Addressing the tobacco epidemic in the Philippines: progress since ratification of the WHO FCTC

Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.     

WHO's Framework Convention on Tobacco Control potential impact on tobacco control in Japan

OBJECTIVE: The objective of the paper are to introduce the current global tobacco control measures undertaken by WHO and other international organizations, and to describe the impact on domestic tobacco control in Japan. METHODS: Publications and documents, mainly for WHO, were reviewed especially with reference to the Framework Convention on Tobacco Control (FCTC). RESULTS: WHO has been promotion comprehensive tobacco control globally as well as regionally in order to assist and promote its national health policy. In 1998, WHO established the Tobacco Free Initiative (TFI) to take action against the growing health impact of tobacco consumption around the world. WHO has also been proposing the FCTC, the first international convention in the health field, which includes, for example, restrictions on advertisement, selling to, or buying from persons aged under 18. Currently, the FCTC is being negotiated by governments and is expected to be ratified before May 2003. WHO is also working together with other international organizations, such as the World Bank, in synchronizing its global tobacco control policy. DISCUSSION AND CONCLUSIONS: "Smoking and health" is, without doubt, the most significant public health problem internationally and domestically. However, tobacco control tends to be less strict in Japan than in other developed countries. Even among health personnel in Japan, the health impact is still underestimated, thus its control remains partial. Accelerated public health campaigns against tobacco and health promotion activities are greatly needed. These could be carried out more effectively in the broad context of promotion of the FCTC.     

Civil society and the negotiation of the Framework Convention on Tobacco Control

Abstract

Tobacco control civil society organisations mobilised to influence countries during the negotiation of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) between 1999 and 2003. Tobacco control civil society organisations and coalitions around the world embraced the idea of an international tobacco control treaty and came together as the Framework Convention Alliance (FCA), becoming an important non-state actor within the international system of tobacco control. Archival documents and interviews demonstrate that the FCA successfully used strategies, including publication of a newsletter, shaming symbolism and media advocacy to influence policy positions of countries during the FCTC negotiation. The FCA became influential in the negotiation process, by mobilising tobacco control civil society organisations and resources with the help of the Internet, and framing the tobacco control discussion around global public health.     

Linking Global Youth Tobacco Survey (GYTS) data to the WHO framework convention on tobacco control: the case for India

India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) on February 27, 2005. The WHO FCTC is the world's first public health treaty that aims to promote and protect public health and reduce the devastating health and economic impacts of tobacco. Post ratification, each member state as part of general obligation has agreed to develop, implement, periodically update and review comprehensive multisectoral national tobacco control strategies, plans and programmes in accordance with this Convention and the protocols to which it is a Party. The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people across countries and the GYTS surveillance system intends to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. The South-East Asia Region of WHO has developed the "Regional Strategy for Utilization of the GYTS" to meet this need for countries in the Region. In 2003, India has passed its national tobacco control legislation (India Tobacco Control Act [ITCA]), which includes provisions designed to reduce tobacco consumption and protect citizens from exposure to second hand smoke. Data in the GYTS (India) report can be used as a baseline measure for future evaluation of the tobacco control programs implemented by the Ministry of Health and Family Welfare, Government of India. India has to upscale some provisions of its National Law to accommodate all of the requirements of FCTC. Using determinants measured by GYTS in India, the government can monitor the impact of enforcing various provisions of the ITCA and the progress made in achieving the goals of the WHO FCTC and the Regional Strategies. Effective enforcement of the provisions of ITCA will show in the receding numbers of tobacco use prevalence figures and reduction in the expenditures associated with tobacco use in India.     

The role of public participation in public health initiatives: An analysis of the WHO Framework Convention on Tobacco Control

Abstract

This is a content analysis of 489 written documents and 142 hearing testimonies, submitted to the World Health Organisation (WHO), regarding the Framework Convention on Tobacco Control (FCTC) during the comment period of 2000. Our aim was to consider the benefits and limitations of inviting public participation. We found that, overall, those who offered commentary were in support of the FCTC and any ensuing treaty, especially if it protected children. The minority who opposed the treaty argued that restrictions on tobacco trade would further damage the economies of poor nations that are financially dependent upon tobacco. The FCTC that was adopted at the World Health Assembly in May 2003 addressed many of the concerns raised by the public in written commentary and hearing testimony: children and youth; advertising and sponsorship; tobacco product labelling; second-hand smoke; taxes; smuggling; liability; tobacco product regulation; and the involvement of non-government organisations (NGOs). We conclude that the benefits of public participation in public health policy formation are numerous, including levelling the playing field for public health activists and NGOs, building the expertise of advocates that can be generalised to other public health efforts, giving the political process legitimacy and credibility, as well as coalition building and grassroots momentum.     

Tobacco Companies�� Use of Developing Countries�� Economic Reliance on Tobacco to Lobby Against Global Tobacco Control: The Case of Malawi

Transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it.We analyze tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organizations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC.Malawi began exporting tobacco in 1893,¹ and today it is the world''s most tobacco-dependent economy. Tobacco accounts for 70% of Malawi''s foreign earnings,^2,3 and 600 000 to 2 million members of the country''s total workforce of 5 million people are directly employed in the tobacco sector, which consists primarily of tobacco farming and factory processing jobs.⁴ US-based tobacco leaf–buying companies Universal Corporation and Alliance One International control tobacco prices and influence trade policies in Malawi, restricting competition, depressing tobacco prices for Malawi''s farmers, and contributing to the country''s poverty.⁵ Cigarette manufacturers and global leaf companies (merchant companies that buy tobacco leaf through prearranged contracts with manufacturers) fund child labor “corporate social responsibility” projects in Malawi to distract public attention from how they profit from low wages and cheap tobacco.⁶In addition, British American Tobacco (BAT), other cigarette manufacturers, and the International Tobacco Growers’ Association (ITGA), an organization created by tobacco companies in 1984 to weaken global tobacco control activities,^7–9 have used the governments of Malawi and other developing countries to lobby against global tobacco control efforts,^7,10 particularly the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC; 11 The FCTC is an international treaty designed to reduce the health damage of tobacco by committing signatories to enact laws that control the tobacco industry''s production and promotion of tobacco, increase taxes, and promote education about the dangers of tobacco use and secondhand smoke. The FCTC was passed in February 2005, and, as of April 2009, 164 countries (not including the United States) had ratified and were implementing the framework.

TABLE 1

Malawi, Global Tobacco Control, and the Framework Convention on Tobacco Control: Timeline

Shared vision,shared vulnerability: A content analysis of corporate social responsibility information on tobacco industry websites

Tobacco companies rely on corporate social responsibility (CSR) initiatives to improve their public image and advance their political objectives, which include thwarting or undermining tobacco control policies. For these reasons, implementation guidelines for the World Health Organization's Framework Convention on Tobacco Control (FCTC) recommend curtailing or prohibiting tobacco industry CSR. To understand how and where major tobacco companies focus their CSR resources, we explored CSR-related content on 4 US and 4 multinational tobacco company websites in February 2014. The websites described a range of CSR-related activities, many common across all companies, and no programs were unique to a particular company. The websites mentioned CSR activities in 58 countries, representing nearly every region of the world. Tobacco companies appear to have a shared vision about what constitutes CSR, due perhaps to shared vulnerabilities. Most countries that host tobacco company CSR programs are parties to the FCTC, highlighting the need for full implementation of the treaty, and for funding to monitor CSR activity, replace industry philanthropy, and enforce existing bans.     

Smoking cessation should have more emphasis within Tobacco Control? The case against

Tobacco is the only consumer product today that, when used as intended rather than by accident, kills half of its regular consumers. This led to the ratification of an international treaty prepared by the World Health Organisation, the Framework Convention on Tobacco Control (FCTC), now ratified by 164 countries. Within this historical framework, it may be asked what place is occupied by support for tobacco cessation in the worldwide fight against smoking. Even if the efficacy of treatment of tobacco dependence is proven, it is not the most cost-effective method of Tobacco Control and its efficiency is still questionable.     

从消极控烟国到积极控烟国——关于"十二五"时期全面控烟的建议

从2006年1月起世界卫生组织<烟草控制框架公约>在中国正式生效,"十一五"时期中国为履行该<公约>采取了一系列控烟行动,但是吸烟人数和烟草消费量仍在上升,烟草行业仍在不断"上水平",实际控烟效果甚微.烟草已成为威胁中国人群健康的最大"杀手",烟草业是中国最大的健康危害型产业.维护公众健康安全是中国政府履行公共安全服务...     

Evolution of Tobacco Labeling and Packaging: International Legal Considerations and Health Governance

Numerous national governments have recently adopted packaging and labeling legislation to curb global tobacco uptake. This coincides with the World Health Organization’s 2011 World No Tobacco Day, which recognized the extraordinary progress of the Framework Convention on Tobacco Control (FCTC).The tobacco industry has presented legal challenges to countries, including Australia, Uruguay, and the United States, for enacting legislation meeting or exceeding FCTC obligations.We argue that national governments attempting to meet the obligations set forth in public health treaties such as the FCTC should be afforded flexibilities and protection in developing tobacco control laws and regulations, because these measures are necessary to protect public health and should be explicitly recognized in international trade and legal agreements.THE 2011 WORLD NO TOBACCO Day recognized the substantial progress of the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control (FCTC). Yet FCTC implementation challenges remain, specifically for tobacco packaging health warnings required by article 11. Taking the recent Australian plain packaging legislation as one example, we have explored the challenges and barriers faced by national governments attempting to abide by the obligations and recommendations of the FCTC. We have argued that there is a continuing need for measures to protect populations from the scourge of tobacco and for the prioritization of health in all global policy.Tobacco use is a global epidemic that kills approximately six million people annually.1 The FCTC, the only international public health treaty, is a landmark in global health governance and the battle against tobacco use. Currently, 176 countries are FCTC parties, with about 20 national governments adopting or strengthening FCTC-related national tobacco legislation.2 The FCTC is binding on countries that become parties to the treaty.Tobacco accounts for almost two thirds of global noncommunicable disease, and thus a global approach to tobacco control, as emphasized by the United Nations General Assembly Special Session on noncommunicable diseases, is needed. Furthermore, smoking increases the risks of infectious diseases such as HIV/AIDS and tuberculosis and those caused by the human papilloma virus and Helicobacter pylori, and there are substantial adverse environmental effects from tobacco growing, manufacturing, and waste disposal.1,3–6 This adds to economic externalities of tobacco use, which include health care costs; lost productivity, pain, and suffering; diversion of agricultural resources away from food growing; and reduced household expenditures for essential goods.7–10Compounding direct effects of smoking on the individual, approximately 600 000 nonsmokers are projected to die from secondhand smoke exposure.11 Thus, binding international obligations involving multisectoral approaches are critical to alleviate the social, economic, and health burdens of tobacco use, especially for the 80% of the world’s one billion tobacco users living in low- and middle-income countries.7Tobacco packaging to influence marketing is a specific FCTC concern. The industry has invested significant resources to target specific consumer demographics, promote brand image, and mislead consumers regarding cigarette safety.12 Article 11 establishes obligations and standards for packaging and health warnings, with implementation and monitoring conducted through the Conference of the Parties.13 The obligations, or required standards, mandate rotating health warnings covering a minimum of 30% of principal display areas (i.e., front and back of packaging).13 Under the FCTC, parties are encouraged to craft national laws for packaging and labeling exceeding these standards.13 In fact, the FCTC recommends warnings covering at least 50% of packaging and the use of graphic displays of health consequences that are not dependent on consumer literacy.14Although most countries include some kind of tobacco product health warning15 and adoption of FCTC recommended labeling has increased, 87 signatory countries fail to meet the FCTC’s minimum obligations for labeling.16 Of 19 countries enacting recommended labeling, none are low income and only 30 mandate labeling covering at least 50% of the package.16 Indeed, the two most populous countries, China and India, have not fully complied with FCTC obligations. India does not meet minimum requirements for principal displayed areas although it includes pictorial warnings.16 China, the world’s largest consumer and producer of tobacco, enacted legislation in 2009 to meet FCTC requirements but has been criticized for not including graphic content.16 As a result, China’s current packaging and labeling legislation fails to meet specific FCTC requirements and may even be less effective than was prior Chinese labeling.17The combination of limited low- and middle-income country FCTC compliance and tobacco industry challenges brought under trade agreements, intellectual property rights, and investment rules suggests that FCTC implementation will require stronger support and diligence in sustaining its effects. Because tobacco use in many developed countries is declining yet demand and production is increasing in low- and middle-income countries, where the industry is focusing marketing efforts, low- and middle-income countries may need more technical, policy, or multinational support to implement effective labeling requirements and guidelines.     

The Status and Future Challenges of Tobacco Control Policy in Korea

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.     

我国烟草控制投入不足及对策

中国烟草危害严重,控烟投入与《烟草控制框架公约》要求存在差距,与实际需求不匹配,远低于其他国家和地区的控烟投入,低于我国其他公共卫生问题的防控投入,从而导致控烟能力不足,控烟成效不理想。建议健全国家烟草控制筹资机制、深入开展国际合作、加强科研、控烟队伍能力建设、支持戒烟门诊的建设。     

Health treaty dilution: a case study of Japan's influence on the language of the WHO Framework Convention on Tobacco Control

BACKGROUND: The Japanese government is an important shareholder in the Japanese tobacco industry. Negotiations to develop the WHO's historic Framework Convention on Tobacco Control (FCTC) were based on consensus, resulting in countries needing to agree to the lowest acceptable common denominator in clause development. OBJECTIVE: To illustrate Japan's role in negotiating key optional language in the FCTC text. METHODS: Summary reports, text proposals, conference papers, and speeches related to the six FCTC negotiation sessions were reviewed for repeated words, concepts and emerging themes. Key stakeholders were interviewed. Key words such as "sovereignty", "appropriate", "latitude", "individual", "flexibility", and "may" representing optional language were examined. RESULTS: The Japanese government's proposals for "appropriate" and optional measures are reflected in the final FCTC text that accommodates flexibility on interpretation and implementation on key tobacco controls. While Japan was not alone in proposing optional language, consensus accommodated their proposals. CONCLUSION: Japan's success in arguing for extensive optional language seriously weakened the FCTC. Accordingly, international tobacco control can be expected to be less successful in reducing the burden of disease caused by tobacco use.     

Accelerated Adoption of Smoke-Free Laws After Ratification of the World Health Organization Framework Convention on Tobacco Control

Objectives. We sought to evaluate the effect of ratifying the World Health Organization Framework Convention on Tobacco Control (FCTC) on countries enacting smoke-free laws covering indoor workplaces, restaurants, and bars.Methods. We compared adoption of smoke-free indoor workplace, restaurant, and bar laws in countries that did versus did not ratify the FCTC, accounting for years since the ratification of the FCTC and for countries’ World Bank income group.Results. Ratification of the FCTC significantly (P < .001) increased the probability of smoke-free laws. This effect faded with time, with a half-life of 3.1 years for indoor workplaces and 3.8 years for restaurants and bars. Compared with high-income countries, upper-middle–income countries had a significantly higher probability of smoke-free indoor workplace laws.Conclusions. The FCTC accelerated the adoption of smoke-free indoor workplace, restaurant, and bar laws, with the greatest effect in the years immediately following ratification. The policy implication is that health advocates must increase efforts to secure implementation of FCTC smoke-free provisions in countries that have not done so.Smoke-free laws improve health by reducing exposure to secondhand smoke and the associated heart disease, cancer, and other disease.1–3 The World Health Organization’s (WHO’s) Framework Convention on Tobacco Control4 (FCTC), in force since 2005, commits the countries that have adopted the treaty to implement tobacco-control measures including smoke-free environments, strong health warning labels, increased tobacco taxes, and safeguarding the policymaking process against the tobacco industry. Article 8 of the FCTC commits countries to

adopt and implement . . . measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.^4(p8)

As of April 2015, 180 countries were parties to the FCTC.5 The FCTC has already been shown to improve the chances for certain tobacco-control policies, such as its role in accelerating the adoption of FCTC-compliant warning labels on tobacco products.6,7 Countries that previously had voluntary warning label agreements with tobacco companies starting in the 1990s,6 along with poorer countries with less state capacity,7 were less likely to have such labels. The FCTC states that countries should pursue graphic health warning labels within 3 years of ratifying the treaty and within 5 years for some other policies, but does not specify a timeframe for smoke-free laws and has no external means of enforcement. In the first 5 years after ratifying the treaty, 24 (14%) of the 175 parties as of 2012 had passed smoke-free indoor workplace laws.8We evaluated the effect of ratifying the FCTC on countries enacting national smoke-free laws. We focused on indoor workplaces, restaurants, and bars because these are the venues for which the tobacco industry internationally has fought strongly to prevent smoke-free environments.9–12     

African media coverage of tobacco industry corporate social responsibility initiatives

Guidelines for implementing the World Health Organization's Framework Convention on Tobacco Control (FCTC) recommend prohibiting tobacco industry corporate social responsibility (CSR) initiatives, but few African countries have done so. We examined African media coverage of tobacco industry CSR initiatives to understand whether and how such initiatives were presented to the public and policymakers. We searched two online media databases (Lexis Nexis and Access World News) for all news items published from 1998 to 2013, coding retrieved items through a collaborative, iterative process. We analysed the volume, type, provenance, slant and content of coverage, including the presence of tobacco control or tobacco interest themes. We found 288 news items; most were news stories published in print newspapers. The majority of news stories relied solely on tobacco industry representatives as news sources, and portrayed tobacco industry CSR positively. When public health voices and tobacco control themes were included, news items were less likely to have a positive slant. This suggests that there is a foundation on which to build media advocacy efforts. Drawing links between implementing the FCTC and prohibiting or curtailing tobacco industry CSR programmes may result in more public dialogue in the media about the negative impacts of tobacco company CSR initiatives.     

Translating the WHO Framework Convention on Tobacco Control (FCTC): can we use tobacco control as a model for other non-communicable disease control?

Tobacco use is the single most preventable cause of death in the world today. Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. Galvanized by the seriousness of the threat, the Member States of the World Health Organization (WHO) negotiated the WHO Framework Convention on Tobacco Control (WHO FCTC), which entered into force in 2005. The treaty has enjoyed tremendous global success, with more than 170 Parties, and is often called the most powerful tool in the fight against tobacco-related morbidity and mortality. As the world undergoes the long-predicted transition from communicable to noncommunicable diseases (NCDs) posing the greater health burden, seminal ideas, processes, and outcomes like the WHO FCTC can be used to inform decision-making and policy-making. To help begin such knowledge transfer, this paper first examines how tobacco control evolved to become a reasonable, politically feasible topic for treating in the highly globalized context of public health and NCDs. Next, some of the key achievements and challenges that have occurred over the past six years of WHO FCTC implementation are discussed. Finally, a consideration of how some of the successes and lessons learned in tobacco control appear in other NCD contexts is presented.     

Linking Global Youth Tobacco Survey 2003 and 2006 data to tobacco control policy in India

Background: India made 2 important policy statements regarding tobacco control in the past decade. First, the India Tobacco Control Act (ITCA) was signed into law in 2003 with the goal to reduce tobacco consumption and protect citizens from exposure to secondhand smoke (SHS). Second, in 2005, India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). During this same period, India conducted the Global Youth Tobacco Survey (GYTS) in 2003 and 2006 in an effort to track tobacco use among adolescents. Methods: The GYTS is a school‐based survey of students aged 13‐15 years. Representative national estimates for India in 2003 and 2006 were used in this study. Results: In 2006, 3.8% of students currently smoked cigarettes and 11.9% currently used other tobacco products. These rates were not significantly different than those observed in 2003. Over the same period, exposure to SHS at home and in public places significantly decreased, whereas exposure to pro‐tobacco ads on billboards and the ability to purchase cigarettes in a store did not change significantly. Conclusions: The ITCA and the WHO FCTC have had mixed impacts on the tobacco control effort for adolescents in India. The positive impacts have been the reduction in exposure to SHS, both at home and in public places. The negative impacts are seen with the lack of change in pro‐tobacco advertising and ability to purchase cigarettes in stores. The Government of India needs to consider new and stronger provisions of the ITCA and include strong enforcement measures.     

上海市某社区医务人员履行《烟草控制框架公约》的调查

目的了解社区医务人员对《烟草控制框架公约》的知识知晓、态度改变和履约行为的变化情况,为医院实施控烟工作提供参考。方法学习《公约》,提高医务人员《公约》的知识知晓率及医务人员对烟草危害的认知度,采用个别访谈结合院内控烟督查观察,并记录吸烟医务人员的控烟态度和行为变化。结果医务人员《公约》的知识知晓率明显提高,医务人员对吸烟危害的认知度由学习前40.9%提高到学习后99.3%(χ2=74.502,P<0.01),控烟行为由学习前的20.0%提高到学习后80.0%(χ2=7.200,P<0.01),但未有戒烟成功者。结论医务人员《公约》知识学习有助于提高知晓率,医务人员对烟草危害的认知度保持较高水平;尽管医务人员控烟行为有改变,但戒烟行为无变化。     

Tobacco control policies in India: implementation and challenges

Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. Government of India has taken various initiatives for tobacco control in the country. Besides enacting comprehensive tobacco control legislation (COTPA, 2003), India was among the first few countries to ratify WHO the Framework Convention on Tobacco Control (WHO FCTC) in 2004. The National Tobacco Control Programme was piloted during the 11 th Five Year Plan which is under implementation in 42 districts of 21 states in the country. The advocacy for tobacco control by the civil society and community led initiatives has acted in synergy with tobacco control policies of the Government. Although different levels of success have been achieved by the states, non prioritization of tobacco control at the sub national level still exists and effective implementation of tobacco control policies remains largely a challenge.     

Attitudes and behavioral response toward key tobacco control measures from the FCTC among Chinese urban residents

Background  

The Chinese National People's Congress ratified the WHO Framework Convention on Tobacco Control (FCTC) on 27 August 2005, signaling China's commitment to implement tobacco control policies and legislation consistent with the treaty. This study was designed to examine attitudes towards four WHO FCTC measures among Chinese urban residents.