1
|
Tselengidis A, Adams S, Freeman B, Mostafa A, Astuti PAS, Cranwell J. From the international tobacco control arena to the local context: a qualitative study on the tobacco advertising, promotion and sponsorship legislative environment in Sudan and the challenges characterising it. BMJ Open 2023; 13:e066528. [PMID: 37295835 PMCID: PMC10277049 DOI: 10.1136/bmjopen-2022-066528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/19/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES The aim of the study was to assess the Sudanese tobacco advertising, promotion and sponsorship (TAPS) legislative environment and the challenges characterising it. We formulated three research questions: What is the TAPS policy context in Sudan? What circumstances led to the development of the current legislative text? Finally, what was the involvement of the different actors in these events? DESIGN We conducted a qualitative analysis using the Health Policy Triangle model to frame the collection and extraction of publicly available information from academic literature search engines, news media databases or websites of national and international organisations, as published by February 2021. The thematic framework approach was employed to code and analyse the textual data and the generated themes were used to map connections across the data and to explore relationships among the generated subthemes and themes. SETTING Sudan. DATA Using a combination of the keywords "Sudan" and "tobacco advertising" (or "tobacco marketing" or "tobacco promotion"), we collected publicly available documents in the English language. We included 29 documents in the analysis. RESULTS Three themes underpin the Sudanese legislative environment on TAPS: (1) limited and outdated TAPS data, (2) stakeholder involvement and tobacco industry interference and (3) TAPS legislation not aligned with the WHO Framework Convention on Tobacco Control Secretariat recommendations. CONCLUSIONS Findings from this qualitative analysis suggest that recommendations to move forward in Sudan should include the systematic and periodic collection of TAPS surveillance data, addressing any remaining legislative content loopholes and protecting policy-making from tobacco industry interference. In addition, best practices from other low-income and middle-income countries with good TAPS monitoring systems, such as Egypt, Bangladesh and Indonesia, or with protective provisions against tobacco industry interference, such as Thailand and the Philippines, could be considered for adaptation and implementation.
Collapse
Affiliation(s)
- Arsenios Tselengidis
- Department for Health, University of Bath, Bath, UK
- Tobacco Control Research Group, University of Bath, Bath, UK
| | - Sally Adams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Jo Cranwell
- Department for Health, University of Bath, Bath, UK
| |
Collapse
|
2
|
Tselengidis A, Adams S, Freeman B, Alam SM, Astuti PAS, Cranwell J. Achieving a tobacco-free Bangladesh by 2040: a qualitative analysis of the tobacco advertising environment and prohibitions in Bangladesh. BMJ Open 2023; 13:e069620. [PMID: 37221031 DOI: 10.1136/bmjopen-2022-069620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES This paper explores the Bangladeshi tobacco advertising, promotion and sponsorship (TAPS) legislative environment, to highlight any potential policy loopholes and to facilitate the identification of additional provisions for inclusion. The study also aimed to identify valuable lessons applicable to other low-income and middle-income countries (LMICs). METHODS We conducted a qualitative health policy analysis using the health policy triangle model to frame the collection and extraction of publicly available information from academic literature search engines, news media databases and websites of national and international organisations, published up until December 2020. We coded and analysed textual data using the thematic framework approach to identify themes, relationships and connections. RESULTS Four themes underpin the Bangladesh legislative environment on TAPS: (1) engaging international actor interest in TAPS policies, (2) the incremental approach to TAPS policy-making, (3) time-sensitive TAPS monitoring data and (4) innovative TAPS monitoring and policy enforcement system. The findings highlight the role of international actors (such as multinational organisations and donors), tobacco control advocates and the tobacco industry in the policy-making process and the competing agendas they bring. We also outline the chronology of TAPS policy-making in Bangladesh and the existing loopholes and policy changes over time. Lastly, we describe the innovative approaches to TAPS monitoring and policy enforcement in Bangladesh to combat the tobacco industry marketing strategies. CONCLUSION This study highlights the role of tobacco control advocates as crucial in TAPS policy-making, monitoring and enforcement in LMICs, and identifies good practices for the sustainability of tobacco control programmes. However, it also points out that tobacco industry interference, coupled with increasing pressure on advocates and legislators, may block progress in tobacco endgame approaches.
Collapse
Affiliation(s)
- Arsenios Tselengidis
- Department for Health, University of Bath, Bath, UK
- Tobacco Control Research Group, University of Bath, Bath, UK
| | - Sally Adams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Jo Cranwell
- Department for Health, University of Bath, Bath, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Dodd M, Ivers R, Zwi AB, Rahman A, Jagnoor J. Investigating the process of evidence-informed health policymaking in Bangladesh: a systematic review. Health Policy Plan 2020; 34:469-478. [PMID: 31237941 PMCID: PMC6736329 DOI: 10.1093/heapol/czz044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 02/02/2023] Open
Abstract
Over the last four decades, Bangladesh has made considerable improvements in population health, this is in part due to the use of evidence to inform policymaking. This systematic review aims to better understand critical factors that have facilitated the diffusion of scientific evidence into multiple phases of health policymaking in Bangladesh. To do this an existing policy framework designed by Shiffman and Smith in 2007, was used to extract and synthesize data from selected policy analyses. This framework was used to ensure the content, context and actors involved with evidence-informed policymaking were considered in each case where research had helped shape a health policy. The 'PRISMA Checklist' was employed to design pre-specified eligibility criteria for the selection of information sources, search strategy, inclusion and exclusion criteria, and process of data extraction and synthesis. Through our systematic search conducted from February to May 2017, we initially identified 1859 articles; after removal of duplicates, followed by the screening of titles, abstracts and full-texts, 24 articles were included in the analysis. Health policy issues included the following topics: maternal and child health, tobacco control, reproductive health, infectious disease control and the impact and sustainability of knowledge translation platforms. Findings suggested that research evidence that could be used to meet key targets associated with the Millennium Development Goals (MDGs) were more likely to be considered as a political (and therefore policy) priority. Furthermore, avenues of engagement between research organizations and the government as well as collective action from civil-society organizations were important for the diffusion of evidence into policies. Through this article, it is apparent that the interface between evidence and policy formulation occurs when evidence is, disseminated by a cohesive policy-network with strong leadership and framed to deliver solutions for problems on both the domestic and global development agenda.
Collapse
Affiliation(s)
- Madeleine Dodd
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia.,School of Public Health & Community Medicine, UNSW; The George Institute for Global Health Australia, UNSW, Australia
| | - Anthony B Zwi
- Health, Rights and Development (HEARD@UNSW), Faculty of Arts and Social Sciences, School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Aminur Rahman
- Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Jackson-Morris A, Latif E. Index of tobacco control sustainability (ITCS): a tool to measure the sustainability of national tobacco control programmes. Tob Control 2016; 26:217-225. [DOI: 10.1136/tobaccocontrol-2015-052799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/29/2016] [Indexed: 11/04/2022]
Abstract
ObjectiveTo produce a tool to assess and guide sustainability of national tobacco control programmes.MethodA two-stage process adapting the Delphi and Nominal group techniques. A series of indicators of tobacco control sustainability were identified in grantee/country advisor reports to The International Union Against Tuberculosis and Lung Disease under the Bloomberg Initiative to Reduce Tobacco Control (2007–2015). Focus groups and key informant interviews in seven low and middle-income countries (52 government and civil society participants) provided consensus ratings of the indicators’ relative importance. Data were reviewed and the indicators were accorded relative weightings to produce the ‘Index of Tobacco Control Sustainability’ (ITCS).ResultsAll 31 indicators were considered ‘Critical’ or ‘Important’ by the great majority of participants. There was consensus that a tool to measure progress towards tobacco control sustainability was important. The most critical indicators related to financial policies and allocations, a national law, a dedicated national tobacco control unit and civil society tobacco control network, a national policy against tobacco industry ‘Corporate Social Responsibility’ (CSR), national mortality and morbidity data, and national policy evaluation mechanisms.ConclusionsThe 31 indicators were agreed to be ‘critical’ or ‘important’ factors for tobacco control sustainability. The Index comprises the weighted indicators as a tool to identify aspects of national tobacco control programmes requiring further development to augment their sustainability and to measure and compare progress over time. The next step is to apply the ITCS and produce tobacco control sustainability assessments.
Collapse
|