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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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De Luca M, Ramirez ML. A Pandemic Treaty: Learning From the Framework Convention on Tobacco Control. Health Secur 2023; 21:105-112. [PMID: 36787479 DOI: 10.1089/hs.2022.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
The World Health Organization recently began developing a "pandemic treaty" in response to the perceived failures of the global COVID-19 response. The Framework Convention on Tobacco Control, which obligates members to certain global standards in tobacco control, is an example of a global public health agreement that may be used as a model for the pandemic treaty. Several challenges related to the convention, many from the tobacco industry itself, must be addressed if it is to be used as a prototype for a pandemic agreement. These include harm reduction policies, private-sector involvement, and its impact in low- and middle-income countries. A pandemic treaty may encounter similar challenges faced by the Framework Convention on Tobacco Control, particularly from industry groups with financial interests related to infectious disease control and prevention. Addressing challenges at the outset may facilitate the development and implementation of a more robust international instrument.
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Affiliation(s)
- Michael De Luca
- Michael De Luca, MD, MS, is a Disaster and Operational Medicine Fellow, Department of Emergency Medicine, The George Washington University, Washington, DC
| | - Mario L Ramirez
- Mario L. Ramirez, MD, MPP, is an Emergency Medicine Physician, Department of Emergency Medicine, Inova Fairfax Hospital, Inova Health System, Fairfax, VA
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Hiilamo H, Glantz S. Global Implementation of Tobacco Demand Reduction Measures Specified in Framework Convention on Tobacco Control. Nicotine Tob Res 2022; 24:503-510. [PMID: 34661672 PMCID: PMC8887591 DOI: 10.1093/ntr/ntab216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/14/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The world's first global health treaty, WHO Framework Convention on Tobacco Control (FCTC) aims to reduce tobacco product demand by focusing on tobacco taxes, smoking bans, health warning labels, and tobacco advertising bans. Previous studies almost unanimously suggest that FCTC has prompted countries to implement more effective tobacco demand reduction policies. AIMS AND METHODS By taking into account the pre-FCTC status, country income level, and state capacity we studied if ratifying FCTC was associated with tobacco demand reduction measures in 2018/2019. We used logistic regression to assess the association of FCTC ratification with adoption demand reduction measures, accounting for years since ratification, baseline status, and other covariates. RESULTS Except for taxes, state of tobacco policy implementation before FCTC ratification did not predict adoption of FCTC policies. Time since FCTC ratification was associated with implementing smoking bans and pictorial HWLs. In contrast, while the tax rate prior to FCTC ratification was positively associated with increased taxes after FCTC ratification, time since FCTC ratification was marginally negatively associated with increases in tobacco taxes. CONCLUSIONS While the FCTC was followed by implementation of compliant demand reduction policies, there are still many parties that have not implemented the FCTC, particularly increasing taxes and ending tobacco advertising and promotions. IMPLICATIONS We assessed changes in tobacco demand reductions measures over 22 years in 193 countries. By using internal tobacco industry documents, we were able establish a baseline before the FCTC negotiations. Unlike previous studies, we included four tobacco demand reductions measures: tobacco taxes, smoking bans, health warning labels, and tobacco advertising ban. The limitation of the study is that we do not have data to describe if demand reduction measures are actually enforced or what their effect on tobacco consumption is.
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Affiliation(s)
- Heikki Hiilamo
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Stanton Glantz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Frieden TR, Buissonnière M. Will a global preparedness treaty help or hinder pandemic preparedness? BMJ Glob Health 2021; 6:e006297. [PMID: 34045186 PMCID: PMC8162099 DOI: 10.1136/bmjgh-2021-006297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/18/2022] Open
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Suriyawongpaisal P, Patanavanich R, Aekplakorn W, Martinez-Moyano I, Thongtan T. Paradox of sustainability in tobacco control in Thailand: A comprehensive assessment of three-decade experiences. Int J Health Plann Manage 2021; 36:381-398. [PMID: 33125812 DOI: 10.1002/hpm.3089] [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: 05/21/2020] [Revised: 08/28/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Over the past 3 decades of tobacco control, Thailand has gained international recognition as a middle-income country with sustained achievement of declining smoking prevalence. However, the number of key Framework Convention on Tobacco Control measures implementation is still far away from the highest-level implementation. As a result, we aim to explore explanatory factors for the paradoxical phenomenon of sustainability in tobacco control in Thailand, to understand what the paradox means, why it happens, and how to take further steps in minimizing the paradox. METHODS We used a mixed-method approach comprising qualitative (review of literature and documents plus Program Sustainability Assessment Tool [PSAT] guided key informant interviews) and semi-quantitative methods (PSAT scoring, Theory of Change [TOC], and causal-loop diagram [CLD]) to synthesize all the findings from the qualitative data. RESULTS Across all eight domains, sustainability scores at the local level are lower than the national level. The highest total score was in three domains: political support, partnership, and organizational capacity. The lowest total score was for the strategic planning domain. We propose a set of key strategic elements and drivers for future strategic planning. DISCUSSION Using CLD, we capture a high-level view of tobacco control with dynamic interactions between contexts, mechanisms, interventions, and outcomes. We believe the deep understanding of tobacco control and the proposed strategy to counteract transnational tobacco companies in Thailand will guide future sustainable actions to reduce the prevalence of smoking, especially in the strategic planning domain that has the lowest PSAT score.
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Affiliation(s)
- Paibul Suriyawongpaisal
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Roengrudee Patanavanich
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ignacio Martinez-Moyano
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, USA
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois, USA
| | - Thanita Thongtan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Bhatta DN, Bialous S, Crosbie E, Glantz S. Exceeding WHO Framework Convention on Tobacco Control (FCTC) Obligations: Nepal Overcoming Tobacco Industry Interference to Enact a Comprehensive Tobacco Control Policy. Nicotine Tob Res 2021; 22:2213-2223. [PMID: 31535694 DOI: 10.1093/ntr/ntz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND The tobacco industry works to block, delay, and weaken national tobacco control legislation to implement the WHO Framework Convention on Tobacco Control (FCTC). This article reviews how Nepal overcame industry opposition and to a comprehensive tobacco control law implementing the FCTC. METHODS We triangulated newspaper articles and policy documents with key informant interviews. RESULTS With the support of international health groups, local tobacco control advocates worked with policymakers in Nepal to pass a comprehensive tobacco control law that exceeded FCTC obligations. The tobacco industry exploited a time of political transition to block consideration by Parliament, arranged and sponsored foreign tours for legislators, made death threats to tobacco control advocates and their families, and argued for the economic importance of tobacco farms. Despite strong interference from Health, and Law and Justice ministers, a 2009 Supreme Court ruling helped tobacco control advocates secure a comprehensive tobacco control law in 2011 that included rotating pictorial health warning labels covering 75% of both sides of cigarette packages, 100% smoke free public places and workplaces, private homes and vehicles, and a tobacco advertising, promotion, and sponsorship ban. CONCLUSIONS Advocates in developing countries should utilize Nepal's experience to reject tobacco industry offers of compromise and continue educating politicians and legislators to generate political support to pass a comprehensive tobacco control law. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak (the abstract in Nepali is available as a Supplementary Material). IMPLICATIONS The tobacco industry exploited a time of political transition in Nepal in its effort to block comprehensive tobacco control policy in Parliament by sponsoring foreign tours of legislatures, making death threats to tobacco control advocates and their families, and arguing for the economic importance of tobacco farms. Tobacco control advocates used litigation to raise awareness and educate legislators and promote strong legislation with the involvement of international health groups. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak.
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Affiliation(s)
- Dharma N Bhatta
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Stella Bialous
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.,Social and Behavioral Sciences Department, School of Nursing, University of California, San Francisco, CA
| | - Eric Crosbie
- School of Community Health Sciences, University of Nevada, Reno, NV
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.,Department of Medicine, Philip R Lee Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, CA
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Rezende LFM, Murata E, Giannichi B, Tomita LY, Wagner GA, Sanchez ZM, Celis-Morales C, Ferrari G. Cancer cases and deaths attributable to lifestyle risk factors in Chile. BMC Cancer 2020; 20:693. [PMID: 32711508 PMCID: PMC7382839 DOI: 10.1186/s12885-020-07187-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background To identify modifiable risk factors that contribute to cancer holds important public health relevance for setting up prevention strategies. Therefore, the aim of this study was to estimate the proportion of cancer cases and deaths attributable to alcohol consumption, high body mass index (BMI), low fruits and vegetables consumption, lack of physical activity, tobacco smoking, and passive smoking in Chile in 2018. Methods We retrieved data from a national representative survey to describe the distribution of six lifestyle risk factors. Relative risks of each risk factor-cancer pair were obtained from published meta-analysis and pooled cohort studies. Cancer cases and deaths were obtained from the GLOBOCAN 2018. Results Nearly 30% of all cancer cases (15,097 out of 50,320 cases) and 36% of all cancer deaths (10,155 out of 28,010 deaths) in Chile in 2018 were attributable to lifestyle risk factors. Smoking and high BMI accounted for most of the cancer cases (9232 and 4394, respectively) and deaths (6868 and 2572). The cancer burden of other lifestyle risk factors varied by sex. In men, the proportion of all cancer cases attributed to alcohol were 3.7% compare to 2.0% for women. Cancers cases and deaths of the larynx, lung, oral/cavity, esophagus and bladder could be at least halved if lifestyle risk factors were eliminated. Conclusion Smoking and high BMI were the leading causes of preventable cancer cases and deaths within the six lifestyles factors considered. Cancer prevention strategies should consider evidence-based interventions and public policies to encourage the adoption of a healthier lifestyle.
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Affiliation(s)
- Leandro F M Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Eliana Murata
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Beatriz Giannichi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Luciana Yuki Tomita
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Gabriela Arantes Wagner
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Zila M Sanchez
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventive, Sao Paulo, SP, Brazil
| | - Carlos Celis-Morales
- Centro de Investigación en Fisiología del Ejercicio - CIFE, Universidad Mayor, Santiago, Chile.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile
| | - Gerson Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile - USACH, Estación Central, 7500618, Santiago, Chile.
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Allen LN, Nicholson BD, Yeung BYT, Goiana-da-Silva F. Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries. LANCET GLOBAL HEALTH 2019; 8:e50-e58. [PMID: 31813787 PMCID: PMC7024987 DOI: 10.1016/s2214-109x(19)30446-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 10/29/2022]
Abstract
BACKGROUND Most countries have endorsed WHO non-communicable disease (NCD) best buy policies, but we know very little about global implementation patterns and about the geopolitical factors affecting implementation. We aimed to assess global implementation based on analysis of multiple geopolitical datasets. METHODS We used the 2015 and 2017 WHO NCD progress monitor reports to calculate aggregate implementation scores for 151 countries, based on their implementation of 18 WHO-recommended NCD policies. We ranked all countries and used descriptive statistics to analyse global trends. We used linear regression to assess the associations between policy implementation and World Bank geographic region, risk of premature NCD mortality, percentage of all deaths caused by NCDs, World Bank income group, human capital index, democracy index, and tax burden. FINDINGS In 2017, the mean NCD policy implementation score was 49·3% (SD 18·4%). Costa Rica and Iran had the joint-highest implementation scores (86·1% of all WHO-recommended policies). Scores were lowest in Haiti and South Sudan (5·5%). Between 2015 and 2017, aggregate implementation scores rose in 109 countries and regressed in 32 countries. Mean implementation rose for all of the 18 policies except for those targeting alcohol and physical activity. The most commonly implemented policies were clinical guidelines, graphic warnings on tobacco packaging, and NCD risk factor surveys. Our multiple linear regression model explained 61·1% of the variance in 2017 aggregate scores (p<0·0001), but we found evidence of a high degree of collinearity between the explanatory variables. INTERPRETATION Implementation of WHO-recommended NCD policies is increasing over time. On average, countries implemented just under half of the NCD policies recommended by WHO in 2017. Nutrition-related policies saw gains, while those related to alcohol and physical activity were the most likely to have been dropped. Aggregate implementation scores tended to be highest in high-income countries that invest in health care and education. FUNDING National Institute for Health Research, Imperial College London, University of Oxford.
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Affiliation(s)
- Luke N Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Beatrice Y T Yeung
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Hoffman SJ, Poirier MJP, Rogers Van Katwyk S, Baral P, Sritharan L. Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption: quasi-experimental evaluations using interrupted time series analysis and in-sample forecast event modelling. BMJ 2019; 365:l2287. [PMID: 31217191 PMCID: PMC6582266 DOI: 10.1136/bmj.l2287] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of the WHO Framework Convention on Tobacco Control (FCTC) on global cigarette consumption. DESIGN Two quasi-experimental impact evaluations, using interrupted time series analysis (ITS) and in-sample forecast event modelling. SETTING AND POPULATION 71 countries for which verified national estimates of cigarette consumption from 1970 to 2015 were available, representing over 95% of the world's cigarette consumption and 85% of the world's population. MAIN OUTCOME MEASURES The FCTC is an international treaty adopted in 2003 that aims to reduce harmful tobacco consumption and is legally binding on the 181 countries that have ratified it. Main outcomes were annual national estimates of cigarette consumption per adult from 71 countries since 1970, allowing global, regional, and country comparisons of consumption levels and trends before and after 2003, with counterfactual control groups modelled using pre-intervention linear time trends (for ITS) and in-sample forecasts (for event modelling). RESULTS No significant change was found in the rate at which global cigarette consumption had been decreasing after the FCTC's adoption in 2003, using either ITS or event modelling. Results were robust after realigning data to the year FCTC negotiations commenced (1999), or to the year when the FCTC first became legally binding in each country. By contrast to global consumption, high income and European countries showed a decrease in annual consumption by over 1000 cigarettes per adult after 2003, whereas low and middle income and Asian countries showed an increased annual consumption by over 500 cigarettes per adult when compared with a counterfactual event model. CONCLUSIONS This study finds no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism. This null finding, combined with regional differences, should caution against complacency in the global tobacco control community, motivate greater implementation of proven tobacco control policies, encourage assertive responses to tobacco industry activities, and inform the design of more effective health treaties.
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Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mathieu J P Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Prativa Baral
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
| | - Lathika Sritharan
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
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