Building the evidence base for effective tobacco control policies: the International Tobacco Control Policy Evaluation Project (the ITC Project)

The Framework Convention on Tobacco Control (FCTC) is a seminal event in tobacco control and in global health. Scientific evidence guided the creation of the FCTC, and as the treaty moves into its implementation phase, scientific evidence can be used to guide the formulation of evidence-based tobacco control policies. The International Tobacco Control Policy Evaluation Project (ITC Project) is a transdisciplinary international collaboration of tobacco control researchers who have created research studies to evaluate and understand the psychosocial and behavioural impact of FCTC policies as they are implemented in participating ITC countries, which together are inhabited by over 45% of the world's smokers. This introduction to the ITC Project supplement of Tobacco Control presents a brief outline of the ITC Project, including a summary of key findings to date. The overall conceptual model and methodology of the ITC Project--involving representative national cohort surveys created from a common conceptual model, with common methods and measures across countries--may hold promise as a useful paradigm in efforts to evaluate and understand the impact of population-based interventions in other important domains of health, such as obesity.     

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.     

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.     

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.     

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.     

《烟草控制框架公约》履约动态及其对烟草发展的影响

简要回顾了《烟草控制框架公约》生效以来主要发展进程,介绍了世界卫生组织强力推动控烟进程采取的措施,通过解析全球6大区域首批缔约国中27个国家的履约进程,描绘了当前世界控烟大潮掀起的动态。阐明了中国烟草将严格履行《公约》,提出中国烟草要更加积极、主动地参与《公约》及相关规则的研究、制定的建议。      

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.     

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。     

基于实证分析的中国烟草产品国际竞争力研究

近年来，中国烟草产业既面临着国外烟草产品进入的冲击以及控烟履约的双重压力，又担当着为国家财政增税的重任，其发展已不能单纯依靠国内需求拉动，更应该积极面向全球需求，开发国际市场。为了精确地测度我国烟草产品的国际竞争力，构建了国际市场占有率（IMS）、贸易竞争力指数（TC）和显性比较优势指数（RCA）三个指标，以计量经济学手段分析了我国烟草产品在全球市场中的主要特征及问题。研究发现，我国烟草及烟草产品的整体竞争力较弱，但烟叶产品在国际市场上有一定的竞争力。      

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。      

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。      

《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。      

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.     

Tobacco industry successfully prevented tobacco control legislation in Argentina

Objective: To evaluate how transnational tobacco companies, working through their local affiliates, influenced tobacco control policymaking in Argentina between 1966 and 2005. Methods: Analysis of internal tobacco industry documents, local newspapers and magazines, internet resources, bills from the Argentinean National Congress Library, and interviews with key individuals in Argentina. Results: Transnational tobacco companies (Philip Morris International, British American Tobacco, Lorillard, and RJ Reynolds International) have been actively influencing public health policymaking in Argentina since the early 1970s. As in other countries, in 1977 the tobacco industry created a weak voluntary self regulating code to avoid strong legislated restrictions on advertising. In addition to direct lobbying by the tobacco companies, these efforts involved use of third party allies, public relations campaigns, and scientific and medical consultants. During the 1980s and 1990s efforts to pass comprehensive tobacco control legislation intensified, but the organised tobacco industry prevented its enactment. There has been no national activity to decrease exposure to secondhand smoke. Conclusions: The tobacco industry, working through its local subsidiaries, has subverted meaningful tobacco control legislation in Argentina using the same strategies as in the USA and other countries. As a result, tobacco control in Argentina remains governed by a national law that is weak and restricted in its scope.     

How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control

Objective: To describe Philip Morris'' global market research and international promotional strategies targeting young adults. Methods: : Analysis of previously secret tobacco industry documents. Results: Philip Morris pursued standardised market research and strategic marketing plans in different regions throughout the world using research on young adults with three principle foci: lifestyle/psychographic research, brand studies, and advertising/communication effectiveness. Philip Morris identified core similarities in the lifestyles and needs of young consumers worldwide, such as independence, hedonism, freedom, and comfort. In the early 1990s Philip Morris adopted standardised global marketing efforts, creating a central advertising production bank and guidelines for brand images and promotions, but allowing regional managers to create regionally appropriate individual advertisements. Conclusions: Values and lifestyles play a central role in the global marketing of tobacco to young adults. Worldwide counter marketing initiatives, coupled with strong, coherent global marketing policies such as the Framework Convention on Tobacco Control, are needed to break associations between young adult values and tobacco brands. As globalisation promotes the homogenisation of values and lifestyles, tobacco control messages that resonate with young adults in one part of the world may appeal to young adults in other countries. Successful tobacco control messages that appeal to young people, such as industry denormalisation, may be expanded globally with appropriate tailoring to appeal to regional values.     

Perspectives on the role of the Society for Research on Nicotine and Tobacco in promoting global tobacco research and reducing tobacco harm.

The Society for Research on Nicotine and Tobacco (SRNT) has a critical role to play in advancing tobacco research globally. To date SRNT has sponsored a number of successful initiatives including meetings held by the society's European affiliate, establishment of the Global Network Committee in 1999, and the 2003 and 2005 global tobacco pre-conferences. The most recent SRNT conference was held for the first time outside of North America and attracted over 900 participants from 50 countries. SRNT also has sponsored workshops, provided member scholarships to researchers from low- and middle-income countries, and partnered with the World Health Organization to host www.treatobacco.net. Although these initiatives are impressive, SRNT can further support global tobacco research by (a) working with other organizations to support global tobacco science and policy (this is especially timely given the recent coming into force of the Framework Convention on Tobacco Control), (b) providing more resources including increased funding and access to online journals for those in low- and middle-income countries, (c) increasing the representation of science at world and national tobacco conferences, and (d) expanding the role of the Training Committee to place increased emphasis on mentoring tobacco scientists from low- and middle-income countries. Science will be crucial in addressing the global tobacco pandemic, and SRNT is uniquely positioned to further tobacco science and research capacity on a global basis.     

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.     

对烟草认知与履行公约实际边界关系的研究

为正确引导不同文化身份人群认知《公约》并正确履约,分析了在履行《烟草控制框架公约》进程中出现的认知差异,不同的烟草发展历史区隔出履约的实际边界;从对烟草的文化认知,特别是从企业性质及其内在规定性等角度,系统解析了烟草企业与其社会责任的辩证关系,对烟草社会责任认识矛盾的根源是对烟草客观存在认识的矛盾,认知的客观差异将影响《公约》实际边界的形成。通过对烟草承担社会责任的现实观察,明确了烟草企业履行社会责任与履行公约义务不存在根本的矛盾。     

Media advocacy and newspaper coverage of tobacco issues: a comparative analysis of 1 year's print news in the United States and Australia.

Tobacco control advocates now recognize the value of influencing news coverage of tobacco; news coverage influences attitudes and behavior as well as policy progression. It is, however, difficult to assess the progress of such efforts within a single national and temporal context. Our data represent the first systematic international comparison of press coverage of tobacco issues. Tobacco articles from major daily newspapers in Australia (12 newspapers; 1,188 articles) and the United States (30 newspapers; 1,317 articles) were collected over 1 year (2001). The analysis shows that coverage in the two countries was similarly apportioned between hard news (>70%) and opinion pieces. Similarly, stories in both countries were most likely to recount positive events. The substantive focus of coverage, however, differed, as did the expression of hostile opinion toward tobacco control efforts (United States, 4%; Australia, 7.1%). Although secondhand smoke and education, cessation, and prevention efforts were covered widely in both settings, these topics dominated coverage in Australia (29.2%) more than in the United States (17.6%), where a more diffuse set of tobacco topics gained relative prominence. The difference in policy conditions seems to offer contrasting opportunities for advocates in the two countries to use newspapers to promote helpful tobacco control messages for both behavior and policy change.