The public's attitudes towards tobacco sales prohibitions: Evidence from a nationally representative survey in the former Soviet state of Georgia

BACKGROUND: In the Caucasus region country of Georgia, no data on public opinion regarding tobacco sales restrictions have been available until now. The aim of the study is to provide data from a nationally representative sample including non-smokers, ex-smokers and current smokers, on their level of support for restricting tobacco sales. METHODS: 1,588 people aged 13-70 were interviewed at home about their level of agreement with eight possible tobacco sales restrictions, which were combined to create a dichotomous scale indicating low agreement (agree with none to three of eight restrictions) or high agreement (agree with four or more of eight restrictions). Levels of agreement were analyzed by demographic segments defined by age, gender, education and income and by tobacco use status. RESULTS: Across all eight forms of tobacco sales restrictions, the average support for tobacco sales restrictions was 85.2% which is a high level of support. Among smokers, 71% of women and 87% of men indicated a high level of agreement for restricted tobacco sales; among occasional smokers 54% and 55% respectively. Above 95% of female and male ex-smokers and never smokers expressed high level of agreement with sales restrictions. After adjustment for other predictors, agreement was significantly associated with age (more agreement with higher age) and smoking status (more agreement among never-smokers, less in current smokers), while there were no significant differences in agreement by gender, education, and income. DISCUSSION: It is of high importance for Georgia to fully implement the Framework Convention on Tobacco Control, including strong sales restrictions, and there is good evidence of public support for doing so. CONCLUSION: The present findings indicate to Georgian public health authorities that the support for tightened tobacco sales restrictions is high.publishedVersio

საქართველოს თამბაქოს კონტროლის პოლიტიკა არომატიზირებული თამბაქოს ახალი ნაწარმების კუთხით - შედარება ევროპულ მიდგომებთან

Introduction: The use of novel tobacco products, such as heated tobacco products (HTPs) and electronic cigarettes (referred to as an electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery systems (ENNDS)), is increasing among the youth globally. Among the key factors contributing to increased use is tobacco marketing, including advertising emphasizing flavored products, which influences perceptions, especially among youth. In Georgia, recent efforts have strengthened tobacco control, with the "new generation" tobacco control legislation adopted in 2017. Consequently, the trend of individual tobacco product (for example cigarettes) consumption has decreased. However, 2019 researches shows that the trend of using novel tobacco products among young people is increasing. The share of novel tobacco products in the market of Georgia started to grow largely in 2019. Perhaps relatedly, youth continue to show high rates of tobacco consumption in Georgia. The primary aim of this study is to investigate/analyze Georgia\u27s responses to addressing tobacco use in youth and identify gaps and challenges of Georgian policy regarding the regulation of novel tobacco products through comparisons with European policy approaches. Methods: This study identified policy documents specifying legislation (e.g., laws and bylaws, government documents, including state strategies and working plans, official announcements, and minutes from official meetings), through Internet search engines, official legislative web pages, and Ministry websites. Comparative analysis was used to identify challenges in the tobacco control policy of Georgia and assess its alignment with international standards. We compared the features of the Georgian policy with key measures for regulating novel tobacco products outlined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and European Union (EU) legislation (e.g Regulating tobacco product content and disclosure; Packaging and labelling of tobacco products; Tobacco advertising, promotion and sponsorship, tobacco industry interfare in tobacco control policy, etc.). Results: Considering the analysis of effective policy characteristics for preventing tobacco use among young people, as outlined by the WHO and the EU, it is evident that Georgia\u27s tobacco control legislation has significant gaps. Youth prevention policies addressing these products are relatively weak. The current legislation does not include restrictions on marketing of novel tobacco products emphasizing flavors, nor does it include restrictions or limitations on using flavorings/additives in any type of tobacco. Only the concentration of emitted substances in cigarettes and amount of nicotine in e-cigarette liquid is limited. However, compliance with these requirements has never been assessed; There is no local laboratory that tests any kind of tobacco product and no samples have ever been sent to any laboratory abroad. ENNDS represent a particular policy challenge, as they are not considered as tobacco products, and no tobacco control legislative requirements apply to them. Tobacco industry interference with Georgia’s tobacco legislation has also been documented to be high; Thus, it is likely that introduction of the control policies on novel product will be met with great resistance, especially since no research has yet been conducted recent years to reveal rates of novel tobacco products use by youth. Conclusions: This study provides the first assessment regarding how Georgia has responded to the growing popularity of novel tobacco products, such as e-cigarettes and HTPs, indicating that its tobacco control legislation has mainly addressed traditional tobacco products but largely neglected these novel products. The tobacco industry has taken advantage of the policy loopholes, and Georgia has become a favorable market for the novel tobacco product industry in recent years. Current findings provide evidence for decision-makers to inform the development of effective regulation and enformcement mechanism of flavored novel tobacco products, as gaps in the current regulations will likely will lead to increased use, particularly among youth.შესავალი: თამბაქოს ახალი პროდუქტების, როგორიცაა გასახურებელი თამბაქო (HTP) და ელექტრონული სიგარეტი (მოხსენიებული, როგორც ნიკოტინის ელექტრონული მიწოდების სისტემები (ENDS) და უნიკოტინო ელექტრონული მიწოდების სისტემები (ENNDS)) პოპულარობა ახალგაზრდებს შორის სულ უფრო იზრდება მსოფლიოში. აღნიშნულის  გამომწვევი მნიშვნელოვანი ფაქტორი თამბაქოს მარკეტინგია, მათ შორის არომატიზატორების გამოყენების გზით, რაც გავლენას ახდენს ადამიანთა, და განსაკუთრებით, ახალგაზრდების აღქმაზე. ბოლო პერიოდში თამბაქოს კონტროლის გაძლიერებისთვის საქართველოში გაწეული ძალისხმევის შედეგად, განსაკუთრებით 2017 წლის წლის შემდეგ, როდესაც საქართველოს პარლამენტმა მიიღო „ახალი თაობის“ თამბაქოს კონტროლის კანონმდებლობა, ცალკეული თამბაქოს ნაწარმის (მაგალითად სიგარეტის) მოხმარების მაჩვენებელი შემცირდა. თუმცა, 2019 წლის კვლევებიდან ჩანს, რომ მზარდია თამბაქოს ახალი ნაწარმების გამოყენების ტენდენცია ახალგაზრდებში.  საქართველოს ბაზარზე თამბაქოს ახალი ნაწარმების წილმა ზრდა მეტწილად 2019 წლიდან დაიწყო, რის გამოც, ამ პერიოდის შემდეგ თამბაქოს მოხმარების მაჩვენებელი საქართველოს ახალგაზრდებში სავარაუდოდ კვლავ გაიზარდა.        წინამდებარე სტატიით წარმოდგენილი კვლევის მიზანია გამოიკვლიოს/გაანალიზოს საქართველოს პასუხი ახალგაზრდებში მოწევის მზარდი მაჩვენებლის მიმართ და გამოავლინოს თამბაქოს ახალი პროდუქტების კონტროლის პოლიტიკის ხარვეზები და გამოწვევები საქართველოში, ევროპულ მიდგომებზე დაყრდნობით. მეთოდოლოგია: კვლევის ფარგლებში გამოყენებულია დოკუმენტური და აღწერითი სამართლებრივი კვლევის, შედარებითი ანალიზის, და ასევე, პოლიტიკის კვლევის მეთოდები. პოლიტიკის დოკუმენტები მოიძებნა ინტერნეტის საძიებო სისტემებში, ოფიციალურ საკანონმდებლო და სამთავრობო ვებგვერდებზე. მოიძიებული დოკუმენტები მოიცავს კანონებს, კანონქვემდებარე აქტებს, სამთავრობო დოკუმენტებს, მათ შორის, სახელმწიფო სტრატეგიებს და სამუშაო გეგმებს, სტატისტიკურ ინფორმაციებს, ოფიციალურ განცხადებებს და შეხვედრის ოქმებს. თამბაქოს კონტროლის არსებული გამოწვევების და საერთაშორისო მიდგომებთან მისი შესაბამისობის გამოსავლენად, შედარებითი ანალიზის საფუძველზე საქართველოს პოლიტიკის მახასიათებლები შედარებული იქნა ჯანმრთელობის მსოფლიო ორგანიზაციის თამბაქოს კონტროლის ჩარჩო კონვენციითა და ევროკავშირის კანონმდებლობით დადგენილ თამბაქოს ახალი პროდუქტების კონტროლის ძირითად ზომებთან (მაგ.: თამბაქოს ნაწარმის შემადგენლობის კონტროლი, რეკლამის, სპონსორობის და პოპულარიზაციის აკრძალვა, თამბაქოს ინდუსტრიის ჩაურევლობა თამბაქოს კონტროლის პოლიტიკაში, და სხვა). კვლევის შედეგები: ახალგაზრდებში თამბაქოს მოხმარების პრევენციისკენ მიმართული ეფექტური პოლიტიკის იმ მახასიათებლების ანალიზის გათვალისწინებით, რომლებიც ჯანმრთელობის მსოფლიო ორგანიზაციის და ევროკავშირის მიერაა დადგენილი, საქართველოს თამბაქოს კონტროლის კანონმდებლობა შეიცავს ბევრ ხარვეზს და ახალგაზრდების მიერ ამ პროდუქტების გამოყენების პრევენციის პოლიტიკა სუსტია.  ქართული კანონმდებლობა არომატიზატორების გამოყენების გზით თამბაქოს ნაწარმის მარკეტინგის აკრძალვას არ ითვალისწინებს. მოქმედი რეგულირება თამბაქოს არც ერთ პროდუქტში არ ზღუდავს არომატიზატორების/დანამატების გამოყენებას. დადგენილია მხოლოდ სიგარეტებიდან გამოფრქვეული ნივთიერებების ზღვრული ოდენობები და ნიკოტინის მაქსიმალური ოდენობა ნიკოტინის შემცველი ელექტრონული სიგარეტის სითხეებისთვის, თუმცა ამ მოთხოვნებთან შესაბამისობა არასოდეს შემოწმებულა. არ არსებობს ადგილობრივი ლაბორატორია, რომელიც შეამოწმებს თამბაქოს რომელიმე ნაწარმის შემადგენლობას. არც უცხო ქვეყნის ლაბორატორიაში გაგზავნილა ოდესმე თამბაქოს რომელიმე ნაწარმის ნიმუშები. თამბაქოს კონტროლის პოლიტიკის დიდი გამოწვევაა უნიკოტნო ელექტრონული სიგარეტები, რომელიც არ განიხილება თამბაქოს ნაწარმად და მათზე არ ვრცელდება თამბაქოს კონტროლის კანონმდებლობის მოთხოვნები. ქვეყანაში თამბაქოს კონტროლის პოლიტიკის საკითხებში თამბაქოს ინდუსტრიის ჩარევის საგანგაშოდ მაღალი ინდექსის გათვალისწინებით, სავარაუდოა, რომ თამბაქოს ახალ პროდუქტზე კონტროლის პოლიტიკის დანერგვას დიდი წინააღმდეგობა შეხვდება, მით უფრო იმის გათვალისწინებით, რომ ბოლო წლებში ჩატარებულა კვლევა ახალგაზრდების მიერ თამბაქო ახალი ნაწარმის მოხმარების მაჩვენებლის გამოსავლენად. დასკვნა: ეს კვლევა წარმოადგენს პირველ შეფასებას საქართველოში იმის შესახებ, თუ როგორ რეაგირებს ქვეყანა თამბაქოს ახალი პროდუქტების (ელექტრონული სიგარეტი, გასახურებელი თამბაქო) მზარდ პოპულარობაზე. საკითხის ანალიზმა აჩვენა, რომ საქართველოს თამბაქოს კონტროლის პოლიტიკა  ძირითადად მორგებულია თამბაქოს ტრადიციულ პროდუქტებზე, ხოლო ახალი პროდუქტები, ცალკეული რეგულაციების ფარგლებს მიღმაა. თამბაქოს ინდუსტრიამ კარგად ისარგებლა პოლიტიკის ხარვეზებით და საქართველო ბოლო წლებში თამბაქოს ახალი ნაწარმის ინდუსტრიისთვის გახდა ხელსაყრელი ბაზარი. კვლევის ფარგლებში გამოვლენილი დასკვნები კარგი ინსტრუმენტია გადაწყვეტილების მიმღებებისთვის - შექმნან არომატიზირებული თამბაქოს ახალი ნაწარმის ეფექტური რეგულირება და აღსრულების მექანიზმი საქართველოში, რადგან არსებული რეგულირების ხარვეზები სავარაუდოდ გამოიწვევს თამბაქოს მოხმარების მაჩვენებლის ზრდას, განსაკუთრებით ახალგაზრდებშ

Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries

Introduction: In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. Methods: We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. Results: Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). Conclusions: An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions

Current practices and perceived barriers to tobacco treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project

INTRODUCTION The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. METHODS In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http:// elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals’ current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. RESULTS At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). CONCLUSIONS The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke

Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence. An assessment across 15 European countries

INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals’ knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals’ self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals’ self-efficacy in delivering tobacco treatment interventions (p&lt;0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p&lt;0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions

Examples regarding research in the field of tobacco control in Georgia

Introduction No tobacco control research capacity existed in Georgia until second part of 90s. The first epidemiological study conducted in 1998 by UNICEF support. The Implementer organization was National Tobacco Counter Center. Afterword the FCTC Implementation and Monitoring Center (FCTCIMC) continued work on the field and conducted several independent and joint studies on several directions of tobacco control. Other institutes which also organizes some studies related to tobacco are Institute of Public Health and National Center for Diseases Control (NCDC). Material and Methods We used scientific articles, reports, web site and Conference resources to analyze existed work done in tobacco control research direction in Georgia. We systematized scientific or relevant work through different topics of tobacco control. Results In General, few studies conducted and researched during last two decades. Most work was done by NCDC and FCTCIMC, which have more capacity to conduct appropriate studies. But, due to financial problems and lack of funding from Governmental or Donor organizations sources above mentioned institutions unable to organize periodical surveys or studies. Conclusions No sustainable surveillance systems exists in Georgia to analyze and compare results from different period of time. There are needs to use local scientific capacity and strengthen them through National research funding schemes or any other relevant donor organizations, which have no conflict of interest with tobacco industry

Tobacco taxation and illicit tobacco in Georgia

Introduction The limited research has been undertaken on tobacco taxation and illicit tobacco trade levels in Georgia. Taxation policy has responsiveness to tobacco control policies in Georgia, because of the FCTC and EU Associate membership obligations. These taxes are a critical tool in reducing tobacco consumption and improving public health status in Georgia. However, the tobacco industry claims that tobacco tax increases will drive up illicit tobacco trade. There is needs to inform decision makers regarding win win policy study in Georgia. Methods We analyzed different statistical and survey data, also legislation, policy documents to learn the current situation related to taxation policy and tobacco illicit trade. Institute of Social Statues and Analyses (ISSA) together with the University of Cape Town conducted household survey In 2017, in five regions in Georgia. The survey was conducted with 2997 households to ascertain smoking prevalence, purchasing behavior and perceptions around illicit tobacco trade. Smokers were also asked to show available cigarette packs, which were examined for the presence of tax stamps and health warnings to identify products not intended for the Georgian market. Results In general, illicit trade rate in Georgia was very high when country had lowest tax rates on tobacco products. The main reason for the increased illegal turnover was high level of corruption until 2004. After reforms inside financial institutes the level of illegal tobacco deceased dramatically. Tobacco industry and their front groups still spreading misleading information. But after ISSA survey results, we defined that illicit cigarette trade in Georgia is low (1.5%), but there are regional differences. Most of the illicit packs were detected the Zugdidi region where the prevalence of illicit reached 6%, while the majority of illicit cigarettes were purchased in kiosks or at informal outlets. Conclusions Tobacco tax rate is very law to compare with EU requirements. Despite recent increases of tobacco taxes, the illicit cigarette trade penetration of Georgia is negligible. Strong administrative measures, presence of SICPA control and ban of tobacco sales at kiosks and informal outlets would allow better control of illicit market and could address the persistent issue of illegal single cigarette sales

The influence of public opinion on tobacco control policy-making in Georgia: Perspectives of governmental and non-governmental stakeholders

Introduction: Georgia has one of the highest smoking rates (36%) in Europe. This may be due partly to the fact that the present Georgian tobacco control regulations are weakly enforced. It is unclear if the authorities are aware that they would have majority public support for tighter enforcement of tobacco control regulations. The study aimed to fill a knowledge gap by addressing these research questions: (1) To what degree are policy makers aware of the Georgian public’s opinions about tobacco control and enforcement? (2) To what degree do policy makers take Georgian public opinion into account in their decision-making, including tobacco control and enforcement? Methods: This study used a collective case study methodology. The data were obtained through 12 semi-structured interviews during the period from April to May 2013, with three respondents each from the Ministry of Health, the Parliament of Georgia, Opinion Research Agencies and Non-Governmental Organizations. Thematic Network Analysis was used to analyze the interview data. Results: Policy-makers are aware that public opinion favors tobacco control and enforcement. However, Georgian politicians don’t take public opinion into account during policy-making. Tobacco industry influence is very strong in the Georgian policy-making arena. Some policy-makers are themselves lobbyists for the tobacco industry, and ignore public opinion. Public health planning and strategy development occur without public involvement. Conclusions: Georgia faces a challenge in increasing the influence of public opinion in health policy making generally, and in tobacco control in particular