Tobacco control in the Eastern Mediterranean region: implementation progress and persisting challenges

Abu-Rmeileh, Niveen M E; Khader, Yousef; Rahim, Hanan Abdul; Mostafa, Aya; Nakkash, Rima; Hamadeh, Randah R; Romdhane, Habiba Ben; Salloum, Ramzi G.

doi:10.1136/tobaccocontrol-2021-056539

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…In India, officials feared public opposition to enforcement; despite their knowledge on the matter, they hesitated to enforce the laws 38. While in the Eastern Mediterranean officials feared litigations and resistance from the hospitality sector if they would enforce the smoke-free law 29 42…”

Section: Resultsmentioning

confidence: 99%

“…Active civil society was seen to mobilise enforcement by government agencies in India and Mexico, whereas limited antitobacco advocacy by non-governmental organisations weakened enforcement in Pacific island countries 37 39 43. The susceptibility of officials in Uganda to bribery and resistance and the litigations from the hospitality sector in Eastern Mediterranean was all found to impact enforcement negatively 33 42. Contrarily, empowering subnational authorities in Iran, Nigeria, and community-based organisations in Bangladesh through diverse membership taskforces and mobile courts led to timely enforcement 35 36 44.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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BackgroundThe burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs.MethodsWe conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs.ResultsWe included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process.ConclusionsThe synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs.PROSPERO registration numberCRD42020191541.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Such result is very important especially with the increasing popularity of waterpipe products in the region and the fact that waterpipe products are not taxed in the same manner as cigarettes. 34 Fourth, results on the cross-price elasticities in the three countries indicated some substitution between cigarettes and waterpipe products, and within each product variety. However, gender differences varied across the three countries whereby higher cross-price elasticities were generally observed for women in Lebanon and Jordan.…”

Section: Discussionmentioning

confidence: 95%

“…This indicates an elastic demand for waterpipe products as compared with cigarettes. Such result is very important especially with the increasing popularity of waterpipe products in the region and the fact that waterpipe products are not taxed in the same manner as cigarettes 34…”

Section: Discussionmentioning

confidence: 99%

Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment

et al. 2022

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ObjectivesThis study assessed the extent to which the elasticity of cigarette and waterpipe tobacco products differs between men and women. We also explored the levels of substitution and complementarity in tobacco products among men and women.SettingThe study examines tobacco elasticities in three Arab countries: Lebanon, Jordan and the West Bank of Palestine.ParticipantsWe used data from nationally representative surveys of adults aged ≥18 years in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679). The proportion of women was 50.0% of the sample in Lebanon and Palestine, and 44.6% in Jordan.Primary and secondary outcome measuresA zero-inflated Poisson regression model estimated own-price and cross-price elasticities for two variations of cigarettes and five variations of waterpipe tobacco products. Elasticities were measured based on eight scenarios of prices.ResultsDemand for waterpipe tobacco products was elastic for both men and women. The cross-price elasticities in the three countries indicate the existence of substitution between cigarettes and waterpipe products and by different varieties within each of the two tobacco products. Gender differences varied across the three countries whereby higher cross-price elasticities were observed for women in Jordan and Palestine. For example, the price elasticity for discount waterpipe was −1.4 and −0.6 for women and men in Jordan, respectively.ConclusionsResults on the elasticity of demand for tobacco products and the existence of substitution between tobacco products reveal the higher responsiveness of men and women to changes in tobacco prices. This should be taken into consideration in tobacco control strategies particularly when reducing tobacco consumption via taxation policies.

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“…There is lack of evidence pertaining to the trend of tobacco usage patterns, tobacco interventions and implementation challenges among civilians in humanitarian settings affected by armed conflict, despite key vulnerability factors prevailing in those settings. Due to the lack of structure in governance, poor policy-making, underdeveloped health systems and weak regulatory environments, it is challenging to implement tobacco control measures 10 11. Consequently, the prevalence of tobacco usage is almost always higher in these settings as compared with non-humanitarian regions.…”

Section: Introductionmentioning

confidence: 99%

Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol

Gudi

Swain²,

Kulkarni

et al. 2022

BMJ Open

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IntroductionTobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings.Methods and analysisThis scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation.Ethics and disseminationThis review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.

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Tobacco control in the Eastern Mediterranean region: implementation progress and persisting challenges

Cited by 6 publications

References 13 publications

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

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

Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment

Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol

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