Tobacco‐Control Policies in Tobacco‐Growing States: Where Tobacco Was King

Context

The 5 major tobacco-growing states (Kentucky, North Carolina, South Carolina, Tennessee, and Virginia) are disproportionately affected by the tobacco epidemic, with higher rates of smoking and smoking-induced disease. These states also have fewer smoke-free laws and lower tobacco taxes, 2 evidence-based policies that reduce tobacco use. Historically, the tobacco farmers and hospitality associations allied with the tobacco companies to oppose these policies.

Methods

This research is based on 5 detailed case studies of these states, which included key informant interviews, previously secret tobacco industry documents (available at http://legacy.library.ucsf.edu), and media articles. This was supplemented with additional tobacco document and media searches specifically for this article.

Findings

The tobacco companies were particularly concerned about blocking tobacco-control policies in the tobacco-growing states by promoting a pro-tobacco culture, beginning in the late 1960s. Nevertheless, since 2003, there has been rapid progress in the tobacco-growing states’ passage of smoke-free laws. This progress came after the alliance between the tobacco companies and the tobacco farmers fractured and hospitality organizations stopped opposing smoke-free laws. In addition, infrastructure built by National Cancer Institute research projects (COMMIT and ASSIST) led to long-standing tobacco-control coalitions that capitalized on these changes. Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states.

Conclusions

The environment has changed in the tobacco-growing states, following a fracture of the alliance between the tobacco companies and their former allies (tobacco growers and hospitality organizations). To continue this progress, health advocates should educate the public and policymakers on the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced.     

Evaluating the Strength of School Tobacco Policies: The Development of a Practical Rating System

BACKGROUND: School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present preliminary validation data.
METHODS: This study presents the systematic development of a rating system to assess the strength of school tobacco policies. Based on the empirical literature and the expertise of an advisory panel consisting of educational leaders and tobacco control advocates and practitioners, a "gold standard" school tobacco policy was developed and guided the content of the 40-point rating system. The 4 domains of the School Tobacco Policy Index were: Tobacco-free environment (14 points), Enforcement (12 points), Prevention and treatment services (6 points), and Policy organization (8 points).
RESULTS: The Index was pilot-tested using 95 Missouri public school district tobacco policies and proved to be highly reliable among coders. The evaluated policies varied greatly between school districts, with the lowest total policy score of φ and the highest score of 21. School district policy scores were significantly related to a number of county-level tobacco policy characteristics, including support for a tobacco excise tax increase.
CONCLUSIONS: The Index is a user-friendly, practical tool for tobacco control professionals and educators, providing them with the ability to easily evaluate their own school policies. Their evaluation efforts will be useful in strengthening existing policies and developing new comprehensive policies to protect the health of students, staff, administrators, and visitors.     

The Relationship Between School Policies and Youth Tobacco Use*

BACKGROUND: The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school‐based programs have resulted in limited success, it is necessary to identify other setting‐level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS: Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS: Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS: The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.     

Evaluation of Measurement Tools for Tobacco Product Displays: Is there an App for that?

Tobacco product displays are a pervasive presence in convenience stores, supermarkets, pharmacies, and other retailers nationwide. The influence that tobacco product displays have on purchases and tobacco product initiation, particularly on young people and other vulnerable populations, is well known. An objective measurement tool that is valid, reliable, and feasible to use is needed to assess product displays in the retail setting. This study reports on the relative accuracy of various tools that measure area and/or distance in photos and thus could be applied to product displays. We compare results of repeated trials using five tools. Three tools are smartphone apps that measure objects in photos taken on the device; these are narrowed down from a list of 284 candidate apps. Another tool uses photos taken with any device and calculates relative area via a built-in function in the Microsoft Office Suite. The fifth uses photos taken with the Narrative Clip, a “life-logging” wearable camera. To evaluate validity and reliability, we assess each instrument''s measurements and calculate intra-class correlation coefficients. Mean differences between observed measurements (via tape measure) and those from the five tools range from just over one square foot to just over two square feet. Most instruments produce reliable estimates though some are sensitive to the size of the display. Results of this study indicate need for future research to test innovative measurement tools. This paper also solicits further discussion on how best to transform anecdotal knowledge of product displays as targeted and disproportionate marketing tactics into a scientific evidence base for public policy change.     

Tobacco and the Malays: ethnicity,health and the political economy of tobacco in Malaysia

Objectives: To identify the historical nexus between Malaysia’s largest and politically dominant ethnic group and the political economy of tobacco, and to consider the implications of this connection for tobacco control.

Design: Primary and secondary documentary sources in both English and Malay were analysed to illuminate key events and decisions, and the discourse of industry and government. Sources included: speeches by Malaysian political and industry actors; tobacco industry reports, press releases and websites; government documents; World Health Organization (WHO) tobacco control literature; and press reports.

Results: Malays have the highest smoking prevalence among Malaysia’s major ethnic groups. The tobacco industry has consistently been promoted as furthering Malay economic development. Malays play the major role in growing and curing. Government-owned Malay development trusts have been prominent investors in tobacco corporations, which have cultivated linkages with the Malay elite. The religious element of Malay ethnicity has also been significant. All Malays are Muslim, and the National Fatwa Council has declared smoking to be haram (forbidden); however, the Government has declined to implement this ruling.

Conclusion: Exaggerated claims for the socio-economic benefits of tobacco production, government investment and close links between tobacco corporations and sections of the Malay elite have created a conflict of interest in public policy, limited the focus on tobacco as a health policy issue among Malays and retarded tobacco control policy. More recently, ratification of the WHO Framework Convention on Tobacco Control, regional free trade policies reducing the numbers of growers, concerns about smoking from an Islamic viewpoint, and anxieties about the effects of smoking upon youth have increasingly challenged the dominant discourse that tobacco furthers Malay interests. Nevertheless, the industry remains a formidable political and economic presence in Malaysia that is likely to continue to proclaim that its activities coincide with Malay socio-economic interests.     

自测健康评定量表修订版的反应度研究

目的　了解自测健康评定量表修订版 (SRHMSV1 0 )的反应度。方法　应用SRHMSV1 0首次现场测试 2 0 0 0人 ;在高校学员中 ,间隔一周测试 150人 ;在中医科住院患者、皮肤病患者及部队老年心血管患者中 ,间隔一周测试 13 0人 ,间隔四周测试 12 7人 ;在孕产妇女中 ,产后一周测试 55人 ,产后 42天测试 53人。结果　高校学员一周内的健康状况没有明显变化 ;中医科住院患者间隔一周、四周SRHMSV1 0的测试得分与首次均不存在显著性差异 (P >0 0 5) ;皮肤病患者间隔一周、四周测试SRHMSV1 0的量表总分与首次均存在显著性差异 (P <0 0 5) ;部队老年心脏病患者经过一周的疗养 ,自测健康没有明显变化 ,间隔四周测试SRHMSV1 0的量表总分与首次存在显著性差异 (P <0 0 1) ;孕产妇女产后一周、产后 42天测试SRHMSV1 0的量表总分与首次均存在显著性差异 (P <0 0 1)。结论　SRHMSV1 0具有较好的反应度 ,能够及时、灵敏地反映不同人群的自测健康变化情况     

An Instrument for Assessing Public Health System Performance: Validity in Rural Settings

PURPOSE: This study evaluated the validity and utility of the Local Public Health System Assessment Instrument (Local Instrument) of the National Public Health Performance Standards Program in rural settings. METHODS: The study compared the Local Instrument scores of 6 rural local public health systems to external assessments of those public health systems. The 6 public health systems represented 3 states in which 1 of the 2 local jurisdictions had scored well below and the other well above the state median in a pilot test of the Local Instrument. The study design featured a case study approach consisting of an iterative and integrated combination of semistructured individual and focus group interviews along with the collection of archival materials provided by the 6 public health systems. FINDINGS: Despite differences in Local Instrument scores, the representative public health systems in each state provided roughly the same levels of public health services. Sites varied tremendously in the percentage of survey items rated highly or less relevant. CONCLUSIONS: The National Public Health Performance Standards Program Local Instrument can provide a useful structure and process for assessing public health system performance at the local level. Key informants provided several recommendations to improve the Local Instrument, including clarification of difficult terminology and acronyms, and development of multiple instruments structured around subsets of survey items.     

Caribbean pleasure industry: Tourism,sexuality and AIDS in the Dominican Republic

State-owned tobacco companies, which still account for 40% of global cigarette production, face continued pressure from, among others, the International Monetary Fund (IMF), to be privatised. This review of available literature on tobacco industry privatisation suggests that any economic benefits of privatisation may be lower than supposed, because private owners avoid competitive tenders (thus underpaying for assets), negotiate lengthy tax holidays and are complicit in the smuggling of cigarettes to avoid import and excise duties. It outlines how privatisation leads to increased marketing, more effective distribution and lower prices, creating additional demand for cigarettes among new and existing smokers, leading to increased cigarette consumption, higher smoking prevalence and lower age of smoking initiation. Privatisation also weakens tobacco control because private owners, in their drive for profits, lobby aggressively against effective policies and ignore or overturn existing policies.

This evidence suggests that further tobacco industry privatisation is likely to increase smoking and that instead of transferring assets from state to private ownership, alternative models of supply should be explored.     

A Statewide Movement to Promote the Adoption of Tobacco‐Free School Policies*

BACKGROUND: Since most tobacco users become addicted to nicotine as teenagers, prevention efforts for youth remain central to comprehensive prevention programs. National and state efforts that encourage adoption and enforcement of comprehensive tobacco‐free school (TFS) policies can lead to significant reductions of youth tobacco use. In 2003, North Carolina (NC) Health and Wellness Trust Fund grantees began to focus statewide on the adoption of and compliance with TFS policies in NC schools. This study examined 46 NC districts that passed TFS policies between 2003 and early August of 2005 to see what factors were important in policy passage in order to support the continued promotion of TFS policy adoption across the state. METHODS: Detailed interviews were conducted with 118 key informants who were intimately involved with passage of their school districts’ TFS policies, and results were coded and analyzed for common themes. RESULTS: The study found several strategies key to adoption of TFS policies: effective leadership from organizations and individuals in positions of influence, grassroots organizing from community coalitions and youth groups, and communication strategies that optimally position policy adoption and compliance. CONCLUSION: States that have not yet achieved TFS policy adoption can focus on leadership development, grassroots organizing, and improved communication to advance their advocacy efforts.     

Assessing Microcomputer Competencies for the Elementary Teacher: An Indepth Study of Illinois Schools

Concerned with current elementary school students' microcomputer competencies and skills, this study analyzes responses from administrators and teachers from elementary school districts in Illinois. Conducted in 1986, all 431 elementary school districts in the state of Illinois were surveyed. The questionnaire used identified: respondent biographical information and microcomputer training; school demographic data; perceived student ability, application and understanding levels; and desired future student levels of competencies.

This study reveals current elementary administrative/teacher perceptions about student microcomputer competence in the elementary school. Implications of this study range from a call for indepth microcomputer assessment activities within individual schools to developing means for acquiring better student understanding about microcomputer problems and increasing student involvement or interaction with microcomputer concerns. This study calls on all educators to begin determining exactly what “microcomputer knowledge” their students need in order to function effectively in the future.     

区域性艾滋病与性病防制管理评估方法

艾滋病／性病的防制是涉及从分子生物学到社会文化各个层面的复杂系统工程。防制成效主要取决于管理而不是技术。针对目前艾滋病／性病防制管理普遍薄弱的实际情况，运用软系统分析及专家咨询法提出了一个简便而实用的防制管理评估工具，包括3个层次共96项评估指标。通过它不仅可以简单快捷地了解一个地区艾滋病／性病防制的总体水平，又能系统而全面地发现具体的可以改进的防制管理问题。同时，该评估方法中所提出的指标体系实际也是防制管理的具体原则与要求．可作为防制管理的参考标准或操作指南。     

Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries

Tobacco is widely considered to be a uniquely harmful product for human health. Since the mid-1990s, the strategies of transnational tobacco corporations to undermine effective tobacco control policy has been extensively documented through internal industry documents. Consequently, the sale, use and marketing of tobacco products are subject to extensive regulation and formal measures to exclude the industry from policy-making have been adopted in the Framework Convention on Tobacco Control. In contrast to tobacco, alcohol is subject to less stringent forms of regulation, and the alcohol industry continues to play a central role in policy-making in many countries and at the global level. This article examines whether there is a sufficient rationale for such different regulatory approaches, through a comparative analysis of the political economy of the tobacco and alcohol industries including the structure of the industries, and the market and political strategies they pursue. Despite some important differences, the extensive similarities which exist between the tobacco and alcohol industries in terms of market structure and strategy, and political strategy, call into question the rationale for both the relatively weak regulatory approach taken towards alcohol, and the continued participation of alcohol corporations in policy-making processes.