Tobacco prevention policies in west-African countries and their effects on smoking prevalence

Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries

INTRODUCTION

Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa.

METHODS

This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls.

RESULTS

Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30).

CONCLUSIONS

The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.

Assessment of Tobacco Control Policy Instruments, Status and Effectiveness in Africa: A Systematic Literature Review

Introduction

The tobacco industry has for decades been associated with environmental damage, health-related diseases, human rights violations and corruption issues. The World Health Organisation formulated the Framework Convention on Tobacco Control with the aim of controlling tobacco production and consumption. Most of the countries on the continent of Africa were also the target of the framework given the high importation and use of tobacco products. The main aim of this study was to find out the current status of tobacco control policies and their effectiveness in Africa.

Material and Methods

This study was a systematic literature review that was conducted between the months of August and November 2020 by extracting data from the databases of PubMed, Elsevier Scopus and Web of Science. Only English articles were culled from the retrieved papers. Out of the 910 papers retrieved, only 17 papers from African countries were selected on the quality synthesis after meeting the inclusion criteria.

Results

The results of the study showed that three governance resources were identified of regulatory (64.70%, N=11) which had smoke-free environment, advertisement bans, and cessation programs, economics (29.41%, N=5) which were taxation measures and informative (5.886%, N=1) which were mass media campaigns. Furthermore, Western African countries especially South Africa reported many pronouncements on smoke-free environment and taxation measures. Mass media campaigns proved to be more effective policies as compared to others.

Conclusion

This study recommends that the future research should be done on the effectiveness of mixed policy instruments as compared to single application. Furthermore, the researcher recommends the use of more informative policies in dealing with inelastic behaviours like those related to tobacco due to the addictive nature.

A health policy analysis of the implementation of the National Tobacco Control Act in Nigeria

Non-communicable diseases (NCDs) have emerged as a public health issue of concern in Nigeria. The massive increase in tobacco use amongst different population groups is a common NCDs risk factor. To this effect, the National Tobacco Control Act (NTCA) was enacted following the WHO Framework Convention on Tobacco Control (FCTC). This article conducts a health policy agenda-setting analysis of the NTCA using the Kingdon's multiple streams model and analyses its implementation using the Principal-Agent theory. The purposive and snowballing sampling methods were used to select and review relevant peer-review literature. Other data sources included gray literature, government reports, Non-Governmental Organization briefs and media resources. Though NTCA conforms to WHO FCTC, Nigeria only domesticated her obligation to this framework legislatively while the executive and administrative measures were found lacking. The challenges and gaps identified in the NTCA implementation include; revision of textual health warnings and lack of pictorial health warnings on cigarette packs, poor taxation, and the National Tobacco Control Commission's (NTCC) lack of regulatory autonomy, hence, the poor policy implementation reported in this article. To effectively implement NTCA, a review of textual warnings, enforcement of pictorial warnings, regulatory autonomy of the NTCC and review of the tobacco taxation are suggested to help in the prevention and control of NCDs.

Consumption of legal and illegal cigarettes in the Gambia

BACKGROUND

The prevalence of cigarette smoking in the Gambia is relatively high, compared with most African countries. Little is known about the characteristics of the smokers and their habits, particularly with regard to tobacco tax avoidance and tax evasion.

METHODS

A nationally representative survey of 1211 smokers conducted in November/December 2017 employed a three-stage stratified sampling method and resulted in 1205 complete observations. The sociodemographic characteristics and smoking behaviours were analysed, including smoking intensity and brand preferences. Information on the physical features of cigarette packs that smokers had, observed by enumerators, and self-reported cigarette prices were used to estimate the proportion of illegal cigarettes on the market.

FINDINGS

As in many African countries, most smokers were male, between the ages of 25 and 54 years living primarily in urban areas. The three most popular cigarette brands are Piccadilly, Royal Business and Bond Street, which account for over three-quarters of all cigarette purchases. Price information suggests that about 7.3% of smokers purchased an illicit cigarette at their last purchase. When smoking intensity was taken into account, 8.6% of the total cigarette market was estimated to be illicit. Using an alternative method of evaluating pack's features revealed that only 0.9% of last purchases were illicit.

CONCLUSION

Despite recent excise tobacco tax increases, the use of illicit cigarettes in the Gambia is low and does not represent a significant obstacle to reaching both the public health and fiscal goals of higher tobacco taxes.

Prevalence of Cardiovascular Disease Risk Factors in the Gambia: A Systematic Review

Cardiovascular disease (CVD) is increasingly becoming a major chronic disease burden in sub-Saharan Africa. The aim of this review was to provide an up-to-date overview on prevalence of CVD risk factors in the Gambia. The findings from seven included studies revealed that most CVD risk factors are very prevalent in the Gambia, with some specific groups in the population such as urban dwellers being more at risk. Obesity prevalence ranged from 2.3% to 11.7%, with rate being particularly high in urban women aged ≥35 years. Diabetes prevalence was 0.3%. Hypertension prevalence ranged from 18.3% to 29%. Prevalence of hypercholesterolemia ranged from 2.2% to 29.1%. Prevalence of smoking ranged from 16% to 42.2% in men. Prevalence of insufficient fruit and vegetable consumption, inadequate physical activity, and alcohol consumption was 77.8%, 14.6%, and 2.3%, respectively. These findings suggest urgent need for preventive measures and further research to prevent CVD in the Gambia.

The effect of cigarette price increases on cigarette consumption, tax revenue, and smoking-related death in Africa from 1999 to 2013

OBJECTIVES

This study investigates the effects of price hikes on cigarette consumption, tobacco tax revenues, and reduction in smoking-caused mortality in 36 African countries.

METHODS

Using panel data from the 1999-2013 Euromonitor International, the World Bank and the World Health Organization, we applied fixed-effects and random-effects regression models of panel data to estimate the elasticity of cigarette prices and simulate the effect of price fluctuations.

RESULTS

Cigarette price elasticity was the highest for low-income countries and considerably lower for other African economies. The administered simulation shows that with an average annual cigarette price increase of 7.38%, the average annual cigarette consumption would decrease by 3.84%, and the average annual tobacco tax revenue would increase by 19.39%. By 2050, the number of averted smoking-attributable deaths (SADs) will be the highest in South Africa, followed by the Democratic Republic of Congo, Madagascar, and Ethiopia.

CONCLUSIONS

Excise tax increases have a significant effect on the reduction of smoking prevalence and the number of averted smoking-attributable deaths, Low-income countries are most affected by high taxation policies.

Emergence of Colorectal Cancer in West Africa: Accepting the Inevitable

It seems not too long ago that colon and rectal cancer is a "rare" disease in rural Africa; however, over the last 30 years in West Africa, published evidence has shown decade by decade increases in the incidence of colorectal cancer (CRC). Therefore, CRC should now be accepted as a recognized disease in native Africans; nevertheless, we must acknowledge that the incidence is a fraction of what obtains in the developed countries of Europe and America. This presentation will attempt to examine the emergence of CRC within the West African axis over the last four decades.

Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa

Introduction. This review examines whether electronic cigarettes (e-cigs) implementation or vulgarization in sub-Saharan Africa (SSA) could be helpful in curtailing the toll of tobacco smoking in the region. Discussion. There are about 1.3 billion smokers worldwide, with nearly 80% of them living in developing countries where the burden of tobacco-related illnesses and deaths is the heaviest. Studies report that e-cigs may facilitate smoking cessation, reduction, or abstinence and may pose only a small fraction of the risks of traditional tobacco cigarettes; e-cigs may also considerably reduce second-hand smoking. Thereby, implementation of e-cig use could help to substantially reduce the burden driven by tobacco smoking in SSA, in a particular context of lack of regulations and control policies towards this threat. However, the evidence is not clear on whether e-cigs are risk-free, especially if used in the long term. Conclusions. On the whole, if e-cigs were to be introduced in SSA, they should be strictly recommended to current and/or ex-smokers as a method to quit smoking or prevent relapse and never-smokers should be strongly encouraged to avoid using these devices. Bans on sales of e-cigs to youngsters should be legislated, e-cig advertisements prohibited, and their usage continuously controlled and monitored.