULTS We identified 945 sponsorships during the study period for the top 75 brands consumed by underage drinkers. The most popular youth brands were far more likely to engage in sponsorship and to have a higher number of sponsorships. The identified sponsorships overwhelmingly associated alcohol brands with integral aspects of American culture, including sports, music, the arts and entertainment, and drinking itself. The most popular brands among underage drinkers were much more likely to associate their brands with these aspects of American culture than brands that were less popular among underage drinkers. CONCLUSIONS Alcohol brand sponsorship must be viewed as a major alcohol marketing strategy that generates brand capital through positive associations with integral aspects of culture, creation of attractive brand personalities, and identification with specific market segments. Alcohol research, practice and policy should address this highly prevalent form of alcohol marketing.
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Affiliation(s)
- Olivia Belt
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Korene Stamatakos
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Amanda J. Ayers
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Victoria A. Fryer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - David H. Jernigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Qin Y, Su J, Xiang Q, Hu Y, Xu G, Ma J, Shi Z. Effectiveness of a television advertisement campaign on giving cigarettes in a chinese population. J Epidemiol 2014; 24:508-13. [PMID: 25196169 PMCID: PMC4213226 DOI: 10.2188/jea.je20130172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Anti-tobacco television advertisement campaigns may convey messages on smoking-related health consequences and create norms against giving cigarettes. Methods Altogether, 156 and 112 slots of a television advertisement “Giving cigarettes is giving harm” were aired on Suzhou and Yizheng, respectively, over one month in 2010. Participants were recruited from 15 locations in Suzhou and 8 locations in Yizheng using a street intercept method. Overall 2306 residents aged 18–45 years completed questionnaires, including 1142 before the campaign and 1164 after, with respective response rates of 79.1% and 79.7%. Chi square tests were used to compare the difference between categorical variables. Results After the campaign, 36.0% of subjects recalled that they had seen the advertisement. Residents of Suzhou had a higher recall rate than those of Yizheng (47.6% vs. 20.6%, P < 0.001). The rate of not giving cigarettes dropped from 32.1% before the campaign to 28.5% after (P = 0.05). In the post-campaign evaluation, participants who reported seeing the advertisement were more likely not to give cigarettes in the future than those who reported not seeing the advertisement (38.7% vs. 27.5%, P < 0.001). Conclusions Our study showed that an anti-tobacco television advertisements helped change societal norms and improve health behavior. Continuous and adequate funding of anti-tobacco media campaigns targeted at different levels of the general population is needed, in conjunction with a comprehensive tobacco control effort.
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Affiliation(s)
- Yu Qin
- Jiangsu Provincial Center for Disease Control and Prevention
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Mackey TK, Liang BA, Pierce JP, Huber L, Bostic C. Call to action: promoting domestic and global tobacco control by ratifying the framework convention on tobacco control in the United States. PLoS Med 2014; 11:e1001639. [PMID: 24800816 PMCID: PMC4011850 DOI: 10.1371/journal.pmed.1001639] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tim K. Mackey and colleagues outline why the United States should ratify the Framework Convention on Tobacco Control (FCTC). Please see later in the article for the Editors' Summary
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Affiliation(s)
- Tim K. Mackey
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, California, United States of America
- Global Health Policy Institute, San Diego, California, United States of America
- Joint Masters Program on Health Policy and Law, University of California, San Diego-California Western School of Law, San Diego, California, United States of America
- * E-mail:
| | - Bryan A. Liang
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, California, United States of America
- Global Health Policy Institute, San Diego, California, United States of America
| | - John P. Pierce
- Department of Family and Preventative Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Laurent Huber
- Action on Smoking and Health, Washington, DC, United States of America
- The Framework Convention Alliance for Tobacco Control, Washington, DC, United States of America
| | - Chris Bostic
- Action on Smoking and Health, Washington, DC, United States of America
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Aoun J, Saleh N, Waked M, Salamé J, Salameh P. Lung cancer correlates in Lebanese adults: a pilot case--control study. J Epidemiol Glob Health 2013; 3:235-44. [PMID: 24206794 PMCID: PMC7320416 DOI: 10.1016/j.jegh.2013.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/04/2013] [Accepted: 06/21/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Lung cancer is one of the most prevalent types of cancers. However, there are no epidemiological studies concerning lung cancer and its risk factors in Lebanon. This study was carried out to determine the association between lung cancer and its most common risk factors in a sample of the Lebanese population. METHODS A hospital-based case-control study was conducted. Patients were recruited in a tertiary health care center. A questionnaire in Arabic was designed to assess the possible risk factors for lung cancer. RESULTS For females, cigarette smoking (ORa=9.76) and using fuel for heating (ORa=9.12) were found to be the main risk factors for lung cancer; for males, cigarette smoking (ORa=156.98), living near an electricity generator (ORa=13.26), consuming low quantities of fruits and vegetables (ORa=10.54) and a family history of cancer (ORa=8.75) were associated with lung cancer. Waterpipe smoking was significantly correlated with lung cancer in the bivariate analysis. CONCLUSION In this pilot study, it was found that in addition to smoking, outdoor and indoor pollution factors were potential risk factors of lung cancer. Additional studies would be necessary to confirm these findings.
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Affiliation(s)
- Joseph Aoun
- Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon
| | - Nadine Saleh
- Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon
| | | | - Joseph Salamé
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Public Health, Section II, Lebanese University, Beirut, Lebanon
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Moreland-Russell S, Harris J, Snider D, Walsh H, Cyr J, Barnoya J. Disparities and menthol marketing: additional evidence in support of point of sale policies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4571-83. [PMID: 24071922 PMCID: PMC3823340 DOI: 10.3390/ijerph10104571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022]
Abstract
This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control.
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Affiliation(s)
- Sarah Moreland-Russell
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mails: (J.H.); (D.S.); (H.W.); (J.C.)
| | - Jenine Harris
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mails: (J.H.); (D.S.); (H.W.); (J.C.)
| | - Doneisha Snider
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mails: (J.H.); (D.S.); (H.W.); (J.C.)
| | - Heidi Walsh
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mails: (J.H.); (D.S.); (H.W.); (J.C.)
| | - Julianne Cyr
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mails: (J.H.); (D.S.); (H.W.); (J.C.)
| | - Joaquin Barnoya
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO 63112, USA; E-Mail:
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Hammond D, Wakefield M, Durkin S, Brennan E. Tobacco packaging and mass media campaigns: research needs for Articles 11 and 12 of the WHO Framework Convention on Tobacco Control. Nicotine Tob Res 2012; 15:817-31. [PMID: 23042986 DOI: 10.1093/ntr/nts202] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Communicating the health risks of smoking remains a primary objective of tobacco-control policy. Articles 11 and 12 of the World Health Organization's Framework Convention on Tobacco Control establish standards for two important forms of communication: packaging regulations (Article 11), and mass media campaigns (Article 12). METHODS A narrative review approach was used to identify existing evidence in the areas of package labeling regulations (including health warnings, constituent and emission messages, and prohibitions on misleading information) and communication activities (including mass media campaigns and news media coverage). When available, recent reviews of the literature were used, updated with more recent high-quality studies from published literature. RESULTS Implementation of Articles 11 and 12 share several important research priorities: (a) identify existing consumer information needs and gaps, (b) research on the message source to identify effective types of content for health warnings and media campaigns, (c) research on how messages are processed and the extent to which the content and form of messages need to be tailored to different cultural and geographic groups, as well as subgroups within countries, and (d) research to identify the most cost-effective mix and best practices for sustaining health communications over time. CONCLUSION A unifying theme of effective health communication through tobacco packaging and mass media campaigns is the need to provide salient, timely, and engaging reminders of the consequences of tobacco use in ways that motivate and support tobacco users trying to quit and make tobacco use less appealing for those at risk of taking it up.
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Affiliation(s)
- David Hammond
- Department of Health Studies & Gerontology, University of Waterloo, Waterloo, Canada.
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Leischow SJ, Ayo-Yusuf O, Backinger CL. Converging research needs across framework convention on tobacco control articles: making research relevant to global tobacco control practice and policy. Nicotine Tob Res 2012; 15:761-6. [PMID: 22990225 DOI: 10.1093/ntr/nts199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Much of the research used to support the ratification of the WHO Framework Convention on Tobacco Control (FCTC) was conducted in high-income countries or in highly controlled environments. Therefore, for the global tobacco control community to make informed decisions that will continue to effectively inform policy implementation, it is critical that the tobacco control community, policy makers, and funders have updated information on the state of the science as it pertains to provisions of the FCTC. Following the National Cancer Institute's process model used in identifying the research needs of the U.S. Food and Drug Administration's relatively new tobacco law, a core team of scientists from the Society for Research on Nicotine and Tobacco identified and commissioned internationally recognized scientific experts on the topics covered within the FCTC. These experts analyzed the relevant sections of the FCTC and identified critical gaps in research that is needed to inform policy and practice requirements of the FCTC. This paper summarizes the process and the common themes from the experts' recommendations about the research and related infrastructural needs. Research priorities in common across Articles include improving surveillance, fostering research communication/collaboration across organizations and across countries, and tracking tobacco industry activities. In addition, expanding research relevant to low- and middle-income countries (LMIC), was also identified as a priority, including identification of what existing research findings are transferable, what new country-specific data are needed, and the infrastructure needed to implement and disseminate research so as to inform policy in LMIC.
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