Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries

Abstract

ObjectivesThis study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.Setting545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.ParticipantsCommunity audits and surveys of adults (35–70 years, n=12 953).Primary and secondary outcome measuresSummary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models.ResultsAverage tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1).ConclusionsThis study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.

PhenX: Vector measures for tobacco regulatory research

“…Many countries have adopted stronger restrictions on tobacco marketing than the USA, and some Vector measures in the PhenX Toolkit are included in routine international surveillance instruments, such as the Global Youth and Adult Tobacco Surveys and surveys by the ITC Policy Evaluation Project in 29 countries 44. Even the price of the cheapest cigarette pack from the STARS instrument can be compared with data collected in urban and rural neighbourhoods across low-income, middle-income and high-income countries using the Environmental Profile of a Community’s Health (EPOCH), which assesses environmental determinants of cardiovascular health 45. In addition, one adaptation of a widely used ITC scale46 has incorporated information about the retail availability of tobacco from EPOCH community assessments 45…”

Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002–2016

“…). With regard to public health, higher quit ratios are associated with greater tobacco control policies (eg, price, health warnings), social unacceptability of smoking and knowledge of smoking-related effects on health68 so research may help to determine the effectiveness of these public health initiatives for persons with cannabis use or CUDs who smoke cigarettes. Based on our results, both public health and clinical efforts to improve cigarette quit outcomes may benefit from including those with any cannabis use.…”

Reducing the Global Burden of Cardiovascular Disease, Part 1

“…105,106 In PURE, we have observed that the implementation of policies to control tobacco use (eg, higher cigarette costs, lower availability, antismoking signage, and bans on tobacco advertising) was more prevalent in HICs compared with MICs or LICs, and where all these measures are combined, there are higher quit rates among smokers. 107 Agricultural policies, coupled with advances in agricultural technology, have greatly changed the food supply in most HICs, resulting in greater availability and consumption of refined carbohydrates, vegetable oils, processed foods, sugary beverages, and meats, with similar trends in the global food system now impacting MICs and LICs to variable degrees. 79 In MICs and LICs, healthy dietary choices are a further challenge to adhere to on a long-term basis because healthy diets are not practicable or affordable because of the unaffordability of many healthy foods (eg, fresh fruit and vegetables).…”