The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project

This paper describes the conceptual model that underlies the International Tobacco Control Policy Evaluation Project (ITC Project), whose mission is to measure the psychosocial and behavioural impact of key policies of the Framework Convention on Tobacco Control (FCTC) among adult smokers, and in some countries, among adult non-smokers and among youth. The evaluation framework utilises multiple country controls, a longitudinal design, and a pre-specified, theory-driven conceptual model to test hypotheses about the anticipated effects of specific policies. The ITC Project consists of parallel prospective cohort surveys of representative samples of adult smokers currently in nine countries (inhabited by over 45% of the world's smokers), with other countries being added in the future. Collectively, the ITC Surveys constitute the first-ever international cohort study of tobacco use. The conceptual model of the ITC Project draws on the psychosocial and health communication literature and assumes that tobacco control policies influence tobacco related behaviours through a causal chain of psychological events, with some variables more closely related to the policy itself (policy-specific variables) and other variables that are more downstream from the policy, which have been identified by health behaviour and social psychological theories as being important causal precursors of behaviour (psychosocial mediators). We discuss the objectives of the ITC Project and its potential for building the evidence base for the FCTC.     

Opportunities and risks of the proposed FCTC protocol on illicit trade

Illicit trade in tobacco products presents a threat to public health because it undermines the use of tax and price policies, which are among the most effective mechanisms for reducing tobacco consumption. Parties to the WHO Framework Convention on Tobacco Control (FCTC) are in the final stages of negotiating a protocol aimed at strengthening international cooperation in the fight against illicit tobacco trade. While an effective multilateral response to illicit tobacco trade would make a significant contribution to global tobacco control, achieving this through the FCTC forum is challenging. First, while illicit tobacco trade is a health problem, the expertise, experience and capacity needed to combat illicit trade are not traditionally found in health agencies. The development of links with other agencies, both domestic and international, is critical to ensure both an effective response and an efficient use of limited governmental and non-governmental resources. Second, in many parts of the world, the tobacco industry cooperates closely with governments in the combating of illicit trade. This cooperation poses risks for tobacco control, particularly if relationships and norms of cooperation spill over into other areas of FCTC implementation. An examination of the industry's positioning suggests that it sees an opportunity to portray itself as 'legitimate' and 'responsible', a friend of governments, and a way to integrate itself into FCTC processes. This paper makes suggestions for moving forward in this challenging area towards ensuring that the approach taken actually reduces illicit tobacco trade, strengthens tobacco tax policies and does not operate to undermine the FCTC.     

Human rights-based approach to tobacco control

The Framework Convention for Tobacco Control (FCTC) is currently the most potent tool for implementation of tobacco control laws across the globe. The FCTC is derivative from previously constructed international human rights conventions. These previous conventions have enforcement mechanisms, unlike the FCTC. However, the FCTC relies on state parties to report periodically on its implementation rather than on a continuous monitoring system. The Human Rights and Tobacco Control Network proposes that abiding by the principles of human rights delineated by international treaties, citizens across the globe can demand effective action for tobacco control. This paper explains the link between fundamental human rights and the right to tobacco control. Mechanisms are described to link the FCTC and its principles with human rights-based monitoring reports, which are provided to oversight committees for the other human rights conventions. The initial work of the Human Rights and Tobacco Control Network is summarised and considers the future directions for the human rights-based approach to tobacco control.     

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.     

《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。      

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.     

Methods of the International Tobacco Control (ITC) Four Country Survey

This paper outlines the design features, data collection methods and analytic strategies of the International Tobacco Control (ITC) Four Country Survey, a prospective study of more than 2000 longitudinal respondents per country with yearly replenishments. This survey possesses unique features that sets it apart among surveys on tobacco use and cessation. One of these features is the use of theory-driven conceptual models. In this paper, however, the focus is on the two key statistical features of the survey: longitudinal and "quasi-experimental" designs. Although it is often possible to address the same scientific questions with a cross-sectional or a longitudinal study, the latter has the major advantage of being able to distinguish changes over time within individuals from differences among people at baseline (that is, differences between age and cohort effects). Furthermore, quasi-experiments, where countries not implementing a given new tobacco control policy act as the control group to which the country implementing such a policy will be compared, provide much stronger evidence than observational studies on the effects of national-level tobacco control policies. In summary, application of rigorous research methods enables this survey to be a rich data resource, not only to evaluate policies, but also to gain new insights into the natural history of smoking cessation, through longitudinal analyses of smoker behaviour.     

《烟草控制框架公约》研究Ⅰ.历史回顾、制定过程和主要目的

章对“吸烟与健康”的早期研究、世界卫生组织烟草控制的历史、《烟草控制框架公约》的制定过程进行了简要回顾，并对世界卫生组织制定《公约》的主要目的进行了分析，为烟草业全面研究分析其可能产生的影响，探讨在未来履行公约具体义务的前提下，烟草业可采取的有关措施提供背景资料和相关依据。     

烟草制品包装和标签履约情况综述及对我国卷烟包装影响的思考

综述了相关国家烟草制品包装和标签履约动态,介绍了已经实施图片健康警告的国家和地区图片警示标签使用情况,以及有关烟草制品包装和标签问题的学术研究,提出了公约履约对我国卷烟包装影响的思考.     

Achieving the Framework Convention on Tobacco Control's potential by investing in national capacity

May 2003 marked a critical achievement in efforts to stem the global tobacco epidemic, as the member states of the World Health Organization unanimously endorsed the Framework Convention on Tobacco Control (FCTC). However, the adoption of the FCTC signifies only the end of the beginning of effective global action to control tobacco. Over the next several years the utility of the FCTC process and the treaty itself will be tested as individual countries seek to ratify and implement the treaty's obligations. Significant barriers to the treaty's long term success exist in many countries. It is crucial that the international tobacco control community now refocuses its efforts on national capacity building and ensures that individual countries have the knowledge, tools, data, people, and organisations needed to implement the convention and develop sustained tobacco control programmes. This paper provides a model of national tobacco control capacity and offers a prioritised agenda for action.     

国内外禁止或限制烟草广告现状分析

文章对世界卫生组织《烟草控制框架公约》生效前后,世界上不同国家和地区禁止或限制烟草广告的现状以及趋势进行了分析,并结合《烟草控制框架公约》有关烟草广告的具体规定,提出了新形势下如何合理合法开展烟草产品的广告宣传工作的一些建议。      

中国烟业 别被FCTC撞了腰

<正> 在日内瓦举行的世界卫生大会上,世卫组织(WHO)的192个成员国5月21日一致通过了第一个限制烟草的全球性条约——《烟草控制框架公约》(FCTC),其总干事布伦特兰女士把这天称为“历史性的日子”。 自20世纪80年代末以来,几乎每年的世界卫生大会都有关于控烟工作的决议。但直至FCTC的出现,全球烟草业才感受到真正的威胁。     

Implementation of the WHO Framework Convention on Tobacco Control in mainland China

As per China's ratification of the WHO Framework Convention on Tobacco Control (FCTC), it should have implemented effective packaging and labelling measures prior to 9 January 2009 and enacted a comprehensive ban on all tobacco advertising, promotion and sponsorship prior to 9 January 2011. In addition, universal protection against secondhand tobacco smoke should have been implemented before 9 January 2011 by ensuring that all indoor workplaces, all indoor public places, all public transportation and possibly other (outdoor or quasi-outdoor) public places are free of secondhand smoke. The authors conducted a review of various sources of information to determine the current status of FCTC implementation in mainland China. Even though China has made considerable efforts to implement the FCTC, there is still a significant gap between the current state of affairs in China and the requirements of the FCTC. The Chinese tobacco monopoly under which commercial and other vested interests of the tobacco industry are jeopardizing tobacco control efforts is thought to be the most crucial obstacle to the effective implementation of the FCTC across the country.     

Tobacco and poverty: evidence from Vietnam

This review examined existing evidence to investigate the link between tobacco and poverty in Vietnam, to assess the impact of tobacco control policies on employment related to tobacco consumption and to identify information gaps that require further research for the purposes of advocating stronger tobacco control policies. A Medline, PubMed and Google Scholar search identified studies addressing the tobacco and poverty association in Vietnam using extensive criteria. In all, 22 articles related either to tobacco and health or economics, or to the potential impact of tobacco control policies, were identified from titles, abstracts or the full text. 28 additional publications were identified by other means. PHA, LTT and LTTH reviewed the publications and prepared the initial literature review. There is extensive evidence that tobacco use contributes to poverty and inequality in Vietnam and that tobacco control policies would not have a negative impact on overall employment. Tobacco use wastes household and national financial resources and widens social inequality. The implementation and enforcement of a range of tobacco control measures could prove beneficial not only to improve public health but also to alleviate poverty.     

我国烟草行业质量追溯体系建设的现状与展望

建设烟草行业质量追溯体系是世界卫生组织《烟草控制框架公约》的具体要求,是提升行业整体技术体系的重要组成部分,也是践行"国家利益至上、消费者利益至上"行业共同价值观的集中体现。本文综述了我国烟草行业追溯技术的研究进展和质量追溯体系在烟草种植、打叶复烤、卷烟制造、专卖流通、零售流通环节的应用现状和不足,对构建烟草行业全产业链质量追溯体系进行了分析与展望,为我国烟草行业质量追溯体系的建设与发展提供参考。      

Product liability

Product liability litigation has made important contributions to tobacco control, especially by uncovering incriminating industry documents and publicizing product dangers and industry misconduct. WHO Framework Convention on Tobacco Control (FCTC) Article 19 encourages Parties to strengthen legal procedures to facilitate these lawsuits and to establish mechanisms for mutual assistance. Creative lawyers will continue to find ways to bring the tobacco industry to justice in forums around the world.     

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.     

《烟草控制框架公约》履约前基本情况调查报告和履约思路的思考

本调查报告对我国履行《烟草控制框架公约》之前的基本情况分15个专题所采集的资料进行分析认为:关注健康成为人类社会文明进步的主流,但未来一段时间内吸烟人口将不会有很大变化。中国已经形成了比较完备的控烟法规体系。烟草业要努力降焦减害,树立负责任的社会形象。要关注卷烟包装、烟草税收、烟草走私、未成年人吸烟等问题,使履约控烟和烟草经济平衡发展。烟草业履约的基本思路是:关注健康,履行义务,加强自律,平衡发展。      

Introducing tobacco cessation in developing countries: an overview of Project Quit Tobacco International

Project Quit Tobacco International is a pioneering attempt to develop culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia. An overview of the formative research that contributed to intervention development is presented followed by a discussion of the research design adopted to evaluate the introduction of tobacco cessation in medical schools and clinics chosen for pilot testing. Four stages of research and implementation are described as a means of providing colleagues in developing countries with a prototype for future tobacco cessation research and training efforts.     

对《烟草控制框架公约》第13条烟草广告、促销和赞助实施准则的分析和思考

介绍了《烟草控制框架公约》第13条烟草广告、促销和赞助实施准则,综合比较了我国和世界其它国家在广泛禁止或限制烟草广告、促销和赞助方面的情况,并结合我国国情,对准则相关条款进行了适用性分析,提出了可分步执行条款和暂时无法执行条款的建议。