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Lyle G, Hendrie D. Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020. Global Health 2024; 20:40. [PMID: 38715053 PMCID: PMC11075264 DOI: 10.1186/s12992-023-01012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/27/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020. METHODS We replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide. RESULTS Identical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries. CONCLUSIONS Considerable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.
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Affiliation(s)
- Greg Lyle
- Curtin University School of Population Health, Perth, Bentley Campus, 6102, Australia.
| | - Delia Hendrie
- Curtin University School of Population Health, Perth, Bentley Campus, 6102, Australia
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Al-Dahshan A, Al Muraikhi H, Musa S, Joudeh A, Al Baker W, Selim N, Bougmiza I. Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study. Front Public Health 2023; 11:1166016. [PMID: 37275499 PMCID: PMC10235512 DOI: 10.3389/fpubh.2023.1166016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Objective To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar. Methods A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed. Results The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months. Conclusion The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.
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Affiliation(s)
- Ayman Al-Dahshan
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Hissa Al Muraikhi
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Sarah Musa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Anwar Joudeh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wadha Al Baker
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Nagah Selim
- Department of Community Medicine, Primary Health Care Corporation, Doha, Qatar
- Department of Public Health and Preventive Medicine, Cairo University, Giza, Egypt
| | - Iheb Bougmiza
- Department of Community Medicine, Primary Health Care Corporation, Doha, Qatar
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Hebbar PB, Dsouza V, Bhojani U, Prashanth NS, van Schayck OC, Babu GR, Nagelhout GE. How do tobacco control policies work in low-income and middle-income countries? A realist synthesis. BMJ Glob Health 2022; 7:e008859. [PMID: 36351683 PMCID: PMC9644319 DOI: 10.1136/bmjgh-2022-008859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs. METHODS We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs. RESULTS We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process. CONCLUSIONS The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs. PROSPERO REGISTRATION NUMBER CRD42020191541.
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Affiliation(s)
- Pragati Bhaskar Hebbar
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Vivek Dsouza
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Upendra Bhojani
- Cluster on Chronic conditions and public policies, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | | | - Onno Cp van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Netherlands
| | - Giridhara R Babu
- Epidemiology, Public Health Foundation of India, Bangalore, India
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Gudi N, Swain A, Kulkarni MM, Pattanshetty S, Zodpey S. Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol. BMJ Open 2022; 12:e058225. [PMID: 35906062 PMCID: PMC9345044 DOI: 10.1136/bmjopen-2021-058225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Tobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings. METHODS AND ANALYSIS This scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation. ETHICS AND DISSEMINATION This review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.
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Affiliation(s)
- Nachiket Gudi
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Muralidhar M Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sanjay Pattanshetty
- Department of Global Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Awawda S, Chalak A, Khader Y, Mostafa A, Abla R, Nakkash R, Jawad M, Salloum RG, Abu-Rmeileh NM. Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment. BMJ Open 2022; 12:e058495. [PMID: 35851023 PMCID: PMC9297203 DOI: 10.1136/bmjopen-2021-058495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study assessed the extent to which the elasticity of cigarette and waterpipe tobacco products differs between men and women. We also explored the levels of substitution and complementarity in tobacco products among men and women. SETTING The study examines tobacco elasticities in three Arab countries: Lebanon, Jordan and the West Bank of Palestine. PARTICIPANTS We used data from nationally representative surveys of adults aged ≥18 years in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679). The proportion of women was 50.0% of the sample in Lebanon and Palestine, and 44.6% in Jordan. PRIMARY AND SECONDARY OUTCOME MEASURES A zero-inflated Poisson regression model estimated own-price and cross-price elasticities for two variations of cigarettes and five variations of waterpipe tobacco products. Elasticities were measured based on eight scenarios of prices. RESULTS Demand for waterpipe tobacco products was elastic for both men and women. The cross-price elasticities in the three countries indicate the existence of substitution between cigarettes and waterpipe products and by different varieties within each of the two tobacco products. Gender differences varied across the three countries whereby higher cross-price elasticities were observed for women in Jordan and Palestine. For example, the price elasticity for discount waterpipe was -1.4 and -0.6 for women and men in Jordan, respectively. CONCLUSIONS Results on the elasticity of demand for tobacco products and the existence of substitution between tobacco products reveal the higher responsiveness of men and women to changes in tobacco prices. This should be taken into consideration in tobacco control strategies particularly when reducing tobacco consumption via taxation policies.
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Affiliation(s)
- Sameera Awawda
- Economics Department, Birzeit University, Ramallah, Palestine, State of
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon, Beirut, Lebanon
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of
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