Tobacco control in the Russian Federation--a policy analysis

Burden and geographic distribution of oral cavity and oropharyngeal cancers in the Russian Federation

Background

The global incidence of lip and oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) is steadily increasing. While tobacco and alcohol consumption are established risk factors, a considerable proportion of these cancers has become attributed to human papilloma virus (HPV) infection. We aimed to describe the occurrence and identify potential risk factors of OCCs and OPCs across the Russian Federation during 2007-2018.

Methods

We conducted an ecological analysis using publicly accessible data from the P.A. Herzen Moscow Oncology Research Institute. Incidence and mortality rates by jurisdiction were mapped for geospatial analysis. We pre-defined 11 potential contributing risk factors and used univariable and multivariable Poisson regression model with backwards stepwise variable selection to identify associated factors with OCC and OPC.

Results

A total of 190,585 individuals were diagnosed with OCCs and OPCs in Russia between 2007-2018. Non-uniform geographic distribution of cancer cases was noted where the Far Eastern Federal District had the highest rate of OCC and the Central Federal District of OPCs. Districts with high weekly alcohol consumption had significantly higher incidence and mortality rates in both sexes. Districts with high rates of daily smoking had higher incidence of OCC among females, and those with low smoking trends had lower mortality rates for OCCs and OPCs.

Conclusion

We detail the burden of OCCs and OPCs across Russia, with the aim of elucidating modifiable risk factors and proposing evidence-based prevention strategies. Tobacco/alcohol sales control measures and smoking/drinking cessation programs should continue to be prioritized as public health measures, especially for females.

Trends and risk factors of global incidence, mortality, and disability of genitourinary cancers from 1990 to 2019: Systematic analysis for the Global Burden of Disease Study 2019

Background

The incidence of kidney, bladder, and prostate cancer ranked ninth, sixth, and third in male cancers respectively, meanwhile, the incidence of testicular cancer also increased gradually in the past 30 years.

Objective

To study and present estimates of the incidence, mortality, and disability of kidney, bladder, prostate, and testicular cancer by location and age from 1990 to 2019 and reveal the mortality risk factors of them.

Materials

The Global Burden of Diseases Study 2019 was used to obtain data for this research. The prediction of cancer mortality and incidence was based on mortality-to-incidence ratios (MIRs). The MIR data was processed by logistic regression and adjusted by Gaussian process regression. The association between the socio-demographic index and the incidence or disease burden was determined by Spearman's rank order correlation.

Results

Globally in 2019, there were 371,700 kidney cancer cases with an age-standardized incidence rate (ASIR) of 4.6 per 100,000, 524,300 bladder cancer cases, with an ASIR of 6.5 per 100,000, 1,410,500 prostate cancer cases with an ASIR of 4.6 per 100,000 and 109,300 testicular cancer incident cases with an ASIR of 1.4 per 100,000, the ASIR of these four cancers increased by 29.1, 4, 22, and 45.5% respectively. The incidence rate of the four cancers and the burden of kidney cancer were positively correlated with the socio-demographic index (SDI), regions with a higher SDI faced more of a burden attributable to these four cancers. High body-mass index has surpassed smoking to be the leading risk factor in the past thirty years for kidney cancer mortality. Smoking remained the leading risk factor for cancer-related mortality for bladder cancer and prostate cancer and the only risk factor for prostate cancer. However, the contribution of high fasting plasma glucose to bladder cancer mortality has been increasing.

Conclusion

The incidence of bladder, kidney, prostate, and testicular cancer is ever-increasing. High-income regions face a greater burden attributable to the four cancers. In addition to smoking, metabolic risk factors may need more attention.

Agenda-setting of tobacco control policy in Iran: a retrospective policy analysis study

BACKGROUND

The prevalence of tobacco use, especially hookah, has increased in Iran In recent years, particularly among young people and women, and the age of onset of use has decreased. Tobacco use is the fourth leading risk factor for non-communicable diseases in Iran. These issues cause concerns in the country and led to the present study on tobacco control agenda-setting in Iran over a 30-year timeframe.

METHODS

We conducted this retrospective analytical study to investigate process analysis in Iran using Kingdon's multiple-streams framework (MSF). We collected the data using semi-structured interviews with key informants (n = 36) and reviewing policy documents (n > 100). Then, we analyzed the policy documents and in-depth interviews using the document and framework analysis method. We used MAXQDA 11 software to classify and analyze the data.

RESULTS

Iran's accession to the Framework Convention on Tobacco Control (FCTC) opened a window of opportunity for tobacco control. The policy window opens when all three streams have already been developed. The adoption of the comprehensive law on the national control and campaign against tobacco in the Islamic Consultative Assembly in 2006 is a turning point in tobacco control activities in Iran.

CONCLUSIONS

The tobacco control agenda-setting process in Iran was broadly consistent with MSF. The FCTC strengthened the comprehensive plan for national control of tobacco as a policy stream. However, there are several challenges in developing effective policies for tobacco control in the Iranian setting.

Trends in tobacco smoking and smoking cessation in Russia with a focus on Indigenous populations: A narrative review

Introduction

Tobacco smoking is one of the main preventable causes of illness and premature death. Globally, more than 7 million people die annually from diseases associated with smoking, and this number is projected to increase to 8 million per year by 2030. Wide disparities in smoking prevalence exist by gender, age, socioeconomic status, rurality and ethnicity. In several countries, smoking is disproportionately high among the Indigenous populations.

Objective

This review assesses the prevalence and harm of smoking and current trends in smoking cessation among the diverse multi-ethnic populations of Russia, with a particular emphasis on Indigenous populations.

Data sources

We systematically searched health, nursing, social science and grey literature databases and bibliographies for relevant studies. Search strings combined keywords related to smoking prevalence and smoking cessation with keywords related to Russia and the Indigenous populations of Russia.

Study selection

Studies were included if they were published between 1 January 2005 and 14 October 2020, and if they reported prevalence of tobacco smoking and/or activities and outcomes of a smoking cessation programme or ban in the Russian Federation.

Conclusions

Tobacco smoking is significant in the entire Russian population, a higher prevalence of smoking in Indigenous populations compared to the dominant Russian (Slavic) ethnic group is common. Smoking prevalence data for most of the Indigenous ethnic groups of Russia remains unclear. Tobacco control interventions for Indigenous groups are underdeveloped even though they have the potential to deliver proportionately greater reduction in smoking harm.

Tobacco Use Depictions in Popular Soviet and Post-Soviet Movies from 1950 to 2019: The Possible Impact of Restrictive Policies

To reduce the initiation to smoking and its social acceptance, restrictive policies to decrease tobacco exposure in movies and television shows have been implemented in some countries around the world. What is not as clear is how effective these policies are in reducing tobacco exposure on screen. The objective of this study was to analyze trends in tobacco use in Soviet and post-Soviet films over time and also to assess the effectiveness of restrictive policies. Methods: 140 top commercially successful Soviet and Russian films released from 1950 to 2019 were content analyzed. The outcome data were transformed to approximate multivariate normality before being analyzed with one-way analyses of variance followed by Bonferroni multiple comparison post hoc tests. Results: Smoking rates in the top films fluctuated insignificantly in the 1950s-2000s. Yet, in the 2010s, the number of tobacco events in the movies declined significantly, compared to all other decades studied (p < 0.05). Conclusions: Changes in tobacco consumption in the Soviet Union and Russia did not have significant effects on tobacco use in domestic movies released from 1950 to 2009. The decrease in tobacco use rates found in Russian films in the 2010s can be explained by extensive public policies aiming to reduce tobacco exposure in newly released films.

Time trends in smoking in Russia in the light of recent tobacco control measures: synthesis of evidence from multiple sources

BACKGROUND

The study aims at identifying long-term trends and patterns of current smoking by age, gender, and education in Russia, including the most recent period from 2008 during which tobacco control policies were implemented, and to estimate the impact on mortality of any reductions in prevalence. We present an in-depth analysis based on an unprecedentedly large array of survey data.

METHODS

We examined pooled micro-data on smoking from 17 rounds of the Russian Longitudinal Monitoring Study of 1996-2016, 11 other surveys conducted in Russia in 1975-2017, and two comparator surveys from England and the USA. Standardization by age and education, regression and meta-analysis were used to estimate trends in the prevalence of current smoking by gender, age, and educational patterns.

RESULTS

From the mid-1970s to the mid-2000s smoking prevalence among men was relatively stable at around 60%, after which time prevalence declined in every age and educational group. Among women, trends in smoking were more heterogeneous. Prevalence more than doubled above the age of 55 years from very low levels (< 5%). At younger ages, there were steep increases until the mid-2000s after which prevalence has declined. Trends differed by educational level, with women in the lowest educational category accounting for most of the long-term increase. We estimate that the decline in male smoking may have contributed 6.2% of the observed reduction in cardiovascular deaths among men in the period 2008-16.

CONCLUSIONS

The implementation of an effective tobacco control strategy in Russia starting in 2008 coincided with a decline in smoking prevalence among men from what had been stable, high levels over many decades regardless of age and education. Among women, the declines have been more uneven, with young women showing recent downturns, while the smoking prevalence in middle age has increased, particularly among those with minimal education. Among men, these positive changes will have made a small contribution to the reduction in mortality seen in Russia since 2005.

Predictors of tobacco smoking among acutely ill patients in a Moscow hospital: A cross-sectional study

INTRODUCTION

Tobacco smoking is a major preventable risk factor for non-communicable diseases. The aim of this study was to investigate predictors of tobacco smoking among acute medically ill patients admitted to a Moscow hospital, and the association between smoking and alcohol use.

METHODS

Patients admitted to the V. P. Demikhov hospital in Moscow from November 2016 through December 2017 were asked to participate in this study (inclusion criteria were acute medically ill patients aged ≥18 years). Sociodemographic data were collected, in addition to questionnaires on mental distress (Hopkins Symptom Checklist 5), alcohol use (Alcohol Use Disorder Identification Test 4, AUDIT-4) and smoking (Fagerström Test for Nicotine Dependence).

RESULTS

A total of 3009 patients were recruited to the study. Using a binary logistic regression model adjusted for all variables, it was found that living without a partner resulted in a higher risk of smoking tobacco compared to being married or living with a partner (odds ratio, OR=1.60 for divorced, p=0.001; and OR=1.62 for single, p=0.002), and being economically non-active resulted in a higher risk compared to being economically active (OR=1.47; p=0.003). Harmful alcohol use (AUDIT-4 score ≥5 [for females] / 7 [for males]) resulted in a higher risk of smoking compared to those without harmful alcohol use (OR=4.04; p<0.001).

CONCLUSIONS

Smoking was highly prevalent and associated with other adverse sociodemographic and lifestyle factors such as harmful alcohol use.

Cigarette consumption estimates for 71 countries from 1970 to 2015: systematic collection of comparable data to facilitate quasi-experimental evaluations of national and global tobacco control interventions

OBJECTIVES

To collect, appraise, select, and report the best available national estimates of cigarette consumption since 1970.

DESIGN

Systematic collection of comparable data.

SETTING AND POPULATION

71 of 214 countries for which searches for national cigarette consumption data were conducted, representing over 95% of global cigarette consumption and 85% of the world's population.

MAIN OUTCOME MEASURES

Validated cigarette consumption data covering 1970-2015 were identified for 71 countries. Data quality appraisal was conducted by two research team members in duplicate, with greatest weight given to official government sources. All data were standardised into units of cigarettes consumed per year in each country, a detailed accounting of data quality and sourcing was prepared, and all collected data and metadata were made freely available in an open access dataset.

RESULTS

Cigarette consumption fell in most countries over the past three decades but trends in country specific consumption were highly variable. For example, China consumed 2.5 million metric tonnes (MMT) of cigarettes in 2013, more than Russia (0.36 MMT), the United States (0.28 MMT), Indonesia (0.28 MMT), Japan (0.20 MMT), and the next 35 highest consuming countries combined. The US and Japan achieved reductions of more than 0.1 MMT from a decade earlier, whereas Russian consumption plateaued, and Chinese and Indonesian consumption increased by 0.75 MMT and 0.1 MMT, respectively. These data generally concord with modelled country level data from the Institute for Health Metrics and Evaluation and have the additional advantage of not smoothing year-over-year discontinuities that are necessary for robust quasi-experimental impact evaluations.

CONCLUSIONS

Before this study, publicly available data on cigarette consumption have been limited; they have been inappropriate for quasi-experimental impact evaluations (modelled data), held privately by companies (proprietary data), or widely dispersed across many national statistical agencies and research organisations (disaggregated data). This new dataset confirms that cigarette consumption has decreased in most countries over the past three decades, but that secular country specific consumption trends are highly variable. The findings underscore the need for more robust processes in data reporting, ideally built into international legal instruments or other mandated processes. To monitor the impact of the WHO Framework Convention on Tobacco Control and other tobacco control interventions, data on national tobacco production, trade, and sales should be routinely collected and openly reported.

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

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.

Analysis of non-compliance with smoke-free legislation in Russia

OBJECTIVES

The study examined the smokers' non-compliance rates in indoor public places in Russia and the sociodemographic factors associated with non-compliance.

METHODS

Univariate analysis and logistic regression models were performed using cross-sectional data from a representative sample of Russian adults (N = 4006).

RESULTS

27.2% of Russian smokers did not comply with smoke-free bans. Non-compliance was attributed to sociodemographic characteristics of smokers, mainly to the number of cigarettes smoked per day, regular alcohol consumption, being aged between 15 and 34 years, being in the highest income group and living in an urban area. Neither the sex, nor the family status of smokers exerted a statistically significant affiliation with non-compliance. Higher rates of non-compliance were observed in restaurants, cafes, bars and nightclubs, common domestic premises of apartment buildings and indoor workplaces. Violations on public transport, in governmental buildings, health and sport facilities, colleges and universities were less common.

CONCLUSIONS

There is a need to revise the methods of enforcement with respect to sociodemographic characteristics of smokers associated with non-compliance in public places where violations are widespread.

Effects of Smoking on the Prevalence of Allergic Disorders in Russian Adolescents: A Retrospective Cross-sectional Study

Introduction

Smoking is one of the leading causes of death. Smoking also decreases lung efficiency and impairs lung function in children of all ages. Second-hand tobacco smoking increases both the frequency and severity of childhood asthma. However, the role of active tobacco smoking in the manifestation of asthma remains inconclusive. The aim of this article was to describe the current understanding of the prevalence and adverse effects of cigarette smoking and to determine whether there is an association between smoking and the manifestation and progression of asthma among adolescents and high school students in Russia.

Objectives

This study aimed to determine the true prevalence of bronchial asthma (BA), allergic rhinitis (AR), and atopic dermatitis (AD) in the population of adolescents in the Russian Federation. In the GA²LEN (Global Allergy and Asthma European Network) study, we analyzed participant responses to confirm a connection between smoking and asthma exacerbation or development. This study examined the association between parental smoking and childhood atopic disorders. We sought to determine the effects of exposure to environmental tobacco smoke and childhood cigarette smoking on asthma symptoms among high school and college students in Moscow, Russia. We analyzed the reactions to the present tobacco control policy and evaluated the significance of the success of the policy. A number of methods were used, including questionnaires, surveys, and statistical analysis software.

Results

Our research indicates a moderate decrease in smoking prevalence among Russian teenagers. From the data and results of our study, 25.3% of the respondents said that they have ever smoked for as long as a year. Among the participants who had ever smoked, most of them started smoking at the age of 16 years while the state-reported average age for a new smoker is 11.4. Fifty percent of the respondents who had shortness of breath had been woken by an attack once a week in the last three months. Only 21.1% of the people with asthma were taking medicines for it. According to our calculations, there is no significant association between smoking status and the prevalence of asthma, hay fever, and sinusitis. More respondents (34.2%) had fathers who regularly smoked during their childhood than mothers who regularly smoked during their childhood or before the children were born (7.9%). There is a statistically significant association between a mother smoking during childhood or before the birth of a child and that child being hospitalized before the age of two years for lung disease.

Conclusion

The fact that the smoking rates among study participants are relatively low is quite encouraging and anti-smoking campaigns should be intensified to drive the rates lower. The data analyzed do not provide sufficient evidence to show that there is any causative association between smoking status and the development of asthma, hay fever, or sinusitis. Since there is no clear association between smoking status and the development of asthma, hay fever, or allergic sinusitis, it is imperative to say that smoking cessation will have very little effect on allergy prevalence as per the data analyzed. From the conducted analysis, it is evident that there is a clear link between second-hand smoke and asthma in children. According to our results, children whose mothers smoked are especially vulnerable to asthma and other respiratory disorders.

The perspectives of politicians on tobacco control in Turkey

Background

Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations.

Aim

This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT).

Methods

This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption.

Results and recommendations

Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.

The burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND

Over the past few decades, social and economic changes have had substantial effects on health and wellbeing in Russia. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to evaluate trends in mortality, causes of death, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and associated risk factors in Russia from 1980 to 2016.

METHODS

We estimated all-cause mortality by use of a multistage modelling process that synthesised data from vital registration systems, surveys, and censuses. A composite measure of health loss due to both fatal and non-fatal disease burden (DALYs) was calculated as the sum of YLLs and YLDs for each age, sex, year, and location. Health progress was evaluated in comparison with patterns of change in similar countries by use of the Socio-demographic Index that was developed for GBD 2016.

FINDINGS

Following rapid decreases in life expectancy after the collapse of the Soviet Union, life expectancy at birth in Russia improved between 2006 and 2016. The all-cause mortality rate decreased by 16·6% (95% uncertainty interval 9·4-33·8) between 1980 and 2016. This overall decrease encompasses the cycles of sharp increases and plateaus in mortality that occurred before 2005. Child mortality decreased by 57·5% (53·5-61·1) between 2000 and 2016. However, compared with countries at similar Socio-demographic Index levels, rates of mortality and disability in Russia remain high and life expectancy is low. Russian men have a disproportionate burden of disease relative to women. In 2016, 59·2% (55·3-62·6) of mortality in men aged 15-49 years and 46·8% (44·5-49·5) of mortality in women were attributable to behavioural risk factors, including alcohol use, drug use, and smoking.

INTERPRETATION

Trends in mortality in Russia from 1980 to 2016 might be related to complicated patterns of behavioural risk factors associated with economic and social change, to shifts in disease burden, and to changes in the capacity of and access to health care. Ongoing mortality and disability from causes and risks amenable to health-care interventions and behaviour modifications present opportunities to continue to improve the wellbeing of Russian citizens.

FUNDING

Bill & Melinda Gates Foundation.

Application of policy analysis frameworks in tobacco control research: A systematic review of qualitative literature

Background: Tobacco consumption is still considered as the first preventable cause of death in the world. In order to influence tobacco policy process, researchers and policymakers must use frameworks of policy-making to understand the process to provide them insights for influence the process. This systematic review aims to review the application of policy analysis frameworks in the field of tobacco control. Methods: A systematic search for articles was performed using four databases (Ovid Medline, Scopus, Cochrane Library, and PubMed) up to December 19, 2016. The articles were selected based on inclusion and exclusion criteria. All research studies focusing on tobacco policy and on one or more specified frameworks of policy analysis included in this study. Finally, thematic analysis was used to synthesize the findings. Results: 17 studies based on eligibility criteria were included in this study. The findings of this study showed that most of the studies were in North America, published in the Health journals, conducted to analyze the national and state policies, focused on analyzing agenda-setting phase. Multiple streams model was the most widely used framework within the literature. Few studies had used advocacy coalition framework. From the three agenda setting frameworks and theories (MSF, PEF, ACF), the ACF framework is the most detailed framework in terms of elements and factors affecting the dynamics of political sub-system the reasons for models selection and suitability for the study was noted only in a small number of studies. The results of this study showed underuse and the incomplete or improper use of policy analysis models and frameworks in the field of tobacco research. Conclusion: The study showed that a number of theories and frameworks have been used but their use was limited and have significant methodological weaknesses.

Depression and smoking characteristics among HIV-positive smokers in Russia: A cross-sectional study

INTRODUCTION

Globally, persons with HIV infection, depression and substance use disorders have a higher smoking prevalence and smoke more heavily than other populations. These associations have not been explored among Russian smokers with HIV infection and substance use disorders. The purpose of this study was to examine the relationship between the presence of depressive symptoms and smoking outcomes in an HIV-positive cohort of Russian smokers with a history of substance use disorders (alcohol and/or drug use disorders).

METHODS

We performed a cross-sectional secondary data analysis of a cohort of HIV-positive regular smokers with a history of substance use disorders recruited in St. Petersburg, Russia in 2012-2015. The primary outcome was heavy smoking, defined as smoking > 20 cigarettes per day. Nicotine dependence (moderate-very high) was a secondary outcome. The main independent variable was a high level of depressive symptoms in the past 7 days (defined as CES-D > = 24). We used multivariable logistic regression to examine associations between depressive symptoms and the outcomes, controlling for age, sex, education, income, running out of money for housing/food, injection drug use, and alcohol use measured by the AUDIT.

RESULTS

Among 309 regular smokers, 79 participants (25.6%) had high levels of depressive symptoms, and 65 participants (21.0%) were heavy smokers. High levels of depressive symptoms were not significantly associated with heavy smoking (adjusted odds ratio [aOR] 1.50, 95% CI 0.78-2.89) or with moderate-very high levels of nicotine dependence (aOR 1.35, 95% CI 0.75-2.41).

CONCLUSIONS

This study did not detect an association between depressive symptoms and smoking outcomes among HIV-positive regular smokers in Russia.

Point-of-Sale Tobacco Advertising and Display Bans: Policy Evaluation Study in Five Russian Cities

Background

The tobacco industry uses point-of-sale (POS) advertising, promotion, and product display to increase consumption of its products among current users, to attract new consumers, and to encourage former customers to resume tobacco use. As part of a comprehensive tobacco control effort, Russia—having one of the highest tobacco use prevalence rates in the world—enacted legislation that banned tobacco POS advertising, effective November 15, 2013, and banned the display of tobacco and the sale of cigarettes in kiosks, effective June 1, 2014.

Objective

The objective of the study was to evaluate the implementation of the national law by assessing the state of POS advertising, promotion, and product display, and sales in kiosks across Russia.

Methods

Two waves of observations were conducted to measure compliance with the POS restrictions: wave 1 took place in April-May 2014 after the advertising ban was in effect and again in August-September 2014 after the display ban and elimination of tobacco sales in kiosks came into effect. Observations were conducted by local trained staff that traveled to 5 populous cities in different regions of Russia (Moscow, St. Petersburg, Kazan, Ekaterinburg, and Novosibirsk). Staff followed a published POS evaluation protocol and used mobile phones to collect data. Observations were conducted in a roughly equal number of supermarket chains, convenience stores, and kiosks. Observed items included advertising at POS, product displays, and cigarette sales in kiosks.

Results

Observations were made in 780 venues in wave 1 and in 779 revisited venues in wave 2. In wave 1, approximately a third of supermarkets and convenience stores (34.2%, 184/538) were advertising cigarettes using light boxes, and over half of observed venues (54.3%, 292/538) had signage such as banners or shelf liners that used colors or images related to cigarette brands. Product displays were common in wave 1. In wave 2, compliance with advertising restrictions was very good: there were virtually no light boxes (1.0%, 5/489); banners or shelf liners were observed in 30.5% (149/489) of supermarkets/convenience stores; approximately 7.4% (36/489) of venues were still displaying products in a powerwall. In wave 2, 41.3% (100/242) of kiosks continued to sell tobacco.

Conclusions

Russia’s compliance with POS bans was excellent. Remaining compliance issues are largely with the use of cigarette brand colors or images used in banners or shelf liners; this type of infraction is more difficult to enforce as inspectors need to be deeply familiar with tobacco industry products and marketing practices. A sizable proportion of kiosks continue to sell tobacco post restrictions.

Factors influencing the tobacco control policy process in Egypt and Iran: a scoping review

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.

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015

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.

Is There Any Impact Of The Gutkha Ban on Users and Vendors in Rangareddy District? A Cross Sectional Study

Introduction:

Gutkha contains harmful and carcinogenic chemicals and oral cancer caused by tobacco usage has been reported as a major preventable cause of death worldwide by the World Health Organization. The Telangana state government implemented a ban on gutkha usage starting in 2013 but how effective this ban has been remains unclear.

Objectives:

The objective of this study was to determine the actual impact of the gutkha ban on users and vendors.

Methodology:

A cross-sectional study was conducted among gutkha users and tobacco vendors in Ranga Reddy district, Telangana. Based on a pilot study the sample size was determined as 368 and 384 for users and vendors respectively. Two separate questionnaires were administered to these groups. The parameters studied mainly included knowledge regarding the ban, and its impact.

Results:

About 49.1% of the users were aware of the ban on gutkha. Newspapers were the main source of information regarding the ban as reported by 45.3% of users. After the ban, 29.8% of gutkha users switched to other tobacco products. Awareness of health hazards and non-availability of gutkha was the most important reason stated for quitting or reducing consumption.

Conclusion:

The perspective of ban when visualized from the users point of view depicted a negative impact while the vendors portrayed a positive impact. Considering the addictive potential of the ingredients of gutkha, recording the effects of the ban on regular consumers and determining whether they can still obtain the products by illicit trade, would be noteworthy for implementation of strict rules.

Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda

Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance.

Can demand-side policies stop the tobacco industry's damage? Lessons from Turkey

Trade and investment liberalisation in the post-1980 period allowed the penetration of transnational tobacco companies into the Turkish market. State control over the market was gradually removed and tobacco farming, manufacturing, trade and consumption were reshaped in line with the needs of transnational tobacco companies. The resultant increase in product proliferation and aggressive marketing strategies led to a dramatic rise in cigarette consumption in the 1990s, making Turkey a market with one of the sharpest consumption increases in the world. While Turkey implemented demand-side tobacco control policies to reduce consumption after 1996, it continued to stimulate manufacturing and trade in a conflicting way. The Turkish case verifies that the liberalisation process facilitated by the state under the auspices of international institutions conflicts with tobacco control. Liberalisation paves the way for market expansions of transnational tobacco companies that resist tobacco control in their drive for profit. Current global tobacco control policies, with no interest in controlling manufacturing, have limited effect on consumption. The Turkish case indicates the necessity of establishing public control over tobacco manufacturing and trade from a public health perspective.

An international smoking ban-how many lives will be saved?

Multicomponent tobacco control strategies are crucial to combat the ongoing global smoking challenge. In the twenty-first century, many countries have signed up to the World Health Organization Framework Convention on Tobacco Control, and in recent years a mounting number of countries and regions have implemented partial or complete smoking bans to protect the general public from passive smoke exposure. There is substantial evidence that workers, particularly in the hospitality sector, benefit from reduced exposure. More recently, several reports have appeared from different countries showing a temporal relationship between the introduction of a smoking ban and reduced hospital admissions for cardiovascular, respiratory and maternity outcomes. This will have a measurable benefit for public health, saving many lives. Multicomponent strategies could also reduce active smoking significantly if successfully implemented worldwide.

Trends and educational differences in non-communicable disease risk factors in Pitkäranta, Russia, from 1992 to 2007

AIM

Mortality and morbidity from non-communicable diseases (NCDs) is a major public health problem in Russia. The aim of the study was to examine trends and educational differences from 1992 to 2007 in NCD risk factors in Pitkäranta in the Republic of Karelia, Russia.

METHODS

Four cross-sectional population health surveys were carried out in the Pitkäranta region, Republic of Karelia, Russia, in 1992, 1997, 2002, and 2007. An independent random sample of 1000 persons from the general population aged 25-64 years was studied in each survey round. The total number of respondents in the four surveys was 2672. The surveys included a questionnaire, physical measurements, and blood sampling, and they were carried out following standard protocols.

RESULTS

The NCD risk factor trends generally increased in Pitkäranta during the study period with the exception of systolic blood pressure and smoking among men. Especially significant increases were observed in alcohol consumption among both sexes and in smoking among women. Educational differences and differences in trends were relatively small with the exception of a significant increase in smoking in the lowest female educational category.

CONCLUSIONS

Trends showing an increase in some major NCD risk factors and signs of emerging socio-economic differences call for stronger attention to effective health promotion and preventive policies in Russia.