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Vasilescu CL, McKee M, Reeves A. Quantitative Textual Analysis as a means to explore corporate interests in food safety. Health (London) 2024; 28:372-389. [PMID: 37309822 DOI: 10.1177/13634593231173807] [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: 06/14/2023]
Abstract
The growing body of scholarship on the commercial determinants of health has, so far, mostly employed qualitative methods but this is now being complemented by a small, yet growing, corpus of quantitative studies. We illustrate the use of one such method, quantitative text analysis (QTA), in a case study of submissions to a public consultation on a draft scientific opinion by the European Food Safety Authority on the chemical acrylamide, demonstrating how this method can be used and insights that might be drawn from it. We use Wordscores as one example of QTA to illuminate the diverse positions taken by actors submitting comments and then assess whether the final policy documents moved towards or away from the positions taken by different stakeholders. We find a broadly uniform position among the public health community, opposed to acrylamide, contrasting with industry positions that were not monolithic. Some firms recommended major amendments to the guidance, largely reflecting the impact on their practices, while policy innovators seeking ways to reduce acrylamide in foods aligned with the public health community. We also find no clear movement in the policy guidance, likely because most submissions supported the draft document. Many governments are required to conduct public consultations, some attracting enormous numbers of responses, with little guidance on how best to synthesise the responses so the default position is often a count of those for and against. We argue that QTA, primarily a research tool, might usefully be applied in analysing public consultation responses to understand better the positions taken by different actors.
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Mechili EA, Przewoźniak K, Driezen P, Kyriakos CN, Girvalaki C, Mons U, Quah ACK, Fernández E, Trofor AC, Demjén T, Katsaounou PA, Zatoński W, Fong GT, Vardavas CI. Smokers' support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. OPEN RESEARCH EUROPE 2023; 1:52. [PMID: 37645112 PMCID: PMC10446023 DOI: 10.12688/openreseurope.13405.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.78; 95%CI=0.67-0.91, daily smokers (OR=0.68; 95%CI=0.47-0.97), menthol smokers (OR=0.55; 95%CI=0.36-0.86), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.56) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 21% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.
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Affiliation(s)
- Enkeleint A. Mechili
- Department of Health Care, Faculty of Health,, University of Vlora, Vlora, 9401, Albania
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
| | - Krzysztof Przewoźniak
- Maria Skłodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, Warsaw, 02-034, Poland
- Health Promotion Foundation, Mszczonowska, Nadarzyn, 05-830, Poland
- Collegium Civitas, plac Defilad 1, Warsaw, 00-901, Poland
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, University Avenue West 200, Waterloo, Ontario, N2L 3G1, Canada
| | - Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 310 Reynolds Building, St. Dunstan's Road, London, W6 9RP, UK
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany
| | - Anne CK Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), Av Gran Via De L’Hospitalet 199-203, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via De L’Hospitalet 199-203, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Madrid, 28029, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Strada Universității 16, Iași, 700115, Romania
- AerPur Romania, Street Argentina 35 Sector 1, Bucharest, 011753, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Fiumei 18/B IB IV LPH I 2, Budapest, 1044, Hungary
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Ipsilantou 45-47, Athens, 10676, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Mszczonowska, Nadarzyn, 05-830, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Nowy Świat 4 st, Kalisz, 62-800, Poland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, University Avenue West 200, Waterloo, Ontario, N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Toronto, Ontario, M5G 0A3, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
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Bennett E, Topp SM, Moodie AR. National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries - A Scoping Review and Framework Synthesis. Int J Health Policy Manag 2023; 12:6876. [PMID: 37579395 PMCID: PMC10425693 DOI: 10.34172/ijhpm.2023.6876] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Corporations in unhealthy commodity industries (UCIs) have growing influence on the health of national populations through practices that lead to increased consumption of unhealthy products. The use of government-led public health surveillance is best practice to better understand any emerging public health threat. However, there is minimal systematic evidence, generated and monitored by national governments, regarding the scope of UCI corporate practices and their impacts. This study aims to synthesise current frameworks that exist to identify and monitor UCI influence on health to highlight the range of practices deployed by corporations and inform future surveillance efforts in key UCIs. METHODS Seven biomedical, business and scientific databases were searched to identify literature focused on corporate practices that impact human health and frameworks for monitoring or assessment of the way UCIs impact health. Content analysis occurred in three phases, involving (1) the identification of framework documents in the literature and extraction of all corporate practices from the frameworks; (2) initial inductive grouping and synthesis followed by deductive synthesis using Lima and Galea's 'vehicles of power' as a heuristic; and (3) scoping for potential indicators linked to each corporate practice and development of an integrated framework. RESULTS Fourteen frameworks were identified with 37 individual corporate practices which were coded into five different themes according the Lima and Galea 'Corporate Practices and Health' framework. We proposed a summary framework to inform the public health surveillance of UCIs which outlines key actors, corporate practices and outcomes that should be considered. The proposed framework draws from the health policy triangle framework and synthesises key features of existing frameworks. CONCLUSION Systematic monitoring of the practices of UCIs is likely to enable governments to mitigate the negative health impacts of corporate practices. The proposed synthesised framework highlights the range of practices deployed by corporations for public health surveillance at a national government level. We argue there is significant precedent and great need for monitoring of these practices and the operationalisation of a UCI monitoring system should be the object of future research.
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Affiliation(s)
- Elizabeth Bennett
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Alan Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Hoetger C, Bono RS, White AM, Barnes AJ, Cobb CO. The interaction of nicotine concentration and device power on electronic nicotine delivery system (ENDS) abuse liability among exclusive ENDS users and dual users of ENDS and combustible cigarettes. Exp Clin Psychopharmacol 2022; 30:973-982. [PMID: 34647773 PMCID: PMC9284402 DOI: 10.1037/pha0000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Open-system electronic nicotine delivery systems (ENDS) permit modifications to device characteristics such as power, potentially increasing nicotine and toxicant delivery. Limiting liquid nicotine concentration may carry unintended consequences by prompting users to increase device power to increase nicotine delivery. This study examined the abuse liability of ENDS across nicotine concentration and power settings. In a clinical laboratory study, n = 19 exclusive ENDS users and n = 13 dual ENDS/cigarette users, aged 21-55 completed four Latin-square ordered conditions that varied by liquid nicotine concentration (10 mg/ml [low], 30 mg/ml [high]) and device power (15 watts [low], 30 watts [high]), that were followed by a fifth own brand (OB) condition. A progressive ratio task (PRT) using bar presses to earn ENDS puffs was used to assess abuse liability and compare between conditions using mixed effects linear regressions. The low nicotine/high watt condition was associated with a significantly higher number of bar presses and puffs earned relative to the OB ENDS, high nicotine/high watt, and high nicotine/low watt conditions (p < .05). Findings appeared to be driven largely by exclusive ENDS users; most comparisons were not significant among dual users. Participants worked significantly harder for puffs of low nicotine/high watt ENDS, highlighting previous findings that suggest limiting liquid nicotine concentration without addressing power settings may be insufficient to reduce the abuse liability of ENDS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University
- Center for the Study of Tobacco Products, Virginia Commonwealth University
| | - Rose S. Bono
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Health Behavior and Policy, Virginia Commonwealth University
| | - Augustus M. White
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Health Behavior and Policy, Virginia Commonwealth University
| | - Andrew J. Barnes
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Health Behavior and Policy, Virginia Commonwealth University
| | - Caroline O. Cobb
- Department of Psychology, Virginia Commonwealth University
- Center for the Study of Tobacco Products, Virginia Commonwealth University
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Selin J, Nyrhinen R. Gambling policy positions of Finnish newspapers between 2004 and 2020: An automated content analysis. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:605-622. [DOI: 10.1177/14550725221083438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Aims: The media can influence gambling policy formation and public opinion. Previous research has established that the tension between political or public interest in gambling revenue and gambling harm is fundamental for understanding gambling policy. There are two opposing gambling policy positions: (1) gambling revenue or the economic benefits of gambling, and (2) the harmful impacts of gambling. This study is the first study to estimate these gambling policy positions of newspapers on a common scale. The objective is to estimate how the gambling policy positions of major Finnish daily newspapers evolved between 2004 and 2020. This knowledge deepens our understanding about the changes in the relative balance between harm and revenue in gambling policy. Methods and data: The data consisted of newspaper editorials ( N = 58) on gambling policy from five major Finnish daily newspapers between 2004 and 2020. The data were analysed with the automated content analysis algorithm Wordfish. Results: The results show that there has been a clear shift in the gambling policy positions of the major Finnish newspapers towards increased acknowledgement of the importance of prevention and reduction of gambling harm. Conclusions: Due to the interplay between the media, politics, and the public, it is likely that the importance of prevention and reduction of gambling harm will be recognised and addressed to a larger extent when gambling policy is formulated in Finland in the future. More generally, if the gambling policy positions of media and other stakeholders change, this can facilitate a promotion of harm prevention policies.
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Affiliation(s)
- Jani Selin
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riku Nyrhinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
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6
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Vardavas CI. European Tobacco Products Directive (TPD): current impact and future steps. Tob Control 2022; 31:198-201. [PMID: 35241588 DOI: 10.1136/tobaccocontrol-2021-056548] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Efforts to reduce the toll of tobacco-related morbidity and mortality in the European Union are spearheaded by the Tobacco Products Directive (TPD), a legal act implemented during 2016-2021, with the overall aim to reduce tobacco consumption by 2% in Europe. Within this time frame, several core tobacco control measures were implemented, the impact of which is outlined within this manuscript. Key successful legislative actions implemented in this time frame led to greater availability of information and further regulation of additives, the banning of mentholated cigarettes, enhanced pictorial package warnings and a regulatory framework for e-cigarettes. While repeated cross-sectional data indicated a 12.5% relative reduction in smoking prevalence after implementation of the TPD, the differential regulation of cigarettes and roll-your-own tobacco compared with other products, such as cigarillos, e-cigarettes and heated tobacco products, may have also led to product displacement. Moreover, as the TPD could not keep up with the ever-changing nicotine product landscape, further adaptations may be needed.
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Khalturina DA, Zykov VA, Zubkova TS. “Health in All Policies” Approach and Health Impact Assessment in Russia and the world. Public Health 2022. [DOI: 10.21045/2782-1676-2021-1-4-15-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study presents analysis of the international and Russian experience of implementation of “health in all policies” approach into legislation, as well as of health impact assessment. Certain steps towards the implementation of this approach have already been made in Russia, however, in general, there is still a lot to be done. It was revealed that the current system regulatory impact assessment (RIA) in Russia has a narrow focus and is focused on protecting the interests of business, which does not correspond to the well-established world practice, which presupposes complex RIA, including the impact of regulation on public health. Recommendations for strengthening the principle of “health by all policies” in Russian legislation and the introduction of the practice of assessing the regulatory impact on public health in Russia are presented.
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Affiliation(s)
- D. A. Khalturina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| | - V. A. Zykov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| | - T. S. Zubkova
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
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8
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Gallagher AWA, Gilmore AB, Eads M. Tracking and tracing the tobacco industry: potential tobacco industry influence over the EU's system for tobacco traceability and security features. Tob Control 2020; 29:e56-e62. [PMID: 31543502 PMCID: PMC7799412 DOI: 10.1136/tobaccocontrol-2019-055094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Subsequent to the transnational tobacco companies' (TTC) history of involvement in tobacco smuggling, the Illicit Trade Protocol (ITP) requires that tobacco tracking and tracing (T&T) systems be established independent of the industry. In response, TTCs developed a T&T system, originally called Codentify, promoting it via an elaborate set of front groups to create a false impression of independence. The European Union (EU) is one of the first and largest jurisdictions to operationalise T&T. We explore how industry efforts to influence T&T have evolved. METHODS Analysis of tobacco industry documents, policy documents, submissions to a relevant consultation and relationships between the tobacco industry and organisations proposed by it and approved by the European Commission to provide a data repository function within the EU's T&T system. FINDINGS 17 months after TTCs sold Codentify to Inexto and Philip Morris International claimed Inexto was independent, leaked documents suggest TTCs and Inexto continued to have a financial and operational relationship. Inexto's meetings with TTCs, engagement with EU Member States and promotion of industry-favoured technical standards suggest TTCs influenced Inexto's activities, using the company to undermine EU T&T. The EU's T&T system appears to be inconsistent with the ITP due to its 'mixed' governance and seven of eight organisations approved as data repository providers having pre-existing industry business links. CONCLUSIONS TTC's efforts to maximise their control and minimise external scrutiny of T&T systems seriously limit attempts to address tobacco smuggling. Countries implementing T&T should be alert to such efforts and should not replicate the EU system.
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Affiliation(s)
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Michael Eads
- Sovereign Border Solutions, Cape Town, South Africa
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9
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Mialon M, Vandevijvere S, Carriedo-Lutzenkirchen A, Bero L, Gomes F, Petticrew M, McKee M, Stuckler D, Sacks G. Mechanisms for addressing and managing the influence of corporations on public health policy, research and practice: a scoping review. BMJ Open 2020; 10:e034082. [PMID: 32690498 PMCID: PMC7371213 DOI: 10.1136/bmjopen-2019-034082] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING We identified mechanisms at the national, regional and global levels. RESULTS Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).
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Affiliation(s)
- Melissa Mialon
- School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
- School of Nutrition and Dietetics, University of Antioquia, Medellin, Colombia
| | | | | | - Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fabio Gomes
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
| | - David Stuckler
- Dondena Research Centre and Department of Policy Analysis and Public Management, Bocconi University, Milano, Lombardia, Italy
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Burwood, Victoria, Australia
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10
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Stakeholder interests in gambling revenue: an obstacle to public health interventions? Public Health 2020; 184:102-106. [DOI: 10.1016/j.puhe.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 11/20/2022]
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11
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Reis J, Spencer PS. Decision-making under uncertainty in environmental health policy: new approaches. Environ Health Prev Med 2019; 24:57. [PMID: 31521129 PMCID: PMC6745059 DOI: 10.1186/s12199-019-0813-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 01/30/2023] Open
Abstract
Decision-making in environmental health policy is a complex procedure even in well-known conditions. Thus, in the case of uncertainty, decision-making becomes a hurdle race. We address scientific uncertainty, methods to reduce uncertainty, biomedical doubt and science communication, and the role of stakeholders, activists, lobbies and media that together influence policy decisions. We also consider the major responsibility and role of the medico-scientific community in this process. This community can and should teach the principle of scientific uncertainty to all stakeholders, advise policy-makers and underline the ethical issues, considering that our brains are not only the deposit of our humanity but also the route to environmental health and societal harmony.
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Affiliation(s)
- Jacques Reis
- Faculté de Médecine, University of Strasbourg, 4 Rue Kirschleger, 67000, Strasbourg, France.
- Association RISE, 3 rue du loir, 67205, Oberhausbergen, France.
| | - Peter S Spencer
- Oregon Institute of Occupational Health Sciences and School of Medicine (Neurology), Oregon Health & Science University, Portland, OR, 97201, USA
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12
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Madureira Lima J, Galea S. The Corporate Permeation Index - A tool to study the macrosocial determinants of Non-Communicable Disease. SSM Popul Health 2019; 7:100361. [PMID: 30906842 PMCID: PMC6411497 DOI: 10.1016/j.ssmph.2019.100361] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 01/24/2023] Open
Abstract
Commercial interests have long been identified as a macrosocial determinant of health. We present a composite indicator of corporate permeation- the Corporate Permeation Index (CPI) -, a novel tool for explaining variations in the consumption of products such as alcohol or tobacco and in the comprehensiveness of health policy regarding these products. Using a published framework for the analysis of commercial influences on health as a theoretical basis, we collected 25 indicators of corporate permeation comparable across 148 countries in five continents for six years 2010–2015. Two alternative approaches were used in each of the steps taken to build the measure – imputation of missing data, multivariate analysis, and weighing and aggregation of the subcomponents. We assessed the Index’s criterion-related validity by calculating the strength of the association among the different formulations of the Index. Alternative formulations of the CPI are highly correlated. Whilst High Income Countries are generally overrepresented among the lowest scores, some High Income Countries have high permeation scores. There is no clear regional pattern, with scores showing as much intra-regional as inter-regional variability. The CPI appears to be a robust measure of corporate permeation at the national level, suggesting tremendous variability in permeation worldwide. There are limitations to the CPI, the most notable of which is the lack of large scale cross-country comparable data on some important mechanisms of corporate permeation (e.g., lobbying expenditures by large corporations). Further work will target proxy measures for these phenomena to be incorporated in the Index calculation.
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Affiliation(s)
| | - Sandro Galea
- School of Public Health, Boston University, United States
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13
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Williams R, Alexander G, Aspinall R, Batterham R, Bhala N, Bosanquet N, Severi K, Burton A, Burton R, Cramp ME, Day N, Dhawan A, Dillon J, Drummond C, Dyson J, Ferguson J, Foster GR, Gilmore I, Greenberg J, Henn C, Hudson M, Jarvis H, Kelly D, Mann J, McDougall N, McKee M, Moriarty K, Morling J, Newsome P, O'Grady J, Rolfe L, Rice P, Rutter H, Sheron N, Thorburn D, Verne J, Vohra J, Wass J, Yeoman A. Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018; 392:2398-2412. [PMID: 30473364 DOI: 10.1016/s0140-6736(18)32561-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
This report presents further evidence on the escalating alcohol consumption in the UK and the burden of liver disease associated with this major risk factor, as well as the effects on hospital and primary care. We reiterate the need for fiscal regulation by the UK Government if overall alcohol consumption is to be reduced sufficiently to improve health outcomes. We also draw attention to the effects of drastic cuts in public services for alcohol treatment, the repeated failures of voluntary agreements with the drinks industry, and the influence of the industry through its lobbying activities. We continue to press for reintroduction of the alcohol duty escalator, which was highly effective during the 5 years it was in place, and the introduction of minimum unit pricing in England, targeted at the heaviest drinkers. Results from the introduction of minimum unit pricing in Scotland, with results from Wales to follow, are likely to seriously expose the weakness of England's position. The increasing prevalence of obesity-related liver disease, the rising number of people diagnosed with type 2 diabetes and its complications, and increasing number of cases of end-stage liver disease and primary liver cancers from non-alcoholic fatty liver disease make apparent the need for an obesity strategy for adults. We also discuss the important effects of obesity and alcohol on disease progression, and the increased risk of the ten most common cancers (including breast and colon cancers). A new in-depth analysis of the UK National Health Service (NHS) and total societal costs shows the extraordinarily large expenditures that could be saved or redeployed elsewhere in the NHS. Excellent results have been reported for new antiviral drugs for hepatitis C virus infection, making elimination of chronic infection a real possibility ahead of the WHO 2030 target. However, the extent of unidentified cases remains a problem, and will also apply when new curative drugs for hepatitis B virus become available. We also describe efforts to improve standards of hospital care for liver disease with better understanding of current service deficiencies and a new accreditation process for hospitals providing liver services. New commissioning arrangements for primary and community care represent progress, in terms of effective screening of high-risk subjects and the early detection of liver disease.
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Affiliation(s)
| | | | | | - Rachel Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, Birmingham, UK
| | - Nick Bosanquet
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Anya Burton
- Hepatocellular Carcinoma UK and National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | | | - Matthew E Cramp
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - John Dillon
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | | | - James Ferguson
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham R Foster
- Barts Liver Centre, Queen Mary University of London, London, UK
| | | | | | | | | | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle, UK; The Royal College of General Practitioners, London, UK
| | - Deirdre Kelly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Jake Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Philip Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | | | | | - Peter Rice
- Scottish Health Action on Alcohol Problems (SHAAP), Bath, UK
| | | | - Nick Sheron
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | | | | | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London
| | - John Wass
- Department of Endocrinology, Churchill Hospital, Oxford, UK
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14
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Alla K, Oprescu F, Hall WD, Whiteford HA, Head BW, Meurk CS. Can automated content analysis be used to assess and improve the use of evidence in mental health policy? A systematic review. Syst Rev 2018; 7:194. [PMID: 30442191 PMCID: PMC6238396 DOI: 10.1186/s13643-018-0853-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This review assesses the utility of applying an automated content analysis method to the field of mental health policy development. We considered the possibility of using the Wordscores algorithm to assess research and policy texts in ways that facilitate the uptake of research into mental health policy. METHODS The PRISMA framework and the McMaster appraisal tools were used to systematically review and report on the strengths and limitations of the Wordscores algorithm. Nine electronic databases were searched for peer-reviewed journal articles published between 2003 and 2016. Inclusion criteria were (1) articles had to be published in public health, political science, social science or health services disciplines; (2) articles had to be research articles or opinion pieces that used Wordscores; and (3) articles had to discuss both strengths and limitations of using Wordscores for content analysis. RESULTS The literature search returned 118 results. Twelve articles met the inclusion criteria. These articles explored a range of policy questions and appraised different aspects of the Wordscores method. DISCUSSION Following synthesis of the material, we identified the following as potential strengths of Wordscores: (1) the Wordscores algorithm can be used at all stages of policy development; (2) it is valid and reliable; (3) it can be used to determine the alignment of health policy drafts with research evidence; (4) it enables existing policies to be revised in the light of research; and (5) it can determine whether changes in policy over time were supported by the evidence. Potential limitations identified were (1) decreased accuracy with short documents, (2) words constitute the unit of analysis and (3) expertise is needed to choose 'reference texts'. CONCLUSIONS Automated content analysis may be useful in assessing and improving the use of evidence in mental health policies. Wordscores is an automated content analysis option for comparing policy and research texts that could be used by both researchers and policymakers.
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Affiliation(s)
- Kristel Alla
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia. .,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Archerfield, QLD, 4108, Australia.
| | - Florin Oprescu
- School of Health and Sport Sciences, The University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, CYSAR K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital Campus, The University of Queensland, Herston, QLD, 4029, Australia
| | - Harvey A Whiteford
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Archerfield, QLD, 4108, Australia
| | - Brian W Head
- School of Political Science, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Carla S Meurk
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Archerfield, QLD, 4108, Australia
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15
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Hawkins B, Holden C. European Union implementation of Article 5.3 of the Framework Convention on Tobacco Control. Global Health 2018; 14:79. [PMID: 30071862 PMCID: PMC6090908 DOI: 10.1186/s12992-018-0386-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Article 5.3 of the World Health Organization's Framework Convention on Tobacco Control (FCTC) requires Parties to the agreement to take proactive measures to protect health policy from the vested interests of the tobacco industry. Parties to the FCTC are required to submit periodic reports to the Convention Secretariat on the efforts undertaken to implement it. Previous analyses of national compliance with the FCTC suggest that Article 5.3 implementation is piecemeal and insufficient in many contexts, with governments relying on general transparency and other existing policies for the purpose of Article 5.3 implementation. No in-depth study of Article 5.3 compliance within the European Union (EU) - a signatory to the Convention - has been undertaken. This study seeks to assess the extent of Article 5.3 compliance in European Union institutions, through an analysis of the mechanisms in place in the European Commission and European Parliament. It analyses EU documents relevant to Article 5.3 compliance, as well as semi-structured interviews with policy actors in the EU institutions and the field of tobacco control. RESULTS As with many national governments, Article 5.3 compliance within EU institutions is partial and incomplete. Much of the compliance activity cited in EU reports is derived from general codes of conduct for EU staff and the Juncker Commission's transparency agenda. Interview respondents reveal widespread lack of knowledge about the existence of the FCTC and Article 5.3 amongst key policy actors across the institutions. Within the Commission policies vary greatly between Directorates General, and issues surrounding the conceptualisation of the role of Members of the European Parliament affect implementation in that context. While there is growing awareness of the issue in both the Commission and the Parliament, in large part as a result of the experience of lobbying over the Tobacco Products Directive, there remains considerable resistance in both institutions to further substantive action to implement Article 5.3. CONCLUSIONS We recommend that a binding and comprehensive policy and code of conduct, specifically designed for the implementation of Article 5.3 and based on the World Health Organization's guidelines, be created to cover the activities of all employees of all EU institutions. Crucially, such guidelines would need to deal explicitly with third parties acting for the tobacco industry.
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Affiliation(s)
- Benjamin Hawkins
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Chris Holden
- Department of Social Policy and Social Work, University of York, York, UK
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16
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Madureira Lima J, Galea S. Corporate practices and health: a framework and mechanisms. Global Health 2018; 14:21. [PMID: 29448968 PMCID: PMC5815179 DOI: 10.1186/s12992-018-0336-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/26/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Global Burden of Disease estimates that approximately a third of deaths worldwide are attributable to behavioural risk factors that, at their core, have the consumption of unhealthful products and exposures produced by profit driven commercial entities. We use Steven Lukes' three-dimensional view of power to guide the study of the practices deployed by commercial interests to foster the consumption of these commodities. Additionally, we propose a framework to systematically study corporations and other commercial interests as a distal, structural, societal factor that causes disease and injury. Our framework offers a systematic approach to mapping corporate activity, allowing us to anticipate and prevent actions that may have a deleterious effect on population health. CONCLUSION Our framework may be used by, and can have utility for, public health practitioners, researchers, students, activists and other members of civil society, policy makers and public servants in charge of policy implementation. It can also be useful to corporations who are interested in identifying key actions they can take towards improving population health.
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Affiliation(s)
- Joana Madureira Lima
- Department of Sociology, University of Oxford, Manor Rd Building, Manor Road, Oxford, OX1 3UQ, UK.
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
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17
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O'Leary R, Borland R, Stockwell T, MacDonald M. Claims in vapour device (e-cigarette) regulation: A Narrative Policy Framework analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:31-40. [PMID: 28414981 DOI: 10.1016/j.drugpo.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/20/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The electronic cigarette or e-cigarette (vapour device) is a consumer product undergoing rapid growth, and governments have been adopting regulations on the sale of the devices and their nicotine liquids. Competing claims about vapour devices have ignited a contentious debate in the public health community. What claims have been taken up in the state arena, and how have they possibly influenced regulatory outcomes? METHODS This study utilized Narrative Policy Framework to analyze the claims made about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the 2016 deeming rule legislation from the United States, and examined the claims and the regulatory outcomes in these jurisdictions. RESULTS The vast majority of claims in the policy documents represented vapour devices as a threat: an unsafe product harming the health of vapour device users, a gateway product promoting youth tobacco uptake, and a quasi-tobacco product impeding tobacco control. The opportunity for vapour devices to promote cessation or reduce exposure to toxins was very rarely presented, and these positive claims were not discussed at all in two of the four documents studied. CONCLUSION The dominant claims of vapour devices as a public health threat have supported regulations that have limited their potential as a harm reduction strategy. Future policy debates should evaluate the opportunities for vapour devices to decrease the health and social burdens of the tobacco epidemic.
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Affiliation(s)
- Renée O'Leary
- Centre for Addictions Research of British Columbia, P.O. Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Ron Borland
- Cancer Council Victoria, 615 St. Kilda Road, Melbourne, Victoria 3004, Australia
| | - Tim Stockwell
- Centre for Addictions Research of British Columbia, P.O. Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Marjorie MacDonald
- Centre for Addictions Research of British Columbia, P.O. Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
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18
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Bertollini R, Ribeiro S, Mauer-Stender K, Galea G. Tobacco control in Europe: a policy review. Eur Respir Rev 2017; 25:151-7. [PMID: 27246592 PMCID: PMC9487237 DOI: 10.1183/16000617.0021-2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/25/2016] [Indexed: 11/26/2022] Open
Abstract
Tobacco is responsible for the death of 6 million people every year globally, of whom 700 000 are in Europe. Effective policies for tobacco control exist; however, the status of their implementation varies across the World Health Organization (WHO) European Region. In order to tackle the tobacco epidemic, action has been taken though the implementation of both legally binding and non-legally binding measures. This article aims to present the achievements and challenges of tobacco control in Europe, focussing on the available legally binding instruments such as the WHO Framework Convention on Tobacco Control and the revision of the Tobacco Products Directive at the European Union level. Tobacco still faces heavy lobbying of the tobacco industry, which has systematically contrasted policies to achieve public health objectives. The legal instruments for tobacco control in Europe presented here are not always adequately enforced in all the countries and there is certainly room for improving their implementation. Finally, the need for a strong political commitment towards the end-game of the tobacco epidemic is emphasised. We can stop the epidemic of tobacco-related diseases but we need political commitment to the endgame of this epidemichttp://ow.ly/10lEFC
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Affiliation(s)
| | | | | | - Gauden Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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19
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Wagener TL, Floyd EL, Stepanov I, Driskill LM, Frank SG, Meier E, Leavens EL, Tackett AP, Molina N, Queimado L. Have combustible cigarettes met their match? The nicotine delivery profiles and harmful constituent exposures of second-generation and third-generation electronic cigarette users. Tob Control 2016; 26:e23-e28. [PMID: 27729564 DOI: 10.1136/tobaccocontrol-2016-053041] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/21/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Electronic cigarettes' (e-cigarettes) viability as a public health strategy to end smoking will likely be determined by their ability to mimic the pharmacokinetic profile of a cigarette while also exposing users to significantly lower levels of harmful/potentially harmful constituents (HPHCs). The present study examined the nicotine delivery profile of third- (G3) versus second-generation (G2) e-cigarette devices and their users' exposure to nicotine and select HPHCs compared with cigarette smokers. METHODS 30 participants (10 smokers, 9 G2 and 11 G3 users) completed baseline questionnaires and provided exhaled carbon monoxide (eCO), saliva and urine samples. Following a 12-hour nicotine abstinence, G2 and G3 users completed a 2-hour vaping session (ie, 5 min, 10-puff bout followed by ad libitum puffing for 115 min). Blood samples, subjective effects, device characteristics and e-liquid consumption were assessed. RESULTS Smokers, G2 and G3 users had similar baseline levels of cotinine, but smokers had 4 and 7 times higher levels of eCO (p<0.0001) and total 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (i.e., NNAL, p<0.01), respectively, than G2 or G3 users. Compared with G2s, G3 devices delivered significantly higher power to the atomiser, but G3 users vaped e-cigarette liquids with significantly lower nicotine concentrations. During the vaping session, G3 users achieved significantly higher plasma nicotine concentrations than G2 users following the first 10 puffs (17.5 vs 7.3 ng/mL, respectively) and at 25 and 40 min of ad libitum use. G3 users consumed significantly more e-liquid than G2 users. Vaping urges/withdrawal were reduced following 10 puffs, with no significant differences between device groups. DISCUSSION Under normal use conditions, both G2 and G3 devices deliver cigarette-like amounts of nicotine, but G3 devices matched the amount and speed of nicotine delivery of a conventional cigarette. Compared with cigarettes, G2 and G3 e-cigarettes resulted in significantly lower levels of exposure to a potent lung carcinogen and cardiovascular toxicant. These findings have significant implications for understanding the addiction potential of these devices and their viability/suitability as aids to smoking cessation.
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Affiliation(s)
- Theodore L Wagener
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Evan L Floyd
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Occupational and Environmental Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Irina Stepanov
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Leslie M Driskill
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Summer G Frank
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ellen Meier
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eleanor L Leavens
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Alayna P Tackett
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Neil Molina
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lurdes Queimado
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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20
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Hatchard JL, Fooks GJ, Gilmore AB. Standardised tobacco packaging: a health policy case study of corporate conflict expansion and adaptation. BMJ Open 2016; 6:e012634. [PMID: 27855104 PMCID: PMC5073631 DOI: 10.1136/bmjopen-2016-012634] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate opposition to standardised tobacco packaging in the UK. To increase understanding of how transnational corporations are adapting to changes in their access to policymakers precipitated by Article 5.3 of the Framework Convention on Tobacco Control (FCTC). DESIGN Case study web-based documentary analysis, using NVivo V.10. Examination of relationships between opponents of standardised packaging and transnational tobacco companies (TTCs) and of the volume, nature, transparency and timing of their activities. SETTING UK standardised packaging policy debate 2011-2013. PARTICIPANTS Organisations selected on basis of opposition to, or facilitation thereof, standardised tobacco packaging in the UK; 422 associated documents. RESULTS Excluding tobacco manufacturing and packaging companies (n=12), 109 organisations were involved in opposing standardised packaging, 82 (75%) of which had a financial relationship with 1 or more TTC. These 82 organisations (43 actively opposing the measure, 39 facilitating opposition) were responsible for 60% of the 404 activities identified, including the majority of public communications and research production. TTCs were directly responsible for 28% of total activities, predominantly direct lobbying, but also financially underwrote third party research, communication, mass recruitment and lobbying. Active organisations rarely reported any financial relationship with TTCs when undertaking opposition activities. CONCLUSIONS The multifaceted opposition to standardised packaging was primarily undertaken by third parties with financial relationships with major tobacco manufacturers. Low levels of transparency regarding these links created a misleading impression of diverse and widespread opposition. Countries should strengthen implementation of Article 5.3 of the FCTC by systematically requiring conflict of interest declarations from all organisations participating in political or media debates on tobacco control.
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Affiliation(s)
- Jenny L Hatchard
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Gary J Fooks
- School of Languages and Social Sciences, Aston University, Birmingham, UK
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
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21
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Stuckler D, Reeves A, Loopstra R, McKee M. Textual analysis of sugar industry influence on the World Health Organization's 2015 sugars intake guideline. Bull World Health Organ 2016; 94:566-73. [PMID: 27516634 PMCID: PMC4969989 DOI: 10.2471/blt.15.165852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To determine whether sugar industry-related organizations influenced textual changes between the draft and final versions of the World Health Organization's (WHO's) 2015 guideline Sugars intake for adults and children. METHODS Stakeholder consultation submissions on the draft guideline from seven sugar industry-related and 10 public health organizations were assessed using the Wordscores program. Document scores were rescaled using the Martin-Vanberg transformation to improve comparability. Draft and final guidelines were compared to identify changes influenced by the sugar industry and public health organizations. FINDINGS There was a small shift in transformed Wordscores score between the draft and final guidelines, from 0.25 to 0.24, towards the industry position. The change was linked to increased use of the word "low" to describe the quality of the evidence, consistent with industry arguments. There was also a shift from use of the word "consumption" to "intake", irrespective of policy position. Scores for World Sugar Research Organisation and Sugar Nutrition UK submissions ( 0.11 and 0.18, respectively) represented strong pro-industry positions and scores for European Public Health Alliance and Wemos submissions (1.00 and 0.88, respectively) represented the strongest public health positions. Industry tactics included challenging the quality of the evidence, distinguishing between different types of sugar and advocating harm reduction. CONCLUSION There was little change between draft and final versions of the WHO sugars intake guideline 2015, following industry consultation. The main change was linked to emphasizing the low quality of the evidence on sugar's adverse effects. Guideline development appeared relatively resistant to industry influence at the stakeholder consultation stage.
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Affiliation(s)
- David Stuckler
- Department of Sociology, University of Oxford, Manor Road Building, Oxford, OX1 3UQ, England
| | - Aaron Reeves
- International Inequalities Institute, London School of Economics and Political Science, London, England
| | - Rachel Loopstra
- Department of Sociology, University of Oxford, Manor Road Building, Oxford, OX1 3UQ, England
| | - Martin McKee
- Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, England
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22
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Joossens L, Gilmore AB, Stoklosa M, Ross H. Assessment of the European Union's illicit trade agreements with the four major Transnational Tobacco Companies. Tob Control 2016; 25:254-60. [PMID: 26022741 PMCID: PMC4853556 DOI: 10.1136/tobaccocontrol-2014-052218] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/04/2015] [Indexed: 11/05/2022]
Abstract
To address the illicit cigarette trade, the European Union (EU) has signed agreements with the four major Transnational Tobacco Companies (TTCs) that involve establishing extensive systems of cooperation. All agreements foresee two types of payments: annual payments (totalling US$ 1.9 billion over 20 years) and supplementary seizure payments, equivalent to 100% of the evaded taxes in the event of seizures of their products. While limited by the fundamental lack of transparency in this area, our analysis suggests that these agreements have served largely to secure the TTCs' interests and are threatening progress in tobacco control. The seizure payments are paltry and a wholly inadequate deterrent to TTC involvement in illicit trade. Despite the agreements, growing evidence indicates the TTCs remain involved in the illicit trade or are at best failing to secure their supply chains as required by the agreements. The intention of the seizure-based payments to deter the tobacco industry from further involvement in the illicit cigarette trade has failed because the agreements contain too many loopholes that provide TTCs with both the incentive and opportunity to classify seized cigarettes as counterfeit. In addition, the shifting nature of cigarette smuggling from larger to smaller consignments often results in seizures that are too small to qualify for the payments. Consequently, the seizure payments represent a tiny fraction of the revenue lost from cigarette smuggling, between 2004 and 2012, 0.08% of the estimated losses due to illicit cigarette trade in the EU. Our evidence suggests the EU should end these agreements.
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Affiliation(s)
- Luk Joossens
- Association of the European Cancer Leagues & Tobacco Control Expert, Foundation Against Cancer, Brussels, Belgium
| | - Anna B Gilmore
- Department for Health, University of Bath and UK Centre for Tobacco and Alcohol Studies, Bath, UK
| | - Michal Stoklosa
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
| | - Hana Ross
- University of Cape Town, Cape Town, South Africa
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23
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Peeters S, Costa H, Stuckler D, McKee M, Gilmore AB. The revision of the 2014 European tobacco products directive: an analysis of the tobacco industry's attempts to 'break the health silo'. Tob Control 2016; 25:108-17. [PMID: 25713313 PMCID: PMC4669229 DOI: 10.1136/tobaccocontrol-2014-051919] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/16/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND The 2014 European Union (EU) Tobacco Products Directive (TPD) was negotiated in a changed policy context, following adoption of the EU's 'Smart Regulation' agenda, which transnational tobacco companies (TTCs) anticipated would increase their influence on health policy, and the WHO Framework Convention on Tobacco Control (FCTC), which sought to reduce it. This study aims to explore the scale and nature of the TTCs' lobby against the EU TPD and evaluate how these developments have affected their ability to exert influence. METHODS Analysis of 581 documents obtained through freedom of information requests, 28 leaked Philip Morris International (PMI) documents, 17 TTC documents from the Legacy Library, web content via Google alerts and searches of the EU institutions' websites, plus four stakeholder interviews. RESULTS The lobby was massive. PMI alone employed over 160 lobbyists. Strategies mainly used third parties. Efforts to 'Push' (amend) or 'Delay' the proposal and block 'extreme policy options' were partially successful, with plain packaging and point of sales display ban removed during the 3-year delay in the Commission. The Smart Regulation mechanism contributed to changes and delays, facilitating meetings between TTC representatives (including ex-Commission employees) and senior Commission staff. Contrary to Article 5.3, these meetings were not disclosed. CONCLUSIONS During the legislative process, Article 5.3 was not consistently applied by non-health Directorates of the European Commission, while the tools of the Smart Regulation appear to have facilitated TTC access to, and influence on, the 2014 TPD. The use of third parties undermines Article 5.3.
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Affiliation(s)
- Silvy Peeters
- Department for Health, University of Bath, and member of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
| | - Hélia Costa
- Department of Sociology, University of Oxford, Oxford, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, and member of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
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McKee M. Reflecting on 'European policymaking on the tobacco advertising ban: the importance of escape routes'. HEALTH ECONOMICS, POLICY, AND LAW 2015; 10:437-442. [PMID: 26040513 DOI: 10.1017/s1744133115000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Martin McKee
- Professor of European Public Health,London School of Hygiene and Tropical Medicine,London
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McKee M, Daube M. Europe’s governments must implement standardised tobacco packaging now. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev 2015; 16:519-30. [PMID: 25988272 DOI: 10.1111/obr.12289] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/11/2015] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Abstract
Unhealthy diets represent one of the major risk factors for non-communicable diseases. There is currently a risk that the political influence of the food industry results in public health policies that do not adequately balance public and commercial interests. This paper aims to develop a framework for categorizing the corporate political activity of the food industry with respect to public health and proposes an approach to systematically identify and monitor it. The proposed framework includes six strategies used by the food industry to influence public health policies and outcomes: information and messaging; financial incentive; constituency building; legal; policy substitution; opposition fragmentation and destabilization. The corporate political activity of the food industry could be identified and monitored through publicly available data sourced from the industry itself, governments, the media and other sources. Steps for country-level monitoring include identification of key food industry actors and related sources of information, followed by systematic data collection and analysis of relevant documents, using the proposed framework as a basis for classification of results. The proposed monitoring approach should be pilot tested in different countries as part of efforts to increase the transparency and accountability of the food industry. This approach has the potential to help redress any imbalance of interests and thereby contribute to the prevention and control of non-communicable diseases.
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Affiliation(s)
- M Mialon
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | - B Swinburn
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - G Sacks
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
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27
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Steele SL, Gilmore AB, McKee M, Stuckler D. The role of public law-based litigation in tobacco companies' strategies in high-income, FCTC ratifying countries, 2004-14. J Public Health (Oxf) 2015; 38:516-521. [PMID: 26036703 PMCID: PMC5072156 DOI: 10.1093/pubmed/fdv068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Tobacco companies use a host of strategies to undermine public health efforts directed to reduce and eliminate smoking. The success, failure and trends in domestic litigation used by tobacco companies to undermine tobacco control are not well understood, with commentators often assuming disputes are trade related or international in nature. We analyse domestic legal disputes involving tobacco companies and public health actors in high-income countries across the last decade to ascertain the types of action and the success or failure of cases, develop effective responses. Methods WorldLii, a publicly available online law repository, was used to identify domestic court cases involving tobacco companies from 2004 to 2014, while outcome data from LexisNexis and Westlaw databases were used to identify appeals and trace case history. Results We identified six domestic cases in the UK, Australia and Canada, noting that the tobacco industry won only one of six cases; a win later usurped by legislative reform and a further court case. Nevertheless, we found cases involve significant resource costs for governments, often progressing across multiple jurisdictional levels. Discussion We suggest that, in light of our results, while litigation takes up significant time and incurs legal costs for health ministries, policymakers must robustly fend off suggestions that litigation wastes taxpayers' money, pointing to the good prospects of winning such legal battles.
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Affiliation(s)
- Sarah L Steele
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Anna B Gilmore
- Department for Health and UK Centre for Tobacco and Alcohol Studies, University of Bath, Bath, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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28
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Tackett AP, Lechner WV, Meier E, Grant DM, Driskill LM, Tahirkheli NN, Wagener TL. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 2015; 110:868-74. [PMID: 25675943 DOI: 10.1111/add.12878] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/11/2014] [Accepted: 01/30/2015] [Indexed: 02/04/2023]
Abstract
AIMS To evaluate biochemically verified smoking status and electronic nicotine delivery systems (ENDS) use behaviors and beliefs among a sample of customers from vapor stores (stores specializing in ENDS). DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey of 215 adult vapor store customers at four retail locations in the Midwestern United States; a subset of participants (n = 181) also completed exhaled carbon monoxide (CO) testing to verify smoking status. MEASUREMENTS Outcomes evaluated included ENDS preferences, harm beliefs, use behaviors, smoking history and current biochemically verified smoking status. FINDINGS Most customers reported starting ENDS as a means of smoking cessation (86%), using newer-generation devices (89%), vaping non-tobacco/non-menthol flavors (72%) and using e-liquid with nicotine strengths of ≤20 mg/ml (72%). There was a high rate of switching (91.4%) to newer-generation ENDS among those who started with a first-generation product. Exhaled CO readings confirmed that 66% of the tested sample had quit smoking. Among those who continued to smoke, mean cigarettes per day decreased from 22.1 to 7.5 (P <0.001). People who reported vaping longer [odds ratio (OR) = 4.659, 95% confidence interval (CI) = 2.001-10.846], using newer-generation devices (OR = 2.950, 95% CI = 1.037-8.395) and using non-tobacco and non-menthol flavors (OR = 2.626, 95% CI = 1.133-6.085) were more likely to have quit smoking. CONCLUSIONS Among vapor store customers in the United States who use electronic nicotine delivery devices to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.
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Affiliation(s)
- Alayna P Tackett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA; Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
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Hiilamo H, Glantz SA. Old wine in new bottles: tobacco industry's submission to European Commission tobacco product directive public consultation. Health Policy 2014; 119:57-65. [PMID: 25467283 DOI: 10.1016/j.healthpol.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Between September and December 2010 the European Commission Health & Consumer Protection Directorate-General (DGSANCO) held a public consultation on a possible revision of the European Union Tobacco Products Directive (2001/37/EC). We used content analysis of the tobacco industry's and related parties' 300 submissions to the public consultation to determine if tobacco industry and its allies in Europe are prepared to reduce harm of the tobacco products as their public statements assert. The industry submission resorted to traditional tobacco industry arguments where illicit trade and freedom of choice were emphasized and misrepresented the conclusions of a DGSANCO-commissioned scientific report on smokeless tobacco products. Retailers and wholesalers referred to employment and economic growth more often than respondents from other categories. The pattern of responses in the submission differed dramatically from independent public opinion polls of EU citizens' support for tobacco control policies. None of the major tobacco manufacturers or their lobbying organizations supported any of the DGSANCO's proposed evidence based interventions (pictorial health warnings, plain packaging or point-of-sale display bans) to reduce harms caused by cigarette smoking.
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Affiliation(s)
- Heikki Hiilamo
- Helsinki University, Faculty of Social Sciences, PO Box 16, 00014 Helsinki, Finland.
| | - Stanton A Glantz
- Department of Medicine Center for Tobacco Control Research & Education Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94143-1390, United States
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