Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia : A scoping review and narrative synthesis

Background: Tobacco advertising, promotion and sponsorship (TAPS), has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognized as a top priority for the government, and all forms of tobacco advertising, promotion as well as sponsorship are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed to understand the extent, and nature of the evidence gaps on TAPS in Ethiopia and identify primary research priorities to inform future research direction. Methods: Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarized descriptively, and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. Results: Overall, 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socioeconomic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. Conclusions: There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring

Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia: a scoping review and narrative synthesis

# Background Tobacco advertising, promotion and sponsorship (TAPS) has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognised as a top priority for the government, and all tobacco advertising, promotion, and sponsorship forms are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed at understanding the extent and nature of the evidence gaps on TAPS in Ethiopia and identifying primary research priorities to inform future research direction. # Methods Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarised descriptively and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. # Results 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socio-economic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. # Conclusions There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, compliance monitoring, and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring

Compliance with tobacco advertising and promotion laws at points-of-sale in Ethiopia: an observational study in 10 cities

Background Ethiopia enacted a comprehensive tobacco control law in 2019, which bans tobacco advertising and promotion activities. However, compliance with these laws at points-of-sale (PoS) has not been studied, resulting in a lack of research evidence on how the regulations are implemented. The purpose of the study was to assess compliance with tobacco advertising and promotion laws at PoS in 10 cities in Ethiopia. Methods Multi-stage cluster sampling was used to select 1648 PoS (supermarkets, minimarkets, merchandise stores, regular shops, permanent kiosks, khat shops, street vendors, and food and drink wholesalers). Data were collected using standardized observational checklists. Tobacco advertising and promotion indicators were used to compute indoor and outdoor compliance. Poisson regression models with log link function and robust variance were used to assess factors associated with open display of cigarette packages and indoor non-compliance. Results The average indoor compliance rate was 92.9% (95% CI:92.3-93.5). Supermarkets had the highest compliance (99.7%), while permanent kiosks showed the lowest compliance (89.8%). The highest average indoor compliance was observed at PoS in Addis Ababa (98.0%). About 60% of PoS were fully compliant in indoors. Indoor open display of cigarette packages was prevalent (32.5%, 95% CI:30.0-35.1). The average outdoor compliance was 99.6% (95% CI:99.5-99.7). Outdoor full compliance was 96.5%. Open display of cigarettes was significantly higher in permanent kiosks (adjusted prevalence ratio (adjPR) 6.73; 95% CI: 3.96-11.42), regular shops (adjPR 5.16; 95% CI: 3.05-8.75), and khat shops (adjPR 2.06; 95% CI: 1.11-3.83), while indoor non-compliance was significantly higher in these same types of PoS. Conclusions While outdoor compliance rates were relatively high, the lower indoor compliance rates particularly due to the high prevalence of open cigarette package displays indicates a major area for improvement in enforcing tobacco advertising and promotion laws

Prevalence, patterns, and factors associated with tobacco use among patients with priority tobacco related illnesses at four Kenyan national referral hospitals, 2022.

Tobacco use is a risk factor for many chronic health conditions. Quantifying burden of tobacco use among people with tobacco-related illnesses (TRI) can strengthen cessation programs. This study estimated prevalence, patterns and correlates of tobacco use among patients with TRI at four national referral hospitals in Kenya. We conducted a cross-sectional study among patients with five TRI (cancer, cardiovascular diseases, cerebrovascular disease, chronic obstructive pulmonary disease, and pulmonary tuberculosis) during January-July 2022. Cases identified from medical records were interviewed on socio-demographic, tobacco use and cessation information. Descriptive statistics were used to characterize patterns of tobacco use. Multiple logistic regression models were used to identify associations with tobacco use. We identified 2,032 individuals with TRI; 46% (939/2,032) had age ≥60 years, and 61% (1,241/2,032) were male. About 45% (923/2,032) were ever tobacco users (6% percent current and 39% former tobacco users). Approximately half of smokers and 58% of smokeless tobacco users had attempted quitting in the last month; 42% through cessation counselling. Comorbidities were present in 28% of the participants. Most (92%) of the patients had been diagnosed with TRI within the previous five years. The most frequent TRI were oral pharyngeal cancer (36% [725/2,032]), nasopharyngeal cancer (12% [246/2.032]) and lung cancer (10% [202/2,032]). Patients >60 years (aOR 2.24, 95% CI: 1.84, 2.73) and unmarried (aOR 1.21, 95% CI: 1.03, 1.42) had higher odds of tobacco use. Female patients (aOR 0.35, 95% CI: 0.30, 0.41) and those with no history of alcohol use (aOR 0.27, 95% CI: 0.23, 0.31), had less odds of tobacco use. Our study shows high prevalence of tobacco use among patients with TRI in Kenya, especially among older, male, less educated, unmarried, and alcohol users. We recommend tobacco use screening and cessation programs among patients with TRI as part of clinical care