Tobacco control, global health policy and development: towards policy coherence in global governance

The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.     

Development of a state wide tobacco treatment specialist training and certification programme for Massachusetts

OBJECTIVE: To describe the research conducted to structure and develop a statewide tobacco training and certification programme for tobacco treatment specialists (TTSs) in Massachusetts. DESIGN: Qualitative research strategies were used to obtain information on certification development and opinions regarding TTS training and certification from key informants. A role definition and validation study was then conducted to determine the core competencies for TTSs. A comprehensive training programme was developed, piloted, and finalised, and a certification programme was initiated. PARTICIPANTS: Key informants included: individuals involved in the development of their professional certification programmes; tobacco treatment providers from across Massachusetts; and national tobacco treatment experts. MAIN OUTCOME MEASURES: Participants' opinions about the need for and structure of a training and certification programme for individuals specialising in the provision of moderate to intensive tobacco treatment; delineation of core competencies for TTSs, using the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) clinical practice guideline as a foundation for the development of evidence based standards of practice for the treatment of nicotine dependence. RESULTS: The data support a comprehensive training and certification programme for TTSs in Massachusetts. Main concerns include the cost of obtaining certification, the potential to exclude uncertified healthcare professionals from delivering basic tobacco treatment, and the role of the TTS in the healthcare delivery system and the community. The training programme developed for Massachusetts was piloted, and the structure of a statewide training and certification programme for TTSs was finalised. CONCLUSIONS: The research provides support for the need and acceptance of a training and certification programme for TTSs in Massachusetts, and presents the challenges to be addressed. We demonstrated the feasibility of developing and implementing an evidence based training programme, and of initiating a statewide certification programme in Massachusetts. This work will add to a national dialogue on the development of a training and certification programme for tobacco treatment providers and encourage further research into the potential impact of statewide and national certification.     

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies

It is now well established that children's exposure to environmental tobacco smoke (ETS) results in substantial public health and economic impacts. Children are more likely than adults to suffer health effects from ETS exposure, and the home is the most important site of such exposure.
  Although the responsibility and authority of the community and health professionals to protect children from harm are entrenched in North American society, social, economic, legal, and political factors contribute to a lower level of support for ETS control measures in homes compared with workplaces and public places. It is now clear that ETS control in home environments must be a priority on the public health agenda. Programme and policy options and strategies for ETS control in home environments are outlined. We conclude that the current research base is inadequate to fully support programme and policy development in this area and priorities for research are identified.


Keywords: environmental tobacco smoke; homes; children     

国内口用型无烟气烟草制品专利分析

为使我国烟草行业相关科技人员准确把握口用型无烟气烟草制品的研发现状,预测今后的发展趋势,对国家知识产权局1985-2018年公开公告的有关口用型无烟气烟草制品的专利进行了检索和统计分析。结果表明:(1)1985-2018年口用型无烟气烟草制品中国专利共计270件,其中发明233件、实用新型28件、外观设计9件。其中袋装口含型专利占50%以上,是目前口用型无烟气烟草制品专利的主流技术。(2)2008年以来,口用型无烟气烟草制品中国专利申请经历了活跃期和高峰期,国内烟草行业专利申请总量于2013年超过国外烟草公司,专利申请量以云南中烟工业有限责任公司和中国烟草总公司郑州烟草研究院领先。国外烟草公司申请的口用型无烟气烟草制品中国专利中,雷诺士烟草公司的申请量最多,其次是菲利浦·莫里斯烟草公司和美国无烟烟草公司,且均为发明专利。(3)袋装口含烟关键技术是产品配方、制备技术、包装技术等,含化烟关键技术是制备工艺、产品形态、产品配方等;袋装口含烟专利在包装方式、缓释技术、熟化技术等领域涉及较少,含化烟专利在缓释技术、成型技术等领域涉及较少。     

Lessons from the history of tobacco harm reduction: The National Cancer Institute's Smoking and Health Program and the "less hazardous cigarette".

Scientists and public health practitioners are sharply divided today over the risks and benefits of tobacco harm-reduction strategies. At the same time, a range of novel tobacco products is being marketed with claims of reduced exposure or risk. Current scientific efforts to study tobacco products and harm reduction should be informed by past experience. During the 1960s and 1970s, there was substantial support within government and academia, as well as among voluntary health organizations, for efforts to modify tobacco products to reduce harm. This paper analyzes the former National Cancer Institute (NCI) Smoking and Health Program, which, between 1968 and 1980, pursued the development of "less hazardous" cigarettes as its primary goal. During this period, the program spent over dollar 50 million on contract research, of which 74% went toward biological and chemical analysis of modified cigarettes, 9.6% to epidemiological studies of risk factors, and only 1.4% to studies evaluating smoking cessation or prevention programs. NCI officials predicted during the mid-1970s that new "low-tar" cigarette brands would substantially reduce smoking-related mortality, but by 1978 the research agenda began to change in response to a reorganization of NCI research activities, modification of government antismoking efforts, and an emerging understanding of nicotine addiction that challenged key scientific assumptions. In retrospect, the program suffered from significant weaknesses that severely limited the likelihood that it would generate knowledge beneficial to public health, including a research agenda that failed to include surveillance and behavioral research, tobacco industry influence of the research agenda, and a lack of access to information about the characteristics of products on the market. There exists today a need for a public health-oriented research agenda on tobacco products and harm reduction, but current efforts should include input from a diverse range of disciplines, collect data on users' behavior, and limit the involvement of industry scientists.     

US news media coverage of tobacco control issues

Objective

To characterise the relative amount and type of daily newspaper, local and national TV newscast, and national news magazine coverage of tobacco control issues in the United States in 2002 and 2003.

Design

Content analysis of daily newspapers, news magazines, and TV newscasts.

Subjects

Items about tobacco in daily newspapers, local and national TV newscasts, and three national news magazines in a nationally representative sample of 56 days of news stratified by day of week and season of the year, from 2002 and 2003.

Main outcome measures

Story theme, tobacco topics, sources, story prominence, story valence (orientation), and story type.

Results

Tobacco coverage was modest over the two‐year period as estimated in our sample. Only 21 TV stories, 17 news magazine stories, and 335 daily newspaper stories were found during the two‐year sampling period. Noteworthy results for the newspaper data set include the following: (1) government topics predominated coverage; (2) government action and negative health effects topics tended not to occur together in stories; (3) tobacco stories were fairly prominently placed in newspapers; (4) opinion news items tended to favour tobacco control policies, while news and feature stories were evenly split between positive and negative stories; and (5) tobacco coverage in the southeast, which is the country''s major tobacco producing region, did not differ from the rest of the country.

Conclusion

Results suggest mixed support in news coverage for tobacco control efforts in the United States. The modest amount of news coverage of tobacco is troubling, particularly because so few news stories were found on TV, which is a more important news source for Americans than newspapers. When tobacco was covered, government themed stories, which often did not include mentions of negative health effects, were typical, suggesting that media coverage does not reinforce the reason for tobacco control efforts. However, some results were encouraging. For example, when newspapers did cover tobacco, they accorded the stories relatively high prominence, thus increasing the chance that readers would see tobacco stories when they were published.     

Building capacity for tobacco control research and policy

The Fogarty International Center (FIC) initiative, "International Tobacco and Health Research Capacity Building Program" represents an important step in US government funding for global tobacco control. Low- and middle-income countries of the world face a rising threat to public health from the rapidly escalating epidemic of tobacco use. Many are now parties to the Framework Convention on Tobacco Control (FCTC) and capacity development to meet FCTC provisions. One initial grant provided through the FIC was to the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to support capacity building and research programmes in China, Brazil, and Mexico. The initiative's capacity building effort focused on: (1) building the evidence base for tobacco control, (2) expanding the infrastructure of each country to deliver tobacco control, and (3) developing the next generation of leaders as well as encouraging networking throughout the country and with neighbouring countries. This paper describes the approach taken and the research foci, as well some of the main outcomes and some identified challenges posed by the effort. Individual research papers are in progress to provide more in-depth reporting of study results.     

Integrating tobacco control into health and development agendas

Tobacco use is one of the major risk factors for non-communicable diseases, with a profound impact on resource-poor low-income and middle-income countries such as India, where tobacco use is high and where socioeconomic as well as health inequalities are rampant. Effective implementation of the Framework Convention on Tobacco Control requires multisectoral efforts that can fructify through integration of tobacco control into broader health and development agendas such as food and water security, environment, the right to education and human rights. The global tobacco control community will need to explore innovative partnerships beyond its traditional confines and build a global coalition that supports tobacco control by partnering with others having convergent concerns on common determinants. A firm political commitment and intersectoral coordination between government and non-government agencies is paramount in order to implement effective tobacco control programmes. Integration of tobacco control into other health and development agendas as described in this paper has the potential to contribute to the achievement of all the eight United Nations Millennium Development Goals. This paper explores why the whole of government should accord a high priority to tobacco control, and how this integration could be achieved.     

Businesses' voluntary pro-health tobacco policies: a review and research agenda

Research on the role of businesses in tobacco control has focused primarily on retailers, advertising firms and the hospitality industry, all of which have tended to support tobacco industry interests and resist effective tobacco control policies. However, in several countries, businesses have a history of voluntarily adopting tobacco-related policies that may advance tobacco control objectives. These phenomena have received little research attention. Existing literature on businesses ending tobacco sales, instituting voluntary workplace smoking restrictions and establishing non-smoker only hiring policies was reviewed. A research agenda on voluntary business initiatives would enhance and complement research on mandatory tobacco control policies by identifying new advocacy opportunities; suggesting avenues for strengthening or reinforcing existing policy initiatives; laying the groundwork for new mandatory policies; helping to inform ethical debates about contentious voluntary policies; and contributing to a better understanding of how alliances between the tobacco industry and other businesses might be weakened.     

Consumption and production waste: another externality of tobacco use

OBJECTIVE: To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing. STUDY SELECTION: All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed. DATA SOURCES: Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities. Data from the Center for Marine Conservation's International Coastal Cleanup Project were used to describe some environmental impacts of tobacco-related trash. Data from the United States Environmental Protection Agency's (EPA's) Toxics Release Inventory and reported global cigarette consumption totals were used to estimate waste production from cigarette manufacturing. DATA EXTRACTION AND SYNTHESIS: In 1995, an estimated 5.535 trillion cigarettes (27,675 million cartons and 276,753 million packages) were sold by the tobacco industry globally. Some of the wastes from these products were properly deposited, but a large amount of tobacco consumption waste ends up in the environment. Some is recovered during environmental clean-up days. For the past eight years (1990-1997), cigarette butts have been the leading item found during the International Coastal Cleanup Project; they accounted for 19.1% of all items collected in 1997. The tobacco manufacturing process produces liquid, solid, and airborne waste. Among those wastes, some materials, including nicotine, are designated by the EPA as Toxics Release Inventory (TRI) chemicals. These are possible environmental health hazards. In 1995, the global tobacco industry produced an estimated 2262 million kilograms of manufacturing waste and 209 million kilograms of chemical waste. In addition, total nicotine waste produced in the manufacture of reduced nicotine cigarettes was estimated at 300 million kilograms. CONCLUSIONS: Laws against littering relative to cigarette butts could be better enforced. Additional taxes might be levied on cigarette products that would then be directed to environmental clean-up efforts. The tobacco industry should improve the biodegradability of filters, reduce packaging waste, and educate its customers. Worksites and public buildings should be encouraged or required to supply appropriate disposal mechanisms at all building entrances. Public awareness campaigns about the magnitude and prevention of cigarette consumption waste could be developed through partnerships among environmental groups, health organisations, and environmental protection agencies. Tobacco production waste should be a source of concern and regulation by governments throughout the world; it contains numerous chemicals which may be considered health hazards, not the least of which is nicotine produced in the manufacture of low-nicotine cigarettes.     

Evolution of a comprehensive tobacco control programme: building system capacity and strategic partnerships--lessons from Massachusetts

BACKGROUND: Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. OBJECTIVES: The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building, and shared leadership. METHODS: The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. RESULTS: The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. CONCLUSION: Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts.     

Global assessment of deforestation related to tobacco farming

OBJECTIVES: To assess the global amount of forest and woodland consumed annually for curing tobacco between 1990 and 1995; to estimate tobacco's share in total deforestation; to rank tobacco-growing countries by the degree of impact of tobacco deforestation; and to indicate environmental criticality emerging from tobacco's impact on forest resources. DESIGN: Production of country-specific estimates of forests/woodlands needed and depleted on the basis of growing stock/increment of woody biomass involved and wood consumption of tobacco. Comparison of results with secondary statistics on forest cover, deforestation, and population development. RESULTS: An estimated 200,000 ha of forests/woodlands are removed by tobacco farming each year. Deforestation mainly occurs in the developing world, amounting to 1.7% of global net losses of forest cover or 4.6% of total national deforestation. Environmental criticality exists or is emerging in 35 countries with an estimated serious, high, and medium degree of tobacco-related deforestation, mainly in southern Africa, middle east, south, and east Asia, South America, and the Caribbean. CONCLUSION: The hypothesis that deforestation from tobacco production does not have a significant negative effect has to be challenged. For empirical validation, the globally significant pattern of estimated tobacco-related environmental damage ought to be included in international research agendas on global environmental change, to become an integral and rational part of tobacco control policy.     

Whose standard is it,anyway? How the tobacco industry determines the International Organization for Standardization (ISO) standards for tobacco and tobacco products

OBJECTIVE: To describe the extent of the tobacco industry involvement in establishing international standards for tobacco and tobacco products and the industry influence on the International Organization for Standardization (ISO). METHODS: Analysis of tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Search words included "ISO", "CORESTA", "Barclay", "compensation and machine smoking", "tar and nicotine deliveries", and the name of key players, in different combinations. RESULTS: It is clear that the tobacco industry, through the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA), play a major role in determining the scientific evidence and suggesting the standards that are eventually adopted as international standards for tobacco and tobacco products in several areas, including the measurement of cigarette tar and nicotine yield. CONCLUSIONS: ISO's tobacco and tobacco products standards are not adequate to guide tobacco products regulatory policies, and no health claims can be made based on ISO's tobacco products standards. There is an urgent need for tobacco control advocates and groups worldwide to be more involved with the work of the ISO, both directly and through their national standardisation organisations.     

我国烟田杂草研究现状及防治对策展望

杂草防除是农业生产所面临的持久挑战,为应对这一挑战,实现烟田杂草的有效控制,本文介绍了我国烟田杂草种类和发生规律研究概况,简述了烟田杂草调查的量化参数,回顾了杂草种子库的研究,综述了杂草防除方法,分析了除草剂药害问题,同时对未来烟田杂草绿色防控对策,如植物化感物质研究与利用、杂草生物防治及杂草生物学研究等进行了展望。期望为我国烟田杂草的研究与防除提供参考。     

《烟草控制框架公约》研究Ⅱ.主要內容、对烟草业的影响和需采取的措施

文章在对"吸烟与健康"的早期研究、世界卫生组织烟草控制的历史,以及《烟草控制框架公约》的制定过程进行了简要回顾的基础上(见本文第1部分),全面概括了其主要内容,并就其对烟草业的影响进行分析,探讨了在未来履行公约具体义务的过程中,烟草业可采取的有关应对措施。      

An ethnographic study of tobacco control in hospital settings

Background

Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm.

Objective

To study hospital workplace culture relevant to tobacco use and control as part of a mixed‐methods research project that investigated hospital‐based registered nurses'' integration of cessation interventions.

Design

The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient‐care documents on 16 adult in‐patient wards.

Results

The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients'' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence.

Conclusion

Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients'' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.     

Hair as a biomarker for exposure to tobacco smoke

This article provides an overview of the hair nicotine biomarker for assessment of exposure to tobacco smoke, with emphasis on environmental tobacco smoke (ETS). Measurement of nicotine in hair can be an informative tool for research looking at ETS and related illnesses. There are still unresolved issues in relation to this biomarker such as influence of hair treatment, hair colour, and growth rate on nicotine levels in hair, which need to be addressed in order to further refine this biomarker for exposure assessment. Nevertheless, hair nicotine promises to be a valid and reliable measure of longer term exposure that can be readily applied in epidemiological studies of exposure to tobacco smoke, and more specifically ETS, and its risk to health.     

The tobacco settlement: an analysis of newspaper coverage of a national policy debate, 1997-98

OBJECTIVE: To examine the framing of tobacco policy issues in the news media during the national tobacco settlement debate of 1997-98. The major aims were (1) to describe the extent of newspaper coverage of each of the specific components of the proposed tobacco settlement; (2) to identify the tobacco control frames, and the dominant frame, appearing in each newspaper article; and (3) to examine trends in tobacco control frames over time. DESIGN: A content analysis was performed on 117 articles related to national tobacco legislation appearing in the Washington Post from 1 January 1997 through 18 June 1998. MAIN OUTCOME MEASURES: (1) Major policy themes of the settlement referred to or implied in each article; (2) major frames used to discuss the problem of tobacco in each article. RESULTS: The generation of new revenue was the dominant theme of the articles, appearing as a major focus in 44% (52) of the articles. Other than the issues of Food and Drug Administration regulation of tobacco and restrictions on cigarette advertising, the public health policy aspects of the tobacco settlement received little attention. The problem of tobacco was portrayed as one of youth smoking in 55% (64) of the articles, but as one of a deadly product in none of the articles. CONCLUSIONS: Future discussions of comprehensive tobacco policy should be driven by a more specific discussion of the precise programme and policy mechanisms by which tobacco use can be most effectively prevented and controlled. The public health community must find ways to frame the tobacco issue more broadly than simply as one of youth smoking.     

Smoke knows no boundaries: legal strategies for environmental tobacco smoke incursions into the home within multi-unit residential dwellings

OBJECTIVE: To describe legal theories that non-smoking residents of multiple occupancy buildings may employ when affected by environmental tobacco smoke (ETS) from neighbouring units. DESIGN: Legal research was conducted in several US states. Research was performed among statutes and regulations. State health regulations were examined as well as common law claims of nuisance, warranties of habitability, and the right of quiet enjoyment. RESULTS: Through the use of state regulations, such as a sanitary code, several states provide general language for protecting the health of residents in multi-unit buildings. State law also supports more traditional claims of nuisance, warranties of habitability, and the right of quiet enjoyment. CONCLUSIONS: The use of state regulations has the potential to provide an effective, existing vehicle for resolution of ETS incursion problems. The general health protection language of the regulations, in conjunction with the latest evidence of the harmful effects of ETS, gives state agencies authority to regulate environmental tobacco smoke incursions among apartments in multi-unit dwellings. Where state regulations are not available, other common law legal remedies may be available.     

The Tobacco Control Scale: a new scale to measure country activity

Objectives

To quantify the implementation of tobacco control policies at country level using a new Tobacco Control Scale and to report initial results using the scale.

Method

A questionnaire sent to correspondents in 30 European countries, using a scoring system designed with the help of a panel of international tobacco control experts.

Results

The 30 countries are ranked by their total score on the scale out of a maximum possible score of 100. Only four countries (Ireland, United Kingdom, Norway, Iceland) scored 70 or more, with an eight point gap (most differences in scores are small) to the fifth country, Malta, on 62. Only 13 countries scored above 50, 11 of them from the European Union (EU), and the second largest points gap occurs between Denmark on 45 and Portugal on 39, splitting the table into three groups: 70 and above, 45 to 62, 39 and below. Ireland had the highest overall score, 74 out of 100, and Luxembourg was bottom with 26 points. However even Ireland, much praised for their ban on smoking in public places, did not increase tobacco taxes in 2005, for the first time since 1995.

Conclusions

Although the Tobacco Control Scale has limitations, this is the first time such a scale has been developed and applied to so many countries. We hope it will be useful in encouraging countries to strengthen currently weak areas of their tobacco control policy.