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

Clara K Chow, Daniel J Corsi, Anna B Gilmore, Annamarie Kruger, Ehimario Igumbor, Jephat Chifamba, Wang Yang, Li Wei, Romaina Iqbal, Prem Mony, Rajeev Gupta, Krishnapillai Vijayakumar, V Mohan, Rajesh Kumar, Omar Rahman, Khalid Yusoff, Noorhassim Ismail, Katarzyna Zatonska, Yuksel Altuntas, Annika Rosengren & 12 others Ahmad Bahonar, AfzalHussein Yusufali, Gilles Dagenais, Scott Lear, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Sumathy Rangarajan, Koon Teo, Martin McKee, Salim Yusuf

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.

Setting: 545 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.

Participants: Community audits and surveys of adults (35–70 years, n=12 953).

Primary and secondary outcome measures: Summary 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.

Results: Average 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).

Conclusions: This 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.

Original languageEnglish
Article numbere013817
Number of pages13
JournalBMJ Open
Volume7
Issue number3
DOIs
Publication statusPublished - 31 Mar 2017

Fingerprint

Public Policy
Tobacco
Cross-Sectional Studies
Health
Tobacco Products
Logistic Models
Odds Ratio
Smoking
Outcome Assessment (Health Care)
Costs and Cost Analysis

Keywords

  • Tobacco control
  • Policy implementation
  • social unacceptability
  • tobacco health harms
  • low income country

Cite this

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. / Chow, Clara K; Corsi, Daniel J; Gilmore, Anna B; Kruger, Annamarie; Igumbor, Ehimario; Chifamba, Jephat; Yang, Wang; Wei, Li; Iqbal, Romaina; Mony, Prem; Gupta, Rajeev; Vijayakumar, Krishnapillai; Mohan, V; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Ismail, Noorhassim; Zatonska, Katarzyna; Altuntas, Yuksel; Rosengren, Annika; Bahonar, Ahmad; Yusufali, AfzalHussein; Dagenais, Gilles; Lear, Scott; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Rangarajan, Sumathy; Teo, Koon; McKee, Martin; Yusuf, Salim.

In: BMJ Open, Vol. 7, No. 3, e013817, 31.03.2017.

Research output: Contribution to journalArticle

Chow, CK, Corsi, DJ, Gilmore, AB, Kruger, A, Igumbor, E, Chifamba, J, Yang, W, Wei, L, Iqbal, R, Mony, P, Gupta, R, Vijayakumar, K, Mohan, V, Kumar, R, Rahman, O, Yusoff, K, Ismail, N, Zatonska, K, Altuntas, Y, Rosengren, A, Bahonar, A, Yusufali, A, Dagenais, G, Lear, S, Diaz, R, Avezum, A, Lopez-Jaramillo, P, Lanas, F, Rangarajan, S, Teo, K, McKee, M & Yusuf, S 2017, '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', BMJ Open, vol. 7, no. 3, e013817. https://doi.org/10.1136/bmjopen-2016-013817
Chow, Clara K ; Corsi, Daniel J ; Gilmore, Anna B ; Kruger, Annamarie ; Igumbor, Ehimario ; Chifamba, Jephat ; Yang, Wang ; Wei, Li ; Iqbal, Romaina ; Mony, Prem ; Gupta, Rajeev ; Vijayakumar, Krishnapillai ; Mohan, V ; Kumar, Rajesh ; Rahman, Omar ; Yusoff, Khalid ; Ismail, Noorhassim ; Zatonska, Katarzyna ; Altuntas, Yuksel ; Rosengren, Annika ; Bahonar, Ahmad ; Yusufali, AfzalHussein ; Dagenais, Gilles ; Lear, Scott ; Diaz, Rafael ; Avezum, Alvaro ; Lopez-Jaramillo, Patricio ; Lanas, Fernando ; Rangarajan, Sumathy ; Teo, Koon ; McKee, Martin ; Yusuf, Salim. / 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. In: BMJ Open. 2017 ; Vol. 7, No. 3.
@article{72a075c1542d4c31abaedab08c4d6029,
title = "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 = "Objectives: This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.Setting: 545 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.Participants: Community audits and surveys of adults (35–70 years, n=12 953).Primary and secondary outcome measures: Summary 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.Results: Average 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).Conclusions: This 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.",
keywords = "Tobacco control, Policy implementation, social unacceptability, tobacco health harms, low income country",
author = "Chow, {Clara K} and Corsi, {Daniel J} and Gilmore, {Anna B} and Annamarie Kruger and Ehimario Igumbor and Jephat Chifamba and Wang Yang and Li Wei and Romaina Iqbal and Prem Mony and Rajeev Gupta and Krishnapillai Vijayakumar and V Mohan and Rajesh Kumar and Omar Rahman and Khalid Yusoff and Noorhassim Ismail and Katarzyna Zatonska and Yuksel Altuntas and Annika Rosengren and Ahmad Bahonar and AfzalHussein Yusufali and Gilles Dagenais and Scott Lear and Rafael Diaz and Alvaro Avezum and Patricio Lopez-Jaramillo and Fernando Lanas and Sumathy Rangarajan and Koon Teo and Martin McKee and Salim Yusuf",
year = "2017",
month = "3",
day = "31",
doi = "10.1136/bmjopen-2016-013817",
language = "English",
volume = "7",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

TY - JOUR

T1 - Tobacco control environment

T2 - 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

AU - Chow, Clara K

AU - Corsi, Daniel J

AU - Gilmore, Anna B

AU - Kruger, Annamarie

AU - Igumbor, Ehimario

AU - Chifamba, Jephat

AU - Yang, Wang

AU - Wei, Li

AU - Iqbal, Romaina

AU - Mony, Prem

AU - Gupta, Rajeev

AU - Vijayakumar, Krishnapillai

AU - Mohan, V

AU - Kumar, Rajesh

AU - Rahman, Omar

AU - Yusoff, Khalid

AU - Ismail, Noorhassim

AU - Zatonska, Katarzyna

AU - Altuntas, Yuksel

AU - Rosengren, Annika

AU - Bahonar, Ahmad

AU - Yusufali, AfzalHussein

AU - Dagenais, Gilles

AU - Lear, Scott

AU - Diaz, Rafael

AU - Avezum, Alvaro

AU - Lopez-Jaramillo, Patricio

AU - Lanas, Fernando

AU - Rangarajan, Sumathy

AU - Teo, Koon

AU - McKee, Martin

AU - Yusuf, Salim

PY - 2017/3/31

Y1 - 2017/3/31

N2 - Objectives: This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.Setting: 545 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.Participants: Community audits and surveys of adults (35–70 years, n=12 953).Primary and secondary outcome measures: Summary 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.Results: Average 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).Conclusions: This 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.

AB - Objectives: This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.Setting: 545 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.Participants: Community audits and surveys of adults (35–70 years, n=12 953).Primary and secondary outcome measures: Summary 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.Results: Average 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).Conclusions: This 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.

KW - Tobacco control

KW - Policy implementation

KW - social unacceptability

KW - tobacco health harms

KW - low income country

UR - https://doi.org/10.1136/bmjopen-2016-013817

UR - https://doi.org/10.1136/bmjopen-2016-013817

U2 - 10.1136/bmjopen-2016-013817

DO - 10.1136/bmjopen-2016-013817

M3 - Article

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

M1 - e013817

ER -