Reducing the gap between the economic costs of tobacco and funds for tobacco training in schools of public health

Tobacco use costs approximately dollar 167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.     

‘A preferred consultant and partner to the Royal Government,NGOs, and the community’: British American Tobacco’s access to policy-makers in Cambodia

British American Tobacco Cambodia (BATC) has dominated the country’s tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC’s in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia’s increasingly controversial political and business leadership that is centred around the Cambodian People’s Party with the aim of gaining access to policy-makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company’s ostensible contribution to Cambodia’s economic and social development and, more significantly, provided BATC with opportunities to petition policy-makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia’s economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia’s compliance with the Framework Convention on Tobacco Control.     

“Anti-Smoking Data Are Exaggerated” Versus “The Data Are Clear and Indisputable”: Examining Letters to the Editor About Tobacco

Media advocacy plays a unique role in tobacco control policy development. Letters to the editor in particular are an interesting form of media advocacy because they reflect community sentiment regarding the policy agenda and provide insight into the public debate. The authors used ethnographic context analysis to examine the techniques used by writers of 262 tobacco-related letters to the editor published in 61 newspapers across Missouri over a 2-year period when tobacco tax and smoke-free indoor air initiatives were occurring across the state. The authors found that pro–tobacco control letter writers often used didactic strategies, citing numbers and reports, to convey information and presented their training or experience as a health professional (e.g., M.D., Ph.D.) to add legitimacy to their arguments. Anti–tobacco control letter writers, in contrast, used narrative strategies to support their stance, claimed authority as a smoker or small business owner to legitimize their claims by relating to the audience, and used collectivity to capture the attention of policymakers. These results present the importance of strategic media advocacy in tobacco control. Tobacco control advocates should increase their use of narrative strategies and collectivity in order to better connect with the public and policymakers.     

"Anti-smoking data are exaggerated" versus "the data are clear and indisputable": examining letters to the editor about tobacco

Media advocacy plays a unique role in tobacco control policy development. Letters to the editor in particular are an interesting form of media advocacy because they reflect community sentiment regarding the policy agenda and provide insight into the public debate. The authors used ethnographic context analysis to examine the techniques used by writers of 262 tobacco-related letters to the editor published in 61 newspapers across Missouri over a 2-year period when tobacco tax and smoke-free indoor air initiatives were occurring across the state. The authors found that pro-tobacco control letter writers often used didactic strategies, citing numbers and reports, to convey information and presented their training or experience as a health professional (e.g., M.D., Ph.D.) to add legitimacy to their arguments. Anti-tobacco control letter writers, in contrast, used narrative strategies to support their stance, claimed authority as a smoker or small business owner to legitimize their claims by relating to the audience, and used collectivity to capture the attention of policymakers. These results present the importance of strategic media advocacy in tobacco control. Tobacco control advocates should increase their use of narrative strategies and collectivity in order to better connect with the public and policymakers.     

上海南京路步行街控制吸烟健康促进的实践探索

通过创建南京路商业控烟一条街,探索商业公共环境控烟干预的健康促进模式。通过社区诊断,运用社区动员,发动社会参与,社区赋权与政策改革,培育健康新理念,建立多部门合作,营造健康环境等健康促进策略和措施,开展控烟健康促进活动,形成了步行街商业社区各部门参与的商业社区控烟健康促进组织与网络,并初步形成了干预街区的控烟评价政策,干预区域90%以上的单位成为无烟单位。     

Kentucky legislators' views on tobacco policy.

CONTEXT: Kentucky leads the nation in adult and teen smoking prevalence. Even though Kentucky is one of the most tobacco-dependent states, tobacco policy is subject to change in light of possible national tobacco legislation. OBJECTIVE: To describe the degree of agreement among Kentucky legislators regarding tobacco control and tobacco farming policy, and to discover whether use of the policy Delphi method produces a shift toward consensus on tobacco policy. DESIGN: A two-round policy Delphi study was conducted using in-person interviews. SETTING: Legislators' offices in Frankfort, Kentucky. PARTICIPANTS: Volunteer sample of 116 Kentucky legislators (84% response rate). MAIN OUTCOME MEASURES: Degree of agreement on tobacco control and tobacco farming policies. RESULTS: Lawmakers were highly supportive of policies to lessen the state's dependence on tobacco, and were favorable toward stronger tobacco control policies. There were discrepancies, however, between what policies legislators thought were desirable and what policies were realistic. Tobacco interests were identified as possible explanations for this disparity. Tobacco allotment ownership was associated with less support for tobacco control and tobacco farming policies. A shift toward consensus on tobacco policy was achieved in the second round for 45% of the interview items common to both rounds. CONCLUSIONS: Kentucky legislators were highly supportive of reducing the state's dependence on tobacco and more supportive of tobacco control policies than expected. The policy Delphi method has the potential for shifting opinions about tobacco policies among state legislators. The findings of this study identify opportunities for public health policy change in one of the most tobacco-dependent states in the United States.     

Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities

OBJECTIVES: To assess the effect of community tobacco interventions in Aboriginal communities. METHODS: The study consisted of a pre- and post-study of the effect of a multi-component tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. RESULTS: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t = -4.5, 95% CI -33.6 - (-12.5), p < or = 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. CONCLUSIONS: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.     

Tobacco control advocacy in Australia: reflections on 30 years of progress.

Australia has one of the world's most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged and enshrined in World Health Organization policy documents yet is seldom the subject of analysis in the public health policy research literature. Australian public health advocates tend to not work in settings where evaluation and systematic planning are valued. However, their day-to-day strategies reveal considerable method and grounding in framing theory. The nature of media advocacy is explored, with differences between the conceptualization of routine "programmatic" public health interventions and the modus operandi of media advocacy highlighted. Two case studies on securing smoke-free indoor air and banning all tobacco advertising are used to illustrate advocacy strategies that have been used in Australia. Finally, the argument that advocacy should emanate from communities and be driven by them is considered.     

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.     

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.     

The World Health Organization's Framework Convention on Tobacco Control: implications for global epidemics of food-related deaths and disease

This paper reviews the major elements of the WHO Framework Convention on Tobacco Control and considers those that can be applied to diet and nutrition. Tobacco and food policy have important differences: the two commodities have distinctly different health impacts, and food companies may be more responsive to public concerns than the tobacco industry. Nevertheless, both food and tobacco policy address public health issues surrounding legal products. Both require comprehensive and multi-sector approaches at global and national levels. The degree of flexibility possible in interacting and partnering with the private sector and food and related industries and the related implications for regulations and laws are reasons for a more nuanced approach to diet and physical activity policy.     

Tobacco industry allegations of "illegal lobbying" and state tobacco control

OBJECTIVES: This study assessed the perceived effect of tobacco industry allegations of "illegal lobbying" by public health professionals on policy interventions for tobacco control. METHODS: Structured interviews were conducted with state health department project managers in all 17 National Cancer Institute-funded American Stop Smoking Intervention Study (ASSIST) states. Documentation and media records related to ASSIST from the National Cancer Institute, health advocates, and the tobacco industry were analyzed. RESULTS: The tobacco industry filed formal complaints of illegal lobbying activities against 4 ASSIST states. These complaints had a temporary chilling effect on tobacco control policy interventions in those states. ASSIST states not targeted by the tobacco industry developed an increased awareness of the industry's tactics and worked to prepare for such allegations to minimize disruption of their activities. Some self-reported self-censorship in policy activity occurred in 11 of the 17 states (65%). CONCLUSIONS: Public health professionals need to educate themselves and the public about the laws that regulate lobbying activities and develop their strategies, including their policy activities, accordingly.     

我国医务人员参与控烟工作的问题及对策分析

烟草危害是当今世界最严重的公共卫生问题之一,控烟工作面临严峻的考验。医务人员在控烟工作中发挥着重要的作用。本文强调了我国医务人员参与控烟工作的重要性;分析控烟工作过程中存在的问题,如医务人员吸烟率高、控烟知识薄弱、控烟培训不足、不能主动提供戒烟帮助等;从政府、医疗机构及其医务人员自身等多种途径提出了促进医务人员参与控烟的对策,旨在进一步发挥医务人员在控烟工作中的表率作用,带动全社会积极参与控烟工作。     

Reducing the burden of tobacco: what’s the endgame?

Tobacco use causes a tremendous amount of morbidity and mortality globally, with a staggering level of financial costs. In many countries, public health interventions have been able to reduce the prevalence of smoking and the associated burden. However, despite these successes, there is still much work left to be done. This commentary argues that the tobacco control interventions recommended by the World Health Organization are necessary but not sufficient to adequately address the consequences of tobacco use.     

Awareness and implementation of the 2000 United States public health service tobacco dependence treatment guideline in a public hospital system

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.     

Evidence building for policy: tobacco surveillance/surveys and research in India

India is at a crucial juncture relating to tobacco control and implementing the recommendations of the WHO FCTC. Tobacco consumption in the country remains alarmingly high in urban as well as rural areas. Smokeless tobacco consumption is very popular among larger masses, including the youth. Cigarette smoking has declined, but bidi use has increased concomitantly. Youth continue to be lured to initiate tobacco consumption through efficient marketing strategies of tobacco companies. The epidemiology of tobacco consumption is markedly varied across the country, with high rates in 15 States. Progress has been made towards tobacco control by the enactment of laws and regulations and the National Tobacco Control Program. Strengthening their implementation and enforcement is the biggest challenge and requires resource inputs. Evidence generation and its translation and utilisation for policy interventions would be useful.     

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.     

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.     

Failure to defend a successful state tobacco control program: policy lessons from Florida

OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum.     

Post-tobacco master settlement agreement: policy and practice implications for social workers

The 1998 Tobacco Master Settlement Agreement (MSA) was developed between states and tobacco manufacturers to settle the states' lawsuits against tobacco manufacturers and recover tobacco health-related costs. States won billions of dollars and concessions regarding how tobacco products could be advertised. The purpose of the MSA was to prevent cigarette smoking and compensate for health expenses incurred in the treatment of tobacco smoking-related illnesses. Twelve years after the settlement, it is clear that MSA monies have been gravely diverted from tobacco prevention and cessation programs to balance budgets. The authors' review indicates that increases in funding for state tobacco prevention and cessation programs reduce tobacco use across all populations. Implications for social policy and social work practice are offered.