Editorial
Meeting the Targets of a Healthier Future: Vision for Tobacco Endgame
Monika Arora a,b , Amit Yadav a , Manjusha Chatterjee a , Abhinav Bassi b , Ankur Singh a , Radhika Shrivastav b , Manu Raj Mathur a , K. Srinath Reddy a
aPublic Health Foundation of India (PHFI), New Delhi, India
bHealth Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
Tobacco is a major threat to the proposal and prospects of Sustainable Development Goals that the world is hoping to adopt in 2015. The need for tobacco control has been recognized as a global health imperative to address the global burden of Non Com- municable Diseases (NCDs). It is imperative that tobacco control measures be stepped up, at pace with progressive, ground-breaking and radical international measures moving towards a tobacco-free society. Although successes in tobacco control efforts have been regionally skewed, there are a number of positive developments and initiatives in the overall global tobacco control movement that can be replicated as best practices. Along with the WHO Frame- work Convention on Tobacco Control (FCTC) and WHO MPOWER strategies, tobacco control movements in various countries have adopted contextually relevant strategies and activities that have found success. There is a need to derive a more innovative perspec- tive on FCTC and MPOWER and to explore innovative partnerships beyond the traditional confines to build a global coalition that sup- ports tobacco control by partnering with others having convergent concerns on common determinants.
With the World Health Assembly considering a target of 30%
relative reduction in tobacco use prevalence by 2025, the global narrative on tobacco control is increasingly exploring the concept of tobacco endgame, which envisions reducing tobacco prevalence and availability to minimal levels. Tobacco control is also listed as a cost effective intervention that will contribute to the global goal of reducing NCD death rates by 2% per year. Experts aiming at the end game give a target for tobacco-free world, where less than 5% of people smoke, by 2040. This call has been accepted by countries like Finland and Norway who propose to become tobacco- free within next three decades. At the same time, Singapore and the state of Tasmania in Australia have proposed to restrict sale of tobacco products to individuals born after the year 2000 with a vision to make future generations tobacco-free. Bhutan has im- posed a total ban on manufacture and sale of tobacco and Gutka (a smokeless form of tobacco) ban can be considered as India' s big step towards tobacco endgame.
This is the time when governments must adopt comprehensive targets for ensuring reduction in prevalence of tobacco use in keeping with the recommendations from WHO. With this growing concern of tobacco use globally and the global initiative towards endgame for tobacco, it is of utmost importance to have a platform where public health researchers, experts, advocates, policy mak- 0954-6111/$–see front matter © 2013 Elsevier Ltd. All rights reserved.
ers, and other multi-discipline stakeholders discuss and deliberate on the contemporary public health policy and program innovations, need for effective measures and advocacy strategies to achieve the public health goal of a tobacco-free world.
The Public Health Foundation of India (PHFI) and HRIDAY (Health Related Information Dissemination Amongst Youth) in collaboration with the Ministry of Health and Family Welfare, Government of India (MoHFW), World Health Organization, World Bank, World Heart Federation, Centers for Disease Control and Prevention (CDC, USA) and National Cancer Institute (NIH, USA) is organizing the
“1st International Conference on Public Health in the 21st Century:
The End-Game for Tobacco”. The Conference will be held during September 10th to 12th, 2013 in New Delhi. The Conference en- visions to provide a platform not only for knowledge transfer and information sharing but agenda setting, for the future pathways of the tobacco control movement globally to put an end to tobacco.
With the decisions at the recently concluded Fifth Session of the Conference of Parties of the WHO-FCTC in the background, the Conference programme encompasses various themes related to the current tobacco endgame narrative including strategies for reducing prevalence to less than 5% by 2040, protection from tobacco industry interference, plain packaging of all tobacco prod- ucts, alternative livelihoods for tobacco growers, tobacco taxation, curbing illicit trade in tobacco products, youth tobacco use preven- tion programmes, providing accessible and affordable treatment for tobacco dependence and cessation, monitoring and surveil- lance among others. In addition, the Conference will focus on developing multi-sectoral partnerships and taking tobacco control beyond health sector to integrate it with the development goals and appropriate treatment under trade agreements and treaties.
The “1st International Conference on Public Health in the 21st Century: The End-Game for Tobacco” is a call for collective res- olution to fight tobacco with global cohesion and integration of tobacco control into other health and development agendas for the achievement of our common health and development goals.
The Conference presents an opportunity to share experiences and insights on various stages and strategies of tobacco control includ- ing governance, policy, advocacy, research, and practical facets to put an end to tobacco. This is the first global endeavour to bring tobacco control advocates from across the world to deliberate and devise an action plan to work towards the endgame target in the 21st century.
Abstracts from:
International Conference on Public Health Priorities in the 21st Century: The Endgame for Tobacco
New Delhi, India, September 10 –12, 2013
ORAL PRESENTATIONS
Making the case to Finance Ministers (the economics of tobacco control)
OP006
TOBACCO TAX YARDSTICK: DOES IT WORK?
Konstantin Krasovsky.Ukrainian Institute for Strategic Research of the Ministry of Health, Ukraine
Background:Tobacco tax yardstick is the recommendation to have tax com- ponent between two-thirds and four-fifths of the total retail cost. The WHO Report on the global tobacco epidemic suggests applying level of total taxes (excise + VAT) above 75% of retail price as an indicator of “effective tobacco taxation policies”. However, what would be the impact of taxation policy on tobacco consumption in a country that already keeps tax share in retail price above the recommended level? Does tax level exceeding 75% of retail price reduce tobacco consumption without tax increase or with just adjustment of specific tax rates for inflation?
Objective:Since 1990s, Denmark, Finland, France, Ireland, Portugal and the UK had levied cigarette taxes higher than 75% of retail price. The paper ex- plores effectiveness of tobacco taxation policy in terms of tobacco consumption reduction in these countries in 1990–2010.
Method:Data on tobacco sales, tax rates and prices were taken from the EU and national databases. Trends of total tobacco consumption were estimated including both legal and illegal (smuggling into and out of the country) cigarette and other tobacco products sales.
Result:In the considered countries, four kinds of tobacco taxation policy were practiced: 1) Tax decrease followed by tobacco consumption increase while tax proportion in retail price was about 75%; 2) No decline in tobacco consump- tion when taxes were stable, while the tax proportion exceeded 75%; 3) After steep tax increase tobacco consumption was sharply reduced, while there were almost no changes in the tax proportion; 4) Moderate tax increases reduced tobacco consumption only if they increased real prices, adjusted for inflation, income and illicit tobacco share, while tax proportion in the increased real price could even decline.
Conclusion:Keeping tobacco tax component high (even above 75% of retail price) did not contribute to the health objectives aimed at reducing tobacco consumption if real prices were not increased. Decrease of tobacco affordability over time caused by tax hikes and
other factors is a key determinant of tobacco consumption decline even in high income countries that already have very high tobacco taxes. Effective tobacco taxation public health policy should reduce tobacco products affordability as low as possible.
OP012
SMOKING-ATTRIBUTABLE MORTALITY IN BANGLADESH: PROPORTIONAL MORTALITY STUDY
Dewan Shamsul Alam1, Prabhat Jha2, Chinthanie Ramasundahettige2, Peter Kim Steatfield3, Louis Wilhelmus Niessen1, Mohammad Ashique Chowdhury1. 1Centre for Control of Chronic Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh;2Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael' s Hospital, University of Toronto, Canada;3Centre for Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh
0954-6111/$–see front matter © 2013 Elsevier Ltd. All rights reserved.
Objective:Bangladesh has over 20 million smokers and over half of adult men smoke cigarettes or bidis. There are no direct estimates of the consequences of smoking on cause-specific mortality in the world' s 7th most populous country of 150 million people.
Methods:We compared ever versus never smoking among four specific ma- jor causes of deaths (cases) to deaths not attributable to tobacco (controls) registered from 2003 to 2010 in an ongoing demographic surveillance in Mat- lab, rural Bangladesh. Odds ratios (OR) were adjusted for age, education, and use of chewing tobacco and combined with national death rates and smoking prevalences to estimate survival from ages 25–69 years by smoking status.
Results:About 84% of the 2213 men aged 25–69 years dying from tobacco- attributable diseases were ever smokers, as compared to 73% ever smokers among the 261 control deaths (RR=1.7, 99% CI, 1.1–2.5). The ORs of death due to smoking were highest for cancers, with lower risks for respiratory, vascular and other medical diseases. There was a clear dose-response relationship of mortality risk with age of initiation of smoking and with the daily amount of cigarettes or bidis smoked. These death rates suggest that among Bangladeshi men aged 25 years, 32% of smokers would die before age 70 versus 19% among otherwise similar never smokers. These risks correspond to about 24% of all deaths at ages 25–69 years, or a total of 42 000 smoking-attributable deaths in Bangladeshi men in 2010.
Conclusion:Smoking already causes over a quarter of all deaths in middle aged Bangladeshi men, and smokers lose about seven years of life. Without a large increase from the currently low level of adult smoking cessation, smoking deaths in Bangladesh are likely to grow.
OP016
SOLDIER ON: THE FIGHT FOR SUSTAINABLE FUNDING FOR TOBACCO CONTROL
Irene Patricia Nidea Reyes.HealthJustice Philippines, Quezon City, Philippines Background:An end game strategy for tobacco control needs long-term plan- ning and self-sustainable revenue for a comprehensive response to the tobacco epidemic. Like in most countries, tobacco control in the Philippines remains underfunded. There have been significant gains, mainly because of foreign- funded projects. However, with no regular and sufficient funding, there an ever-present danger that the gains will be reversed.
Objective:This paper will discuss the importance of sustainable funding for tobacco control as an essential element for the endgame of tobacco. It will review the Philippine experience in advocating for tobacco control funding, look at the challenges and lessons learned, as well as identify opportunities and strategies to convince the government to fund tobacco control.
Method:Review and analysis of research and strategies in pushing for sustain- able funding for tobacco control in the Philippines
Result:The government lacks the capacity to handle tobacco control programs and challenges, particularly tobacco industry interference in policy implemen- tation and litigation, due to lack of funding. There was an opportunity to push for sustainable funding for tobacco control during the reform of the tobacco tax law. But the final version provided funding mostly for curative programs.
Despite media and legislative advocacy, the law did not specify funding for tobacco control. The most ideal is still to push for earmarking a portion of ex- cise tax of tobacco for tobacco control programs or imposing a surcharge from tobacco and/or alcohol. But, we should also look beyond the recommendations of Article 6 and its Guidelines and seek more aggressive ways of funding. For example, looking at polluters pay principle, we should demand an amount from
the industry and use this to address health and environmental harms. Reframing tobacco control within the context of prevention of non-communicable diseases (NCDs) is helpful particularly when the policymakers are not too supportive of tobacco control programs or there is strong tobacco industry lobby. But, there is a need to be cautious to not lose focus on tobacco control even when it is integrated within NCDs.
Conclusion:The Philippine experience reflects the situation in other countries where implementation of tobacco control programs are dependent on the pri- ority given by the government. Reliance on foreign funding without pushing for sustainability at the country level would be a temporary victory when we are faced with a well-funded opponent.
OP020
ESTIMATING TOBACCO ILLICIT TRADE FEATURES AND EVOLUTION IN URUGUAY
Dardo Curti, Marcelo Boado, Eduardo Bianco.Centro de Investigacion de la Epidemia de Tabaquismo–CIET Uruguay, Uruguay
Background:The main single strategy to reduce tobacco consumption is tax- ation. The tobacco industry (TI) and its allies argued repeatedly that price increasing boost Tobacco Products Illicit Trade (TPIT). Since 2005 to 2010, Uruguay applied WHO-FCTC and in short time got significant outcomes. Re- cently, TI and allies publicly argued that in Uruguay had a noticeable increasing in TPIT.
Objective:Estimating TPIT magnitude, features and evolution since 2005–2010.
Method:Analyzing data from: 1) A smokers cohort (ITC project Uruguay– ITC-U, 2006–2010) crossing data on brand name, price, purchase location, pres- ence or not of required health warnings. 2) Official national and international databases.
Result:1) TPIT features: ITC-U included Montevideo (MVD), 2 inland and 2 border cities. Consumers of illegal cigarettes in Montevideo remained stable close to 10%, there was a small increasing at the 2 inland cities (with levels minor to 10%).The highest levels were found at the 2 border cities: over 24.4%
in Salto and 65.3% in Rivera. There is no illegal tobacco products production in Uruguay, TIP comes mostly from Paraguay. Evolution–On absolute figures, in last 10 year, there was a net and sustained declining in total tobacco market, with TPIT remaining stable or experimenting a small decreasing. On percent- age, TPIT increased: 15–16% in early 2000 to 19–20% in 2010–2012, considering amount of cigarettes; 11.5% (2006) to 16.1% (2010), considering quantity of smokers. Distribution channels–TIP are mostly sold in “legal shops”, mainly in bars, popular warehouses, 24 hour supermarkets. “Legal shops” sales reach 60% in MVD and peak to 80% in inland cities. Gender–In 2006 to 2008, women used ITP more than men (2006: 12.6% vs. 8.1%; 2008: 12.8% vs. 10.1%). In 2010 we found an increasing in both genders: men 16.3% and women: 15.5%.
Education–The less educated people are those who consume the most and showed a progressive increasing: 13.9% (2006), 15.3% (2008) and 22.1% (2010).
No significant variation in more educated. Age–While those older than 40 yo consumed TIP in greater proportion, between 2008 and 2010 it increased on under 40 yo consumption.
2) Taxes, prices and TPIT. Uruguay increased significantly tobacco taxes to 72.5% by 2010. Between 2008 and 2010, while legal cigarette prices increased by 45% and HRT by 49%, illegal cigarettes prices increased by 27%.
Conclusion: Uruguay implemented WHO-FCTC in effective manner without evidence of significant increasing of TPIT.
OP030
LOW TOBACCO TAXES, AN INCENTIVE FOR INCREASE IN YOUTH TOBACCO CONSUMPTION: A CASE STUDY OF UGANDA
Possy Rwabutaku Mugyenyi1, Emmanuel Kofi Ntie2.1Centre for Tobacco Control in Africa-CTCA, Uganda;2World Health Organization, Uganda Background:Tobacco kills about 6 million people, 10% of them die as a result of second hand smoke. There is ample evidence that higher tobacco taxes reduce tobacco consumption by inducing current users to quit, keeping former users from restarting and preventing potential users from starting. Increasing tobacco taxes is the single most effective measure to reduce tobacco consumption and is particularly effective in preventing transition from experimentation to regular use that is the most likely route the youth use to initiate smoking. Taxation is one of the most effective measures that result in significant reduction in tobacco consumption. More important about this measure is that raising to- bacco taxes increases revenue for Government, resulting in double advantage.
Governments generate revenue for health promotion and other social services while at the same time; the public health objective of consumption reduction is attained. What is even more interesting is that increasing tobacco taxes impacts more on the youths and the poor whose purchasing power is limited.
This makes tax increase more relevant to tobacco control.
Objective:1) To evaluate the impact of low tobacco taxes on consumption rates among the youths in low income country 2) To document other factors responsible for increasing tobacco consumption by the youths other than tax and price 3) To generate and package evidence for advocacy for higher tobacco taxes among policy makers
Method:The study was conducted in Uganda and the main method used was desk review of existing literature. The documents reviewed included Govern-
ment of Uganda budget papers, tax system operating in Uganda analyzed from Ministry of Finance and Uganda Revenue Authority and Statistical abstracts from Uganda Bureau of Statistics–UBOS, for a period of over 10 years (2001–2013).
The tobacco consumption rates for a period of over 10 years (2001–2013) were also reviewed for adults and youths from Uganda Demographic Health Survey (UDHS) and Global Youth Tobacco Survey (GYTS). Tax and price rates over the years were analyzed and compared with consumption rates over the same period to determine any correlation.
Result:1) Consumption rates of tobacco decreased among male adults but remained stable among female adults over the 10 year period. 2) Consumption rates tobacco increased>50% among the youths over the 10 year period. 3) Tobacco taxes remained low resulting in retail pack prices reducing in absolute terms. 4) Ministerial directive banning tobacco product adverts in place.
Conclusion:
•Tobacco taxation is the most effective measure to reduce consumption of manufactured tobacco products as it reduces its affordability and accessibil- ity by the youths and the poor.
•Tobacco taxation has the double advantage of increasing Government rev- enue while at the same time it reduces consumption.
•The common myth that increasing tobacco taxes increases illicit trade has no basis as it has not been proven.
Alternative livelihoods for tobacco farmers and retailers OP011
SUBSTITUTING FCV TOBACCO IN INDIA: ECONOMIC VIABILITY AND CHALLENGES
Arunkumar Ranganath Kulkarni, Bubaneshwar Sabar, Dattatraya
Ramachandra Revankar.Centre for Multi Disciplinary Development Research (CMDR), India
Background:Flue Cured Virginia tobacco is a region specific cash crop culti- vated in limited area in Andhra Pradesh and Karnataka, which account for more than 90% of total FCV tobacco cultivation in India. Article 17 and 18 of WHO' s FCTC lay stress on existing gaps in research and emphasize that the parties should promote research related to health/environmental and socioeconomic aspects and economically viable and sustainable alternatives to tobacco crop.
Objective:The main purpose of undertaking this study was to make a situation analysis of a tobacco growing region with respect to socio-economic back- ground of farmers, their perception on tobacco cultivation and other crops, institutional benefits available for tobacco, returns from different crops and challenges in shifting.
Method:The study followed a five stage stratified sampling method covering two FCV tobacco growing districts in Karnataka, which account for about 40% of FCV tobacco produced in India. The required database for the study was gath- ered through primary survey of randomly selected 400 tobacco and a control group of 36 non tobacco farm households.
Result:It is clear both from review of literature and this study that farmers are interested to shift from tobacco. But, this willingness is conditional or is responsive to fulfilment of demands. The review of literature also indicates that although there are alternatives that are being tried out, they are backed by huge investment of infrastructure. Based on net returns per unit of cultivation this study indicates the possibilities of promoting ginger, chilly, sugarcane and plantation crops as alternatives to FCV tobacco in Karnataka. From the sample covered in this study we could not find other remunerative livelihoods taken up by tobacco growers.
Conclusion:The gross returns backed by institutional support eye wash the tobacco growers of any other burden say repeated outstanding credit (cleared by Tobacco Board annually) and hardships of cultivating this laborious crop.
Therefore, the cultivation of other crops cannot be left to the providence of natural factors. While the study shows alternative crops like ginger, chilly, sug- arcane and plantation crops to be profitable, alternative livelihoods like dairy, poultry scoreless in terms of return. Additional dose of investment and mar- keting link may be necessary to lift them from an activity limited to household consumption to a viable business activity
The MDGs, NCDs, tobacco control and sustainable development beyond 2015
OP002
SCOPING THE TOTAL ENVIRONMENTAL COSTS CAUSED BY THE MANUFACTURED CIGARETTE INDUSTRY
E. Tursan d' Espaignet, Y Liu, T. Novotny, S. Bialous, S. Pujari, C. Curtis, V. Arnold.Tobacco Free Initiative (TFI), World Health Organization, Geneva Tobacco use is now the world' s single leading preventable cause of death.
It kills over 6 million people each year and causes countless health, social, and economic hardships. If current trends continue, tobacco use will kill more than 8 million people worldwide per year by 2030. Compared to the rela- tively well known health hazards associated with personal tobacco use, the impact of tobacco on the environment is less well known. Article 18 of the
WHO Framework Convention on Tobacco Control requires Parties to protect the environment and the health of persons within their respective Territories.
Manufactured cigarettes are by far the most widely consumed tobacco product globally. Every year, cigarette factories all around the world produce about 5–6 trillion cigarettes (around 150,000–200,000 each second). This production process requires use of significant natural resources that results in substantial land degradation, water and air pollution, pesticide exposures, and destruction of biodiversity. The life cycle of each cigarette imposes a heavy burden on the environment, from tobacco cultivation through manufacturing, packaging, distribution, consumption, and disposal of non-biodegradable cigarette filters.
Through United Nations agencies, the world community has developed a range of treaties and accords to help the world manage environmental externalities associated with agriculture, fishing, housing, transport, food processing, health services, recreation and countless other human endeavours. A fundamental difference between these activities and tobacco production and consumption is that while the former activities' negative externalities require careful manage- ment, these externalities are counterbalanced by the positive benefits required for the well-being and survival of humans and other living organisms. Tobacco production on the other hand has no redeeming positive features save those for the economic viability of the multi-national, national, and local tobacco industries. An examination of several international environmental agreements, treaties, and conventions (theUnited Nations Framework Convention on Cli- mate Change (UNFCCC) or Convention on Biological Diversity (UNCBD), and the Rio 20 Declaration) indicate that such instruments could provide new avenues with which to address the tobacco epidemic as an environmental issue. While the financial benefits of the tobacco industry accrue to a relatively few individ- ual corporations and shareholders, the substantial health, social, personal and environmental costs are borne by societies at large. Under principles such as the Extended Producer Responsibility Principle (EPR), the tobacco industry should be held responsible for the environmental damage caused by tobacco produc- tion. Past and current environmental costs should be measured and valued and the costs recouped in full from the tobacco industry. A similar exercise should also be contemplated for all other forms of tobacco products. This session will detail the environmental externalities of tobacco production and propose novel approaches to the tobacco epidemic as a global environmental problem.
OP015
TOBACCO EPIDEMIC AND CHILD ABUSE IN INDONESIA: MINISTRY OF SOCIAL WELFARE ROLE AND RESPONSIBILITY
Wasis Sumartono.MUSA UP (Multi-media Utilizing Scientists Against Unhealthy Promotion), Indonesia
Background:In the near future, Ministry of Social Welfare, Republic of Indone- sia, will conduct a national survey on child abuse. It was said that this survey is aimed to collect information on the prevalence of physical, emotional and sexual abuse to Indonesian males and females aged 13–24 years in Indonesia.
The unclear reason on why Ministry of Social Welfare do not give attention to tobacco related child abuse have raised question on the author. This paper will report examples adverse effects of tobacco epidemic on child abuse in Indonesia.
Objective:The objective of this study is to encourage Ministry of Welfare to give attention to this kind of child abuse in their scope of national survey.
Method:This is a qualitative study on tobacco related child abuse in Indonesia.
The author used combination method of observation, focus group discussion, non-formal in-depth interview with various informants including high school students, teachers, parent, and head of public health centre. This was done by the author during 2008–2013 in the tours of duty as a researcher of National Institute of Health Research and Development. The overheard information from Indonesian news papers, Indonesian Tobacco Control network, and internet also added to make a more comprehensive review on the tobacco related child abuse.
Result:Year 2009–2011, in Gorontalo, it was revealed that fathers were very permissive to boy smoking, on the other hand, girls were afraid to be slapped by their fathers if asking their fathers not to smoking inside their home. In the year 2012, in Bengkulu, a poor nicotine addicted father smoked five packs of cigarette a day though sometimes he had to owe food for his children.
Year 2013, a Head of Public Health Centre in West Nusa Tenggara reported that tobacco epidemic had caused local tobacco farmers did not care harmful effects of tobacco smoke to their own child–using a case of child death near tobacco leaf processing stove,
Conclusion:The implementation of effective smoking control strategies should be implemented in Indonesia as integral part of child abuse prevention and control. This including total ban on tobacco ads and promotion, increasing real cigarette price and tobacco taxes, prohibit sale to minors, ban on to- bacco importation and encourage crop substitution to local tobacco farmers.
If Indonesian social welfare has become Indonesian Ministry of Social Welfare Mission, consequently, the Ministry should play its role and responsibility in this kind of child abuse prevention.
OP024
CAN TOBACCO CONTROL “FOLLOW THE MONEY”? ANALYZING DEVELOPMENT ASSISTANCE FOR FCTC IMPLEMENTATION
Jeff Collin, Lucy Eskell, Evgeniya Plotnikova, Sarah Hill.University of Edinburgh, United Kingdom
Background:The global burden of tobacco-related disease is shifting from rich to poor countries, with 80% of tobacco deaths predicted to occur in low- and middle-income countries by 2030. While the WHO Framework Convention on To- bacco Control (FCTC) provides the architecture for preventing tobacco-related disease and death at a global level, investment in its implementation lags well behind international development assistance for other health issues. Addressing this gap assumes new significance in the context of the changing development agenda beyond the Millennium Development Goals.
Method:Based on FCTC implementation reports from 161 countries we exam- ined assistance received and given for tobacco control by World Bank income group and WHO region.
Result:Low income countries are less likely to receive all forms of assistance for tobacco control compared with middle-income countries, and most likely to report resource deficits in implementation of the FCTC. Countries in the European region are more likely to receive support than those in any other region. Countries in Europe are also most likely to provide assistance, followed by those in the African region of which 30% report providing tobacco control assistance to other countries. Regional foci of cooperation are evident in the South Pacific, South East Asia and Eastern Europe. A lack of political will is the most frequently reported barrier to FCTC implementation, followed by lack of financial resources.
Conclusion:The world' s poorest countries face the greatest barriers to tobacco control; assistance received by these countries is well below the level required for effective implementation of the FCTC. A much greater international com- mitment will be needed in order to address the growing health and economic cost of tobacco at a global level. Additionally, significant progress might be made by tobacco control advocates engaging more effectively with other devel- opment and global health agendas and by working to prioritise tobacco control measures within national development planning processes.
OP028
TAKING CONTROL OF TOBACCO TOWARDS THE ACHIEVEMENT OF MDGS Olivia Herlinda.The Office of President' s Special Envoy on MDGs, Indonesia Background:The relation between MDGs and tobacco is its impact to the achievement of MDGs, specifically in the low income country such as Indonesia.
Indonesia with more than 240 million of citizens and a weak regulation to control tobacco, make itself in the third place as a country with the biggest number of smokers after China and India. No doubt, Indonesia is a good target of big tobacco companies.
Objective:The purpose of writing this paper is to make readers be more concerned and more aware about tobacco and its impact of many life aspects, especially the ones within the MDGs. Tobacco needs to be controlled so that the health quality and the productivity of people will increase.
Method:It needs all of the elements of government, NGOs and individuals to decrease the consumption of Tobacco in Indonesia. Some of the Free Tobacco action has been conducted. The Indonesia government also has created Tobacco Control Regulation Layout but hasn' t got realized until now.
Result:The result of the UI demographic foundation shows that most of the poor people in Indonesia spend about 70% of their income to buy cigarettes and only 3.2% for education. A clear number of how tobacco affects almost every life aspect, specifically in poor people' s life. Some of the women see smoking as a modernity proof and independence from old rules restraint or as a sign of the equity with men. According to WHO in 2011, 10% of the Indonesian smokers were women. The National Commission for Tobacco Control in 2011 found that there' re 32,400 Indonesian toddlers having malnutrition caused by the tobacco smoke. TBC is one of the growing burden diseases in Indonesia and the prevalence is higher on smokers. The death rate caused by smoking was reported has reached 50% with cancer and cardiac arrest as a major killer. Each cigarette contains about 4000 chemical agents, with 250 dangerous agents and 50 carcinogenic agents. Those agents have been proven to increase the severity of global warming. All those things mentioned above are showing how tobacco has affected the attainment of MDGs.
Conclusion:To support the attainment of MDGs, we should make first a com- prehensive framework, which will push the tobacco regulation to integrate.
All the sectors have to cooperate to commit to control the supply of tobacco, especially from the health, agriculture, Industry, and trade sector. The main purpose of controlling tobacco is to improve the human quality by protecting youth generation now and in the future from tobacco dangers.
Innovation in tobacco control strategies and interventions
OP008
CLUSTER RANDOMISED TRIAL OF A BRIEF TOBACCO CESSATION INTERVENTION FOR LOW INCOME COMMUNITIES, INDIA
Bidyut K. Sarkar1, Lion Shahab2, Monika Arora3, Jasjit S. Ahluwalia4, K. Srinath Reddy3, Robert West2.1Public Health Foundation of India, India and University College London (UCL);2University College London (UCL), Epidemiology and Public Health, United Kingdom;3Public Health Foundation of India, India;4University of Minnesota Medical School, USA
Background:India has 275 million tobacco users and tobacco use kills more than a million people in the country each year. There is an urgent need to develop and evaluate affordable and scalable interventions to promote cessation of tobacco use.
Objective:This trial evaluated the effectiveness of a brief affordable and scal- able tobacco cessation intervention delivered by trained health professionals to promote quitting of tobacco use offered through outreach into poor urban communities.
Method:This pragmatic, community-based cluster randomised trial involving adult current tobacco users compared a brief intervention consisting of a single session of quit advice and training in craving control using simple yogic breath- ing exercises (QA-YB) with a control condition consisting of very brief advice (VBA). The study was carried out in 32 urban slum communities in Delhi, 16 randomly allocated to each arm, yielding a total sample size of 1185 tobacco users. Follow-up is 4 weeks and 7 months after the intervention. The 4-week follow-up is complete; the 7-month follow-up will be completed in September.
An intention to treat analysis for abstinence rates and analysis using generalized estimating equations (GEE) to take into account the clustering effect would be performed to provide population odds ratios and outcome at individual level.
Subgroup analysis of smokers and smokeless tobacco users separately would be presented.
Outcome measure: The primary outcome is self-report of having been abstinent from tobacco in the 6-months preceding the 7-month follow-up, with confir- mation by saliva cotinine. This paper presents self-reported point prevalence tobacco abstinence at the 4-week follow-up.
Result:94% and 97% were followed-up at 4-weeks in the intervention and con- trol arm, respectively. Intention-to-treat analysis (with those lost to follow-up considered as continuing tobacco users) showed that the self-reported absti- nence rate was significantly higher in the intervention than the control arm (14.1% versus 7.2%, p<0.001χ2=14.2)
Conclusion:Preliminary results suggest that a brief tobacco cessation outreach intervention may be effective. If confirmed this will offer an affordable and scalable model of a brief intervention (consisting of single session of quit advice and training on breathing exercises) for India and possibly other countries.
OP010
BUILDING TOBACCO FREE AND CREATING ECO-FRIENDLY ENVIRONMENT IN HILLS OF HIMACHAL PRADESH
Surender Nikhil Gupta1, Narender Sharma2, Naveen Gupta3.1Regional Health and Family Welfare Training Centre, Kangra, India;2Executive Director, Himachal Pradesh Voluntary Health Association, India;3Freelance Researcher in Epidemiology, Kangra, India
Background:The hill state of Himachal Pradesh with a varied geographical terrain has a higher incidence of smoking for men (33.6%) as compared to the national average (32.7%). As per GATS 2010, 21.2% of adults consume tobacco in some form or other. About 40% of the adult male consumes tobacco of which 33% smoke and 3.8% women of adult women consume tobacco with majority smoking. The exposure to second hand smoke at home is 83% in HP and is among the highest in India
Objective:Building tobacco free and creating eco-friendly environment in hills of Himachal Pradesh
Method:For creating an environment of safe and fresh air, Health department with HPVHA focused on capacity building/empowering of stakeholders for inter sectoral collaborations, creation of effective coalitions. It initiated policy advo- cacy for formation of Steering Committees at State and District level, creation of flying squads and advocated for notification of courts for compounding the fines and trial for offence on tobacco advertising. It focused on stakeholder sensitization on smoke free laws and conducted about 100 workshop/trainings amongst the authorized personnel. The momentum has now been taken to all district/subdistrict levels and through rural penetration, Panchayat resolutions of smoke free are being passed
Result:Micro level networks and collaborations up to the grassroots with cross sectional stakeholders formed. All district/development blocks are complying with the smoke free provisions, more than 40000 violators fined in the state in 2 years and about Rs 50 Lakhs amount have been collected as fine by the enforcement officials. About 36,000 stakeholders/enforcement officials sen- sitized at workshops and meetings. 90% Panchayats have passed smoke free resolutions and compliance of smoke free in the state reached to 83%. A cadre of sensitized stakeholders from cross section departments, community based institutions has been formed and combined effect of health department and HPVHA have realized that the social legislation of smoke free laws has to be
initiated from the top focusing on policy advocacy and go down gradually in the hierarchy by strengthening the enforcement mechanism and community awareness
Conclusion:Unless a resolute effort is made to implement smoke free laws, it will have no concrete consequence. It needs to be efficiently executed and enforced with cross sectional stakeholders with an incorporation of knowledge sharing, information exchange, coalition-building, networking, advocacy with policymakers and enforce.
OP013
A BRIEF INTERVENTION TO ADDRESS SMOKING AMONG ADOLESCENTS IN NIGERIA
Oluwakemi Ololade Odukoya, Kofoworola Abimbola Odeyemi.Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
Background:Majority of smokers start before the age of eighteen years. Schools play a critical role in promoting the health of adolescents and have the potential to influence their health behaviour.
Objective:To assess the effect of a short school based anti-smoking inter- vention program on cigarette smoking among students in secondary schools in Lagos state, Nigeria.
Method:A non-randomized, controlled intervention study among students in six secondary schools in Lagos state. Data was collected at baseline and follow up using self-administered questionnaires to selected respondents using a multi stage sampling method. Intervention was carried out among students using health talks, information leaflets and posters.
Result:Nine hundred and seventy three students participated in the baseline survey while 948 participated at follow up. There were significant increments (p<0.001) in the mean knowledge (8.39 vs.11.98; p<0.001) and attitude scores (13.24 vs. 14.99; p<0.01) after the intervention. There was however no sta- tistically significant change in the current smoking habits of the respondents (4% vs. 3%; p=0.41) in the intervention group post intervention. Nevertheless, the number of never-smokers who reported that they were likely to initiate cigarette smoking within the next year significantly reduced from 18.7% to 12.7% after the intervention (p<0.05). There was also a significant increase in the proportion of current smokers who desired to quit smoking from 47.4% to 85.7% (p<0.05) in the intervention group.
Conclusion:Even brief anti-smoking programs of this nature are effective at improving the knowledge and modifying the attitude of the respondents but do not improve adolescents smoking related habits. It however motivated current smokers to desire to quit and reduced the perceptions of smoking initiation in the near future among never smokers Health education sessions on cigarette smoking should be introduced into the secondary school curriculum and peri- odic anti-smoking awareness programmes should be organised for the students.
More intensive approaches may need to be considered to influence the smoking behaviour of adolescent smokers.
OP022
FUNDING ENDGAME STRATEGIES: INNOVATIVE FINANCING MECHANISMS Deborah Ko Sy, Allan V. Villanueva.HealthJustice Philippines, Quezon City, Philippines
Background:Many policy proposals for endgame strategies require a significant amount of political will and potentially a substantial amount of resources to assess the risks that the policy would bring, to implement the strategy or policy, or to manage the economic and other impact after the policy comes into force. In developing countries, funding to undertake the most fundamental tobacco control strategies meet varying amounts of challenges due to the lack of resources. Innovative financing mechanisms may be used to sustain endgame strategies and to contribute to a strategy of employing the “polluter' s pay”
principle on the tobacco industry.
Objective:This paper aims to illustrate proposed innovative financing mecha- nisms and provide examples on how these may contribute to endgame strategies.
Method:The research analyzes two proposed innovative financing mechanisms that employs the “polluter' s pay” principle: Standard Tobacco Levy proposed by WHO (high-income countries could allocate $0.10 per pack of cigarettes sold, middle-income countries ($0.06), and low-income countries ($0.02). to raise approximately $10.8 billion for global health), and Repatriated Tobacco Profit Tax by Callard & Collishaw (levying a 1% Tax on Repatriated Tobacco Profits (TRTP) could raise $200 million a year to support implementation of the Framework Convention on Tobacco Control (FCTC)); and compares these with other logical variations. It then explores how such mechanisms could potentially contribute to various tobacco control measures including endgame strategies.
Result:Although the STL has been widely disseminated, it has not been widely embraced. Callard & Collishaw have pointed out its flaws and have proposed in the alternative, the TRTP which is claimed to be more equitable. To provide an opportunity for comprehensive consideration, states must be provided with a few more variations of the proposed STL and the TRTP as well as other mechanisms including setting standards for charging a variety of fees.
In addition to augmenting national tobacco control budgets, proceeds can be used to facilitate international cooperation and contribute to endgame strate-
gies requiring international cooperation such as global funding to promote alternative livelihood or to enforce the removal of tobacco subsidies. It can also fund activities of international organizations such as the WCO and the Interpol in their anti-smuggling drive.
Conclusion:There is a higher probability of reaching international consensus on the manner of raising funds if the objective and the criteria for raising additional funds are clearly defined but each state is allowed to choose from a variety of options to impose a levy. In this case, the bone of contention would be on the amount of contribution from each state so as to achieve equity.
Further study on the elements that contribute to equity is required.
The availability of additional funds for global coordination activities acceler- ates the denormalization of the tobacco industry and promotes inter-sectoral cooperation at the country level especially in developing nations.
OP025
TOBACCO TREATMENT PROTOCOL IN TERTIARY CARE HOSPITALS–THE WAY FORWARD IN TOBACCO CONTROL IN LMICS
Rakesh Gupta1, Namit Soni2, Rajesh Parashar1, Shahla Khan1.1SK Soni Hospital & Rajasthan Cancer Foundation, India;2SK Soni Hospital, India Background:In India, amongst the strategic approaches for an effective to- bacco control, the health system' s approach to deliver tobacco treatment is lacking. One such solution is to have a tobacco-treatment protocol (TTP) in hospitals. Besides assisting country in the “O” component of MPOWER, it can also help the member countries to fulfil their commitment to the Article 14 of the FCTC (Framework Convention on Tobacco Control).
Objective:It is to assess if the model of tobacco treatment protocol can be realized in an Indian setting through a framework: (1) Concurrence from management; (2) Establishing a working group; (3) Empowerment along with communication with all to ensure their buy-in; (4) A high visibility to the cam- paign; (5) Close monitoring of the implementation; (6) A formal declaration after (a) evaluation of its efficacy by an external agency and (2) replication by other hospitals in the existing health system.
Method:The TTP comprised of: Screen, Ask, Advise, Treat or Refer and Follow- up: 1) The hospital reception screens patients for any tobacco use (SCREEN);
2) The screen-identified patients receive consultation, in addition to their management for the primary ailment (ASK, ADVISE, TREAT or REFER); 3) The interventions are–“minimum (∼3 minutes)” or “brief (for∼10 minutes)”;
Intensive (for∼30–40 minutes; for addicts or habitual users; and those less con- fident or have relapsed frequently in past, etc.); the last intervention is done through the in-house Tobacco Cessation Clinic (TCC); 2) Those requiring and willing are prescribed cessation medication and/or NRT; All screened patients are followed-up through the calls made on their cell phones after 6 months of their first report to the hospital.
Result:The program has completed 4 and a half months till date. Within the first quarter: 1. The enrolment of tobacco users on monthly basis averages to
∼9.54% of the total patients seen in the hospital–new and follow up (468 out of 4902). About 9% of these have received doctors' consultation. In telephonic follow up, a quit success of∼40% has been observed.
Conclusion:Despite challenges and barriers at all levels, and its brief duration of actual implementation, this exercise in human behaviour modification of health workers and patients alike appears implementable; and, effective too.
Its replication in the health systems should lower their tobacco burden by increasing quit rates in LMICs.
OP031
CHARACTERISTICS OF TOBACCO RETAILERS IN NEW ZEALAND Lindsay Robertson, Louise Marsh, Crile Doscher.University of Otago, New Zealand
Background: New Zealand (NZ) does not require tobacco retailers to be licensed or registered, and any type of outlet is permitted to sell tobacco. Consequently, tobacco is retailed widely yet it is not known how many outlets sell tobacco or where they are located. Smokefree Enforcement Officers (SEOs), based within District Health Boards, are responsible for enforcing legislation which prohibits point-of-sale tobacco displays and promotion, and sales of tobacco to minors.
To monitor retailer compliance with smoke-free legislation, SEOs are required to manually compile and maintain databases of tobacco retailers in their region.
Objective:This research aimed to describe the number and types of tobacco retail outlets in NZ, to examine how SEOs identify tobacco retailers, and to examine the distribution of outlets according to neighbourhood depriva- tion, proximity to secondary schools, and the extent to which tobacco is sold alongside alcohol.
Method:The names and physical addresses of known tobacco retail outlets were obtained from SEOs throughout NZ. Geographic Information System software was used to map tobacco retail outlets, neighbourhood socioeconomic depri- vation and secondary schools. Descriptive statistics, simple linear regression and logistic regression were used to examine the relationship between tobacco retailers, neighbourhood deprivation and proximity of retail outlets to schools.
Result:A total of 5,008 tobacco outlets were identified, giving a density of 1 outlet per 617 people or 1 outlet per 165 smokers. One-half of secondary schools had a tobacco retail outlet within a 500 m walking distance. Tobacco retail outlets were more densely located in areas of higher socioeconomic
deprivation. A third of all tobacco outlets had a licence to sell alcohol and 13%
of tobacco retailers were on-licensed premises (e.g. bars), where alcohol is purchased for consumption.
Conclusion:This study indicates the widespread retail availability of tobacco in New Zealand, and the ease of access to tobacco retail outlets by secondary school students and people living in lower socioeconomic neighbourhoods. Our research highlights the need to investigate policies to decrease the retail availability of tobacco in New Zealand, and mandate registration to enhance enforcement of smoke-free legislation. This will help achieve the government' s goal of becoming a smoke-free nation by 2025.
Tailoring tobacco control across different political, cultural and resource settings
OP003
ASSOCIATION BETWEEN BEING EMPLOYED IN A SMOKEFREE WORKPLACE AND LIVING IN A SMOKEFREE HOME IN LMICs
Gaurang P. Nazar1, John Tayu Lee2, Monika Arora3, Neil Pearce4, Christopher Millett2.1Public Health Foundation of India & London School of Hygiene and Tropical Medicine, India;2Imperial College London, United Kingdom;3Public Health Foundation of India, India;4London School of Hygiene and Tropical Medicine, United Kingdom
Background:Smoke-free policies are known to be associated substantial health and economic benefits. Early arguments that smoke-free workplace policies would lead to shifting of smoking into the home have not been seen to hold true in high income countries.
Objective:We aimed to assess the impact of smoke-free workplace policy on living in smoke-free homes in low- and middle-income country (LMIC) settings.
Method:Country-specific individual level analysis was conducted using cross- sectional Global Adult Tobacco Survey data from fifteen LMICs (2008–2011).
These LMICS included India, Bangladesh, Thailand, China, Philippines, Viet Nam, Brazil, Mexico, Uruguay, Poland, Romania, Russian Federation, Turkey, Ukraine and Egypt. For each country, our study population was GATS partici- pants (≥15 years of age) working indoors but not in their homes. The number of study participants ranged from 1,174 in Romania to 12,561 in India. Adjusted odds ratios (AORs) and 95% CIs of living in smoke-free homes were estimated for participants employed in smoke-free workplaces vs. those employed in work- places where smoking occurred, using multivariate logistic regression models.
The covariates adjusted in the regression models included age, gender, place of residence, region (where available), education, occupation, current smoking, current smokeless tobacco use and number of household members.
Result:The percentage of participants employed in a smoke-free workplace reporting living in a smoke-free home was higher than among those employed in a workplace where smoking occurred in all 15 countries. The percentage of participants living in a smoke-free home and employed in a smoke-free workplace varied from 20% in China to 75% in Mexico. Overall, the percentage of participants living in smoke-free homes was higher in urban settings, among females, non smokers and highly educated participants, with exceptions in cer- tain LMICs. AORs of living in smoke-free homes among participants employed in smoke-free workplaces (vs. those not employed in smoke-free workplaces) ranged from 1.12 [95% CI 0.79–1.58] in Uruguay to 2.29 [95% CI 1.37–3.83]
in China. The point estimate was greater than two for China, Philippines and India. The association was insignificant in Uruguay and Mexico.
Conclusion:Despite country-specific differences, observed consistent associa- tion implies, enhanced implementation and enforcement of 100% smoke-free policies in LMICs is likely to bring about substantial additional health benefits by smoke-free norm spreading.
OP014
CHEAPER BY THE CARTON: EXAMINING PACIFIC PEOPLES USAGE AND SUPPLY OF DUTY-FREE TOBACCO
El-Shadan Tautolo1, Richard Edwards2, Heather Gifford3.1AUT University, New Zealand;2University of Otago, New Zealand;3Whakauae Research for Maori Health & Development, New Zealand
Background:New Zealand is building a comprehensive tobacco control pro- gramme that includes working towards the goal of a smoke-free nation by the year 2025. In relation to this vision, the recent (2010–2012) and proposed (2013–2016) tax increases have resulted in a greater focus on the issue of duty free cigarettes. Given the frequent travel between NZ and Pacific Island countries the movement of Pacific peoples, which is now occurring at higher levels than at any time in the past, the risk that duty free tobacco sales pose towards undermining tobacco control interventions such as tax increases among Pacific Island communities is particularly high.
Objective:This qualitative research study involved focus group interviews with Pacific smokers and non-smokers regarding the buying and smoking/distributing of duty free cigarettes, whether it is being used as a strategy to circumvent tax increases in the price of cigarettes, and how this behaviour is viewed (posi- tively or negatively) within the Pacific community. The latter is important given evidence that smuggling or distribution of cigarettes is often viewed positively within high prevalence disadvantaged communities.
Method:Data collection for this project was performed using six focus groups with Pacific smokers and non-smokers. The interviews were semi-structured and transcripts were analysed to extract key themes and information regarding the purchase and practices involving duty-free tobacco and Pacific people in NZ.
Result:The findings suggest tobacco tax increases are being undermined as a public health measure by duty free sales in Pacific communities in NZ, and the curtailment of duty free sales should be implemented to help achieve a smoke- free NZ. Moreover, the findings highlight the emergence and proliferation of duty-free tobacco purchases being incorporated within traditional gift-giving practices within Pacific Communities, and the complexities and issues this may have in attempting to curtail the sale and purchase of duty-free tobacco in NZ and other Pacific countries.
Conclusion:This research sought to understand more about the impact of NZ duty free laws on Pacific smokers and in particular the importance of buying and consumption of cheap duty free tobacco. The research has helped close the huge knowledge gap regarding culturally specific and culturally appropriate information regarding Pacific health and the impact of tobacco-related harm, and suggested that curbing duty free sales will be an important component of achieving a tobacco free endgame for pacific communities in New Zealand.
OP026
ANTI-SMOKING MESSAGES AS BEHAVIORAL CUES TO ACTION IN A MIDDLE- INCOME COUNTRY
Ethel Alderete.National Council of Scientific and Technologic Research (CONICET), Argentina
Background:Anti-smoking campaigns have been effective in reducing smok- ing in high income countries, consistently reaching large audiences by using significant budgetary allotments, often financed by tobacco industry settle- ments. In low and middle income countries resources to design and disseminate anti-smoking messages are scarce. The model of effects is that evidence about health effects of smoking changes beliefs, thus affecting attitudes and driving interest in behavior change. Smokers need to have seen the campaign and remember it; they must appraise the information presented as believable and personally relevant; and it must make them think about taking action. Action may include, thinking about quitting or taking steps towards quitting, providing quitting advice, and protecting oneself or others from exposure to cigarette smoke.
Objective:We assessed exposure to anti-smoking messages and individual' s smoking-related behavioral changes.
Method:We conducted a population survey in a city of a tobacco producing region of Argentina. We developed a quota sampling strategy to obtain a ran- dom sample of respondents (18–59 years) from high, middle and low-income households (N=983).
Result:Messages reach the public through mass media; signs and posters in institutions and public places; and a standard written warning in cigarette packs. Exposure to any type of message was widespread (97.3%); 70.5% recalled only the Standard Brief Messages (SBM): “smoking is bad for your health”, or “smoking causes lung cancer”, only 29.5% recalled Comprehensive Health Consequences Messages (CHCM) (e.g. other cancers, cardiovascular disease, effects on the mother and child, second hand smoke effects). On behalf of message exposure, a higher percentage of men reported thinking about quitting (39.7% vs. 22.3%) or seeking quitting advice (27.6% vs. 19,7%), while a higher percentage of women reported thinking about the damage caused to others (92% vs. 84.4%1) or trying to be less exposed to tobacco smoke (85.7% vs.
76.8%). Although smoking rates were similar across the 3 SES groups, a larger percentage of high SES respondents reported seeking quitting advice (35.6% vs.
22.1% vs. 18.3%). Regarding the usefulness of different types of messages (SBM vs. CHCM), a higher percentage of those who recalled CHCM sought quitting advice (31.9% vs. 17.4%). The proportion of respondents who avoided smoking in the workplace, talked to family or friends, or to a physician about quitting, was also higher among those who recalled CHCM (p=0.014, 0.032, 0.000).
Conclusion:Anti-smoking messages can be a useful component of comprehen- sive tobacco control strategies. Updated information about the diverse health effects of smoking can increase the effectiveness of campaigns. To address inequities, messages should also target subpopulation groups (e.g. low SES, women) with tailored information.
OP034
BREAKING THROUGH THE SMOKESCREEN: A QUALITATIVE STUDY OF TOBACCO CONTROL IN THE INDIAN ARMED FORCES
Ashok Kumar Jindal, Ayon Gupta.Government of India
Background:The Indian Armed Forces akin to militaries the world over, have a legacy of a pro-tobacco culture. Anecdotal evidence however suggests that the prevalence rates of tobacco use are declining as service personnel become more aware of the deleterious effects of tobacco. There is a paucity of studies on tobacco control in the Indian Armed Forces context.
Objective:To examine the factors affecting tobacco use by service personnel and recommend policy initiatives for tobacco cessation and control in the Armed Forces
Method:Analysis of Health Policy documents and practices of all three services;
Focused Group Discussions with current and former smokers and Key Informant Interviews
Result:No standalone tobacco control policy exists in the Armed Forces but remedial actions for tobacco control are being taken within the broader frame- work of overall health directives. Tobacco control legislation of the GoI is being implemented in letter and spirit leading to a drop in the prevalence of tobacco use. Peer pressure, length of sentry duties, increased consumption with alcohol and easy availability of tobacco products were cited by study participants as the major factors associated with tobacco use. Awareness of harmful health effects of tobacco, pictorial warnings on tobacco packaging, knowing of someone in the social circle with cancer and unnecessary expenditure on tobacco products were cited as the main reasons to quit by former smokers.
Major policy initiatives suggested to reduce tobacco use are: 1) Designated smoking areas. 2) Smoking ban within Armed Forces workplaces (including vehi- cles, aircraft, naval vessels). 3)Complete ban on smoking during Basic Military Training 4) Discouraging the availability of tobacco products at Officers Messes, service institutions, during regimental functions. 5) Peer counselors and 6) Access to smoking cessation programs.
Conclusion:Due to the unique characteristic of being a population that has to follow orders in the form of regulations and instructions, the military is an ideal group for effective tobacco control policy interventions which will have substantial impact on reducing tobacco use and safeguarding health.
OP036
PERCEPTIONS OF WOMEN AND TOBACCO CONTROL ADVOCATES ABOUT GENDER ISSUES IN ARGENTINA
Ethel Alderete1, Andrea Caceres2, Silvina Ramos3.1National Council of Scientific and Technologic Research (CONICET), Argentina;2New England Organization Project, Cambridge, MA, United States;3Universidad Nacional de Buenos Aires, Argentina
Background:Argentina has a high rate of female smoking (22%). Gender sensi- tive tobacco control policies are lacking, as is locally relevant gender sensitive research.
Objective:A study on the Development of Gender Sensitive Tobacco Control in Argentina included the examination of gender perspectives.
Method:We used the Intersectorial Feminist Framework and conducted qual- itative interviews (N=17) with tobacco control and women' s (gender rights, immigrants, sex workers, lesbian) advocates.
Result:To examine gender perspectives we asked “What is your understanding of gender issues?” Women' s advocates provided elaborate conceptualizations:
“Gender has been emptied of content; it should have a feminist perspective.
The feminism that we propose is a struggle to eliminate, reduce inequalities, so sexual differences are not operationalized as social inequalities, to end the subjection and unfairness of the conditions of life of women.” “We the women, have a way of looking at the world that often collides with the authorized discourses, authorized by the law, by theology, by science, by politics.” To- bacco control advocates provided narrower responses with comments about the relevance of a gendered approach. “How women construct the issues of health, to conduct an analysis based on a gender perspective.” “It is a concept that I associate with women. But I lean more towards tobacco issues because I never focused on women organizations.” To examine differences in priority setting we asked “What are the main concerns of women?” The following is a summary of women' s advocates perspectives: “Access to a life free from violence; sexual and reproductive rights, free sexuality; overcoming social and political inequalities; equality in terms of employment, occupation and use of free time.” Tobacco control advocates tapped superficially into economic aspects and their analysis leaned towards health issues. “In the labor market there have been few changes. There is a participation [of women], but there is no access to decision making; the salaries continue to be less than for men.”
“First [they worry about] making ends meet, their work, then they care about their health.” “Among most women I know taking care of their health is not their main concern. Cholesterol, sugar, and exercise that are not their agenda.”
“Aesthetics, this is one issue that mobilizes women. There is a group more of the naturist type. There is another group worried about aesthetics, like being fat.”
Conclusion:Significant gaps exist between advocacy movements involved with prominent public health issues. We identified potentially unifying themes (e.g.
women' s death toll due to femicide, tobacco consumption, and illegal abor- tion) and key players who could advocate for a common action agenda. Tobacco control strategies need adjournments to be inclusive of all population groups.
Incorporation of gender perspectives is a high priority.
Multi-sectoral coordination at national and global levels OP004
CROSS-COMPARISON OF TAX POLICIES AND PRICES IN WEST AFRICA:
LESSONS FOR WAEMU & ECOWAS POLICYMAKERS
Abdoulaye Diagne, Valare Nketcha Nana.Consortium pour la Recherche Economique et Sociale, Senegal
Background:As far as tobacco taxation is concerned, the situation in West
