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

Abstract

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.

FCTC followed by accelerated implementation of tobacco advertising bans

“…Consistent with studies of health warnings 67 and smoke-free laws, 8 our analysis shows that FCTC ratification was followed by accelerated adoption of complete advertising bans on television and radio, national print media and billboards. By 2014 more than half the countries from all income groups had implemented complete bans on television, radio, national print media and billboard advertising.…”

“…8 Poorer countries with less state capacity 7 and countries that had previously entered into voluntary warning label agreements with tobacco companies were less likely to have enacted such strong labels 6 and progress on smoke-free laws slowed over time. 8 …”

Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control

“…The introduction of these new products may also have been a response to the growing popularity of e-cigarettes beginning around 2007 after independent companies introduced them before the major multinational tobacco companies entered the e-cigarettes market 55 , 57 . Furthermore, the global decline of cigarette consumption and decrease in adult smoking prevalence (from 24% in 2007 to 21% in 2015), combined with the success of tobacco control, including implementation of the FCTC, 59 – 62 may also have lead the tobacco companies to consider alternative products to protect their profits and political interests. HTP serves both purposes by keeping consumers using the companies’ tobacco products while providing the industry with an avenue to lobby for exemptions from FCTC and similar national regulations by claiming that HTP would be good for public health 58 .…”

Correlates of compliance with national comprehensive smoke-free laws

“…Characteristically, this has been reported in jurisdictions with decreasing smoking prevalence and relatively long history in tobacco control such as Australia,1 Canada,2 England,3 New Zealand4 5 or at subnational levels in the USA 6 7. Since the entry into force of the WHO Framework Convention on Tobacco Control (FCTC),8 a much more diverse range of countries regarding socioeconomic development, legislative traditions and with different tobacco control experience and trajectories have adopted a national comprehensive smoking ban law.The evidence indicates that such a comprehensive law may face some enforcement challenges resulting in a suboptimal compliance in particular venues of some countries. For this paper, a national comprehensive smoking ban covers all indoor workplaces, indoor public places and public transport, in line with the obligations of the WHO FCTC.…”