Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control.

There has been a global decline in tobacco consumption that, if continued, will negatively impact the tobacco industry's profits. This decline led the industry to invent and market new products, including heated tobacco products (HTP). HTP are an extension of the industry's strategies to undermine government's tobacco regulatory efforts as they are being promoted as part of the solution for the tobacco epidemic. Under the moniker of 'harm reduction', the tobacco companies are attempting to rehabilitate their reputation so they can more effectively influence governments to roll back existing tobacco control policies or create exemptions for their HTP. Rolling back tobacco control policies will make it easier for the companies to renormalise tobacco use to increase social acceptability for all their products. When regulations are absent or when loopholes exist in classifying HTP as a tobacco product (thus subject to all tobacco control regulations), the industry's marketing of HTP is making these products more visible to the public and more accessible. Governments need to ensure that HTP are regulated as tobacco products or drugs and reject partnerships with the tobacco companies to promote 'harm reduction'. The tobacco companies remain the vector of the tobacco-caused epidemic and cannot be part of the global tobacco control solution

Tracking progress of tobacco control in Pakistan against the MPOWER package of interventions : challenges and opportunities

MPOWER is an evidence-based package of the six most effective demand reduction interventions to reduce tobacco use. Global evidence shows that introduction of this package has accelerated and strengthened tobacco control worldwide with over 5 billion people living in 136 countries covered by at least one of these key interventions. This paper comments on how tobacco control laws in a low and middle income country, Pakistan, are meeting the MPOWER package provisions and what the challenges and opportunities for tobacco control are in the country. Pakistan is home to over 24 million tobacco users consuming a variety of tobacco products including 10 million smokeless tobacco users. Pakistan has introduced several laws to meet its international commitments under the framework convention against tobacco control and MPOWER package. However, gaps in existing policies, poor law enforcement, and a conflicting political economy of tobacco in the country pose major challenges for effective tobacco control. The changing political environment with renowned public health activists in current government, an active and independent judiciary, increasing use of social media, and a dynamic civil society offer opportunities to strengthen its efforts for effective policy actions against tobacco use

Developing Capacity, Skills, and Tobacco Control Networks to address Tobacco-related Disparities: Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP)

Priority populations disproportionately experience tobacco-related disparities, despite population level declines in tobacco use. The Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP) recruits and trains African immigrants/African Americans, Asian Americans/Pacific Islanders, American Indians, Chicano/Latinos, and LGBTQ community members to develop leaders to address tobacco harms in their communities. This paper describes and evaluates the LAAMPP Institute, and discusses lessons learned through the Institute and future directions for community-based tobacco-control efforts. The mixed-methods evaluation included qualitative key informant interviews with LAAMPP Fellows and community and project contacts, a Skills Assessment Tool, project case studies, and a social network analysis of the Fellows’ tobacco-control social networks at baseline and follow-up. At follow-up, Fellows’ tobacco control networks were larger, more extensive and diverse, and included more actors perceived to be influential in tobacco control. Fellows’ skills increased in core competencies (tobacco control, advocacy, facilitation, collaboration, cultural/community competence) and Fellows used tobacco, advocacy and cultural/community competencies more frequently. Four of five cohorts successfully passed policies. The results of LAAMPP suggest that a cross-cultural leadership institute contributes to the successful development of capacity and leadership skills among priority populations and may be a useful model for others working toward health equity

The United States\u27 Engagement in Global Tobacco Control: Proposals for Comprehensive Funding and Strategies

Tobacco use kills more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, tobacco-related diseases will kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming healthcare budgets, robbing families of their primary wage earners, and hindering economic development. Tobacco consumption is shifting from industrialized to developing countries, spurred by rising incomes, trade liberalization, and intensive marketing. Although Congress empowered the U.S. Food and Drug Administration to regulate tobacco domestically, the United States has failed to lead globally. The United States is among a small minority of countries that has signed, but not ratified, the World Health Organization (WHO) Framework Convention on Tobacco Control. A tiny percentage of U.S. funding for global health is dedicated to international tobacco control. U.S. trade policy has supported and enabled the industry to expand tobacco use overseas. In this Commentary, we argue for robust U.S. engagement in global tobacco control, first explaining why it is in the national interest of the United States and then suggesting a comprehensive strategy for supporting tobacco control in low- and middle-income countries

Global Tobacco Control and Economic Norms: An Analysis of Normative Commitments in Kenya, Malawi And Zambia

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos

Global Regulatory Strategies for Tobacco Control

Recent tobacco control regulation in North America and Western Europe has had a salutary effect, even if smoking remains a pressing public health hazard. But in the 21st century, the tobacco industry has quietly moved its locus of activity to lucrative, emerging markets: the vast populations in Africa, Asia, Eastern Europe, and Latin America. The poorest, least educated, and sickest people on earth inhabit these regions. Big Tobacco\u27s new marketing strategy will cause untold morbidity for the world\u27s most vulnerable. However, there are a variety of effective tobacco control policies that nations can and should enact. The World Health Organization treaty, the Framework Convention for Tobacco Control, requires signatory nations to adopt a variety of tobacco control policies to the fullest extent permissible under their constitutions. The Second Conference of FCTC Parties recently set regulatory goals in Bangkok, Thailand, including the first FCTC protocol on illicit trade of tobacco products, a second protocol on cross border advertising regulations. Effective tobacco control policies include: national tobacco regulatory agencies; comprehensive bans on tobacco advertising, promotion, and sponsorship; health warnings on cigarette packets that cover at least half of the packet, convey the risks, rotate messages, and use images; mandating smoke-free environments; and tax and price policies that make smoking prohibitively expensive. This article examines legislation and regulation from all parts of the world in each of these spheres, and evaluates their effectiveness. The imperatives of science, ethics, and human rights oblige society to reduce the burden of smoking, particularly among the most disadvantaged

Predicting smokers' non-compliance with smoking restrictions in public places

Objective: The present study aimed to identify the predictors of non-compliance with smoking restrictions among Greek college student smokers. Differences in attitudes to smoking bans and tobacco control policies between current smokers and non-smokers were also examined. Methods: Data were collected from college students (n = 229, mean (SD) age 21.27 (3.15) years). Measures included tobacco dependence, attitudes to tobacco control policies, outcome expectancy and normative beliefs. Results: The majority of current smokers reported noncompliance with existing restrictions. Logistic regression analysis showed that non-compliance was significantly predicted by (less) anticipated regret from tobacco-related health harm, tobacco dependence and perceived prevalence and social acceptability of smoking. Analysis of variance indicated that current non-smokers held significantly more positive attitudes to smoking bans and tobacco control policies than current smokers. Conclusions: Smoking was highly prevalent, and more than half of current smokers reported not complying with existing regulations in public places. Smokers' attitudes to smoking bans and tobacco control policies did not have an effect on compliance behaviour. Future policies to promote compliance with smoking restrictions in Greece should target health-related anticipated regret, and perceived social norms

The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: 1981-1998

Since the 1998 Master Settlement Agreement between states and the tobacco industry, states have unprecedented resources for programs to reduce tobacco use. Decisions concerning the use of these funds will, in part, be based on the experiences of states with existing programs. We review the experiences of several states that have adopted comprehensive tobacco control programs. We also report estimates from econometric analyses of the impact of tobacco control expenditures on aggregate tobacco use in all states and in selected states with comprehensive programs for the period from 1981 through 1998. Our analyses clearly show that increases in funding for state tobacco control programs reduce tobacco use.

“If You Are Old Enough to Die for Your Country, You Should Be Able to Get a Pinch of Snuff”: Views of Tobacco 21 Among Appalachian Youth

Background: Multiple strategies have been utilized in attempts to decrease the prevalence of youth tobacco use. One strategy, raising the minimum legal sale age (MLSA) of tobacco products to 21, known as Tobacco 21, has recently gained popularity. Tobacco 21 legislation targets youth tobacco use by obstructing two main sources of youth tobacco products: stores and older friends. Although these sources are the most common for youth across the nation, regional differences have not been explored. Further, youth perspectives about raising the tobacco MLSA have not been considered. Youth may help identify potential challenges to implementing tobacco control measures, as well as suggest alternatives for intervention, thus helping to shape successful tobacco control policies. Study Aim: This study aimed to 1) examine youth perspectives on raising the tobacco minimum legal sale age to 21 and 2) identify common sources of tobacco products among middle and high school students living in rural, low-income Appalachian communities. Methods: A cross-sectional survey about perceptions and use of tobacco products was conducted with students in the Appalachian regions of Kentucky and North Carolina (N=426). Questions were asked concerning perspectives on the effect of Tobacco 21 implementation. Descriptive statistics characterized participants by Tobacco 21 perspectives. Participants were given the opportunity to further expand upon their opinions in an open-ended format. Results: The majority (58.7%) of participants responded that the same number of youth would use tobacco if the legal purchase age were raised, followed by responses that fewer would use (28.9%) and more would use (12.4%). Significant differences emerged based on tobacco use status (p\u3c.05), friends’ tobacco use (p\u3c.001), and whether participants identified family members as sources of youth tobacco products (p=.047). When given the opportunity to expand upon their views concerning the implementation of Tobacco 21 laws in their communities, many respondents cited poor enforcement of tobacco MLSAs at stores, continued access to tobacco products from family members and friends, and the overall abundance of tobacco in their communities as potential barriers to the successful implementation. Conclusion: Fewer than one-third of participants believed that Tobacco 21 legislation would succeed in reducing the prevalence of youth tobacco use. Perspectives on the effect of Tobacco 21 legislation were related to personal tobacco use, exposure to tobacco users, and beliefs that family members provide tobacco products to youth. Open-ended responses identify potential obstacles in implementing Tobacco 21 legislation in Appalachia. Future research should attempt to include youth perspectives when designing and implementing tobacco control policies and examine family members as sources of tobacco products for youth

Health professional students’ perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011

Background: An important way of reducing tobacco use is to train the health professional (HP) students to assist in tobacco cessation by educating patients and public. In order to shape their thoughts for the desired role, it is vital to understand their existing perceptions regarding HP’s role in tobacco control. Thus, the aim of our study was to find out the perceptions of Pakistani HP students regarding their future role in tobacco control, and examine factors associated with negative perceptions.<p></p> Methods: Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 3445 health professional students in third year of graduate level programs. The dependent variable (perceptions of HP students), was developed using four questions from the survey. Students who did not regard HP’s role in tobacco control were labeled as having negative perceptions. Logistic regression analyses were conducted to analyze association between HP students’ perceptions and various socio-demographic, attitudinal and knowledge related factors; and were reported as adjusted odds ratios with 95% confidence interval.<p></p> Results: We found that 44.8% (n = 1542) of students do not regard HPs as role model for their patients and public, and perceive that HPs do not play an important part in patient’s quitting tobacco use. These negative perceptions were associated with male sex (OR = 1.25, 95% CI 1.02 – 1.53, p value 0.028), and poor knowledge about tobacco cessation techniques (OR = 1.32, 95% CI 1.12 – 1.55, p value < 0.001). Negative perceptions were also associated with their attitudes towards ban on: tobacco advertisements (OR = 1.67, 95% CI 1.13 – 2.48, p value 0.010); and tobacco use at public places (OR = 1.60, 95% CI 1.26 – 2.03, p value < 0.001).<p></p> Conclusion: The role of HPs for tobacco control is fairly under-perceived by HP students, and the undesired negative perceptions are associated with male sex, poor knowledge about tobacco use cessation techniques and negative attitudes towards legislative control. A comprehensive approach, focusing on these aspects should be adopted to train HPs, in order to utilize them as an effective manpower for tobacco control