Towards Tobacco-Free Generation: implementation of preventive tobacco policies in the Nordic countries

AIMS

Europe's Beating Cancer Plan set a goal of creating a Tobacco-Free Generation in Europe by 2040. Prevention is important for achieving this goal. We compare the Nordic countries' preventive tobacco policies, discuss the possible determinants for similarities and differences in policy implementation, and provide strategies for strengthening tobacco prevention.

METHODS

We used the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to identify the key policies for this narrative review. We focused on Articles 6, 8, 9, 11, 13 and 16 of the WHO FCTC, and assessed the status of the required (core) and recommended (advanced) policies and their application to novel tobacco and nicotine products. Information on the implementation of strategies, acts and regulations were searched from global and national tobacco control databases, websites and scientific articles via PubMed and MEDLINE.

RESULTS

The WHO FCTC and European regulations have ensured that the core policies are mostly in place, but also contributed to the shared deficiencies that are seen especially in the regulations on smokeless tobacco and novel products. Strong national tobacco control actors have facilitated countries to implement some advanced policies - even as the first countries in the world: point-of-sale display bans (Iceland), outdoor smoking bans (Sweden), flavour bans on electronic cigarettes (Finland), plain packaging (Norway), and plain packaging on electronic cigarettes (Denmark).

CONCLUSIONS

Collaboration and participation in reinforcing the European regulations, resources for national networking between tobacco control actors, and national regulations to provide protection from the tobacco industry's interference are needed to strengthen comprehensive implementation of tobacco policies in the Nordic countries.

Mental Health Reform Processes and Service Delivery Shift From the Hospital to the Community in Belgium and Hong Kong

Aim

We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies.

Methods

This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy.

Results

Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes.

Conclusions

Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift.

Educational Leave as a Time Resource for Participation in Adult Learning and Education (ALE)

The study investigates effects of the implementation of a law authorizing educational leave in Germany on individual participation in adult learning and education (ALE). In 2015, the federal state of Baden-Württemberg introduced the so-called Bildungszeitgesetz, legitimating an exemption for eligible employees of up to 5 days per year with continued payment of salary. Explaining participation in ALE is a central subject of educational research at national and international level. Current theoretical assumptions of rational choice and empirical findings of educational and socio-statistical research suggest that within the general population, individuals’ availability of time affects the decision to participate and therefore lastly determines participation in ALE. However, current academia mainly discusses time as either a prerequisite for learning activities or as an observable outcome of participation and not as an explanatory factor. Furthermore, since recent studies remain on a descriptive level regarding influences of time on participation in ALE, no causal effects of the availability of time on participation are estimated. Hence, our study addresses this research gap by investigating effects of educational policy interventions such as the Bildungszeitgesetz on participation in ALE. Policy interventions are ideally suited to examine the significance of time resources for participation, as the implementation of the Bildungszeitgesetz provides a specific timeframe for employees to participate in ALE outside of their working time. Drawing on data from the German National Educational Panel Study, we employ a difference-in-differences estimation strategy with propensity score matching and instrumental variable to identify the direct causal effect of the implementation of the Bildungszeitgesetz on participation in ALE (N = 709). This combination toward causal inference controls for observed and unobserved baseline differences as well as heterogeneous treatment effects. The results reveal a non-significant but heterogeneous treatment effect of the implementation of the Bildungszeitgesetz on individual participation in ALE. Contrary to our theoretical assumptions derived from rational choice approaches, we cannot confirm the hypothesis that the availability of time resources due to the implementation of the Bildungszeitgesetz causes a positive effect on participation in ALE. Furthermore, the results reveal that the implementation causes decreasing participation rates for younger adults, women and significantly for migrants.