Exploration of Policy Makers’ Views on the Implementation of the Framework Convention on Tobacco Control in the Gambia: A Qualitative Study

Background: The World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) is the first international health treaty and has now been ratified by 181 countries. However, there are concerns that in many countries, particularly in Sub-Saharan African countries, FCTC legislations and implementation are weak. In this study we report a qualitative study undertaken to assess policy makers’ awareness of the FCTC and national tobacco control policies, and assessed the achievements and challenges to the implementation of the FCTC in The Gambia. Methods: The study involved semi-structured one-to-one interviews with 28 members of the National Tobacco Control Committee in The Gambia, which is responsible for formulating tobacco control policies and making recommendations for tobacco control. We used the Framework method and NVivo11 software for data analysis. Results: Our findings demonstrate that The Gambia has made modest progress in tobacco control before and since ratification of the FCTC, particularly in the areas of policy formulation, bans on tobacco advertising and promotion, smoke free laws and tobacco taxation. Whilst several pieces of tobacco control legislation exist, enforcement and implementation remain a major challenge. We found that policy makers’ awareness of polices covered in the FCTC was limited. Conclusion: Our findings highlight several challenges to the FCTC implementation and the need to step up efforts that will help to accomplish the obligations of the FCTC. To achieve the obligations of the FCTC, The Gambia should develop specific public awareness interventions, establish cessation services, mobilise adequate resources for tobacco control and strengthen tobacco surveillance and research

Prevalence and determinants of susceptibility to tobacco smoking among students in the Gambia

Introduction: Smoking is the biggest preventable cause of death, and kills about 7 million people annually. As smoking prevalence is falling in developed countries, tobacco businesses are turning to low and middle-income countries (LMICs) to generate new tobacco markets. To prevent young people from initiating smoking and becoming regular smokers it is important to understand the causes of susceptibility to smoking. In this study we report a nationwide survey of the prevalence and risk factors of smoking susceptibility among students aged 12-20 in The Gambia. Methods: We used two-stage cluster random sampling to select students in secondary schools throughout The Gambia, and questionnaire to collect data on demographic characteristics and indicators on susceptibility to initiating smoking. Results: Among the total sample of 10,289 students, 9831(96%; 55.6% girls and 44.4% boys, (aged 12-20 years) non-smokers were included in the analysis. Of these, 3,333 (33.9%) were found to be susceptible to smoking. Smoking susceptibility was more common among students attending grant-aided schools, non-Muslims, who had smoking allowed at home, had family members or friends who smoke, were sent to purchase cigarettes, had poor knowledge of the harmful effects of smoking, noticed point-of-sale tobacco advertisements and who had positive attitudes towards smoking. Conclusions This study shows that susceptibility to smoking is common among students and associated with preventable exposures. Although based on cross-sectional data these findings suggest that raising students’ awareness of the harmful effects of smoking and reducing the prevalence of adult smoking, extending tobacco advertising restrictions to include point-of-sale, are all important to preventing the uptake of smoking among students

Prevalence, risk factors and epidemiology of tobacco use among students; and the implementation of tobacco control polices in The Gambia

Background Tobacco consumption, and consequent morbidity and mortality, are expected to grow most markedly over the coming decades in Low and Middle Income Countries (LMICs). The WHO Framework Convention on Tobacco Control (FCTC) was developed in response to the globalisation of the tobacco epidemic and it presents a unique opportunity to reduce the global burden of tobacco. However, data on smoking in LMICs, particularly in sub-Saharan Africa as well as data on the progress of FCTC implementation are limited. The objectives of this thesis were to obtain a reliable and nationally representative estimate of prevalence of smoking, exposure to Second-Hand Smoke (SHS), smoking susceptibility and to identify the major risk factors among young people and to assess current implementation of tobacco control polices in The Gambia. Methods Representative samples of students in grades 7-12 in upper and senior secondary schools throughout The Gambia completed a self-administered questionnaire which included questions on tobacco use, risk factors, and demographic details; indicators of exposure to SHS and indicators of susceptibility to initiating smoking. Semi-structured one-to-one interviews were conducted with 28 members of the National Tobacco Control Committee in The Gambia to assess their awareness of the FCTC and national tobacco control policies, and to assess the achievements in and challenges to the implementation of the FCTC. Results The sample comprised 50 schools and 210 classes were identified for the survey. Of 10,395 eligible students, 10,289 (99%; 55% girls and 44% boys, age 12-20 years) participated. The prevalence of ever smoking was 16.7% and current smoking 4.5%. Smoking was more common among students attending private schools, of Christian or all other faiths other than Islam, living with parents, who had smoking allowed in their homes, with family members or friends who smoked. Most smokers (55.6%) wanted to stop, but only 22% received any stop smoking support. The proportion of students reporting any exposure to SHS was 97.0%. Parental education, living with parents and being sent to purchase cigarettes were associated with exposure to SHS both within and outside the home. About 35% of students were unaware of the harmful effects of exposure to SHS. Among the 9831 non-smokers, 33.9% were found to be susceptible to smoking. Smoking susceptibility was associated with socio-demographic characteristic, tobacco advertisements and having positive attitudes towards smoking. The interviews with policy makers showed that The Gambia has made modest progress in tobacco control before and since ratification of the FCTC, particularly in the areas of policy formulation. Whilst several pieces of tobacco control legislation exist, enforcement and implementation remain major challenges. Conclusions Interventions to reduce tobacco use and exposure to SHS in school children are urgently needed. Raising students’ awareness of the harmful effects of smoking and reducing the prevalence of adult smoking, extending tobacco advertising restrictions to include point-of-sale, are all important established evidenced-based approaches to preventing the uptake of smoking among students. Finally there are needs to step up efforts that will help to accomplish the obligations of the FCTC. To achieve this, The Gambia should develop specific public awareness interventions, establish cessation services, mobilise adequate resources for tobacco control, capacity building and strengthen surveillance and research to inform policy

Prevalence, risk factors and epidemiology of tobacco use among students; and the implementation of tobacco control polices in The Gambia

Background Tobacco consumption, and consequent morbidity and mortality, are expected to grow most markedly over the coming decades in Low and Middle Income Countries (LMICs). The WHO Framework Convention on Tobacco Control (FCTC) was developed in response to the globalisation of the tobacco epidemic and it presents a unique opportunity to reduce the global burden of tobacco. However, data on smoking in LMICs, particularly in sub-Saharan Africa as well as data on the progress of FCTC implementation are limited. The objectives of this thesis were to obtain a reliable and nationally representative estimate of prevalence of smoking, exposure to Second-Hand Smoke (SHS), smoking susceptibility and to identify the major risk factors among young people and to assess current implementation of tobacco control polices in The Gambia. Methods Representative samples of students in grades 7-12 in upper and senior secondary schools throughout The Gambia completed a self-administered questionnaire which included questions on tobacco use, risk factors, and demographic details; indicators of exposure to SHS and indicators of susceptibility to initiating smoking. Semi-structured one-to-one interviews were conducted with 28 members of the National Tobacco Control Committee in The Gambia to assess their awareness of the FCTC and national tobacco control policies, and to assess the achievements in and challenges to the implementation of the FCTC. Results The sample comprised 50 schools and 210 classes were identified for the survey. Of 10,395 eligible students, 10,289 (99%; 55% girls and 44% boys, age 12-20 years) participated. The prevalence of ever smoking was 16.7% and current smoking 4.5%. Smoking was more common among students attending private schools, of Christian or all other faiths other than Islam, living with parents, who had smoking allowed in their homes, with family members or friends who smoked. Most smokers (55.6%) wanted to stop, but only 22% received any stop smoking support. The proportion of students reporting any exposure to SHS was 97.0%. Parental education, living with parents and being sent to purchase cigarettes were associated with exposure to SHS both within and outside the home. About 35% of students were unaware of the harmful effects of exposure to SHS. Among the 9831 non-smokers, 33.9% were found to be susceptible to smoking. Smoking susceptibility was associated with socio-demographic characteristic, tobacco advertisements and having positive attitudes towards smoking. The interviews with policy makers showed that The Gambia has made modest progress in tobacco control before and since ratification of the FCTC, particularly in the areas of policy formulation. Whilst several pieces of tobacco control legislation exist, enforcement and implementation remain major challenges. Conclusions Interventions to reduce tobacco use and exposure to SHS in school children are urgently needed. Raising students’ awareness of the harmful effects of smoking and reducing the prevalence of adult smoking, extending tobacco advertising restrictions to include point-of-sale, are all important established evidenced-based approaches to preventing the uptake of smoking among students. Finally there are needs to step up efforts that will help to accomplish the obligations of the FCTC. To achieve this, The Gambia should develop specific public awareness interventions, establish cessation services, mobilise adequate resources for tobacco control, capacity building and strengthen surveillance and research to inform policy