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Nguenha N, Rodriguez C, Drope J, Bialous SA, Cunguara B, Lencucha R. Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives. Health Policy Plan 2024; 39:333-343. [PMID: 38459919 PMCID: PMC11005848 DOI: 10.1093/heapol/czae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024] Open
Abstract
Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.
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Affiliation(s)
- Nicole Nguenha
- Global Alliance for Tobacco Control, 1 Nicholas St, Suite 1004, Ottawa, Ontario K1N 7B7, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada
| | - Jeffrey Drope
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, Maryland 21205, USA
| | - Stella Aguinaga Bialous
- School of Nursing and Center for Tobacco Control Research and Education, University of California San Francisco, 2 Koret Way, San Francisco, California 94143, USA
| | - Benedito Cunguara
- Ministry of Economy and Finance, Gabinete de Desenvolvimento do Compacto II, Avenida 10 de Novembro, Praça da Marinha, Nº 929, Maputo 929, Mozambique
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 Promenade Sir William Osler, Montreal, Quebec H3G 1Y5, Canada
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Phetphum C, Wangwonsin A, Prajongjeep A, Simsin S. Perspectives of push-pull-mooring effects on a desire for switching to alternative crops among tobacco farmers in Thailand: A qualitative study. Tob Induc Dis 2024; 22:TID-22-07. [PMID: 38204731 PMCID: PMC10777475 DOI: 10.18332/tid/175685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Tobacco use contributes significantly to premature deaths worldwide. A key strategy to curb tobacco consumption involves limiting the tobacco supply through the transition to substitute crops. This study aims to provide insight into why tobacco farmers desire to switch to alternative crops and the support required for a successful transition. METHODS Semi-structured interviews were conducted with 34 tobacco farmers expressing a desire to transition to other crops in two communities in Thailand. Data were recorded and transcribed verbatim in Thai and subsequently translated into English. A deductive content analysis applied the Push-Pull-Mooring (PPM) framework, contextualizing factors for the transition among tobacco farmers. RESULTS Four main categories emerged: 1) push factors, encompassing negative experiences in growing tobacco, such as poverty, health problems, and hopelessness; 2) pull factors, representing positive experiences in transitioning to alternative crops, particularly having a role model; and 3) mooring factors, highlighting characteristic disadvantages of tobacco farmers, particularly the receipt of small tobacco growing quotas. The fourth category focused on the support needed for a successful transition, including the suspension of tobacco debt payments, access to low-interest loans, and the development of marketing capabilities. CONCLUSIONS The study provides a comprehensive understanding of farmers' motivations to switch from tobacco to alternative crops and outlines the necessary support for a successful transition. Offering financial assistance and enhancing the production and marketing capabilities of alternative crops are essential steps toward facilitating a successful switch for farmers and ensuring a secure livelihood beyond tobacco farming.
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Affiliation(s)
- Chakkraphan Phetphum
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
- Tobacco Control Research Unit, Naresuan University, Phitsanulok, Thailand
| | - Artittaya Wangwonsin
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Atchara Prajongjeep
- Department of Community Public Health, Sirindhorn College of Public Health, Phitsanulok, Thailand
| | - Saksin Simsin
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
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Haq I, Sarker MMR, Chakma S. Individual and community-level factors associated with discrimination among women aged 15-49 years in Bangladesh: Evidence based on multiple indicator cluster survey. PLoS One 2023; 18:e0289008. [PMID: 37494354 PMCID: PMC10370754 DOI: 10.1371/journal.pone.0289008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND This research aimed to examine the factors at both the individual and community levels that are linked to discrimination experienced by women aged 15-49 in Bangladesh. METHODS The relevant data was taken from the 2019 Multiple Indicator Cluster Survey in Bangladesh. The risk factors for discrimination against women in Bangladesh were determined using multilevel logistic regression models. RESULTS The overall prevalence of discrimination against women was found to be 10.4% (95% CI: 10.1-10.6). Based on the final model (Model 1V), at the individual level higher odds of discrimination were observed among women from poor (AOR:1.21,95%CI: 1.12-1.32) and middle income households (AOR:1.12, 95%CI:1.02-1.22) compared to those from rich households etc. Women who have never used ICT were 1.27 times (AOR = 1.27, 95% CI = 1.07-1.51) higher odds of discrimination when compared with women who were ICT exposed. Respondents who married before 18 years 10% more likely to (AOR = 1.10, 95% CI:1.02-1.19) discriminated than women married aged 18 years old or above. Women from urban communities were 15% less likely to experience discrimination than their rural counterparts. In comparison to the Sylhet Division, women in the Barisal, Chattogram, Dhaka, Khulna Mymensingh, Rajshahi, and Rangpur Divisions were respectively 3.02, 1.84, 1.68, 2.06, 4.97, 4.06, and 1.74 times more likely to experience discrimination. CONCLUSION Findings revealed that various individual-level factors such as wealth index, CEB, ICT exposure, marital status, functional difficulty, age, women's happiness, magazine and radio exposure, age at marriage, current contraceptive use, polygamy, husband beating, place of attack, and household head age were found to have a significant association with women discrimination. Community-level factors such as residence and division were also found to have a notable impact on discrimination. Policymakers should incorporate substantial components targeting both individual and community levels into intervention programs with the goal of raising awareness about women's discrimination.
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Affiliation(s)
- Iqramul Haq
- Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
| | | | - Sharanon Chakma
- Department of Development and Poverty Studies, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
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Clark M, Cunguara B, Bialous S, Rice K, Drope J, Labonte R, Lencucha R. Foregrounding women and household dynamics to inform Article 17: a qualitative description analysis of tobacco farming households in Mozambique. Tob Control 2023:tc-2022-057881. [PMID: 37402575 DOI: 10.1136/tc-2022-057881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE This paper examines the intrahousehold dynamics between women and men present in tobacco farming households in Mozambique. Attention to the experiences and realities of the smallholder farmers is crucial for understanding approaches to alternative livelihoods. Intrahousehold dynamics can provide important insights into how these households and their members view tobacco production and engage with the political economy of tobacco farming, how they make decisions, and the rationale and values behind these decisions. METHODS Data were collected through single-gender focus group discussions (n=8) with 108 participants (men=57, women=51). Analysis was informed by a qualitative description methodology. This research presents a gender-based analysis examining the perspectives, roles, decision-making processes and desires of female and male tobacco farmers in four key tobacco-growing districts in Mozambique. FINDINGS Throughout this paper, women are found to hold leverage and influence in tobacco farming households, and this leverage is in part gained via the necessity of women's unpaid labour in achieving profitability in tobacco farming. Both women and men are also found to strongly desire and pursue the well-being of the household. CONCLUSION Women hold agency within tobacco-growing households and participate in decision-making processes regarding tobacco agriculture. Women should be included in future tobacco control policies and programmes pertaining to Article 17.
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Affiliation(s)
- Madelyn Clark
- Medicine, Brown University, Providence, Rhode Island, USA
| | - Benedito Cunguara
- Gabinete de Desenvolvimento do Compacto II, Ministry of Economy and Finance, Maputo, Mozambique
| | - Stella Bialous
- School of Nursing and Center for Tobacco Control, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Rice
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Jeffrey Drope
- School of Public Health, University of Illinois Chicago School of Public Health, Chicago, Illinois, USA
| | - Ronald Labonte
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
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Lencucha R. Future of farming must be food not tobacco. Tob Control 2023; 32:269-270. [PMID: 37080585 PMCID: PMC10176362 DOI: 10.1136/tc-2023-058004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Wan X, Jin J, Ran S. Willingness of tobacco farmers to accept compensation for tobacco crop substitution in Lichuan City, China. Tob Control 2023; 32:338-343. [PMID: 34535508 DOI: 10.1136/tobaccocontrol-2021-056751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/04/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study, conducted in China, explores tobacco farmers' willingness to accept (WTA) compensation for tobacco crop substitution. METHODS The contingent valuation method was used to elicit farmers' WTA compensation. A face-to-face survey was conducted with 280 tobacco farmers in Lichuan City, China. The standard logit regressions were used to identify the factors that influence farmers' WTA. RESULTS Without compensation, most of the respondents were unwilling to implement tobacco crop substitution. However, if the government provided compensation, the proportion of respondents' willingness for substitution increased to 86.7%. Male tobacco farmers are more likely to accept a given compensation value than female farmers. Older tobacco farmers have a higher probability of accepting compensation. The number of farmers engaged in tobacco growing in a family is negatively associated with the probability of accepting a given compensation amount. Tobacco farmers with greater confidence in the expected benefits of tobacco crop substitution tend to be more willing to accept compensation. The mean WTA estimate was achieved as US$2020.35/ha/year. CONCLUSIONS If appropriate compensation is provided for tobacco farmers, there is a potential to implement the tobacco crop substitution policy in the study area.
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Affiliation(s)
- Xinyu Wan
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, People's Republic of China
- Faculty of Geographical Science, Beijing Normal University, Beijing, People's Republic of China
| | - Jianjun Jin
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, People's Republic of China
- Faculty of Geographical Science, Beijing Normal University, Beijing, People's Republic of China
| | - Shenghong Ran
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, People's Republic of China
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Phetphum C, Prajongjeep A, Keeratisiroj O, Simsin S, Thawatchaijareonying K. Deteriorating Quality of Life and a Desire to Stop Growing Tobacco Among Virginia and Burley Tobacco Farmers in Thailand. JCO Glob Oncol 2022; 8:e2200180. [PMID: 36049151 PMCID: PMC9470139 DOI: 10.1200/go.22.00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aimed to examine the quality of life of tobacco farmers and their desire to stop growing tobacco. Most tobacco farmers in Thailand have a declining quality of life resulting in reducing growing tobacco.
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Affiliation(s)
- Chakkraphan Phetphum
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
- Tobacco Control Research Unit (Northern Region), Naresuan University, Phitsanulok, Thailand
| | - Atchara Prajongjeep
- Department of Community Public Health, Sirindhorn College of Public Health, Phitsanulok, Thailand
| | - Orawan Keeratisiroj
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Saksin Simsin
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
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Kabir S, Hasan MR, Hossain MI, Suraiya S, Islam FB, Nayan MIH, Haq I, Hossain MS, Souza RT. Determinants and Trends of Health Facility Delivery in Bangladesh: A Hierarchical Modeling Approach. BioMed Research International 2022; 2022:1-13. [PMID: 35937411 PMCID: PMC9355761 DOI: 10.1155/2022/1359572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Abstract
Background Most maternal deaths occur during childbirth and after childbirth. This study was aimed at determining the trends of health facilities during delivery in Bangladesh, as well as their influencing factors. Methods This study used secondary data from three Bangladesh Multiple Indicator Cluster Surveys (MICSs) in 2006, 2012–13, and 2019. The study's target sample was those women who gave birth in the last two years of the survey. A two-level logistic regression was applied to determine the effects on health facility delivery separately in these two survey points (MICSs 2012–13 and 2019). Results The results show that the delivery of health facilities has increased by almost 37.4% in Bangladesh, from 16% in 2006 to 53.4% in 2019. The results of two-level logistic regression show that the total variation in health facility delivery across the community has decreased over recent years. After adding community variables, various individual-level factors such as women with secondary education (OR = 0.55 in 2012-13 vs. OR =0.60 in 2019), women from middle wealth status (OR = 0.49 in 2012-13 vs. OR = 0.65 in 2019), religion, and child ever born showed a strong relationship with health facility delivery in both survey years. At the community level, residents showed significant association only in the 2012-13 survey and indicated a 43% (OR = 1.43 for 2012-13) greater availability of health facilities in urban residences than in rural residences. Using media showed a highly significant connection with health facility delivery in both years as well as an increasing trend over the years in Bangladesh (OR = 1.19 in 2012-13 vs. OR = 1.38 in 2019). However, division, prenatal care, and skilled services all contribute greatly to increasing the delivery of health facilities in Bangladesh. Conclusions The results of this study suggest that policymakers need to pay attention to individual and community-level factors, especially women's education, poverty reduction, and adequate prenatal care provided by well-trained caregivers.
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Lencucha R, Drope J, Magati P, Sahadewo GA. Tobacco farming: overcoming an understated impediment to comprehensive tobacco control. Tob Control 2022; 31:308-312. [PMID: 35241604 DOI: 10.1136/tobaccocontrol-2021-056564] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/03/2021] [Indexed: 12/24/2022]
Abstract
Tobacco farming has emerged as an important concern for tobacco control advocates. Tobacco-growing countries face unique and important challenges to comprehensive, intersectoral tobacco control. These challenges stem from narratives that position tobacco as an important driver of economic growth and development, perpetuated by tobacco interests with close ties to government decision-making. While the global tobacco control movement has enshrined a commitment to alternatives to tobacco growing, there remain numerous obstacles. Tobacco growing is often situated in contexts with limited markets for other agricultural products, limited knowledge and economic resources to pursue alternatives, and/or a structure that favours industry control over the supply chain, all constraining the decision space of farmers. An evidence-informed approach is necessary to address tobacco supply, including growing, processing, manufacturing and trade, in this complex context. This paper reviews the economic, environmental and policy context of tobacco growing with an emphasis on the past decade of empirical work on the political economy of tobacco supply and introduces strategies to pursue alternatives. This analysis debunks many of the arguments used to perpetuate the narrative of tobacco's prosperity and provides critical insights into the institutional constraints faced by government sectors in pursuing a policy of alternatives.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Drope
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Peter Magati
- Consultant, World Health Organization, Nairobi, Kenya
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Wineman A, Chilora L, Jayne TS. Trends in Tobacco Production and Prices in Malawi. Nicotine Tob Res 2022; 24:227-232. [PMID: 34605884 DOI: 10.1093/ntr/ntab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Diversification away from tobacco production has been identified as a priority for Malawi, historically one of the world's most tobacco-reliant countries. METHODS This paper refers to a nationally representative data set to characterize broad trends in production since 2000 to understand whether Malawi is shifting away from tobacco and how production has changed over time. RESULTS From 2004 to 2019, the share of Malawian crop farmers producing tobacco fell from 16% to 5%, and tobacco's share of the total value of crop production also declined sharply. Tobacco farms are generally growing larger (in size and scale of production) over time. However, land productivity remains low, with net returns of 93 000 MWK (128 USD) per hectare at the median. Farm-gate prices for tobacco have declined relative to the prices of maize or fertilizer, rendering tobacco a less lucrative avenue to generate the cash income needed to purchase these key items. In addition, the share of the export price received by farmers has also declined over time, with the median farm-gate price representing 32% of the export price in 2004 and 18% in 2019. CONCLUSIONS In some respects, a transition away from tobacco has already occurred. Additional research is needed to understand why the farm-gate share of tobacco export prices has declined over this period and how the livelihoods of smallholder farm-households that exited tobacco production have been affected. IMPLICATIONS To the extent that tobacco prices appear to be declining, there is a need to rigorously assess whether farmers have suitable crop alternatives (with established markets) and other livelihood options. Likely, investments are yet needed to foster strong alternatives to tobacco; such investments include research and development in on-farm technologies to raise the productivity of non-tobacco crops, as well as improvements in non-tobacco value chains to reduce transportation costs and promote private investment.
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Affiliation(s)
| | | | - Thomas S Jayne
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
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Chingosho R, Dare C, van Walbeek C. Tobacco farming and current debt status among smallholder farmers in Manicaland province in Zimbabwe. Tob Control 2021; 30:610-615. [PMID: 32848076 PMCID: PMC7611881 DOI: 10.1136/tobaccocontrol-2020-055825] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/27/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Zimbabwe is the largest producer of tobacco leaf in Africa and the sixth largest globally. Tobacco leaf is a mainstay of the economy, accounting for about 10% of the country's GDP in 2018. METHODS We use descriptive and regression analyses from a face-to-face survey of 381 smallholder farmers in three major tobacco-farming areas in Manicaland province to determine the prevalence of tobacco-related debt and some of its covariates. The survey was conducted in June and July 2019. RESULTS 74% of respondents are contract farmers and 26% are independent farmers. 57% of respondents indicated that they were in tobacco-related debt. The likelihood of being in tobacco-related debt is significantly more than average for farmers with the following characteristics (holding other characteristics constant): being a contract farmer, having a larger farm, employing only family labour and not recording expenses (as a proxy for financial sophistication). 91% of contract farmers would prefer to be independent farmers, while 63% of independent farmers would prefer to be contract farmers. CONCLUSION There is no evidence to suggest that tobacco growing, in its current state, has benefited the tobacco farmers in Manicaland province. Tobacco farmers are largely victims, rather than beneficiaries, of the sector. There is a strong case for government intervention to improve the conditions of tobacco farmers, either through direct intervention in the tobacco-growing sector, or by encouraging and promoting crop substitution.
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Affiliation(s)
- Rutendo Chingosho
- School of Economics, University of Cape Town, Rondebosch, South Africa
| | - Chengetai Dare
- Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Corné van Walbeek
- Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Rondebosch, Cape Town, South Africa
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Ahmad F, Khan Z, Boeckmann M, Khan MN, Siddiqi K, Ullah S, Zeeb H, Forberger S. Supply Chain Actors' Willingness to Switch the Business of Smokeless Tobacco: A Mixed-Methods Study on Naswar Business in Pakistan. Nicotine Tob Res 2021; 23:1498-1506. [PMID: 33740043 DOI: 10.1093/ntr/ntab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/17/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Provision of alternate livelihoods to smokeless tobacco (SLT) supply chain (SC) actors can help in curtailing SLT business and its consumption. We explored the reasons for SC actors' engagement in Naswar (SLT used in South Asia) business and their willingness to switch to other alternatives. AIMS AND METHODS We conducted an equal-status concurrent mixed-methods study in four districts of Khyber Pakhtunkhwa province of Pakistan. We surveyed 286 general points of sale (GPOS) and exclusive Naswar (EN) vendors through multistage cluster sampling. Additionally, we interviewed 15 tobacco farmers interpretively, being distinct from other SC actors. We assessed the association between vendors' willingness to switch and their awareness about tobacco-harms, profit margin, Naswar as a family business, length of business, education level, and shop type using logistic regression. Qualitative data assessed the farmer's viable alternatives to switch and were analyzed using deductive-inductive thematic analysis. RESULTS Product demand-77% and profit margins-75% were the main drivers for selling SLT by EN vendors. Half of the GPOS and 25% EN vendors expressed willingness to stop Naswar's sale. Vendors aware of tobacco-harms were more willing to switch, but less likely to switch if Naswar was perceived to bring "good profit." Farmers were mainly cultivating tobacco because of profitability, family-run farm, and perceived land-suitability for tobacco. Lack of government support was main constraint for farmers looking to switch. CONCLUSIONS A considerable portion of Naswar SC actors in Pakistan are willing to switch to viable alternatives, with profitability of alternatives, support from authorities, and social obligations as key considerations in doing so. IMPLICATIONS This study highlights that good profit margins in the Naswar business, lack of awareness of tobacco-related health harms, and absence of the government's support are key detriments to switching to alternative businesses among Naswar SC actors in Pakistan. These findings are the first to come out in the context of both Pakistan and Naswar product, making a case for policy interventions focusing on tax increases, awareness campaigns about tobacco-harms, and a proactive role by the government to provide support for the security of livelihoods to those tobacco SC actors who want to switch to other alternatives.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization (ORIC), Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- School of Public Health, Department of Environment and Health, University of Bielefeld, Bielefeld, Germany
| | - Muhammad Naseem Khan
- Health Services Academy, Islamabad, Pakistan.,Department of Psychological Medicine, University of Liverpool, Liverpool, UK
| | - Kamran Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York,UK
| | - Safat Ullah
- Office of Research Innovation and Commercialization (ORIC), Khyber Medical University, Peshawar, Pakistan
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Nguenha N, Cunguara B, Bialous S, Drope J, Lencucha R. An Overview of the Policy and Market Landscape of Tobacco Production and Control in Mozambique. Int J Environ Res Public Health 2021; 18:E343. [PMID: 33466388 PMCID: PMC7795975 DOI: 10.3390/ijerph18010343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022]
Abstract
Background: Tobacco growing has been considered a mainstay of Mozambique's economy, but there is a dearth of analysis of the tobacco policy landscape in the country. Methods: Review of government and non-government documents and academic papers addressing Mozambique's tobacco-growing history, the changes in the political economy of tobacco, and health policies addressing tobacco use and prevention of noncommunicable diseases. Results: Despite its tobacco growing and exporting history, the contribution of tobacco to the economy has been in steady decline in the past two decades, including in the areas dedicated to growing. At the same time there has been an increase in multinational control of the tobacco economy. In parallel, Mozambique's commitment to addressing the growing burden of noncommunicable disease and accession to the Framework Convention on Tobacco Control indicate a potential for internal government tensions to balance immediate economic interests with long term health goals. Conclusions: With the decline in tobacco share of the overall economy, Mozambique may be well-positioned to explore alternative, sustainable livelihoods for farmers that grow tobacco, but it must overcome inter-sectoral barriers and advocate for a whole of government approach to address the health and economic impact of tobacco.
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Affiliation(s)
- Nicole Nguenha
- Independent Researcher, Av. Vladmir Lenine #2081, Flat 1.4, Maputo P.O. Box 55, Mozambique;
| | - Benedito Cunguara
- Independent Researcher, Av. Vladmir Lenine #2081, Flat 1.4, Maputo P.O. Box 55, Mozambique;
| | - Stella Bialous
- Social and Behavioral Sciences Department, School of Nursing, UCSF, San Francisco, CA 94143, USA;
| | - Jeffrey Drope
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1747 West Roosevelt Rd., Chicago, IL 60607, USA;
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5, Canada;
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14
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Sahadewo GA, Drope J, Li Q, Witoelar F, Lencucha R. In-and-Out of Tobacco Farming: Shifting Behavior of Tobacco Farmers in Indonesia. Int J Environ Res Public Health 2020; 17:E9416. [PMID: 33334032 PMCID: PMC7765560 DOI: 10.3390/ijerph17249416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
Understanding the variables that affect farmers' decisions as to whether to grow tobacco and/or other crops provides important insights into their economic lives and can help to inform the development and implementation of policies that shape both tobacco production and tobacco control, such as increasing tobacco excise taxes. This study employs complementary quantitative and qualitative methodologies to identify variables that affect tobacco farmers' economic decision making in Indonesia, a major tobacco producer. The research focuses on the variables that affect tobacco farmers' decisions to continue tobacco farming or shift to non-tobacco farming. It finds that tobacco farmers' decision making is complex but also predictable. The results of the quantitative analysis suggest that farming profits and positive rainfall shocks are two of the key variables that affect the decision to cultivate tobacco. The qualitative results confirm these findings and further illuminate that access to credit, education (agricultural and otherwise) and information play substantial roles in farmers' economic decision making. Most of these variables are affected by the unequal relationship between the tobacco firms that buy tobacco and the farmers, wherein the farmers are consistently at a disadvantage in terms of negotiating key parameters such as prices and evaluation of leaf quality.
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Affiliation(s)
| | - Jeffrey Drope
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago (UIC), Chicago, IL 60608, USA
| | - Qing Li
- Economic & Health Policy Research, Data Science, American Cancer Society, Atlanta, GA 30303, USA;
| | - Firman Witoelar
- Crawford School of Public Policy, Australian National University, Canberra 2600, ACT, Australia;
| | - Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC 3605, Canada;
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15
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Lencucha R, Moyo T, Labonte R, Drope J, Appau A, Makoka D. Shifting from tobacco growing to alternatives in Malawi? A qualitative analysis of policy and perspectives. Health Policy Plan 2020; 35:810-818. [PMID: 32525201 PMCID: PMC8060983 DOI: 10.1093/heapol/czaa057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Tobacco is the primary export commodity in Malawi and an important contributor to foreign earnings. The entrenchment of tobacco interests within government has partly explained why Malawi has lagged in its efforts to address the health consequences of tobacco and has been a vocal opponent of global tobacco control. Despite the extensive historical and entrenched relationship between the economy of Malawi and tobacco production, there have been important shifts at the highest policy levels towards the need to explore diversification in the agricultural sector. There is explicit recognition that alternatives to tobacco production must be pursued. This study provides an analysis of the policies and perspectives that characterize contemporary government approaches to tobacco and alternatives in Malawi by interviewing key government officials working on tobacco policy and reviewing recent policy documents. This research finds that there is openness and movement towards reducing tobacco growing in Malaw, including efforts to reduce tobacco dependency. Rather than a singular tobacco policy discourse in the country, there is a somewhat conflictual set of policies and perspectives on the future of tobacco in Malawi. Informing these policies and perspectives is the interplay between the economics of agricultural production (tobacco vs other crops), global markets (ranging from the ability to generate export earnings to the inability to compete with wealthier countries' non-tobacco crop subsidies) and the lack of developed supply and value chains other than those created by the transnational tobacco industry. The implications for government policy supporting a move away from tobacco dependence are not straightforward: there is a need to fill the supply chain gap for alternative crops, which requires not only strong intersectoral support within the country (and some challenge to the residual pro-tobacco narratives) but also international support.
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Affiliation(s)
- Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, Hosmer House, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5, Canada
| | - Takondwa Moyo
- Center for Agricultural Research and Development, Lilongwe University of Agriculture and Natural Resources, Lilongwe, P.O. Box 219, Malawi
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
| | - Jeffrey Drope
- American Cancer Society, Economic and Health Policy Research, Atlanta, 250 Williams Street Atlanta, GA 30303, USA
| | - Adriana Appau
- PolicyWise for Children and Families, 609 14 St NW #402, Calgary, AB T2N 2A1, Canada
| | - Donald Makoka
- Center for Agricultural Research and Development, Lilongwe University of Agriculture and Natural Resources, Lilongwe, P.O. Box 219, Malawi
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16
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Talukder A, Haq I, Ali M, Drope J. Factors Associated with Cultivation of Tobacco in Bangladesh: A Multilevel Modelling Approach. Int J Environ Res Public Health 2020; 17:E4277. [PMID: 32549295 PMCID: PMC7344697 DOI: 10.3390/ijerph17124277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
Abstract
An increasing number of studies provide evidence on the serious negative consequences of tobacco farming on economic livelihoods, human health and the environment. There is, however, only limited research on tobacco farming in Bangladesh, a significant producer of tobacco leaf. It is not yet well understood why many farmers choose to grow tobacco considering the challenging context. Accordingly, this study examines the factors that influence farmers' decisions to grow tobacco in Bangladesh. Socio-demographic and economic information was collected from 220 tobacco farmers and 117 non-tobacco farmers from the major tobacco-growing district of Kushtia, for a total sample of 337. These farmers were recruited from two sub-districts (or upazilla- Daulatpur and Mirpur) using a stratified random sampling. A two-level logistic regression model was applied for the identification of the variables that condition farmers' decisions to cultivate tobacco leaf. Almost two-thirds of the sampled farmers (65.3%) chose to farm tobacco. The results demonstrate that the following variables shape most farmers' decisions to cultivate tobacco: older age, less education, tobacco firms' short-term financial support of growing tobacco, greater ease of selling tobacco products at market, better access to credit (also provided by the tobacco companies), and farmer's perception about higher profits from tobacco cultivation compared to other crops. This study strongly suggests that the government and others working on tobacco control should consider engaging in initiatives to increase farmers' education, perhaps particularly for older farmers, and provide meaningful financial support in part by helping to increase access to credit and ensuring a better market facility to sell their other healthier agricultural crops, goods and services.
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Affiliation(s)
- Ashis Talukder
- Statistics Discipline, Khulna University, Khulna 9208, Bangladesh;
| | - Iqramul Haq
- Dept. of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka 1207, Bangladesh;
| | - Mohammad Ali
- Statistics Discipline, Khulna University, Khulna 9208, Bangladesh;
| | - Jeffrey Drope
- Scientific Vice President, Economic and Health Policy Research, American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USA;
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17
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Clark M, Magati P, Drope J, Labonte R, Lencucha R. Understanding Alternatives to Tobacco Production in Kenya: A Qualitative Analysis at the Sub-National Level. Int J Environ Res Public Health 2020; 17:E2033. [PMID: 32204418 PMCID: PMC7143228 DOI: 10.3390/ijerph17062033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 01/22/2023]
Abstract
Tobacco is a key cash crop for many farmers in Kenya, although there is a variety of challenges associated with tobacco production. This study seeks to understand alternatives to tobacco production from the perspective of government officials, extension officers, and farmers at the sub-national level (Migori, Busia, and Meru) in Kenya. The study analyzes data from qualitative key-informant interviews with government officials and extension officers (n = 9) and focus group discussions (FGDs) with farmers (n = 5). Data were coded according to pre-identified categories derived from the research aim, namely, opportunities and challenges of tobacco farming and alternative crops, as well findings that illustrate the policy environment that shapes the agricultural context in these regions. We highlight important factors associated with the production of non-tobacco agricultural commodities, including the factors that shape the ability of these non-agricultural commodities to serve as viable alternatives to tobacco. The results highlight the effect that several factors, including access to capital, markets, and governmental assistance, have on farmer decisions. The results additionally display the structured policy approaches that are being promoted in governmental offices towards agricultural production, as well as the institutional shortcomings that inhibit their implementation at the sub-national level.
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Affiliation(s)
- Madelyn Clark
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5, Canada;
| | - Peter Magati
- School of Economics, University of Nairobi, Nairobi 30197, Kenya;
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, GA 30303, USA;
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5, Canada;
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18
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Lencucha R, Pal NE, Appau A, Thow AM, Drope J. Government policy and agricultural production: a scoping review to inform research and policy on healthy agricultural commodities. Global Health 2020; 16:11. [PMID: 31959213 PMCID: PMC6971899 DOI: 10.1186/s12992-020-0542-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Unhealthy foods and tobacco remain the leading causes of non-communicable disease (NCDs). These are key agricultural commodities for many countries, and NCD prevention policy needs to consider how to influence production towards healthier options. There has been little scholarship to bridge the agriculture with the public health literature that seeks to address the supply of healthy commodities. This scoping review synthesizes the literature on government agricultural policy and production in order to 1) present a typology of policies used to influence agricultural production, 2) to provide a preliminary overview of the ways that impact is assessed in this literature, and 3) to bring this literature into conversation with the literature on food and tobacco supply.This review analyzes the literature on government agricultural policy and production. Articles written in English and published between January 1997 and April 2018 (20-year range) were included. Only quantitative evaluations were included. Studies that collected qualitative data to supplement the quantitative analysis were also included. One hundred and three articles were included for data extraction. The following information was extracted: article details (e.g., author, title, journal), policy details (e.g., policy tools, goals, context), methods used to evaluate the policy (e.g., outcomes evaluated, sample size, limitations), and study findings. Fifty four studies examined the impact of policy on agricultural production. The remaining articles assessed land allocation (n = 25) (e.g., crop diversification, acreage expansion), efficiency (n = 23), rates of employment including on- and off-farm employment (n = 18), and farm income (n = 17) among others. Input supports, output supports and technical support had an impact on production, income and other outcomes. Although there were important exceptions, largely attributed to farm level allocation of labour or resources. Financial supports were most commonly evaluated including cash subsidies, credit, and tax benefits. This type of support resulted in an equal number of studies reporting increased production as those with no effects.This review provides initial extrapolative insights from the general literature on the impact of government policies on agricultural production. This review can inform dialogue between the health and agricultural sector and evaluative research on policy for alternatives to tobacco production and unhealthy food supply.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Nicole E Pal
- Faculty of Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Adriana Appau
- Research and Evaluation, PolicyWise for Children and Families, Edmonton, Alberta, Canada
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
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