1
|
van der Eijk Y, Tan GPP, Makhbal B. Is It Time to Ban Flavored Cigarettes in Asia-Pacific Countries? A Scoping Review. Asia Pac J Public Health 2024; 36:542-549. [PMID: 39054851 DOI: 10.1177/10105395241266042] [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] [Indexed: 07/27/2024]
Abstract
Flavored cigarettes encourage youth smoking and deter quitting. No country in Asia-Pacific, a region with some of the world's highest smoking rates, has regulated tobacco flavors. We examined market data, academic literature, and gray literature to describe what is known on flavored cigarettes in the Asia-Pacific region. Of the 12 countries for which market data were available, ten had substantial flavored cigarette market shares ranging from 10% to 97%. With no regulations and growing markets for flavor capsule variants, the tobacco industry's ongoing promotion of flavored cigarettes, which targets primarily youth and women, is expected to drive further increases in smoking prevalence. There are significant research and monitoring gaps on the industry's marketing tactics and use of flavored cigarettes in the region. Given the large market shares, Asia-Pacific countries stand to benefit substantially from a tobacco flavors ban.
Collapse
Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | |
Collapse
|
2
|
Sahadewo GA, Lencucha R, Bandara S, Drope J, Witoelar F. Assessing the Level of Poverty and Utilization of Government Social Programs Among Tobacco Farmers in Indonesia. Nicotine Tob Res 2024; 26:1132-1140. [PMID: 38456837 PMCID: PMC11339166 DOI: 10.1093/ntr/ntae050] [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: 04/24/2023] [Revised: 12/20/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Studies examining profit suggest that former tobacco farmers do as well or better than current tobacco farmers. Research has yet to examine the relationship among current and former tobacco farmers, poverty, and receipt of government social assistance. This type of research is critical to understanding the direct and indirect subsidization of tobacco growing. This study analyzed tobacco farmers' poverty levels and receipt of government social assistance programs. AIMS AND METHODS We designed and conducted an original four-wave economic survey of current and former tobacco farming households in Indonesia between 2016 and 2022. We then used descriptive analysis and probit regression for panel data to estimate the relationship between tobacco farming and poverty status. RESULTS Tobacco farmers' per capita income and poverty rates vary across years. The poverty rate was significantly higher in the year with a higher-than-normal rainfall as it negatively affected farming outcomes. During this year, the poverty rate among current tobacco farmers was also higher than that of former tobacco farmers. Regression estimates from the panel data confirm the association between tobacco farming and the likelihood of being poor. We also found a high share of current tobacco farmers who receive government social assistance programs, such as cash transfer programs and a universal healthcare program. CONCLUSIONS Our findings show high poverty rates-particularly during bad farming years-and high rates of government social assistance among tobacco farmers. The high rates of government assistance among tobacco farmers living in poverty show that the government is indirectly subsidizing the tobacco industry.
Collapse
Affiliation(s)
- Gumilang Aryo Sahadewo
- Departement of Economics, Faculty of Economics and Business, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine and Health and Sciences, McGill University, Montreal, QC, Canada
| | - Shashika Bandara
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jeffrey Drope
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - Firman Witoelar
- Crawford School of Public Policy, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
3
|
Bigwanto M, Pénzes M, Urbán R. Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults. BMC Public Health 2024; 24:1140. [PMID: 38658887 PMCID: PMC11040837 DOI: 10.1186/s12889-024-18626-3] [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: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.
Collapse
Affiliation(s)
- Mouhamad Bigwanto
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl Limau II, Jakarta, 12210, Indonesia.
| | - Melinda Pénzes
- Data-Driven Health Division of the National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, H-1125, Hungary
| | - Róbert Urbán
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
| |
Collapse
|
4
|
Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [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: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
Collapse
Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| |
Collapse
|
5
|
Picanço JMA, Limberger RP, Apel MA. Where should I start? A scoping review about the publications on clove cigarettes. Crit Rev Toxicol 2022; 52:259-293. [PMID: 35971813 DOI: 10.1080/10408444.2022.2097053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The general lack of knowledge about the composition of clove cigarettes and the large number of terms that can be used to define different types of cigarettes that contain cloves makes it difficult to find scientific articles focused on the subject. We reviewed the publications that cited clove cigarettes to assess their relevance. METHODS We searched publications on Scopus, ScienceDirect, PubMed, and Portal CAPES during the first semester of 2021, without date restrictions. Through a quality assessment, the studies found were assorted in ten different categories. RESULTS Indonesian clove cigarettes-also known as kretek-are a mixture of tobacco and cloves rolled in a cigarette and sprayed with oils, plant extract, and food flavorings, in an unknown quantity and composition, different from each brand, which is usually kept in secret. Due to the relatively low prevalence of use in the general population, most publications on tobacco products tend to ignore clove cigarettes or place them in an existing category. Clove cigarettes can be hand-rolled, machine-made, filtered, unfiltered, and each form can be named differently. The interchangeable use of each term, sometimes grouping conventional cigarettes in the mix, can lead the researcher to consider a publication that should be excluded. CONCLUSION The existing regulations on flavored cigarettes, although well-intentioned, are still somewhat vague and broad, leaving possible loopholes that can be exploited by the tobacco industries. Fully understanding the precise effects caused by clove cigarettes can be an important tool in future discussions about tobacco control.
Collapse
Affiliation(s)
| | | | - Miriam Anders Apel
- Faculty of Pharmacy, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
6
|
Braun M, Marsidi LL, Klingelhöfer D, Groneberg DA. Kretek Cigarettes and Particulate Matter Emissions-An Aerosol Spectrometric Study on Typical Indonesian Brands Flavored With Cloves. Nicotine Tob Res 2022; 24:778-784. [PMID: 34633042 DOI: 10.1093/ntr/ntab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/08/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In Indonesia, smoking is widespread. The same applies to second-hand smoke (SHS) exposure. More than 90% of Indonesian smokers smoke clove cigarettes, so-called Kreteks. They often contain more tar and nicotine than conventional cigarettes, but little is known about particulate matter (PM) emissions. In smokers' homes, SHS is the main source of PM that is hazardous to health. This study presents data of PM emissions from Kreteks. METHODS SHS was generated in a closed 2.88 m³ measuring chamber. PM fractions (PM10, PM2.5, PM1) of three popular Kretek brands (two king-sized and one slim-sized) in comparison to conventional cigarettes and a reference cigarette were measured by laser aerosol spectroscopy in real-time. RESULTS The king-sized Kreteks reached PM10 and PM2.5 mean concentrations of up to about 3000 µg/m³, and PM1 mean concentrations of up to about 2700 µg/m³. Consequently, these Kreteks emitted up to about 100% more PM10 and PM2.5, respectively 84% more PM1 than the reference cigarette, and up to about 260% more PM10 and PM2.5, respectively 234% more PM1 than the other investigated cigarettes. CONCLUSIONS PM emissions from Kreteks can be very high. The Indonesian public should be informed and warned about it, considering the high prevalence of smoking and SHS exposure, in particular. The Indonesian tobacco control regulation is limited, and it is overdue to start with a serious and effective tobacco control policy. PM declaration to government authorities could be useful in smoking prevention and tobacco control. IMPLICATIONS Research data are limited for Kretek cigarettes, including data on particulate matter (PM). The clove buds in Kretek cigarettes are for flavoring the smoke and shall soften the smoke feeling. That makes them very popular in Indonesia, in particular. The declaration of PM data of Kreteks and other tobacco products can play a key role in a more effective tobacco policy to reduce consumption of tobacco products, not only in Indonesia. To provide data on PM emissions, this study ascertained PM amounts in passive smoke from Indonesian Kreteks.
Collapse
Affiliation(s)
- Markus Braun
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Laura Lian Marsidi
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Doris Klingelhöfer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
7
|
Morrison CN, Lee JP, Giovenco DP, West B, Hidayana I, Astuti PAS, Mooney SJ, Jacobowitz A, Rundle A. The geographic distribution of retail tobacco outlets in Yogyakarta, Indonesia. Drug Alcohol Rev 2021; 40:1315-1324. [PMID: 33779016 DOI: 10.1111/dar.13285] [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: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Tobacco smoking prevalence in Indonesia is among the highest in the world. Research worldwide identifies that physical access to tobacco through retail outlets is related to increased tobacco smoking. Tobacco outlet density is very high in many Indonesian cities, so tobacco access may contribute to the high prevalence of tobacco use in that country. The aim of this study was to examine distributions of tobacco outlets in one Indonesian city, Yogyakarta, in relation to social and physical environmental conditions. METHODS For this cross-sectional ecological study, we virtually audited randomly selected street segments (n = 1099) using Google Street View. The outcome of interest was a count of tobacco advertising banners (indicating the presence of retail outlets). Exposures were physical environmental conditions (scales of main roads, physical decay, presence of schools, mosques, churches) and social conditions measured at the neighbourhood level (concentrated disadvantage, age composition, population density). RESULTS Tobacco banners were present on 36.4% of sampled street segments, including 55 (37%) of 147 streets with schools; a total of 1381 banners were identified. Multilevel negative binomial regression models for street segments nested within neighbourhoods found the prevalence of tobacco banners per 100 m was lower near schools (RR = 0.66, 95% CI 0.45, 0.97) and was not associated with other exposure measures. DISCUSSION AND CONCLUSIONS Retail tobacco outlets are ubiquitous in Yogyakarta. Although they are relatively less prevalent on streets with schools, the high absolute values and wide spatial distribution means all residents of Yogyakarta are exposed to tobacco outlets.
Collapse
Affiliation(s)
- Christopher N Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Brooke West
- Columbia School of Social Work, Columbia University, New York, USA
| | - Irma Hidayana
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA
| | - Putu A S Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ahuva Jacobowitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| |
Collapse
|
8
|
Astuti PAS, Assunta M, Freeman B. Tobacco Control Stakeholder Perspectives on the Future of Tobacco Marketing Regulation in Indonesia: A Modified Delphi Study. J Prev Med Public Health 2021; 54:330-339. [PMID: 34649395 PMCID: PMC8517369 DOI: 10.3961/jpmph.21.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia. METHODS Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item. RESULTS The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years. CONCLUSIONS Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.
Collapse
Affiliation(s)
- Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
- Udayana Center for NCDs, Tobacco Control and Lung Health, Udayana University, Denpasar, Indonesia
| | - Mary Assunta
- South East Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, Australia
- Prevention Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Kramer E, Ahsan A, Rees VW. Policy incoherence and tobacco control in Indonesia: an analysis of the national tobacco-related policy mix. Tob Control 2021; 32:tobaccocontrol-2021-056633. [PMID: 34362851 DOI: 10.1136/tobaccocontrol-2021-056633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Indonesia has a high smoking prevalence that has not diminished significantly since 1990. Considering this, we aim to summarise the existing national tobacco-related policy mix and explore markers of policy incoherence in tobacco control between 2014 and 2020. METHODS We conducted (1) a review and synthesis of Indonesian tobacco-related legislation and regulations; (2) a systematic search and synthesis of related literature and news reporting; and (3) interviews with tobacco control activists and academics to understand political will towards tobacco control regulations and the tobacco industry. RESULTS Indonesia's existing tobacco-related policy mix lies across the president's office, six national ministries and one independent agency. However, current responsibility lies primarily with four government ministries: Ministries of Health, Finance, Communication and Information, and Trade and Industry, with the Ministry of Finance most active. Evidence demonstrates that official interministerial collaboration was lacking from 2014 to 2020 and suggests that institutional will to introduce more effective tobacco control varies considerably between different arms of government. DISCUSSION Political will differs according to ministerial mandates and priorities, fostering a fragmented policy approach and undermining the development of a coherent response. Without political will from the president or national parliament to create an overarching framework for tobacco control, either via ratification of the Framework Convention on Tobacco Control or another mechanism, there remains no formal impetus for intragovernmental cooperation. Nonetheless, this analysis reveals some government progress and 'pressure points' that advocates can focus on to promote tobacco control policies within the current policy mix.
Collapse
Affiliation(s)
- Elisabeth Kramer
- Sydney Southeast Asia Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Abdillah Ahsan
- Faculty of Economics, University of Indonesia, Depok, West Java, Indonesia
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Nuryunarsih D, Lewis S, Langley T. Health Risks of Kretek Cigarettes: A Systematic Review. Nicotine Tob Res 2021; 23:1274-1282. [PMID: 33503247 PMCID: PMC8360627 DOI: 10.1093/ntr/ntab016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023]
Abstract
Introduction The objective of this study is review the evidence on the health risks associated with smoking kretek cigarettes compared with not smoking or smoking regular cigarettes. Methods We conducted a systematic literature search in five electronic databases: EMBASE (Ovid), ASSIA, PubMed and Scopus. Since kretek use is largely restricted to Indonesia, we identified additional studies using an online search for grey literature and studies in Indonesian journals and the National Library of Indonesia. We included relevant search terms in English (“kretek” and “clove cigarettes”) and Bahasa (“rokok” and “merokok”). We selected studies which compared any health outcome between smokers of kretek cigarettes and non-smokers or smokers of regular cigarettes. We included studies in any smokers compared to non-smokers in Indonesia, since most Indonesian smokers use kretek, but analysed these separately. Study data were extracted by a single reviewer and checked by two reviewers. Methodological quality was assessed using the Newcastle-Ottawa scale. Results We identified 32 studies, all from Indonesia. There were 31 cross-sectional studies and one case control study. This systematic review identified a relatively limited number of studies, and most of these were of poor quality as assessed by the Newcastle Ottawa score. They were generally cross-sectional, small and lacking justification for sample size, had high potential for selection bias because of lack of data on non-respondents or those lost to follow up, and missing information about the statistical analysis. Fourteen studies looked specifically at kretek exposure and eighteen looked at any type of cigarette exposure but were conducted in Indonesia are therefore likely to predominantly reflect kretek exposure. Kretek were found to be associated with oral cancer, cardiovascular disease, chronic health disease, myocardial infarction, asthma, and oral diseases. Conclusions Although existing studies are of poor quality, kretek are likely to be at least as harmful as regular cigarettes.
Collapse
Affiliation(s)
- Desy Nuryunarsih
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,SPECTRUM Consortium, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,SPECTRUM Consortium, Nottingham, UK
| |
Collapse
|
11
|
Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, Chumo F, Cueto L, Niaura R, Zhang A. Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav 2021; 112:106612. [PMID: 33002679 DOI: 10.1016/j.addbeh.2020.106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The growing prevalence of tobacco use in low "to middle" income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. METHODS Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. RESULTS Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. CONCLUSIONS Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.
Collapse
|
12
|
Fauzi R, Areesantichai C. Factors associated with electronic cigarettes use among adolescents in Jakarta, Indonesia. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-01-2020-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PurposeThis study aimed to examine factors associated with electronic cigarette use among adolescents aged 15–19 in Jakarta, Indonesia.Design/methodology/approachThe study was a school-based survey involving 1,318 students from 14 high schools in Jakarta. A multistage cluster sampling methodology was used. The authors used the chi-square test and multiple logistic regression to examine the association between electronic cigarette use and sociodemographic, social influences, health risk perceptions, availability, affordability and conventional cigarette smoking status.FindingsOverall, 6.3% of females and 29% of males reported ever having used electronic cigarettes. Electronic cigarette use was independently associated with sex, school locations, conventional cigarette smoking status, peer use, availability and perceptions that electronic cigarettes aid conventional cigarette smoking cessation. Compared with non-smokers, lifetime (AOR: 8.740, 95% CI: 5.126–14.901) and current conventional cigarette smokers (AOR: 18.380, 95% CI: 10.577–31.938) were more likely to use electronic cigarettes.Social implicationsThe use of electronic cigarettes among adolescents was considerably high in this study. Therefore, the tobacco control policy should be extended to regulate the marketing and use of all types of tobacco products and not just conventional cigarettes.Originality/valueThe study explored beyond individual lifestyle factors that contributed to electronic cigarette use in Indonesia such as affordability, school locations and availability of electronic cigarettes. These issues have not been specifically discussed in previous studies.
Collapse
|
13
|
Astuti PAS, Assunta M, Freeman B. Why is tobacco control progress in Indonesia stalled? - a qualitative analysis of interviews with tobacco control experts. BMC Public Health 2020; 20:527. [PMID: 32306928 PMCID: PMC7168953 DOI: 10.1186/s12889-020-08640-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs). METHOD We conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas. RESULTS The multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption. CONCLUSION Tobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and enforcing the World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC) would enable the Indonesian government to shift the power imbalance towards public health stakeholders. Tobacco control advocates must enhance their network cohesion and embrace other community groups to improve engagement and communication with policymakers.
Collapse
Affiliation(s)
- Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia. .,School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mary Assunta
- South East Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration (PRC), Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
14
|
Septiono W, Kuipers MAG, Ng N, Kunst AE. Changes in adolescent smoking with implementation of local smoke-free policies in Indonesia: Quasi-experimental repeat cross-sectional analysis of national surveys of 2007 and 2013. Drug Alcohol Depend 2020; 209:107954. [PMID: 32171158 DOI: 10.1016/j.drugalcdep.2020.107954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Banning smoking from public places may prevent adolescent smoking, but there is little evidence on impact of smoke-free policies (SFPs) from low and middle-income countries. This study assessed to what extent the adoption of local SPFs in Indonesia between 2007 and 2013 associated with adolescent smoking. METHODS Data on 239,170 adolescents (12-17 years old) were derived from the 2007 and 2013 national health surveys in 497 districts and 33 provinces. This study compared 2013 survey respondents living in districts/provinces that adopted SFPs between 2007 and 2013, with 2007 respondents and 2013 respondents in districts/provinces that did not adopt policies. Multilevel logistic regression analysis assessed whether SFP was associated with daily and non-daily smoking. We controlled for survey year, SFP in 2007, socio-demographics, and district characteristics. RESULTS Strong district SFPs was significantly associated with lower odds of daily smoking (OR:0.81, 95 %CI:0.69-0.97), but non-significantly with non-daily smoking (OR:0.89, 95 %CI:0.76-1.05). Strong provincial SFPs was not associated with daily smoking (OR:1.02, 95 %CI:0.84-1.25), but was associated with higher odds of non-daily smoking (OR:1.22, 95 %CI:0.99-1.51). Moderately strong SFPs did not consistently show associations in the same direction. For example, moderately strong provincial SFP was associated with higher odds of daily smoking (OR:1.27, 95 %CI:1.11-1.46) and lower odds of non-daily smoking (OR:0.82, 95 %CI:0.72-0.93). CONCLUSION We did not detect a consistent short-term effect of district and province-level smoke-free policies on adolescent smoking in Indonesia. Weak implementation and poor compliance may compromise effectiveness, which would call for improvement of SFP implementation in Indonesia.
Collapse
Affiliation(s)
- Wahyu Septiono
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, P.O. Box 22660, Amsterdam 1100DD, the Netherlands.
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, P.O. Box 22660, Amsterdam 1100DD, the Netherlands
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 463, 40530, Gothenburg, Sweden; Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Försörjningsvägen 7B, 90187, Umeå, Sweden
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, P.O. Box 22660, Amsterdam 1100DD, the Netherlands
| |
Collapse
|
15
|
Mlinarić M, Schreuders M, Graen L, Lessenich S. Transnational tobacco companies and the mechanism of externalization: A realist synthesis. Health Place 2019; 61:102240. [PMID: 31734138 DOI: 10.1016/j.healthplace.2019.102240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 10/16/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022]
Abstract
Externalization theory assumes that risks and costs are systematically displaced from high-income countries (HICs) to low- and middle-income countries (LMICs). We review how and why transnational tobacco companies (TTCs) influence the local circumstances of LMICs that trigger externalization mechanisms, leading to tobacco-attributable risk outcomes. Our realist synthesis of scientific evidence and gray literature identifies externalization mechanisms with risk outcomes at the level of health policy, smoking trends, and tobacco production. The results reveal the mediating role of local and global third parties and intermediaries. Externalization mechanisms produce systematic tobacco-attributable inequalities between places located in HICs and those located in LMICs.
Collapse
Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Stephan Lessenich
- Political Sociology of Inequalities, Institute of Sociology, Ludwig Maximilians University Munich, Germany
| |
Collapse
|
16
|
Krishnan-Sarin S, O’Malley SS. The science of flavour in tobacco products. WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES 2019; 1015:125-142. [PMID: 36743396 PMCID: PMC9896977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
17
|
Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:93-102. [PMID: 31254728 DOI: 10.1016/j.drugpo.2019.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Even though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption. METHODS Policy documents enacted during 2004-2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression. RESULTS By 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26-3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 - 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80-5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63-11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17-0.74). CONCLUSIONS Smoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference.
Collapse
|
18
|
Socio-demographic inequalities in cigarette smoking in Indonesia, 2007 to 2014. Prev Med 2019; 123:27-33. [PMID: 30822433 DOI: 10.1016/j.ypmed.2019.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Abstract
The prevalence of smoking in Indonesia is one of the highest in the world. Since 2007, some tobacco control policies have been implemented by the Indonesian government. However, evidence on the effectiveness of such policies at reducing tobacco use in Indonesia is scarcely available. Using both cross-sectional and longitudinal analysis of individual and household data from two waves of the Indonesia Family Life Survey (IFLS), this study explored changes in smoking patterns among Indonesian adults between 2007 and 2014 controlling for sociodemographic factors. Overall, there was no statistically significant change in the prevalence of smoking between 2007 and 2014. However, cigarettes became more affordable. Smokers in 2014 consumed more cigarettes (β: 0.95; 0.73, 1.17) and spent more money on cigarettes (β: IDR 2775; IDR 1124, IDR 4426) compared to those in 2007. Males, individuals <55 years old and those with lower levels of education had a higher likelihood of being smokers in 2014. Respondents with lower education levels and those under 26 years of age had higher odds of initiating smoking during the study period. Similarly, smoking cessation between 2007 and 2014 was more likely among respondents with higher levels of education and aged above 40 years. In conclusion, the implementation of tobacco control measures does not appear to have had a positive impact on smoking behaviours among adults in Indonesia between 2007 and 2014. Instead, cigarette consumption increased differentially across socio-demographic groups. Hence, tailored tobacco control interventions targeting the most socially disadvantaged population may be necessary in Indonesia.
Collapse
|
19
|
Astuti PAS, Freeman B. "It is merely a paper tiger." Battle for increased tobacco advertising regulation in Indonesia: content analysis of news articles. BMJ Open 2017; 7:e016975. [PMID: 28864704 PMCID: PMC5588975 DOI: 10.1136/bmjopen-2017-016975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE At the end of 2012, the Indonesian government enacted tobacco control regulation (PP 109/2012) that included stricter tobacco advertising, promotion and sponsorship (TAPS) controls. The PP did not ban all forms of TAPS and generated a great deal of media interest from both supporters and detractors. This study aims to analyse stakeholder arguments regarding the adoption and implementation of the regulation as presented through news media converge. DESIGN Content analysis of 213 news articles reporting on TAPS and the PP that were available from the Factiva database and the Google News search engine. SETTING Indonesia, 24 December 2012-29 February 2016. METHODS Arguments presented in the news article about the adoption and implementation of the PP were coded into 10 supportive and 9 opposed categories. The news actors presenting the arguments were also recorded. Kappa statistic were calculated for intercoder reliability. RESULTS Of the 213 relevant news articles, 202 included stakeholder arguments, with a total of 436 arguments coded across the articles. More than two-thirds, 69% (301) of arguments were in support of the regulation, and of those, 32.6% (98) agreed that the implementation should be enhanced. Of 135 opposed arguments, the three most common were the potential decrease in government revenue at 26.7% (36), disadvantage to the tobacco industry at 18.5% (25) and concern for tobacco farmers and workers welfare at 11.1% (15). The majority of the in support arguments were made by national government, tobacco control advocates and journalists, while the tobacco industry made most opposing arguments. CONCLUSIONS Analysing the arguments and news actors provides a mapping of support and opposition to an essential tobacco control policy instrument. Advocates, especially in a fragmented and expansive geographic area like Indonesia, can use these findings to enhance local tobacco control efforts.
Collapse
Affiliation(s)
- Putu Ayu Swandewi Astuti
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Preventive Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Becky Freeman
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Preventive Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Lee K, Eckhardt J. Looming threat of Asian tobacco companies to global health. Lancet 2017; 389:1958-1960. [PMID: 28534742 PMCID: PMC5694664 DOI: 10.1016/s0140-6736(17)31223-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Kelley Lee
- Tier 1 Canada Research Chair in Global Health Governance, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada,
| | - Jappe Eckhardt
- Lecturer in International Relations, Department of Politics, University of York, York, UK,
| |
Collapse
|
21
|
Crosbie E, Sosa P, Glantz SA. The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica. Tob Control 2017; 26:60-68. [PMID: 26856614 PMCID: PMC4977207 DOI: 10.1136/tobaccocontrol-2015-052701] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. METHOD Review of tobacco control legislation, newspaper articles and interviewing key informants. RESULTS Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. CONCLUSIONS The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation.
Collapse
Affiliation(s)
- Eric Crosbie
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Patricia Sosa
- International Advocacy Center, Campaign for Tobacco Free Kids, Washington DC, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
22
|
Byron MJ, Cohen JE, Frattaroli S, Gittelsohn J, Jernigan DH. Using the theory of normative social behavior to understand compliance with a smoke-free law in a middle-income country. HEALTH EDUCATION RESEARCH 2016; 31:738-748. [PMID: 27923863 DOI: 10.1093/her/cyw043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Smoke-free laws, which ban smoking in public venues, can be effective in protecting public health, but it has been difficult to achieve compliance with these laws in low- and middle-income countries. This study was conducted to understand the social norms around public smoking and learn how to improve compliance in Bogor, the first Indonesian city to pass a comprehensive smoke-free law. Eleven stratified focus groups were conducted (n = 89). Data were analyzed using the theory of normative social behavior, which posits that the influence of descriptive norms (perceptions about what other people do) on behavior is moderated by injunctive norms (perceptions about what one is expected to do), outcome expectations and group identity. The findings showed that participants perceived smoking in public to be common for men (descriptive norm). Public smoking is acceptable except in places with air conditioning and around children or pregnant women (injunctive norms). Men smoke without penalty of social or legal sanctions (outcome expectations) and may feel affiliation with other smokers (group identity). Together, these factors support public smoking and inhibit compliance with the smoke-free law. Theory-based communication and policy remedies are suggested that may bolster compliance with Bogor's smoke-free law given the current pro-smoking norms.
Collapse
Affiliation(s)
- M J Byron
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - J E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - S Frattaroli
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - J Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - D H Jernigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
23
|
Eckhardt J, Holden C, Callard C. Tobacco control and the World Trade Organization: mapping member states' positions after the framework convention on tobacco control. Tob Control 2016; 25:692-698. [PMID: 26585705 PMCID: PMC4891294 DOI: 10.1136/tobaccocontrol-2015-052486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To note the frequency of discussions and disputes about tobacco control measures at the World Trade Organization (WTO) before and after the coming into force of the Framework Convention on Tobacco Control (FCTC). To review trends or patterns in the positions taken by members of the WTO with respect to tobacco control measures. To discuss possible explanations for these observed trends/patterns. METHODS We gathered data on tobacco-related disputes in the WTO since its establishment in 1995 and its forerunner, the General Agreement on Tariffs and Trade (GATT), prior-FCTC and post-FCTC. We also looked at debates on tobacco control measures within the WTO more broadly. To this end, we classified and coded the positions of WTO member states during discussions on tobacco control and the FCTC, from 1995 until 2013, within the Technical Barriers to Trade (TBT) Committee and the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council. RESULTS There is a growing interest within the WTO for tobacco-related issues and opposition to tobacco control measures is moving away from high-income countries towards low(er) income countries. CONCLUSIONS The growing prominence of tobacco issues in the WTO can be attributed at least in part to the fact that during the past decade tobacco firms have been marginalised from the domestic policy-making process in many countries, which has forced them to look for other ways and forums to influence decision-making. Furthermore, the finding that almost all recent opposition within the WTO to stronger tobacco regulations came from developing countries is consistent with a relative shift of transnational tobacco companies' lobbying efforts from developed to developing countries.
Collapse
Affiliation(s)
- Jappe Eckhardt
- Faculty of Health Sciences, Simon Fraser University - Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada, Tel: +1 604 368 1225
| | - Chris Holden
- Department of Social Policy & Social Work, University of York, Heslington, York, United Kingdom
| | | |
Collapse
|
24
|
Luntungan NNHW, Byron MJ, Hovell MF, Rosen LJ, Anggraeni A, Rees VW. Children's Exposure to Secondhand Smoke during Ramadan in Jakarta, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100952. [PMID: 27681737 PMCID: PMC5086691 DOI: 10.3390/ijerph13100952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
Secondhand smoke exposure (SHS) causes a disproportionate health burden for children, yet existing smoke-free laws are often poorly enforced. We monitored air quality while observing children and adult nonsmokers present in public venues during Ramadan, a period of Muslim religious observance marked by family and social gatherings, in Jakarta, Indonesia. A repeated-measures design was used to assess indoor air quality during and after Ramadan in 43 restaurants and in five smoke-free control venues. Fine particulate matter of 2.5 microns or less (PM2.5) was sampled. The average number of children and active smokers present in each venue was also observed. PM2.5 levels were significantly higher during Ramadan (mean 86.5 µg/m3) compared with post-Ramadan (mean 63.2 µg/m3) in smoking venues (p = 0.015). During Ramadan, there were more active smokers (p = 0.012) and children (p = 0.051) observed in venues where smoking occurred, compared with the same venues post-Ramadan. Poor enforcement of the smoke-free law in Jakarta has failed to protect children from SHS exposure in public venues during Ramadan. Collaboration between the government, NGOs (such as the Indonesian Cancer Foundation (YKI) and the Smoking Control Foundation (LM3)), religious leaders, and venue owners and managers must be developed to ensure that the comprehensive smoking bans apply to all venues, and that smoke-free laws are enforced.
Collapse
Affiliation(s)
| | - M Justin Byron
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA 92182, USA.
| | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Ramat Aviv 69978, Israel.
| | - Annisa Anggraeni
- School of Public Health, Universitas Indonesia, Depok, West Java 16424, Indonesia.
| | - Vaughan W Rees
- Center for Global Tobacco Control, Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| |
Collapse
|
25
|
Lee K, Eckhardt J, Holden C. Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda. PALGRAVE COMMUNICATIONS 2016; 2:16037. [PMID: 28458910 PMCID: PMC5409523 DOI: 10.1057/palcomms.2016.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/17/2016] [Indexed: 05/02/2023]
Abstract
Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance.
Collapse
Affiliation(s)
- Kelley Lee
- Simon Fraser University, Burnaby, Canada
| | | | - Chris Holden
- Department of Social Policy and Social Work, University of York, York, UK
| |
Collapse
|
26
|
Assunta M, Dorotheo EU. SEATCA Tobacco Industry Interference Index: a tool for measuring implementation of WHO Framework Convention on Tobacco Control Article 5.3. Tob Control 2016; 25:313-8. [PMID: 25908597 PMCID: PMC4853530 DOI: 10.1136/tobaccocontrol-2014-051934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/13/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure the implementation of WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 at country level using a new Tobacco Industry Interference Index and to report initial results using this index in seven Southeast Asian countries. METHODS Score sheet based on WHO FCTC Article 5.3 Guidelines sent to correspondents in seven Southeast Asian countries, using a scoring system designed with the help of tobacco control experts and validated through focused group discussions. RESULTS The seven countries ranked from the lowest level of interference to the highest are Brunei, Thailand, Lao PDR, Cambodia, Philippines, Malaysia and Indonesia. Countries that face high levels of unnecessary interaction with the tobacco industry also face high levels of tobacco industry influence in policy development. Most governments do not allow any tobacco industry representatives on their delegation to sessions of the Conference of the Parties or its subsidiary bodies nor accept their sponsorship for delegates, but most governments still accept or endorse offers of assistance from the tobacco industry in implementing tobacco control policies. Most governments also receive tobacco industry contributions (monetary or in kind) or endorse industry corporate social responsibility activities. Governments do not have a procedure for disclosing interactions with the tobacco industry, but Lao PDR, Philippines and Thailand have instituted measures to prevent or reduce industry interference. CONCLUSIONS This Tobacco Industry Interference Index, based on the WHO FCTC Article 5.3 Guidelines, is a useful advocacy tool for identifying both progress and gaps in national efforts at implementing WHO FCTC Article 5.3.
Collapse
Affiliation(s)
- Mary Assunta
- Cancer Council Australia, Sydney, New South Wales, Australia
| | | |
Collapse
|
27
|
Inadequate collaboration: A challenge to reaching global targets for non-communicable disease control and prevention. J Public Health Policy 2015; 37:114-7. [PMID: 26675147 DOI: 10.1057/jphp.2015.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Byron MJ, Cohen JE, Gittelsohn J, Frattaroli S, Nuryunawati R, Jernigan DH. Influence of religious organisations' statements on compliance with a smoke-free law in Bogor, Indonesia: a qualitative study. BMJ Open 2015; 5:e008111. [PMID: 26667011 PMCID: PMC4679994 DOI: 10.1136/bmjopen-2015-008111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore the Bogor public's perspective on Muslim organisations' pronouncements against smoking and the effect of these pronouncements on compliance with a new smoke-free law in the context of a prosmoking social norm. DESIGN Semistructured focus group discussions were conducted, transcribed, coded using ATLAS.ti software, and analysed using thematic content analysis. Photo elicitation was also used during the focus groups. SETTING Bogor, Indonesia. PARTICIPANTS 11 focus groups (n=89), stratified by age, gender and smoking status, with members of the public (46 male, 43 female, ages 18-50). RESULTS There was limited knowledge of and compliance with both the smoke-free law and the religious pronouncements. In most of the focus groups, smoking was described as a discouraged, but not forbidden, behaviour for Muslims. Participants described the decision of whether to follow the religious pronouncements in the context of individual choice. Some participants felt religious organisations lacked credibility to speak against smoking because many religious leaders themselves smoke. However, some non-smokers said their religion reinforced their non-smoking behaviour and some participants stated it would be useful for religious leaders to speak more about the smoke-free law. CONCLUSIONS Religious organisations' pronouncements appear to have had a small effect, primarily in supporting the position of non-smokers not to smoke. Participants, including smokers, said their religious leaders should be involved in supporting the smoke-free law. These findings suggest there is potential for the tobacco control community to partner with sympathetic local Muslim leaders to promote common goals of reducing smoking and public smoke exposure. Muslim leaders' views on smoking would be perceived as more credible if they themselves followed the smoke-free law. Additionally, public health messaging that includes religious themes could be piloted and tested for effectiveness. These findings may also inform similar efforts in other Muslim cities implementing smoke-free laws.
Collapse
Affiliation(s)
- M Justin Byron
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Frattaroli
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - David H Jernigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
29
|
Alzyoud S, Kheirallah KA, Ward KD, Al-Shdayfat NM, Alzyoud AA. Association of Religious Commitment and Tobacco Use Among Muslim Adolescents. JOURNAL OF RELIGION AND HEALTH 2015; 54:2111-2121. [PMID: 25080891 DOI: 10.1007/s10943-014-9921-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to examine the relationship between religious observance and tobacco use among a sample of Jordanian youth. Using multistage, random sampling, a cross-sectional survey of middle and high school students was conducted. Of the 950 Muslim students in the study, 32% were daily tobacco users and 72% prayed regularly. Frequency of praying was negatively associated with tobacco smoking. Religious observance was found to be strongly associated with tobacco smoking among Jordanian youth. Our results indicate that religion can be a culturally important tool in health professionals' efforts for tobacco control.
Collapse
Affiliation(s)
- Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, P.O. Box 150459, Zarqa, 13115, Jordan.
| | - Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | | | - Abd Albaset Alzyoud
- Faculty of Arts, Hashemite University, P.O. Box 150459, Zarqa, 13115, Jordan
| |
Collapse
|
30
|
Tahlil T, Woodman RJ, Coveney J, Ward PR. Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia. BMC Public Health 2015; 15:1088. [PMID: 26499860 PMCID: PMC4619432 DOI: 10.1186/s12889-015-2428-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 10/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Smoking prevention programs have been taught in schools to reduce the high smoking prevalence and its related problems among adolescent populations. Although short-term benefits have been observed, the long-term effectiveness of such programs appear to be inconsistent. This study aims at investigating the long-term impact of both health and Islamic focused interventions amongst students in Indonesia. METHODS At 6 months after completion of the interventions, 427 of the original 447 participants (control group = 128, intervention groups = 299) from a school-based cluster randomized control trial were re-assessed for their smoking knowledge, attitudes, intentions and behaviours using a self-report questionnaire. Data was analyzed according to the study's 2 × 2 factorial design with adjustment for baseline scores, school and classroom clustering effects and multiple comparisons. RESULTS Compared to the control group, significant long term effects were found for the health-based intervention program in improved health (β = 4.3 ± 0.4, p < 0.001), Islamic (β = 1.1 ± 0.4, p = 0.01) knowledge and a reduction of smoking attitudes (β = -11.5 ± 1.8, p < 0.001). For the Islamic-based intervention programs there was an improvement of health (β = 3.7 ± 0.4, p < 0.001) and Islamic (β = 2.2 ± 0.5, p < 0.001) knowledge and a reduction towards smoking attitude (β = -6.0 ± 1.9, p < 0.01) and smoking behaviors in the past month (OR = 0.1, 95 % CI = 0.0-0.8, p = 0.03). The effects were greater but less than additive in the combined group for health (β = -3.2 ± 0.9, p < 0.001 for interaction) and Islamic knowledge (β = -2.3 ± 0.9, p = 0.01 for interaction) but were additive for smoking attitudes (β = 6.1 ± 3.2, p = 0.07 for interaction). No significant effects on smoking intentions were observed at 6 months follow-up in the health or Islamic-based intervention programs. CONCLUSION School-based programs can provide long term benefits on Indonesian adolescents' smoking knowledge and attitudes. Tailoring program intervention components with participants' religious background might maximise program effectiveness. A larger and more encompassing study is now required to confirm the effectiveness of this new Indonesia culturally-based program. Adolescents in similar areas might also benefit from this type of school-based smoking cessation program. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry, ACTRN12612001070820.
Collapse
Affiliation(s)
- Teuku Tahlil
- Nursing Faculty, Syiah Kuala University, Banda Aceh, 23111, Indonesia.
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, 5001, Australia.
| | - John Coveney
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
| | - Paul R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
| |
Collapse
|
31
|
Hurt RD, Murphy JG, Dunn WF. Did we finally slay the evil dragon of cigarette smoking in the late 20th century?: unfortunately, the answer is no - the dragon is still alive and well in the 21st century and living in the third world. Shame on us! Chest 2015; 146:1438-1443. [PMID: 25451345 DOI: 10.1378/chest.13-2804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
If cigarettes were introduced as a new consumer product today, it is unlikely they would receive government regulatory approval. Cigarettes have proven biologic toxicities (carcinogenesis, atherogenesis, teratogenesis) and well-established causal links to human disease. Things were very different in 1913 when the R. J. Reynolds Tobacco Company introduced the first modern cigarette, the iconic Camel. By the early 1950s, definitive scientific reports linked cigarettes and human disease, but it was more than a half century later (2006) that cigarette manufacturers were found guilty by a federal court of deceptive product marketing regarding the health hazards of tobacco use. In the United States, cigarette smoking remains a major but slowly declining problem. But in developing countries, cigarette use is expanding tremendously. In global terms, the epidemic of smoking-caused disease is projected to increase rapidly in coming decades, not decline. Society may have begun to slowly win the smoking battle in the developed world, but we are resoundingly losing the global war on smoking. All is not lost! There is some good news! The 2003 Framework Convention on Tobacco Control, supported strongly by the American College of Chest Physicians, is the first global public health treaty of the new millennium. Many developed societies have begun planning to rid their countries of cigarettes in what is called the Endgame Strategy, and now is the time for the international medical community to help change tobacco policy to a worldwide endgame approach to rid all humanity of smoking-related diseases.
Collapse
Affiliation(s)
| | | | - William F Dunn
- Division of Pulmonary and Critical Care Medicine, Rochester, MN
| |
Collapse
|
32
|
Palipudi K, Mbulo L, Kosen S, Tjandra A, Kadarmanto, Qureshi F, Andes L, Sinha DN, Asma S. A Cross Sectional Study of Kretek Smoking in Indonesia as a Major Risk to Public Health. Asian Pac J Cancer Prev 2015; 16:6883-8. [PMID: 26514461 DOI: 10.7314/apjcp.2015.16.16.6883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco smoking is a major cause of preventable disease and death worldwide. Kreteks are clove-flavored cigarettes made from a combination of tobacco and ground-clove mixed with a sauce, smoked widely in Indonesia. Because health and social consequences of kretek smoking are potentially as great as those of traditional cigarettes, this study examines the prevalence of kretek smoking in Indonesia and associated risk factors. MATERIALS AND METHODS The study used nationally representative Indonesia Global Adult Tobacco Survey data. Multiple logistic regression analysis was employed to identify correlates of kretek smoking. RESULTS One- third of Indonesian adults smoked tobacco of which about 90.0% smoked kreteks. Prevalence of kretek smoking among men (60.9%) was more than 25 times the rate among women (2.3%). Overall, the highest prevalence of kretek use was in the age group 45-54 years (36.5%), followed by 34-44 (35.1%), 25-34 (34.2 %), and 55-64 years (32.8%). By wealth index, prevalence of kreteks smoking among those in the middle index was almost 50% above the rate for the wealthiest group (36.4% vs 24.8% respectively). Logistic regression results showed that being male, being older, having less education, and being less wealthy were significant predictors of kretek smoking, while urban vs rural residence was not. CONCLUSIONS Kretek smoking is common in Indonesia and is entrenched in the sociocultural fabric of the country. However, potential consequences of kretek smoking, particularly as risks for noncommunicable diseases, underscore the importance of a comprehensive approach to tobacco control as outlined in the World Health Organization's MPOWER strategies.
Collapse
Affiliation(s)
- Krishna Palipudi
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, US E-mail : ,
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Tahlil T, Coveney J, Woodman RJ, Ward PR. Exploring recommendations for an effective smoking prevention program for indonesian adolescents. Asian Pac J Cancer Prev 2014; 14:865-71. [PMID: 23621253 DOI: 10.7314/apjcp.2013.14.2.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present qualitative study assessed the need, acceptability and appropriateness for implementing effective and culturally appropriate smoking prevention programs for adolescents in schools in Indonesia. METHODS Snowball sampling was used to recruit participants. The study sample comprised a mixture of staff in the education department, junior high school teachers and individuals who had taught junior high school students in Aceh Province, Indonesia. Data were collected through one hour in-depth face to face or telephone interviews and analyzed using a descriptive content analysis procedure. RESULTS School teachers and policy makers in education firmly supported the implementation of a school-based smoking prevention program in Aceh. An appropriate intervention for smoking prevention program in schools in Aceh should involve both health and Islamic based approaches, and be provided by teachers and external providers. Potential barriers to the program included smoker teachers and parents, time constraints of students and/or teachers, lack of teachers' ability, increase in students' load, the availability of tobacco advertising and sales, and lack of tobacco regulation and support from community and related departments. To increase program effectiveness, involvement of and coordination with other relevant parties are needed. CONCLUSIONS The important stakeholders in Indonesian childhood education agreed that school-based smoking prevention program would be appropriate for junior high school students. An appropriate intervention for smoking prevention program for adolescents in schools in Indonesia should be appropriate to participants' background and involve all relevant parties.
Collapse
Affiliation(s)
- Teuku Tahlil
- Discipline of Public Health, School of Medicine, Flinders University, Australia.
| | | | | | | |
Collapse
|
34
|
Apollonio DE, Glantz SA, Bero LA. Term limits and the tobacco industry. Soc Sci Med 2014; 104:1-5. [PMID: 24581055 DOI: 10.1016/j.socscimed.2013.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/01/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
Abstract
In the 1990s several American states passed term limits on legislators with the stated intention of reducing the influence of wealthy industries on career legislators. Although term limits in the United States do not have a direct relationship to public health, the tobacco industry anticipated that term limits could have indirect effects by either limiting or expanding industry influence. We detail the strategy of the tobacco industry in the wake of term limits using internal tobacco company documents and a database of campaign contributions made to legislators in term limited states between 1988 and 2002. Despite some expectations that term limits would limit tobacco industry access to state legislators, term limits appear to have had the opposite effect.
Collapse
Affiliation(s)
- Dorie E Apollonio
- University of California, San Francisco, Department of Clinical Pharmacy, 3333 California Street Suite 420, San Francisco, CA 94143-0613, USA.
| | - Stanton A Glantz
- University of California, San Francisco, Center for Tobacco Control Research and Education, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143-1390, USA
| | - Lisa A Bero
- University of California, San Francisco, Department of Clinical Pharmacy, 3333 California Street Suite 420, San Francisco, CA 94143-0613, USA
| |
Collapse
|
35
|
Gilmore AB. Understanding the vector in order to plan effective tobacco control policies: an analysis of contemporary tobacco industry materials. Tob Control 2012; 21:119-26. [PMID: 22345234 PMCID: PMC3705181 DOI: 10.1136/tobaccocontrol-2011-050397] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This paper builds on tobacco document research by analysing contemporary materials to explore how the global tobacco market has changed, how transnational tobacco companies (TTCs) are responding and the implications for tobacco control. The methods involved analysis of a variety of materials, including tobacco company annual reports, investor relations materials, financial analyst reports, market research reports and data. Once China, where TTCs have little market share, is excluded, global cigarette volumes are already declining. Nevertheless, industry profits continue to increase. This pattern is explained by the pricing power of TTCs-their ability to increase prices faster than volumes fall, a consequence of market failure. Pricing power is now fundamental to the long term future of TTCs. Consequently, and in light of growing regulations, the business model of the TTCs is changing. Product innovation is now a key marketing technique used to drive consumers to buy more expensive (ie, profitable) premium cigarettes. Contrary to established wisdom, high tobacco excise rates, particularly where increases in excise are gradual, can benefit TTCs by enabling price (profit) increases to be disguised. Large intermittent tax increases likely have a greater public health benefit. TTC investments in smokeless tobacco appear designed to eliminate competition between smokeless tobacco and cigarettes, thereby increasing the pricing power of TTCs while enabling them to harness the rhetoric of harm reduction. Monitoring TTCs can inform effective policy development. The value maximising approach of TTCs suggests that a ban on product innovation and more informed tobacco excise policies are needed.
Collapse
Affiliation(s)
- Anna B Gilmore
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| |
Collapse
|
36
|
Abstract
Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.
Collapse
Affiliation(s)
- Lisa Henriksen
- Stanford University School of Medicine, Palo Alto, CA 94304, USA.
| |
Collapse
|