How do tobacco control policies work in low-income and middle-income countries? A realist synthesis

Hebbar, Pragati B; Dsouza, Vivek; Bhojani, Upendra; Srinivas, Prashanth Nuggehalli; Schayck, Onno Cp van; Babu, Giridhara R; Nagelhout, Gera E.

doi:10.1136/bmjgh-2022-008859

Cited by 8 publications

(4 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Here, different policies may be more effective in different areas of the world [21,49]. Therefore it is important to consider each country's stage in the smoking epidemic [50] as well as their economic, cultural and political determinants [25,51] in the progress and overall evaluation of the impact of MPOWER policies. This is perhaps evident in the uptake of P policies where less than half of all LIC have implemented them and when implemented the overall influence of the policy was low, reaching one in 100 smokers.…”

Section: Discussionmentioning

confidence: 99%

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Lyle,

Hendrie

2024

Global Health

View full text Add to dashboard Cite

Background In response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020. Methods We replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide. Results Identical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries. Conclusions Considerable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

show abstract

Section: Discussionmentioning

confidence: 99%

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Lyle,

Hendrie

2024

Global Health

View full text Add to dashboard Cite

show abstract

“…Likewise, enforcement was dynamic when champions led the inspection drives and there was access to information (tip-offs) and high-level support. Rewards in the form of cash (n = 2) were also a motivating factor, which relate to two studies arguing that the effect of enforcement is stronger when officials are compensated by the fines collected [ 43 , 44 ]. Several barriers raised by the news are consistent with global and Indian tobacco control literature, particularly with regard to gutka, where legal loopholes, lack of awareness and enforcement, and litigation by tobacco industries are associated with violation of the ban, sale of twin packets, without mandated health warnings [ 31 , 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

Dsouza

Kembhavi

et al. 2023

PLOS Glob Public Health

Self Cite

View full text Add to dashboard Cite

Smokeless tobacco (SLT) products like gutka and paan masala are a growing public health crisis in India. Despite enacting a ban—the highest form of regulation—little is known about implementation progress. The purpose of this study was to look at how enforcement of gutka ban is covered in Indian news media and if media is a reliable source of data. We conducted a content analysis of online news reports (n = 192) from 2011 to 2019. News characteristics such as name and type of publication, language, location, slant and beat coverage, visuals, and administrative focus were quantified. Similarly, news contents were inductively coded to examine dominant themes and the implementation landscape. We found that coverage was initially low but increased after 2016. Overall, news reports were in favor of the ban. Five leading English newspapers covered the majority of the ban enforcement reports. Prominent themes like consumption, health hazards, tobacco control responses, impact on livelihoods, and illicit trade were drawn from the textual analysis as the main arguments in relation to the ban. Gutka is largely seen as an issue of crime reflected by the contents, sources, and frequent use of pictures depicting law enforcement. The interconnected distribution channels of the gutka industry hindered enforcement, highlighting the need to study the complexities of regional and local SLT supply chains.

show abstract

“…To the best of our knowledge, few studies have focused on smoking cessation interventions with an implementation science perspective worldwide, with research being conducted primarily in hospital settings [15][16][17][18][19] and a few in non-hospital settings [20][21][22][23], and no reviews have covered settings such as hospitals, communities, workplaces, and schools. Since the implementation of smoking cessation interventions varies globally, and even within countries despite the existence of global and national tobacco control policies [24], there is a need for studies focusing on implementation in a wide range of settings in a speci c country.…”

Section: Introductionmentioning

confidence: 99%

Smoking cessation interventions and implementations across multiple settings in Japan: A scoping review and supplemental survey

Nagasawa¹,

Saito²,

Odawara³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Smoking is the leading risk factor for death worldwide. In Japan, although several evidence-based interventions (EBIs) for smoking cessation have been disseminated or adopted, there is a gap between scientific evidence and the actual implementation. This scoping review aimed to describe the knowledge gaps in local-level smoking cessation interventions in Japan, their implementation outcomes, implementation barriers and facilitators, and the use of implementation strategies.Methods: This study comprised two approaches: (1) a comprehensive scoping review of primary and grey literature, and (2) a supplemental survey of organizations in the grey literature. For the scoping review, we included original studies or reports on smoking cessation interventions targeting adults aged 18 years and older, or providers of cessation support at various settings (community, workplace, school, and clinical settings) in Japan. The extracted data included basic characteristics, intervention categories, implementation outcomes, factors influencing implementation, and implementation strategies for each intervention. Responses to the supplemental survey were extracted same used for the scoping review. To gain a deeper understanding, semi-structured interviews were conducted with some of the organizations in the survey.Results: A total of 600 interventions with 691 intervention components, based on EBIs in the 2020 U.S. Surgeon General Report, from 498 articles were included in the data extraction; 32 of the 88 organizations responded to the survey. Regarding the overall knowledge about smoking cessation intervention components, behavioral counseling and cessation medication in clinical settings were mostly reported (34.7%). Implementation outcomes were measured in 18 articles (3.0%) and penetration was mostly reported. Regarding influential factors, “available resources,” and “knowledge and beliefs about the intervention” for barriers, and “relative priority” for facilitators were mostly reported. Implementation strategies were measured in 29 articles (4.8%), and “Train and educate stakeholders” was mostly reported.Conclusions: Most EBIs reported in the Japanese literature included smoking cessation treatments in clinical settings. While a few articles focused on the implementation indicators in Japan, significant knowledge and experience were extracted from the grey literature, especially in the workplace and community settings. Future research should focus more on implementation to reduce the knowledge gap regarding smoking cessation interventions.

show abstract

How do tobacco control policies work in low-income and middle-income countries? A realist synthesis

Cited by 8 publications

References 65 publications

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

Smoking cessation interventions and implementations across multiple settings in Japan: A scoping review and supplemental survey

Contact Info

Product

Resources

About