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San Sebastián M, Jaakko T, Söderberg S, Zimmet P, Ori B, Heecharan J, Fonseca-Rodríguez O, Kowlessur S. Prevalence and social determinants of smoking among men in Mauritius: a cross-sectional study. Glob Health Action 2024; 17:2367415. [PMID: 38899339 PMCID: PMC11191822 DOI: 10.1080/16549716.2024.2367415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Mauritius has implemented a range of stringent policies to control smoking and promote public health. Regular monitoring focuses on the prevalence of tobacco use, yet there is a gap in understanding its socio-economic patterns. OBJECTIVE The aim of this study was to estimate the prevalence of tobacco smoking and to identify the social determinants associated with smoking among men in Mauritius in 2021. METHODS This is a cross-sectional population-based study conducted by the Ministry of Health and Wellness during 2021. In total, 3622 individuals participated (response rate of 84.1%), of which 1663 were men (45.9%). The study mainly focused on men given the low prevalence of smoking among women. Daily smoking was the outcome and a series of sociodemographic and socioeconomic factors were included as independent variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated to fulfill the study objective. RESULTS The prevalence of smoking among men was 30.4%. People in the 25-34 age group (PR = 1.65; 95% CI: 1.12-2.41), those separated, divorced or widowed (PR = 1.57; 95% CI: 1.16-2.11), the ethnic groups Muslim-Mauritians (PR = 1.70; 95% CI: 1.00-2.89) and Creoles (PR = 1.97; 95% CI: 1.16-3.35), and those with secondary (PR = 1.29; 95% CI: 1.00-1.67) and primary education (PR = 1.47; 95% CI: 1.10-1.98) were statistically significantly associated with daily smoking. CONCLUSIONS Although a gradual decline in smoking prevalence was observed compared with the previous 2015 survey, the Ministry of Health and Wellness should persist in fortifying its anti-smoking measures and concentrate on crafting tailored interventions aimed at the vulnerable groups identified in this study.
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Affiliation(s)
| | - Tuomilehto Jaakko
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umea university, Umea, Sweden
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Bhushan Ori
- Ministry of health and Wellness, Port Louis, Mauritius
| | - Jaysing Heecharan
- Non-communicable Diseases, Health Promotion and Research Unit, Ministry of Health and Wellness, Port Louis, Mauritius
| | | | - Sudhirsen Kowlessur
- Non-communicable Diseases, Health Promotion and Research Unit, Ministry of Health and Wellness, Port Louis, Mauritius
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LoParco CR, Sargsyan Z, Topuridze M, Sturua L, Kegler MC, Petrosyan V, Torosyan A, Grigoryan L, Bazarchyan A, Berg CJ. Associations Between Pro/Anti-Tobacco Media and Messaging Exposure and Knowledge and Support of Smoke-Free Policy Among Adults in Armenia and Georgia. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:501-511. [PMID: 37713644 PMCID: PMC10940185 DOI: 10.1097/phh.0000000000001828] [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] [Indexed: 09/17/2023]
Abstract
CONTEXT Despite high smoking rates, Armenia and Georgia recently adopted smoke-free policies (2022 and 2018). OBJECTIVE We examined associations between exposure to pro-tobacco media (news opposing smoke-free policies; cigarette, e-cigarette, heated tobacco product [HTP] advertisements) and anti-tobacco media (media, community-based action) and (1) knowledge that the policies applied to alternative tobacco products (ATPs), and (2) support for the policies applying to ATPs and various settings. DESIGN We analyzed 2022 survey data. SETTING Data were from 28 communities in Armenia and Georgia. PARTICIPANTS The sample comprised 1468 adults (31.6% past-month smokers). METHODS We conducted multivariable regressions, controlling for country and sociodemographics. RESULTS Participants were knowledgeable that the policy applied to ATPs (79.2%) and supportive of them applying to ATPs and various settings (means = 3.43 and 3.00; 1-4 = strongly support). Greater exposure to anti-tobacco media/community-based action correlated with more likely knowing that the policies applied to ATPs and greater support of the policies applying to various settings; HTP advertisement exposure correlated with less support of the policies applying to various settings. Less exposure to news opposing smoke-free policies and greater exposure to media supporting such policies correlated with greater support of the policies applying to ATPs. CONCLUSIONS Media and community-based action may promote smoke-free policy knowledge and support. HTP advertisements may uniquely undermine smoke-free policies.
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Affiliation(s)
- Cassidy R. LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center; George Washington University, Washington, DC
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Marina Topuridze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Lela Sturua
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Michelle C. Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center; George Washington University, Washington, DC
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Crosbie E, Tran B, Albuquerque de Figueiredo B, Severini L, Severini G, Sebrié EM. Tobacco industry strategies to influence the regulation of new and emerging tobacco and nicotine products in Latin America and the Caribbean. Rev Panam Salud Publica 2024; 48:e43. [PMID: 38859810 PMCID: PMC11164239 DOI: 10.26633/rpsp.2024.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 06/12/2024] Open
Abstract
Objective To document tobacco industry strategies to influence regulation of new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean. Methods We analyzed industry websites, advocacy reports, news media and government documents related to NETNPs, focusing on electronic cigarettes and heated tobacco products. We also conducted a survey of leading health advocates. We applied the policy dystopia model to analyze industry action and argument-based strategies on NETNP regulations. Results Industry actors engaged in four instrumental strategies to influence NETNP regulation - coalition management, information management, direct involvement in and access to the policy process, and litigation. Their actions included: lobbying key policy-makers, academics and vaping associations; providing grants to media groups to disseminate favorable NETNP information; participating in public consultations; presenting at public hearings; inserting industry-inspired language into draft NETNP legislation; and filing lawsuits to challenge NETNP bans. The industry disseminated its so-called harm reduction argument through large/influential countries (e.g., Argentina, Brazil, and Mexico). Industry discursive strategies claimed NETNPs were less harmful, provided safer alternatives, and should be regulated as so-called harm reduction products or have fewer restrictions on their sale and use than those currently in place. Conclusion Our analysis provides a better understanding of industry strategies to undermine tobacco and nicotine control. To help counter industry efforts, health advocates should proactively strengthen government capacities and alert policy-makers to industry attempts to create new regulatory categories (so-called reduced-risk products), provide misleading information of government authorizations of NETNPs, and co-opt so-called harm-reduction messages that serve the industry's agenda.
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Affiliation(s)
- Eric Crosbie
- School of Public HealthUniversity of Nevada RenoRenoNVUnited States of AmericaSchool of Public Health, University of Nevada Reno, Reno, NV, United States of America.
| | - Brian Tran
- School of Public HealthUniversity of Nevada RenoRenoNVUnited States of AmericaSchool of Public Health, University of Nevada Reno, Reno, NV, United States of America.
| | - Beatriz Albuquerque de Figueiredo
- Campaign for Tobacco-Free KidsWashington, D.C.United States of AmericaCampaign for Tobacco-Free Kids, Washington, D.C., United States of America.
| | - Luciana Severini
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Gianella Severini
- Campaign for Tobacco-Free KidsWashington, D.C.United States of AmericaCampaign for Tobacco-Free Kids, Washington, D.C., United States of America.
| | - Ernesto M. Sebrié
- Campaign for Tobacco-Free KidsWashington, D.C.United States of AmericaCampaign for Tobacco-Free Kids, Washington, D.C., United States of America.
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Tsima BM, Motlhatlhedi K, Sharma K, Rantshabeng P, Ndlovu A, Gaolathe T, Kyokunda LT. The association between smoking and cervical human papillomavirus infection among women from indigenous communities in western Botswana. PLoS One 2024; 19:e0302153. [PMID: 38848414 PMCID: PMC11161041 DOI: 10.1371/journal.pone.0302153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Cervical cancer, a malignancy caused by infection with oncogenic human papillomavirus, disproportionally affects women from low resource settings. Persistence of human papillomavirus infection may mediate an association between tobacco use and cervical cancer. In limited resource settings, women from indigenous communities are often marginalized and do not benefit from evidence-based interventions to prevent tobacco use or cervical cancer due to the limited reach of mainstream healthcare services to these communities. This study determined the association between smoking and high-risk human papillomavirus infection among women from indigenous communities in western Botswana. METHODS A cross-sectional study of women in indigenous communities was conducted between June and October 2022. Demographic, clinical and self-reported smoking data were collected. Cervical cytology and HPV DNA testing for high-risk human papillomavirus genotypes were performed. Multilevel multivariable logistic regression models were fit to evaluate the association between smoking and high-risk human papillomavirus infection while adjusting for potential confounders. RESULTS A total of 171 participants with a median (interquartile range) age of 40 (31-50) years from three settlements and two villages were recruited for the study. Of these, 17% were current smokers, 32.8% were living with HIV and high-risk human papillomavirus DNA was detected in 32.8% of the cervical specimens. Women who were current smokers, were nearly twice as likely to have cervical high-risk human papillomavirus infection compared to non-smokers (Adjusted Odds Ratio (95% CI); 1.74(1.09, 2.79)) after controlling for confounders. CONCLUSION These data underscore the need for effective tobacco control to help mitigate cervical cancer risk in this setting. These findings can help inform decisions about targeted cervical cancer prevention and tobacco cessation interventions for women from indigenous communities.
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Affiliation(s)
- Billy M. Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | | | - Andrew Ndlovu
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Szklo A, Souza MCD, Carvalho ADM. [What does the Brazilian National Health Survey have to say about the influence of cigarette spending on household income?]. CAD SAUDE PUBLICA 2024; 40:e00175423. [PMID: 38656070 PMCID: PMC11034624 DOI: 10.1590/0102-311xpt175423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/26/2024] Open
Abstract
In a country whose indicators of population impoverishment continue to increase, it is concerning that individuals spend money to buy cigarettes instead of using this resource in actions that strengthen aspects of the well-being of their lives and that of their families. Based on the Brazilian National Health Survey conducted in 2019, the influence of spending on manufactured cigarettes on the family budget in households with at least one smoker was estimated, stratified by sociodemographic characteristics. Brazilian smokers allocated around 8% of their average per capita monthly household income to the purchase of manufactured cigarettes. The percentage of average monthly expenditure on cigarettes reached almost 10% of this income among smokers aged 15 to 24 and was even higher for those with incomplete elementary education (approximately 11%). In the North and Northeast regions of the country, this expenditure exceeded 9%. The state with the most significant impact on household income was Acre (13.6%), followed by Alagoas (11.9%), Ceará, Pará, and Tocantins (all with approximately 11%). Our findings, therefore, reinforce the importance of strengthening the implementation of effective measures, such as tax policy, to reduce the proportion of smokers. Thus, the money that individuals currently allocate to purchase cigarettes can be used to meet their basic needs, contributing to the promotion of health and improving the quality of life.
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Affiliation(s)
- André Szklo
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
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Hirano T. Japan Tobacco corporate social responsibility activities misleadingly claim to advance Sustainable Development Goals. Tob Control 2024; 33:417-418. [PMID: 36167827 DOI: 10.1136/tc-2022-057630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tomoyasu Hirano
- Institute for Cancer Control, National Cancer Center, Tokyo, Japan
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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] [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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Théodore FL, González-Ángeles LR, Reynales-Shigematsu LM, Saenz-de-Miera B, Antonio-Ochoa E, Llorente B. The Challenges of Tobacco Fiscal Policy Implementation in Mexico From the Perspective of Key Actors. Nicotine Tob Res 2024; 26:444-451. [PMID: 37782763 DOI: 10.1093/ntr/ntad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Raising tobacco taxes is considered the most effective strategy to avoid smoking initiation and discourage its use, especially among vulnerable groups. However, few low- and middle-income countries have adopted high tobacco taxes. Raising taxes is, therefore, an opportunity to strengthen and accelerate tobacco control. The objective of this study is to analyze the barriers and facilitators to the tobacco tax increase in Mexico. AIMS AND METHODS Based on the Governance Analytical Framework, data were generated through 17 in-depth interviews with key intersectoral actors for fiscal policy. The interviews were transcribed and coded according to Hufty's theory of governance. RESULTS Robust scientific evidence, intersectoral coordination, and the presence of "champions" boosted progress in tobacco control (facilitators). The main barriers were the incomplete implementation of the World Health Organization-Framework Convention on Tobacco Control (WHO-FCTC) and MPOWER package and lack of commitment ("political will") by government decision makers and legislators, misinformation about the effects of tobacco taxes, and strong tobacco industry interference. CONCLUSIONS Robust evidence is necessary but not sufficient to advance the implementation of the MPOWER (WHO-FCTC) actions. To achieve tobacco tax increases and public policies that protect people from unhealthy products in general, the implementation of policies or legal frameworks against industry interference in the development of public policies is imperative. IMPLICATIONS By analyzing the barriers and facilitators to increasing the tobacco tax in Mexico, this study identifies two key messages: (1) The need to sensitize legislators and the general population to the problem of smoking not only through epidemiological data but also through testimonies that highlight the life experiences and adversities faced by people who smoke. (2) The need for a regulatory framework to prevent industry interference in public affairs and conflicts of interest. The same framework could be very useful for public health policies to control the consumption of ultra-processed food products or alcohol.
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Affiliation(s)
- Florence L Théodore
- Centro de Investigación de Nutrición y Salud (CINyS), Instituto Nacional de salud Pública, Cuernavaca, Mexico
| | | | | | - Belen Saenz-de-Miera
- Departamento Académico de Economía, Universidad Autonoma de Baja California Sur, Baja California, Mexico
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Chido-Amajuoyi OG, Osaghae I, Agaku IT, Chen B, Mantey DS. Exposure to school-based tobacco prevention interventions in low-income and middle-income countries and its association with psychosocial predictors of smoking among adolescents: a pooled cross-sectional analysis of Global Youth Tobacco Survey data from 38 countries. BMJ Open 2024; 14:e070749. [PMID: 38413149 PMCID: PMC10900417 DOI: 10.1136/bmjopen-2022-070749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To describe the prevalence of school-based tobacco prevention programme exposure among adolescents in low-income and middle-income countries (LMICs) and its association with psychosocial predictors of smoking. DESIGN Analysis of pooled cross-sectional data. SETTING Global Youth Tobacco Survey (GYTS), conducted in 38 LMICs. PARTICIPANTS This was a pooled analysis of data involving a total of 132 755 adolescent respondents to GYTS in 38 LMICs across Africa, Europe and Central/South America between 2014 and 2017. EXPOSURE AND OUTCOME MEASURES The primary independent variable for this study was self-reported exposure to school-based tobacco prevention programmes in the past year. Five psychosocial determinants of smoking were explored as outcomes: perceived addictiveness of nicotine, perceived harm of secondhand smoke exposure, support for restricting cigarette smoking at public indoor locations, support for restricting cigarette smoking at public outdoor areas and self-reported prediction of enjoying cigarette smoking. Multivariable logistic regression models were used to examine the relationship between exposure to school-based tobacco prevention programmes and study outcomes, controlling for sociodemographic and smoking-related characteristics of respondents. RESULTS Overall, 59.1% of adolescents in LMICs self-reported exposure to school-based tobacco prevention programmes. The country-specific prevalence of adolescent exposure to school-based tobacco interventions ranged from 24.9% in the Comoros to 99.3% in Turkmenistan. Exposure to school-based tobacco interventions was significantly associated with greater secondhand smoke harm perceptions (adjusted OR (AOR): 1.69; 95% CI: 1.69 to 1.70), perceptions of addictiveness (AOR: 1.37; 95% CI: 1.36 to 1.37) and supporting tobacco use restrictions indoors (AOR: 1.70; 95% CI: 1.69 to 1.70) and outdoors (AOR: 1.59; 95% CI: 1.59 to 1.60). Exposure to school-based tobacco interventions was associated with lower odds of anticipating enjoying cigarette smoking (AOR: 0.76; 95% CI: 0.76 to 0.76). CONCLUSION Exposure to tobacco prevention programmes in schools is suboptimal in LMICs. Given the protective associations described in this study from school-based tobacco prevention programme exposure, it is imperative that national governments implement school-based programmes into ongoing tobacco control measures.
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Affiliation(s)
| | - Ikponmwosa Osaghae
- Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Israel Terungwa Agaku
- Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Baojiang Chen
- Biostatistics, The University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Dale S Mantey
- Health Promotion/Behavioral Science, The University of Texas Health Science Center at Houston, Austin, Texas, USA
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11
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Londani M, Oladimeji O. Tobacco use and behaviour among South African adolescents and young adults: systematic review and meta-analysis. BMJ Open 2024; 14:e079657. [PMID: 38413155 PMCID: PMC10900320 DOI: 10.1136/bmjopen-2023-079657] [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: 09/08/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Tobacco use, particularly the initiation of smoking during adolescence and young adulthood, represents a significant public health concern in South Africa. This study aims to conduct a comprehensive review of published literature about tobacco use and behaviour among adolescents and young adults and to determine an aggregated prevalence estimate of tobacco use within this demographic. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus and Google Scholar were searched from 1 January 2000 through 31 October 2023. ELIGIBILITY CRITERIA Studies were eligible for inclusion if they were cross-sectional studies conducted in South Africa and measured the prevalence and determinants of tobacco use among adolescents and young adults aged 12-24 years. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted information for each article and saved it into an Excel spreadsheet. Risk of bias analysis was conducted using the Risk of Bias Assessment Tool for non-randomised studies. The methodology quality of each selected study was evaluated using the Joanna Briggs Institute checklist. The heterogeneity of prevalence estimates was assessed using I2 statistic (random-effects DerSimonian-Laid approach). RESULTS Out of 73 articles identified, 12 articles were included in the analysis. The pooled prevalence of current tobacco use among South African adolescents and young adults was estimated to be 22%. The pooled prevalence of tobacco use among school dropouts, university students and secondary school learners was 51%, 20% and 16%, respectively. Stratifying using gender, boys (26%) were two times more likely to use tobacco than girls (13%). CONCLUSION The elevated occurrence of tobacco usage among South African adolescents and young adults is a relevant public health concern. There is a need for more population-based prevalence studies at a national level to estimate the burden of tobacco use in South Africa. PROSPERO REGISTRATION NUMBER CRD42023428369.
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Affiliation(s)
- Mukhethwa Londani
- Directorate of Research and Innovation, Tshwane University of Technology, Pretoria, South Africa
| | - Olanrewaju Oladimeji
- Department of Epidemiology and Biostatistics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Aienobe-Asekharen C, Norris E, Martin W. A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:259. [PMID: 38541261 PMCID: PMC10970500 DOI: 10.3390/ijerph21030259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 07/23/2024]
Abstract
Health communication has been highlighted as a cost-effective preventive intervention in Africa, where the prevalence of tobacco use is still relatively low compared to other World Health Organization (WHO) regions. This scoping review aimed to examine tobacco control health communication interventions in Africa. The review was guided by the PRISMA-ScR checklist. Data was extracted from 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention on Tobacco Control reports on Article 12. Data extraction informed by the Joanna Briggs Institute (JBI) data-extraction questions was used for peer-reviewed studies while a pre-determined template was used for the other sources. Narrative data synthesis informed by the JBI manual for evidence synthesis was employed. A lack of research that comprehensively addresses all areas of health communication and inconsistent use of health communication campaigns were identified. Only an average of 6 countries had ever implemented high-quality national mass-media campaigns in a decade, while an average of 33 countries consistently failed to conduct campaigns that lasted more than 3 weeks. Although the involvement of key populations was clearly vital to ensure content relevance and message clarity, a lack of health communication informed by young people was observed, as they rarely participated in key decision-making despite reportedly being the targets of interventions. Clear health communication for tobacco-use prevention informed by young people is lacking in African countries. Active participation of young people in developing targeted campaigns is needed to facilitate content relevance and comprehension to ultimately contribute to tobacco-use prevention.
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Affiliation(s)
| | | | - Wendy Martin
- Department of Health Sciences, Brunel University London, London UB8 3PH, UK; (C.A.-A.); (E.N.)
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Shahriar MH, Hasan MM, Alam MS, Matthes BK, Gilmore AB, Zubair ABM. Tobacco industry interference to undermine the development and implementation of graphic health warnings in Bangladesh. Tob Control 2024:tobaccocontrol-2022-057538. [PMID: 37185882 DOI: 10.1136/tc-2022-057538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND In Bangladesh, the 2013 Amendment of the Tobacco Control Act made graphic health warnings (GHWs) on the upper 50% of all tobacco packs obligatory. However, at the time of writing (May 2022), GHWs are still being printed on the lower 50% of packs. This paper seeks to explore how the tobacco industry undermined the development and implementation of GHWs in Bangladesh, a country known for a high level of tobacco industry interference (TII) that has rarely been examined in the peer-reviewed literature. METHODS Analysis of print and electronic media articles and documents. RESULTS Cigarette companies actively opposed GHWs, while bidi companies did not. The primary strategy used to influence the formulation and delay the implementation of GHWs was direct lobbying by the Bangladesh Cigarette Manufacturers' Association and British American Tobacco Bangladesh. Their arguments stressed the economic benefits of tobacco to Bangladesh and sought to create confusion about the impact of GHWs, for example, claiming that GHWs would obscure tax banderols, thus threatening revenue collection. They also claimed technical barriers to implementation-that new machinery would be needed-leading to delays. Tensions between government bodies were identified, one of which (National Board of Revenue)-seemingly close to cigarette companies and representing their arguments-sought to influence others to adopt industry-preferred positions. Finally, although tobacco control advocates were partially successful in counteracting TII, one self-proclaimed tobacco control group, whose nature remains unclear, threatened the otherwise united approach. CONCLUSIONS The strategies cigarette companies used closely resemble key techniques from the well-evidenced tobacco industry playbook. The study underlines the importance of continuing monitoring and investigations into industry conduct and suspicious actors. Prioritising the implementation of WHO Framework Convention on Tobacco Control Article 5.3 is crucial for advancing tobacco control, particularly in places like Bangladesh, where close government-industry links exist.
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Affiliation(s)
| | | | | | | | | | - A B M Zubair
- PROGGA: Knowledge for Progress, Dhaka, Bangladesh
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Lencucha RA, Vichit-Vadakan N, Patanavanich R, Ralston R. Addressing tobacco industry influence in tobacco-growing countries. Bull World Health Organ 2024; 102:58-64. [PMID: 38164327 PMCID: PMC10753285 DOI: 10.2471/blt.23.290219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024] Open
Abstract
Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobacco-growing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.
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Affiliation(s)
- Raphael A Lencucha
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QCH3G 1Y5, Canada
| | | | | | - Rob Ralston
- School of Social and Political Science, University of Edinburgh, Edinburgh, Scotland
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Yang Z, Chen J, Han H, Wang Y, Shi X, Zhang B, Mao Y, Li AN, Yuan W, Yao J, Li MD. Single nucleotide polymorphisms rs148582811 regulates its host gene ARVCF expression to affect nicotine-associated hippocampus-dependent memory. iScience 2023; 26:108335. [PMID: 38025780 PMCID: PMC10679859 DOI: 10.1016/j.isci.2023.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/24/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Although numerous susceptibility loci are nominated for nicotine dependence (ND), no report showed any association of ARVCF with ND. Through genome-wide sequencing analysis, we first identified genetic variants associated nominally with ND and then replicated them in an independent sample. Of the six replicated variants, rs148582811 in ARVCF located in the enhancer-associated marker peak is attractive. The effective-median-based Mendelian randomization analysis indicated that ARVCF is a causal gene for ND. RNA-seq analysis detected decreased ARVCF expression in smokers compared to nonsmokers. Luciferase reporter assays indicated that rs148582811 and its located DNA fragment allele-specifically regulated ARVCF expression. Immunoprecipitation analysis revealed that transcription factor X-ray repair cross-complementing protein 5 (XRCC5) bound to the DNA fragment containing rs148582811 and allele-specifically regulated ARVCF expression at the mRNA and protein levels. With the Arvcf knockout mouse model, we showed that Arvcf deletion not only impairs hippocampus-dependent learning and memory, but also alleviated nicotine-induced memory deficits.
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Affiliation(s)
- Zhongli Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Joint Institute of Smoking and Health, Kunming, Yunnan 650024, China
| | - Jiali Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Haijun Han
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yan Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiaoqiang Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Bin Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ying Mao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Andria N. Li
- Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Wenji Yuan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jianhua Yao
- Joint Institute of Smoking and Health, Kunming, Yunnan 650024, China
| | - Ming D. Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Research Center for Air Pollution and Health, Zhejiang University, Hangzhou 310058, China
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16
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Nguenha N, Bialous S, Matavel J, Lencucha R. Tobacco industry presence and practices in Mozambique: a 'chaotic' but worthy market. Tob Control 2023; 33:86-92. [PMID: 35768213 DOI: 10.1136/tc-2022-057390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mozambique has experienced a series of tobacco industry consolidations both in tobacco leaf buying and processing, and in cigarette manufacturing and marketing. The growth of the tobacco industry presence in Mozambique was followed by an increase in tobacco industry's Corporate Social Responsibility (CSR) activities. This is the first paper to describe the history of tobacco industry activities in Mozambique, a party to the WHO Framework Convention on Tobacco Control (FCTC). METHODS We reviewed industry documents and associated web-based information. Industry documents (1990-2021) were identified through University of California San Francisco's Truth Tobacco Industry Documents Library. We followed with a search of web-based sources pertaining to the tobacco industry in Mozambique. We complemented our analysis with select media sources to identify statements by government officials in relation to the tobacco industry. We mapped major tobacco industry players, industry partnerships and corresponding CSR activities. RESULTS Tobacco production increased substantially in Mozambique in the 1990s when tobacco companies began targeting African countries. The increased attention to tobacco production, trade and sales in Mozambique was coupled with greater industry involvement in CSR activities. We identified 10 tobacco industry CSR programmes in Mozambique. Most of the CSR programmes focus on health including HIV/AIDS, social issues and environmental issues. CONCLUSIONS Similar to other tobacco-growing countries, the industry facilitated an increase in tobacco production and continues efforts to increase the tobacco consumption market while engaging in CSR activities focused on social and environmental issues. As in other countries, CSR initiatives in Mozambique enhance industry's reputation. Importantly, these CSR programmes and partnerships breach national laws and the provisions of the FCTC. The continuation of these programmes suggests limited attention within government to protect public policy from industry interference in compliance with Article 5.3 of the FCTC.
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Affiliation(s)
- Nicole Nguenha
- Family Medicine, McGill University, Montreal, Québec, Canada
| | - Stella Bialous
- Center for Tobacco Control, UCSF, San Francisco, California, USA
| | - Joaquim Matavel
- Mental Health Department, Ministry of Health, Maputo, Mozambique
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Ajumobi O, Itanyi IU, Ogidi AG, Slinkard SA, Ezeanolue EE. Potential risk factors for cardiovascular diseases and associated sociodemographic characteristics: A cross-sectional evaluation of a large cohort of women living with HIV in north-central Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002667. [PMID: 38051752 PMCID: PMC10697517 DOI: 10.1371/journal.pgph.0002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Males have a higher prevalence of cardiovascular (CVD) risk factors such as alcohol use, hypercholesterolemia, hypertension, obesity, and smoking based on limited data available from two tertiary health centers in Nigeria. Increasing age and lower educational level influence smoking among the same population in northeastern and northwestern Nigeria. Specifically in women living with HIV (WLHIV), the association between demographic characteristics and CVD risk factors has not been described. In a multi-center cross-sectional study, we documented the association of sociodemographic characteristics with potential CVD risk factors among a large cohort of WLHIV attending five treatment sites in north-central Nigeria. This was a cross-sectional study among 5430 women of reproductive age who received antiretrovirals at five selected treatment sites in Benue State, Nigeria. We performed multivariable regression of sociodemographic characteristics on potential cardiovascular risk factors, namely, smoking, alcohol consumption, and contraceptive use. We found participants' mean age was 33.2 (standard deviation: 6.1) years. Prevalence of smoking, alcohol consumption, and contraceptive use were 0.6%, 11%, and 7% respectively. Older WLHIV (≥ 40 years) had a negative association with contraceptive use (aOR: 0.58, 95%CI: 0.42-0.81). Being educated WLHIV had a positive association with contraceptive use (aOR: 1.34, 95%CI: 1.02-1.76) and a negative association with tobacco smoking (aOR: 0.37, 95%CI: 0.16-0.83). Being a farmer had a negative association with alcohol consumption (aOR: 0.43, 95%CI: 0.35-0.52) and contraceptive use (aOR: 0.61, 95%CI: 0.48-0.76). Compared to being married, being in a single relationship had positive association with alcohol consumption (aOR: 1.30, 95%CI: 1.08-1.56) while parenting was associated with 165% higher odds of contraceptive use (aOR: 2.65, 95%CI: 1.73-4.06). In conclusion, the low prevalence of smoking exists among women living with HIV on antiretroviral treatment. Older age, farming and being married are potential deterrents to lifestyle risk factors for cardiovascular diseases among this population. To improve HIV-related treatment efforts and outcomes, implementing interventions aimed at lifestyle behavioral modification among this population has the potential to reduce cardiovascular disease risks.
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Affiliation(s)
- Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Samantha A. Slinkard
- South Carolina Center for Rural and Primary Healthcare, Columbia, South Carolina, United States of America
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18
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Haklar I, Stephens J, Bowden J, Trigg J. Vaping industry participation standards in health organizations: an exploratory policy content analysis. Health Promot Int 2023; 38:daad146. [PMID: 37943847 PMCID: PMC10636788 DOI: 10.1093/heapro/daad146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The vaping industry has been found to employ similar tactics to tobacco industry actors to seek credibility and distort the scientific evidence base around the health harms of nicotine vaping products. As vaping industry interests undermine vaping control efforts, safeguards are necessary to protect against this influence. We aimed to examine health organizations' policies on vaping industry participation in their activities in Australia. A descriptive approach integrating policy analysis and key informant surveys was used to obtain vaping industry participation information from health research stakeholders. Descriptive statistics on organization type, policy document type, policy document industry focus (tobacco or vaping) and respondent role and responsibility were collected. We used framework analysis to identify themes describing organizational allowances, constraints, and rationale for vaping industry research participation. Relevant health organizations were identified within Australia for policy searching (n = 156), which identified 47 unique policy documents. After contacting 267 key stakeholders from eligible organizations, 31 survey responses were analysed. Research organizations and universities were highly represented in both the policy and survey data. Most health research stakeholders recognized that vaping industry interests counteract public health priorities and opposed vaping industry participation. However, many organizations lacked clear, vaping industry-specific participation policies. To protect the integrity of the emerging evidence base around vaping harms which inform vaping policy, health organizations require strong, comprehensive policies to resist vaping industry participation in research.
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Affiliation(s)
- Isabelle Haklar
- College of Medicine & Public Health, Flinders University, Kaurna (Bedford Park), South Australia 5042, Australia
| | - Jacqueline Stephens
- College of Medicine & Public Health, Flinders University, Kaurna (Bedford Park), South Australia 5042, Australia
- Flinders Health and Medical Research Institute, Kaurna (Bedford Park), South Australia 5042, Australia
| | - Jacqueline Bowden
- College of Medicine & Public Health, Flinders University, Kaurna (Bedford Park), South Australia 5042, Australia
- National Centre for Education and Training on Addiction, Flinders University, Kaurna (Bedford Park), South Australia 5042, Australia
| | - Joshua Trigg
- College of Medicine & Public Health, Flinders University, Kaurna (Bedford Park), South Australia 5042, Australia
- Flinders Health and Medical Research Institute, Kaurna (Bedford Park), South Australia 5042, Australia
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Badu E, Hallett J, Vujcich D, Crawford G, Bellringer ME. Setting the scene: a scoping review of gambling research in Ghana. Health Promot Int 2023; 38:daad171. [PMID: 38091619 DOI: 10.1093/heapro/daad171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Ghana, like many other African countries, has seen a rapid expansion in gambling industry activity in the last decade with sports betting becoming a popular pastime among young Ghanaian males. The proliferation of land based, and online gambling operations presents a significant public health threat to the citizenry. Yet little is known about gambling participation and harms, the size of the gambling market and the role of the gambling industry in influencing and perpetuating gambling behaviour in Ghana. The aim of this study was to contribute to understanding the extent of gambling research in Ghana by mapping out what the current literature indicates. Six databases were searched for peer-reviewed journal articles that focused on gambling in Ghana. The findings from this review demonstrate gambling research in Ghana is in a nascent state with a predominant focus on individual factors and limited consideration of public health. The implications for future research are highlighted, including the requirement for a nationally representative study to understand the prevalence of gambling participation and harm, and the role of the gambling industry. Public health action grounded in sound evidence is urgently required to address the individual and community level problems associated with this harmful commodity.
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Affiliation(s)
- Emmanuel Badu
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Daniel Vujcich
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Maria E Bellringer
- Gambling and Addictions Research Centre, School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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Monzon J, Mus S, Davila G, Barnoya J, Kim M, Thrasher J. Lil Solid: a more affordable option for heated tobacco products in Guatemala. Tob Control 2023:tc-2023-057954. [PMID: 38050166 PMCID: PMC11109015 DOI: 10.1136/tc-2023-057954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Jose Monzon
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
- Health Sciences School, Rafael Landivar University, Guatemala City, Guatemala, Guatemala
| | - Sophia Mus
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Gustavo Davila
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Joaquin Barnoya
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
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Levy DT, Thirlway F, Sweanor D, Liber A, Maria Sanchez-Romero L, Meza R, Douglas CE, Michael Cummings K. Do Tobacco Companies Have an Incentive to Promote "Harm Reduction" Products?: The Role of Competition. Nicotine Tob Res 2023; 25:1810-1821. [PMID: 36692328 PMCID: PMC10664083 DOI: 10.1093/ntr/ntad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Some cigarette companies have started to talk about replacing cigarettes with less harmful alternatives, which might include nicotine vaping products (NVPs), heated tobacco products (HTPs), and oral nicotine delivery products. We consider market competition as a primary driver of whether cigarette companies follow through on their stated intentions. AIMS AND METHODS We focus on the behavior of cigarette companies in the United States. We compare competition in the pre- and post-2012 time periods, analyze the impact of the growth in NVPs on smoking prevalence and cigarette company profits, and examine the potential future role of competition. RESULTS Since 2006, consumers have broadened their use of non-combustible nicotine delivery products (NCNDPs) to include, inter alia, NVPs, HTPs, and oral nicotine pouches. U.S. cigarette companies have acquired major stakes in each of these product categories which corresponds to a period of rapidly declining adult smoking prevalence, especially among younger adults (ages 18-24 years). The shifting dynamics of the nicotine product marketplace are also reflected in cigarette company stock prices. While cigarette companies are likely to promote HTPs and nicotine delivery products over NVPs, their incentives will be directly related to competition from independent firms, which in turn will depend on government regulation. CONCLUSIONS Although cigarette companies will back alternatives to combusted tobacco when threatened by competition, the prospects for their lasting conversion to NCNDPs will depend on the extent of such competition, which will be influenced by government regulation of tobacco products. IMPLICATIONS Regulations that limit competition from independent firms while also protecting cigarette company profits risk slowing or even reversing recent declines in smoking, especially among youth and young adults. Regulations that reduce the appeal and addictiveness of combusted tobacco products, such as higher cigarette taxes or a reduced nicotine standard, will encourage smokers to quit and/or switch to less harmful non-combusted forms of tobacco. The regulation of non-combustible nicotine delivery products and cigarettes should be proportionate to their relative risks, so that smokers have incentives to switch from combustibles to safer alternatives, and cigarette companies have incentives to promote safer products.
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Affiliation(s)
- David T Levy
- Oncology Department, Lombardi Comprehensive Center, Georgetown University, Washington, DC, USA
| | | | - David Sweanor
- Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alex Liber
- Oncology Department, Lombardi Comprehensive Center, Georgetown University, Washington, DC, USA
| | | | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charlestown, SC, USA
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22
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Hiscock R, Alaouie H, Matthes BK, Mehegan J, Bloomfield MJ. Hosting the Tobacco Industry Supply Chain and Political Interference. Nicotine Tob Res 2023; 25:1847-1855. [PMID: 37707978 PMCID: PMC10664082 DOI: 10.1093/ntr/ntad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION We found no comprehensive studies on the location of transnational tobacco and leaf company (TTLC) subsidiaries (business entities they control) or the consequences of their presence on health policy. AIMS AND METHODS Here we assess (1) the global reach of TTLCs by mapping their tobacco growing and manufacturing subsidiaries and (2) the relationship between in-country presence of the tobacco industry and their power and interference. Data on subsidiaries were collated through systematic searching for countries' supply chain activities in documents and web pages. Cross-sectional multiple regression analysis was used to assess the association between the number of agricultural and manufacturing TTLCs and the Tobacco Industry Interference score, and the degree to which these were mediated by tobacco control, good governance, and economic importance of tobacco. RESULTS TTLC supply chain activity had global reach. As the number of TTLCs with tobacco growing and manufacturing activities rose, interference increased significantly. Interference was associated with poorer tobacco control. The association with more TTLCs undertaking final product manufacturing was related to higher-value tobacco exports but was not related to tobacco making a bigger contribution to the economy. CONCLUSIONS TTLCs continue to control the global tobacco supply chain through their globe-spanning subsidiaries. The presence of TTLCs in a country is associated with political interference. Countries should consider their participation in the tobacco supply chain alongside the understanding that they are likely to cede political power to TTLCs, potentially undermining the health of their populations. IMPLICATIONS Tobacco control research has traditionally concentrated on the demand side of tobacco. Our results lend support to calls for more research on the supply of tobacco. Governments should require tobacco companies to provide detailed, up-to-date information in an easily accessible format on in-country supply chain activities. Policymakers should take the likelihood of political interference in health and environmental policy into account when making decisions about foreign direct investment offered by the tobacco industry.
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Affiliation(s)
- Rosemary Hiscock
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Hala Alaouie
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Britta K Matthes
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- Centre for Development Studies, University of Bath, Bath, UK
| | - John Mehegan
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Michael J Bloomfield
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- Department of Social and Policy Sciences, University of Bath, Bath, UK
- Centre for Development Studies, University of Bath, Bath, UK
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23
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Kishore J, Kaur J, Satpathy N, Jena PK, Venkatarao E. The Indian ban on loose cigarettes. Tob Induc Dis 2023; 21:148. [PMID: 37954488 PMCID: PMC10632937 DOI: 10.18332/tid/172515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Jugal Kishore
- Department Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Jagdish Kaur
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Nancy Satpathy
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Sikhsha ‘O’ Anusandhan University, Bhubaneswar, India
| | - Pratap K. Jena
- School of Public Health, Kalinga Institute of Industrial Technology, Bhubaneswar, India
| | - Epari Venkatarao
- Department of Community Medicine, Institute of Medical Sciences and Sum Hospital, Sikhsha ‘O’ Anusandhan University, Bhubaneswar, India
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24
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Acharya Y, Karmacharya V, Paudel U, Joshi S, Ghimire R, Adhikari SR. Perceptions of key stakeholders on taxes on tobacco and alcohol products in Nepal. BMJ Glob Health 2023; 8:e012040. [PMID: 37813451 PMCID: PMC10565236 DOI: 10.1136/bmjgh-2023-012040] [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: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are on the rise in Nepal. Consumption of alcohol and tobacco products remains high. Taxes on these products are significantly below the rate recommended by the WHO. In an effort to understand the reasons behind the slow progress towards the adoption of higher health taxes to curb NCDs, we documented the perceptions of key stakeholders on health taxes, including perceived barriers and facilitators to adopting higher health taxes. METHODS We conducted 45 in-depth interviews with individuals comprising government officials; producers, wholesale distributors and sellers of alcohol and tobacco products; and consumers and representatives from civil society organisations. We conducted a thematic analysis of the resulting data. RESULTS Respondents from alcohol and tobacco industries are not supportive of higher health taxes. They argued that higher taxes can increase illicit trade and worsen inequality. Strikingly, several government officials shared the industries' concerns, arguing that health taxes have limited potential to reduce consumption of alcohol and tobacco products to help curb NCDs. In terms of barriers to adoption of higher health taxes, several local government representatives opined that close ties between industries and politicians at the federal level is a major hindrance. CONCLUSIONS In order to adopt higher health taxes, the government will need to counter the false narrative pushed by alcohol and tobacco industries on the negative economic effects of such taxes. Health taxes earmarked for NCDs need to reflect the amount of revenue raised, reoriented towards prevention efforts and communicated clearly to the public.
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Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, State College, Pennsylvania, USA
| | | | | | - Supriya Joshi
- Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Shiva Raj Adhikari
- Central Department of Economics, Tribhuvan University, Kathmandu, Nepal
- Nepal Health Economics Association, Kathmandu, Nepal
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25
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Londani M, Oladimeji O. Prevalence and Associated Factors of Cigarette Smoking among South African Adolescents and Young Adults: A Systematic Review and Meta-Analysis Protocol. Methods Protoc 2023; 6:85. [PMID: 37736968 PMCID: PMC10514879 DOI: 10.3390/mps6050085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
Tobacco use, particularly the initiation of smoking during adolescence and young adulthood, represents a significant public health concern in South Africa. The influence of socio-cultural factors, marketing strategies of the tobacco industry, and accessibility of tobacco products have all been implicated in this context. This systematic review and meta-analysis protocol aims to scrutinise the body of literature on this issue, providing a comprehensive understanding of the patterns and determinants of tobacco use among South African adolescents and young adults, with an eye towards informing more effective policy interventions. The available literature for studies on tobacco use will be systematically searched and reviewed. Five international scholarly databases, namely PubMed, MEDLINE, EMBASE, Global Health, and Scopus, will be searched. Peer-reviewed studies will be included if they are conducted in South Africa or South African provinces and if they include the prevalence of tobacco use among adolescents and young adults aged between 12 and 24 years. The results of such an analysis can guide future policy designs, enabling them to be more targeted and thus more effective. The findings can also have implications for shaping global tobacco control strategies, given the transferability of successful interventions across different populations and cultural contexts. This protocol has been registered in the PROSPERO database (ID: CRD42023428369).
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Affiliation(s)
- Mukhethwa Londani
- Department of Public Health, Walter Sisulu University, Eastern Cape, Mthatha 5117, South Africa;
- Directorate of Research and Innovation, Tshwane University of Technology, Pretoria 0001, South Africa
| | - Olanrewaju Oladimeji
- Department of Public Health, Walter Sisulu University, Eastern Cape, Mthatha 5117, South Africa;
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26
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Sánchez-Franco S, Montgomery SC, Torres-Narvaez ES, Ramírez AM, Murray JM, Tate C, Llorente B, Bauld L, Hunter RF, Kee F, Sarmiento OL. How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia. Int J Behav Med 2023:10.1007/s12529-023-10211-z. [PMID: 37697141 DOI: 10.1007/s12529-023-10211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings. METHOD A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data. RESULTS We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape. CONCLUSION These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.
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Affiliation(s)
- Sharon Sánchez-Franco
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | | | - Erika S Torres-Narvaez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | - Ana M Ramírez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | - Jennifer M Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Christopher Tate
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Linda Bauld
- College of Medicine and Veterinary Medicine, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Olga L Sarmiento
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia.
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27
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Cohen JE, Myers ML, Ahluwalia IB. WHO Framework Convention on Tobacco Control Learnings. Health Secur 2023; 21:428-429. [PMID: 37552835 PMCID: PMC10541915 DOI: 10.1089/hs.2023.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Affiliation(s)
- Joanna E. Cohen
- Joanna E. Cohen, PhD, is Director, Institute for Global Tobacco Control, and Bloomberg Professor of Disease Prevention, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew L. Myers
- Matthew L. Myers, JD, is Former President, Campaign for Tobacco-Free Kids, Washington, DC
| | - Indu B. Ahluwalia
- Indu B. Ahluwalia, PhD, is Branch Chief, Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. The findings and conclusions in this document are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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28
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Lang J, Mendenhall E, Koon AD. Disentangling opioids-related overdose syndemics: a scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104152. [PMID: 37542742 DOI: 10.1016/j.drugpo.2023.104152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
This article reviews research investigating the synergistic interaction of opioid-related morbidity and mortality with other social, psychiatric, and biological conditions, to describe how and why it is syndemic. Opioid-related overdose syndemics are driven by commercial interests, emerging in communities facing social and economic disadvantage, and interacting with a range of other health conditions. We included articles that empirically investigated an opioid-related syndemic, discussed syndemic co-factors associated with opioid use, or framed opioid consumption conceptually in relation to syndemics. Most articles were conducted in and first authored by investigators from North America. These articles were published in journals focused on general public health (n = 20), drug use and addiction (n = 18), and infectious disease or HIV (n = 15). Most original research articles (n = 60) employed quantitative methods. Unlike scholarship from other disciplines, specifically the controversial "Deaths of Despair" (DoD) framework, most research on opioid-related overdose syndemics fails to fully articulate the macro-structural drivers of localized disease clustering. Instead, the syndemics scholarship emphasizes the clinical manifestations of opioid and substance use, illustrating a problem in translation at the heart of syndemic theory. Moreover, syndemics scholarship on opioid impacts remains largely disconnected from the wider DoD discourse, which represents a missed opportunity for equity-oriented research. Re-directing attention to the sociopolitical forces that shape opioid-related overdose syndemics is necessary to prevent future commercially-driven health crises and repair lives harmed by these deadly syndemics.
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Affiliation(s)
- Jake Lang
- Science, Technology, and International Affairs Program, Walsh School of Foreign Service, Georgetown University, Washington, DC, United States
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, Walsh School of Foreign Service, Georgetown University, Washington, DC, United States.
| | - Adam D Koon
- Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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29
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Muchlis N, Yusuf RA, Rusydi AR, Mahmud NU, Hikmah N, Qanitha A, Ahsan A. Cigarette Smoke Exposure and Stunting Among Under-five Children in Rural and Poor Families in Indonesia. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231185210. [PMID: 37434666 PMCID: PMC10331105 DOI: 10.1177/11786302231185210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
Cigarette smoke exposure in mothers and children is highly prevalent in Asia, especially among rural and poor families. Second-hand smoke exposure might affect the nutritional status of children. Despite the emerging double burden of malnutrition and the very high prevalence of smoking in Indonesia, few studies have examined the effects of parental smoking on children's nutritional status. This study aims to measure the relationship between family smoking behavior and the occurrence of stunting in children under 5 years. This cross-sectional study used a purposive sampling technique, with 221 households with children aged 0 to 59 months from poor areas in Indonesia. Exposure to cigarette smoke is assessed using The Secondhand Smoke Exposure Scale questionnaire. The outcome measured is child stunting (height-for-age Z-score). The prevalence of stunting was estimated at 145 (65.6%). Children living with smoking parents were counted for 157 (71%), and most smoking exposure comes from fathers 147 (67.4%). The predictors of stunting in children under 5 years were a smoker father with (AOR 1.8; 95% CI 1.281-4.641), both parents are smokers increasing the risk of stunting with (COR 3.591; 95% CI 1.67-3.77), being exposed of smoke for more than 3 hours a day increase the risk of stunted children (COR 2.05; 95% CI 1.214-3.629), and using traditional cigarette or kretek expand the risk of stunting (AOR 3.19; 95% CI 1.139-67.785). The findings demonstrate the negative impact of parental smoking on children's growth, reinforcing the importance of reducing smoking prevalence by imposing a smoke-free home policy in the stunting prevention strategy.
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Affiliation(s)
- Nurmiati Muchlis
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Rezky Aulia Yusuf
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
- Save The Teenager Indonesia, Makassar,
Indonesia
| | - Arni Rizqiani Rusydi
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Nur Ulmy Mahmud
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Nurul Hikmah
- Faculty of Public Health, Universitas
Muslim Indonesia, Makassar, South Sulawesi, Indonesia
| | - Andriany Qanitha
- Faculty of Medicine, Universitas
Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Abdillah Ahsan
- Faculty of Economics and Business,
University of Indonesia, Depok, West Java, Indonesia
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30
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Matthes BK, Kumar P, Dance S, Hird T, Carriedo Lutzenkirchen A, Gilmore AB. Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature. Global Health 2023; 19:42. [PMID: 37344818 DOI: 10.1186/s12992-023-00936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND There has been remarkable tobacco control progress in many places around the globe. Tobacco industry interference (TII) has been identified as the most significant barrier to further implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Civil society has been recognised as a key actor in countering TII. While TII has been extensively studied for several decades now, there is little research that focuses on counteractions to limit it and their effectiveness to do so. This scoping review seeks to map the peer-reviewed literature on civil society's activities of countering TII in policymaking to identify common counterstrategies and assess their effectiveness. METHODS Data sources: We searched Embase, IBSS, JSTOR, PubMed, Science Direct, Scopus and Web of Science using the following terms: ("Tobacco industry" OR "Tobacco compan*") AND. ("corporate political activity" OR "CPA" OR "lobbying" OR "interference") AND ("advoca*" OR "counter*" OR "activi*"), without time or language restrictions. STUDY SELECTION Our selection criteria included peer-reviewed studies that were written in English, German, or Spanish that drew on primary data and/or legal and policy documents and reported at least one specific example of civil society members or organisations countering tobacco industry action-based strategies. DATA EXTRACTION Advocates' counterstrategies were analysed inductively and countered industry strategies were analysed using the Policy Dystopia Model (PDM). Perceptions of effectiveness of countering attempts were analysed descriptively. RESULTS We found five common counterstrategies among 30 included papers covering five WHO regions; 1. Exposing industry conduct and false claims; 2. Accessing decision-makers; 3. Generating and using evidence; 4. Filing a complaint or taking legal action; 5. Mobilising coalition and potential supporters. These counterstrategies were used to work against a wide range of industry strategies, which are captured by five action-based strategies described in the PDM (Coalition Management, Information Management, Direct Access and Influence, Litigation, Reputation Management). While some studies reported the outcome of the countering activities, their impact remained largely underexplored. CONCLUSION The review shows that peer-reviewed literature documenting how civil society actors counter TII is scarce. It suggests that advocates employ a range of strategies to counter TII in its different forms and use them flexibly. More work is needed to better understand the effects of their actions. This could stimulate discussions about, and facilitate learning from, past experiences and help to further enhance advocates' capacity.
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Affiliation(s)
- Britta K Matthes
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK.
| | | | - Sarah Dance
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
| | - Tom Hird
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
| | | | - Anna B Gilmore
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
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31
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Koivu AM, Näsänen-Gilmore PK, Hunter PJ, Muthiani Y, Isojärvi J, Heimonen O, Bastola K, Csonka L, Ashorn P, Ashorn U. Antenatal interventions to address harmful behaviors and psychosocial risk factors in the prevention of low birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S148-S159. [PMID: 37331761 DOI: 10.1016/j.ajcnut.2022.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Risk factors related to the harmful behaviors, psychosocial wellbeing, and socio-economic circumstances in the lives of pregnant women can lead to adverse birth outcomes, including low birth weight (LBW). OBJECTIVE This systematic search and review aims to provide a comparative evidence synthesis on the effect of eleven antenatal interventions targeted to address psychosocial risk factors on adverse birth outcomes. METHODS We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between March 2020 and May 2020. We included randomized controlled trials (RCTs) and reviews of RCTs of eleven antenatal interventions for pregnant females reporting LBW, preterm birth (PTB), small-for-gestational-age or stillbirth as outcomes. For interventions where randomization was either not feasible or unethical, we accepted non-randomized controlled studies. RESULTS Seven records contributed data to the quantitative estimates of the effect sizes and 23 contributed to narrative analysis. Psychosocial interventions for reducing smoking in pregnancy likely reduced the risk of LBW, and professionally provided psychosocial support for at-risk women possibly reduced the risk of PTB. Financial incentives or nicotine replacement therapy as smoking cessation aids, or virtually delivered psychosocial support did not appear to reduce the risk of adverse birth outcomes. The available evidence on these interventions was primarily from high-income countries. For other reviewed interventions (psychosocial interventions to reduce alcohol use, group based psychosocial support programs, intimate partner violence prevention interventions, antidepressant medication, and cash transfers) there was little evidence in any direction regarding the efficacy or the data was conflicting. CONCLUSIONS Professionally provided psychosocial support during pregnancy in general and specifically as a means to reduce smoking can potentially contribute to improved newborn health. The gaps in the investments for research and implementation of psychosocial interventions should be addressed to better meet the global targets in LBW reduction.
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Affiliation(s)
- Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland
| | | | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jaana Isojärvi
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Otto Heimonen
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kalpana Bastola
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leon Csonka
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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32
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Nunes-Rubinstein M, Leão T. Arguments used by proponents and opponents in Brazil's regulatory discussions of e-cigarettes and heated tobacco products. Tob Control 2023; 32:296-301. [PMID: 34531313 DOI: 10.1136/tobaccocontrol-2021-056628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019. METHODS We conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request. RESULTS The arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the 'health' theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used. CONCLUSIONS Those that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.
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Affiliation(s)
| | - Teresa Leão
- EPI-Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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Twesten JE, Stecher C, Arinaitwe J, Parascandola M. Tobacco control research on the African continent: a 22-year literature review and network analysis. Tob Control 2023:tc-2022-057760. [PMID: 37068947 DOI: 10.1136/tc-2022-057760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Describe the landscape of tobacco-related topics, funders and institutional networks in Africa. DATA SOURCES We searched PubMed, Embase and African Index Medicus for published articles from January 1996 to August 2018 in any language. STUDY SELECTION Two researchers independently reviewed titles and abstracts for a focus on nicotine or tobacco product(s) and describe data or recommendations specific to Africa. Ultimately, 818 articles were identified. DATA EXTRACTION Three independent coders conducted qualitative analyses of articles and extracted funders, study populations, countries of research focus, research topics, tobacco products, study design and data source. A bibliometric analysis estimated coauthorship networks between the countries of authors' primary institutional affiliation. DATA SYNTHESIS All 54 African countries were represented in two or more articles. The coauthorship network included 2714 unique authors representing 90 countries. Most articles employed a cross-sectional study design with primary data collection, focused on cigarettes and studied use behaviour. Few articles examined tobacco farming or interventions for cessation or prevention. The most frequently cited funder was the US National Institutes of Health (27.2%). A range of coauthorship patterns existed between African institutions with some coauthoring with one institution while others coauthored with 761 institutions in other African countries. CONCLUSIONS The literature review identified the need for implementation research for tobacco control interventions and policies, economic and development impacts of tobacco use research, and tobacco industry and tobacco production and farming research. Numbers of research collaborations between institutions in Africa vary, suggesting the need for regional institutional capacity building.
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Affiliation(s)
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Jim Arinaitwe
- Center for Tobacco Control in Africa, Kampala, Uganda
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
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34
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Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, Demaio S, Erzse A, Freudenberg N, Friel S, Hofman KJ, Johns P, Abdool Karim S, Lacy-Nichols J, de Carvalho CMP, Marten R, McKee M, Petticrew M, Robertson L, Tangcharoensathien V, Thow AM. Defining and conceptualising the commercial determinants of health. Lancet 2023; 401:1194-1213. [PMID: 36966782 DOI: 10.1016/s0140-6736(23)00013-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 10/13/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.
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Affiliation(s)
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, UK
| | - Fran Baum
- Stretton Health Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Krista Bondy
- Stirling Management School, University of Stirling, Stirling, UK
| | - Ha-Joon Chang
- Department of Economics, School of Oriental and African Studies University of London, London, UK
| | - Sandro Demaio
- Victorian Health Promotion Foundation, Melbourne, VIC, Australia
| | - Agnes Erzse
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nicholas Freudenberg
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia
| | - Karen J Hofman
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Paula Johns
- ACT Health Promotion, Rio de Janeiro, Brazil
| | - Safura Abdool Karim
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, NSW, Australia
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Sheikh ZD, Branston JR, Gilmore AB. Tobacco industry pricing strategies in response to excise tax policies: a systematic review. Tob Control 2023; 32:239-250. [PMID: 34373285 PMCID: PMC9985732 DOI: 10.1136/tobaccocontrol-2021-056630] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/01/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore what is known about the tobacco industry's (TI) price-based responses to tobacco excise tax policies and whether these vary by country income group using a systematic review. DATA SOURCES Studies assessing TI pricing tactics were identified via searches of five online databases using a combination of search keywords. STUDY SELECTION Inclusion criteria were applied by two reviewers independently who screened all search results (titles and abstracts) for possible inclusion. They identified 37 publications that reported TI pricing tactics. DATA EXTRACTION Study details were tabulated, and information was extracted on the country income group, population characteristics, excise tax structure, and pricing strategies. DATA SYNTHESIS Of the 37 publications identified, 22 were conducted in high-income countries, while 15 covered low-income and middle-income countries (LMICs). Major pricing strategies employed were: differentially shifting taxes between products (35 studies); launching new brands/products as pathways for downtrading (six studies), product promotions and different prices for the same products for different customers (six studies); price smoothing (two studies); and changing product attributes such as length/size of cigarettes or production processes (three studies). CONCLUSIONS While there is limited evidence to fully ascertain industry responses to tax increases, this review suggests that the TI widely uses a multitude of sophisticated pricing strategies across different settings around the world with the intention of undermining tax policies, thereby increasing tobacco consumption and maximising their profits. There is a need for further research in this area especially in LMICs so that effective policy responses can be developed.
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Affiliation(s)
- Zaineb Danish Sheikh
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
| | - J Robert Branston
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
- School of Management, University of Bath, Bath, UK
| | - Anna B Gilmore
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
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Egbe CO, Ngobese SP, Barca H, Crosbie E. "Are they trying to control us people?": News media coverage of COVID-19 lockdown tobacco sales ban in South Africa. PLoS One 2022; 17:e0278888. [PMID: 36508420 PMCID: PMC9744309 DOI: 10.1371/journal.pone.0278888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
The South African government imposed one of the strictest lockdowns in the world as part of measures to curb the spread of COVID-19 in the country, including a ban on the sale of tobacco products. This study explored news media coverage of arguments and activities in relation to the South African lockdown tobacco sales ban. We collected media articles published between 26 March to 17 August 2020, which corresponded to the period of the sales ban. Data were sourced via google search and snowball identification of relevant articles. Thematic analysis of data was conducted with the aid of NVivo. We analysed a total of 305 articles relevant to the South African tobacco sales ban during the lockdown. Six major themes were identified in the data: challenges associated with implementing the ban, litigation, and threats of litigation to remove the ban, governance process and politicization of the ban, pro and anti-tobacco sales ban activities and arguments and reactions to the announcement lifting the ban. The initial reason for placing the ban was due to the non-classification of tobacco products as an essential item. Early findings of a link between tobacco smoking and COVID-19 disease severity led to an extension of the ban to protect South Africa's fragile health system. Pro-sales ban arguments included the importance of protecting the health system from collapse due to rising COVID-19 hospitalization, benefit of cessation, and the need for non-smokers to be protected from exposure to secondhand smoke. Anti-sales ban arguments included the adverse effect of nicotine withdrawal symptoms on smokers, loss of jobs and the expansion of the illicit cigarette markets. Litigation against the ban's legality was a strategy used by the tobacco industry to mobilize the public against the ban while promoting their business through the distribution of branded masks and door-to-door delivery which goes against current tobacco regulations. The media could serve as a veritable tool to promote public health if engaged in productive ways to communicate and promote public health regulations to the general population. Engagement with the media should be enhanced as part of health promotion strategies.
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Affiliation(s)
- Catherine O. Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- * E-mail:
| | - Senamile P. Ngobese
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hannah Barca
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Eric Crosbie
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, Nevada, United States of America
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Crosbie E, Carriedo A. Applying a Commercial Determinants of Health Lens to Understand, Expose and Counter Industry Co-option, Appeasement and Partnership Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy". Int J Health Policy Manag 2022; 11:2744-2747. [PMID: 35942972 PMCID: PMC9818084 DOI: 10.34172/ijhpm.2022.7371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/15/2022] [Indexed: 01/21/2023] Open
Abstract
Lacy-Nichols and Williams' examination of the food industry illustrates how it altered its approach from mostly oppositional to regulation to one of appeasement and co-option. This reflection builds upon this by using a commercial determinants of health (CDoH) lens to understand, expose and counter industry co-option, appeasement and partnership strategies that impact public health. Lessons learned from tobacco reveal how tobacco companies maintained public credibility by recruiting scientists to produce industry biased data, co-opting public health groups, gaining access to policy elites and sitting on important government regulatory bodies. Potential counter solutions to food industry appeasement and co-option include (i) understanding corporate actions of health harming industries, (ii) applying mechanisms to minimize industry engagement, (iii) dissecting industry relationship building, and (iv) exposing the negative effects of public private partnerships (PPPs). Such counter-solutions might help to neutralise harmful industry practices, products and policies which currently threaten to undermine healthy food policies.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
| | - Angela Carriedo
- World Public Health Nutrition Association, London, UK
- Department of Health, University of Bath, Bath, UK
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Goyal LD, Verma M, Garg P, Bhatt G. Variations in the patterns of tobacco usage among indian females - findings from the global adult tobacco survey India. BMC Womens Health 2022; 22:442. [DOI: 10.1186/s12905-022-02014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Males dominate in tobacco usage, as well as in tobacco research, knowing that women face more severe health consequences. There is a specific lack of information on epidemiological statistics, risks, and the level of knowledge among women regarding tobacco. This study examines the Global Adult Tobacco Survey (GATS)-India dataset to estimate female tobacco usage and assess socio-economic variations in tobacco consumption, awareness regarding the adverse effects of tobacco, noticing pack health warnings (PHW), and intention to quit tobacco use well as factors influencing these domains.
Methods
Using a geographically clustered multistage sampling method, the nationally representative GATS II (2016–17) interviewed 40,265 female respondents aged 15 years and above from all Indian states and union territories. Standard operational definitions were used to estimate the primary independent variables (community, individual, and household categories) and dependent variables like awareness regarding the adverse effects of tobacco, noticing pack health warning (PHW), and intention to quit tobacco. Sampling weights were adjusted while performing the analysis. Bivariate and multivariable analysis were used to generate the estimates.
Results
Of the total female respondents, 84.2% were never-users, 13.3% ever consumed Smokeless Tobacco (SLT) products, 1.8% ever smoked tobacco, and 0.8% were dual users once in their lives. Around 16% of the women had exposure to Second Hand Smoke (SHS) either at their homes, workplaces or in public places. Overall, maximum awareness was seen among non-smoker females (64.7%) and dual users (64.7%), followed by women exposed to SHS, SLT users, and smokers. PHW was noticed more by the bidi smokers, followed by SLT users and cigarette smokers. Factors that positively affected intention to quit smoking included younger age, secondary school education, self-employed status, the habit of buying packed cigarettes/bidi, believing that smoking causes serious illness, and attempted quitting in the last 12 months.
Conclusion
A high proportion of women consume tobacco which is significantly influenced by socio-demographic factors. Tobacco regulators should be especially concerned about women as the tobacco marketing experts target them. Mobilizing self-help groups and organizations working for women and children could assist broader campaigns to generate awareness and motivate quitting attempts.
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Filby S, van der Zee K, van Walbeek C. The temporary ban on tobacco sales in South Africa: lessons for endgame strategies. Tob Control 2022; 31:694-700. [PMID: 33472979 PMCID: PMC9606502 DOI: 10.1136/tobaccocontrol-2020-056209] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The endgame literature recommends that, for a tobacco sales ban to be successful, several demand-side preconditions (eg, low prevalence and effective cessation support) should be in place. The South African Government imposed a ban on the sale of all tobacco and vaping products between 27 March and 17 August 2020, as part of the COVID-19 lockdown. OBJECTIVES To assess how cigarette smokers responded to the sales ban, to evaluate how the ban impacted the cigarette market in South Africa and to use the South African experience to inform endgame planning. METHODS Regular preban cigarette smokers completed an online questionnaire from 4 to 19 June 2020 (n=23 631), in which they reported on their prelockdown cigarette smoking patterns, quitting behaviour (if relevant) and smoking behaviour during the ban. RESULTS About 9% of prelockdown smokers in the sample successfully quit smoking. 93% of continuing smokers purchased cigarettes despite the sales ban. The average price of cigarettes increased by 250% relative to prelockdown prices. Most respondents purchased cigarettes through informal channels. CONCLUSIONS The demand-side preconditions for an effective sales ban were not in place in South Africa, making a sales ban inappropriate. The South African experience suggests that supply-side factors are also important in ensuring the success of a sales ban. These are: (1) the illicit market must be under control before implementing a sales ban; and (2) an effective sales ban needs to be synchronised with a ban on the manufacture, transport and distribution of cigarettes.
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Affiliation(s)
- Samantha Filby
- Research Unit on the Economics of Excisable Products, University of Cape Town School of Economics, Rondebosch, South Africa
| | - Kirsten van der Zee
- Research Unit on the Economics of Excisable Products, University of Cape Town School of Economics, Rondebosch, South Africa
| | - Corné van Walbeek
- Research Unit on the Economics of Excisable Products, University of Cape Town School of Economics, Rondebosch, South Africa
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Tattan-Birch H, Brown J, Jackson SE. 'Give 'em the vape, sell 'em the pods': razor-and-blades methods of pod e-cigarette pricing. Tob Control 2022; 31:773-774. [PMID: 33766938 PMCID: PMC9606490 DOI: 10.1136/tobaccocontrol-2020-056354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Harry Tattan-Birch
- Behavioural Science and Health, University College London, London, London, UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, London, London, UK
| | - Sarah E Jackson
- Behavioural Science and Health, University College London, London, London, UK
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Piper ME, Maddox R, Castro Y, Hinds JT, Henderson PN, Clark H, Guy MC, Choi K. Lessons Learned on Addressing Racism: Recommendations from The Society for Research on Nicotine and Tobacco's Racial Equity Task Force. Addiction 2022; 117:2567-2570. [PMID: 35751445 PMCID: PMC9491328 DOI: 10.1111/add.15964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Megan E Piper
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Raglan Maddox
- Modewa Clan, Papua New Guinea
- National Centre for Epidemiology and Public Health, The Australian National University, Canberra, Australia
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Josephine T Hinds
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Patricia Nez Henderson
- Navajo Nation (Diné), Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Hershel Clark
- Navajo Nation (Diné), Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, VA, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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Nkodia AJ, Tsiobinda BE, Antaon JSS, Missongo SR, Tienkeu PDN, Milandou CHD. [Prevalence and factors associated with smoking among adults living in the Moungali district of Brazzaville in 2021]. Pan Afr Med J 2022; 43:6. [PMID: 36284884 PMCID: PMC9557804 DOI: 10.11604/pamj.2022.43.6.34180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/04/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction tobacco epidemic is a real public health problem in the world and in Africa. The purpose of this study was to estimate the prevalence and identify factors associated with smoking among adults living in the Moungali district. Methods we conducted a cross-sectional analytical study of 800 adults. Two-stage random sampling was used to select subjects in the Moungali district, Brazzaville, in September 2021. Binary logistic regression using the ascending stepwise method allowed identification of the associated factors. The adjustment of the model was verified by the Hosmer Lomeshow test. Data were collected via the Kobo collect V1.30.1 app. and analyzed with the Stata 15.0 software. Results smoking prevalence was 4.63%, 95% CI [3.37-6.31]. Males (AOR=8.36 95% CI [3.74-18.72], p-value < 0.0001), alcohol consumption (AOR=2.6 95% CI [1.11-6.11], p-value = 0.028), and professional activity (formal or informal sector) (AOR=3.91 95% CI [1.16-13.11], p-value = 0.027) were factors significantly associated with smoking. Conclusion this study highlights that smoking is a stronger risk factor in men than in women. In addition, alcohol consumption and professional activity in the formal or informal sector are also factors associated with active smoking. Preventive actions focusing on these factors are necessary to effectively fight smoking in adults.
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Affiliation(s)
- Arkadit Jeandria Nkodia
- Association Congolaise pour la Santé publique et Communautaire, Brazzaville, République du Congo,,Corresponding author: Arkadit Jeandria Nkodia, Association Congolaise pour la Santé publique et Communautaire, Brazzaville, République du Congo.
| | | | | | - Steven Richy Missongo
- Association Congolaise pour la Santé publique et Communautaire, Brazzaville, République du Congo
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Radó MK, van Lenthe FJ, Laverty AA, Filippidis FT, Millett C, Sheikh A, Been JV. Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study. THE LANCET PUBLIC HEALTH 2022; 7:e616-e625. [DOI: 10.1016/s2468-2667(22)00112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
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Ralston R, Bialous S, Collin J. Firm foundation or neglected cornerstone? The paradox of Article 5.3 implementation and the challenge of strengthening tobacco control governance. Tob Control 2022; 31:s1-s4. [PMID: 35260466 PMCID: PMC9125363 DOI: 10.1136/tobaccocontrol-2022-057344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Stella Bialous
- Center for Tobacco Control, UCSF, San Francisco, California, USA
| | - Jeff Collin
- Global Health Policy Unit, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
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Ralston R, Hirpa S, Bassi S, Male D, Kumar P, Barry RA, Collin J. Norms, rules and policy tools: understanding Article 5.3 as an instrument of tobacco control governance. Tob Control 2022; 31:s53-s60. [PMID: 35393367 PMCID: PMC9125364 DOI: 10.1136/tobaccocontrol-2021-057159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Article 5.3 of the WHO Framework Convention on Tobacco Control, elaborated via its implementation guidelines, can be understood as a policy instrument comprising norms, rules and policy tools designed to shape practices of policy making and minimise tobacco industry interference. METHODS This qualitative research is based on in-depth interviews with officials from diverse government sectors and non-governmental organisations across countries (Ethiopia, India, Uganda) that have adopted measures to implement Article 5.3. RESULTS The data highlight varied perceptions and knowledge of Article 5.3 norms between health and non-health sectors. Health officials typically link its core norm of a fundamental conflict between public health and industry interests to the governance norm of protecting public health policies from industry interference. While officials in sectors beyond health broadly endorsed this core norm, they exhibited more limited awareness of Article 5.3 and its model of governance. The results examine how rules to implement Article 5.3 have been codified, but identify the absence of policy tools necessary to operationalise rules and norms. This limitation, alongside restricted awareness beyond health departments, suggests that political commitments to implement Article 5.3 will have limited impact on practices of stakeholder consultation and policy engagement with the tobacco industry. CONCLUSION Conceptualising Article 5.3 as a policy instrument helps to explain how its rules and policy tools interact with each other and with broader governance processes. This framework has the potential to enhance understanding of Article 5.3 and help identify opportunities and constraints in its implementation.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
| | - Selamawit Hirpa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Denis Male
- School of Public Health, Makerere University, Kampala, Uganda
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rachel Ann Barry
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
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Male D, Ralston R, Nyamurungi K, Collin J. 'That is a Ministry of Health thing': Article 5.3 implementation in Uganda and the challenge of whole-of-government accountability. Tob Control 2022; 31:s12-s17. [PMID: 35078911 PMCID: PMC9125367 DOI: 10.1136/tobaccocontrol-2021-057049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/25/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION While Uganda has made legislative progress towards implementing Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC), ongoing challenges in minimising tobacco industry interference have not been adequately explored. This analysis focuses on understanding difficulties in managing industry engagement across government ministries and in developing effective whole-of-government accountability for tobacco control. METHODS Interviews with Uganda government officials within the health sector and beyond, including in Ministries of Trade, Agriculture and Revenue. RESULTS The findings indicate substantial variations in awareness of Article 5.3, its norm and practices across government sectors. The data suggest ambiguity and uncertainty about accountability for Article 5.3 implementation, with policy makers in departments beyond health often uncertain about obligations under the FCTC. Second, we highlight how responsibility for Article 5.3 implementation and the obligations incurred are widely seen as restricted to the Ministry of Health. Third, competing mandates and perceived difficulties in reconciling health goals with economic growth are shown to impact on accountability for tobacco control. Yet, importantly, the data also demonstrate enthusiasm in some unexpected parts of government for actively engaging with Article 5.3 and for promoting greater intersectoral coordination. CONCLUSION This paper demonstrates the intrinsic challenges of developing whole-of-government approaches, highlighting considerable uncertainty and ambiguity among decision makers in Uganda about tobacco control governance. The analysis points to the potential for Uganda's national coordinating mechanism to help reconcile competing expectations and demonstrate the importance of Article 5.3 beyond health actors.
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Affiliation(s)
- Denis Male
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, Makerere University, Kampala, Uganda
| | - Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Hirpa S, Ralston R, Deressa W, Collin J. 'They have a right to participate as a stakeholder': Article 5.3 implementation and government interactions with the tobacco industry in Ethiopia. Tob Control 2022; 31:s5-s11. [PMID: 35101970 PMCID: PMC9125371 DOI: 10.1136/tobaccocontrol-2021-056885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This paper explores implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control in Ethiopia. The analysis highlights how operationalising key requirements of Article 5.3, such as minimising policy engagement with the tobacco industry, has been mediated by path-dependent processes of stakeholder consultation and collaboration that have persisted following privatisation of Ethiopia's state-owned tobacco monopoly. METHODS We conducted semistructured interviews with key officials (n=21) working in tobacco control policy, with high levels of access secured across ministries and agencies beyond health. RESULTS We found contrasting levels of awareness of Article 5.3 across government sectors, with extremely limited awareness in departments beyond health. The data also highlight competing ideas about conflict of interest, in which recognition of a fundamental conflict of interest with the tobacco industry is largely confined to health actors. Beyond limited cross-sectoral awareness and understanding of Article 5.3, gaps in implementation are exacerbated by assumptions and practices around stakeholder consultation, in which attempts to minimise policy interactions with the tobacco industry are mediated by institutionally embedded processes that presume active engagement. The results also highlight a continuation of the close relationship between the Ethiopian government and tobacco monopoly following its privatisation. CONCLUSION The Ethiopian government's recent achievements in tobacco control legislation require that policymakers are actively supported in reconciling perceived tensions and requirements for stakeholder consultation. Effective tobacco control governance would be further enhanced by enabling government agencies to more clearly identify which interactions with the tobacco industry are strictly necessary under Article 5.3 guideline recommendations.
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Affiliation(s)
- Selamawit Hirpa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinbrugh, Edinburgh, UK
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinbrugh, Edinburgh, UK
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Akinyemiju T, Ogunsina K, Gupta A, Liu I, Braithwaite D, Hiatt RA. A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries. Front Public Health 2022; 10:884678. [PMID: 35719678 PMCID: PMC9204349 DOI: 10.3389/fpubh.2022.884678] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
Cancer incidence and mortality rates continue to rise globally, a trend mostly driven by preventable cancers occurring in low-and middle-income countries (LMICs). There is growing concern that many LMICs are ill-equipped to cope with markedly increased burden of cancer due to lack of comprehensive cancer control programs that incorporate primary, secondary, and tertiary prevention strategies. Notably, few countries have allocated budgets to implement such programs. In this review, we utilize a socio-ecological framework to summarize primary (risk reduction), secondary (early detection), and tertiary (treatment and survivorship) strategies to reduce the cancer burden in these countries across the individual, organizational, community, and policy levels. We highlight strategies that center on promoting health behaviors and reducing cancer risk, including diet, tobacco, alcohol, and vaccine uptake, approaches to promote routine cancer screenings, and policies to support comprehensive cancer treatment. Consistent with goals promulgated by the United Nations General Assembly on Noncommunicable Disease Prevention and Control, our review supports the development and implementation of sustainable national comprehensive cancer control plans in partnership with local communities to enhance cultural relevance and adoption, incorporating strategies across the socio-ecological framework. Such a concerted commitment will be necessary to curtail the rising cancer and chronic disease burden in LMICs.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States,Duke Cancer Institute, Durham, NC, United States,*Correspondence: Tomi Akinyemiju
| | - Kemi Ogunsina
- Department of Public Health Sciences, University of Miller School of Medicine, Miami, FL, United States
| | - Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Iris Liu
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida, Gainesville, FL, United States,University of Florida Cancer Center, Gainesville, FL, United States
| | - Robert A. Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States
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He H, Pan Z, Wu J, Hu C, Bai L, Lyu J. Health Effects of Tobacco at the Global, Regional, and National Levels: Results From the 2019 Global Burden of Disease Study. Nicotine Tob Res 2022; 24:864-870. [PMID: 34928373 DOI: 10.1093/ntr/ntab265] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The purpose was to quantify the health effects of tobacco using data from the 2019 Global Burden of Disease study. AIMS AND METHODS We collected detailed information on tobacco consumption overall as well as its individual aspects (smoking, secondhand smoke, and chewing tobacco) for the deaths and disability-adjusted life years (DALYs) for all-cause disease, cardiovascular disease, neoplasms, and chronic respiratory diseases, and their age-standardized rates (ASRs). RESULTS Tobacco was responsible for 8.71 million deaths and 229.77 million DALYs globally in 2019. The ASRs of all tobacco-related deaths and DALYs declined from 1990 to 2019, to 108.55 deaths per 100 000 population and 2791.04 DALYs per 100 000 population in 2019. During any year the ASRs of all tobacco-related deaths and DALYs were higher in males than in females. The ASRs of all tobacco-related deaths and DALYs were highest in countries with a low-middle sociodemographic index (SDI) and lowest in high-SDI countries in 2019. Cardiovascular disease, neoplasms, and chronic respiratory diseases were the three leading causes of tobacco-related mortality. CONCLUSIONS Although the ASRs of deaths and DALYs related to tobacco have declined, the absolute number remain high. Tobacco control policies need to be strengthened further in order to reduce the heavy health burden of tobacco. IMPLICATIONS This study provides a detailed description on the health effects of tobacco, including maps of the current global burden of tobacco-related disease. Although the ASRs of tobacco-related deaths and DALYs have declined, the absolute numbers remain high-tobacco was responsible for 8.71 million deaths and 229.77 million DALYs globally in 2019. The findings may have implications for tobacco control. Countries where progress has been slower in reducing tobacco-related disease burden should study and consider implementing policies and strategies that have been applied in countries like Singapore which show the greatest declines for recent decades.
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Affiliation(s)
- Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Zhenyu Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiayuan Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Chuanyu Hu
- Department of Stomatology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ling Bai
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Chakrabarti A, Memirie ST, Yigletu S, Kiros M, Verguet S. The potential distributional health and financial benefits of increased tobacco taxes in Ethiopia: Findings from a modeling study. SSM Popul Health 2022; 18:101097. [PMID: 35620486 PMCID: PMC9127671 DOI: 10.1016/j.ssmph.2022.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
Ethiopia raised taxes on tobacco products in early 2020, increasing the overall price of the typical pack of cigarettes by about 67%. We quantify the potential impacts of Ethiopia's tobacco tax hike on various outcomes—life years, tax revenues, cigarette expenditures and catastrophic health expenditures (CHE). Using parameters like price elasticity of demand for cigarettes and smoking prevalence in Ethiopia from the existing literature and secondary data sources, we model the potential implications of the reform at the population level and for different wealth quintiles. We focus only on men since a small proportion of Ethiopian women smoke. Results indicate that Ethiopia's tax hike could induce a significant proportion of current smokers to quit smoking and thereby save almost eight million years of life in the current population. The reform is also likely to increase tax revenues by USD26 million in the first year after its introduction. The richest quintile will bear the greatest share of this higher tax burden and the poorest will bear the least. Additionally, deaths due to the main diseases associated with smoking will fall. This is expected to avert up to 173,000 CHE cases due to the out-of-pocket costs that would have been incurred in obtaining medical treatment. This analysis highlights that cigarette tax hikes in countries that have low smoking prevalence can reduce smoking even further, and thereby protect against the future health and financial costs of smoking. Importantly, the effects of these policies can be progressive across the income spectrum. We model the potential impacts of a recent tobacco tax increase in Ethiopia. Results show that the reform could save eight million years of life. Government tax revenue will likely go up by $26 million in the first year. Up to 173,000 fewer cases of catastrophic health expenditures could occur. All these effects are expected to disproportionately benefit the poorest.
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