Uncovering TAPS strategies of the tobacco industry at PoS in low- and middle-income countries: the case of Turkey

2020 ◽  
Vol 30 (5) ◽  
pp. 996-1001
Author(s):  
Fatih Uznay ◽  
Sevtap Gumus
Keyword(s):  
Tobacco Industry ◽  
Tobacco Product ◽  
Tobacco Products ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Survey Form ◽  
Margin Of Error ◽  
Product Displays ◽  
The City

Abstract Background This study aims to uncover strategies executed by the tobacco industry against tobacco advertising, promotion and sponsorship (TAPS) bans at points of sale (PoS) in Turkey. Methods The data are based on a field study conducted in the city of Izmir. There are 10 750 PoS in all of Izmir; the 6200 PoS in the 11 central districts were considered as potential subjects. Using a proportional sampling method (95% confidence interval, 5% margin of error), it was calculated that 384 PoS could adequately represent the whole. Face-to-face interviews were conducted with PoS administrators, using survey form consisting of 53 questions. Descriptive statistics methods have been used to analyze the data. Results Of a total of 384 PoS visited; 96.4% featured at least one type of display/TAPS ban violation, 94.5% featured display settings creating brand dominance on display units, 76.7% received promotional payments and 14.8% received free tobacco products for featured display settings. Additionally, 29.2% of PoS had tobacco product displays visible from outside, 26.8% sold tobacco products on the counter, 24.7% featured advertising items on display units, 19.3% sold tobacco products as single stick and 11.7% had price tags with fonts larger than the legally fixed 20 pt. Conclusions An official institution specializing in tobacco control must be established to continually inspect the tobacco market. Tobacco products must stay hidden, in closed cupboards or under the counter, and communication between PoS and tobacco industry must be limited. In addition, tobacco products must be distributed by government institutions rather than the industry.

Graphic health warnings on tobacco packets and containers: compliance status in Bangladesh

2018 ◽  
Vol 28 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Syed Mahbubur Rahman ◽  
Md Shariful Alam ◽  
ABM Zubair ◽  
Md Hasan Shahriar ◽  
Monowar Hossein ◽  
...  
Keyword(s):  
Smokeless Tobacco ◽  
Low Income ◽  
Full Range ◽  
Tobacco Product ◽  
Tobacco Products ◽  
Middle Income ◽  
Product Categories ◽  
Middle Income Countries ◽  
Key Stakeholders ◽  
Smokeless Tobacco Products

ObjectiveThis study describes and analyses compliance with tobacco product graphic health warning (GHW) legislation introduced in Bangladesh in March 2016.MethodsA survey based on a structured questionnaire was conducted in April 2016 (immediately following the law coming into force), and 8 months later in November 2016, in eight divisional cities in Bangladesh. Five stores from three categories of retailers of combustible and smokeless tobacco products were surveyed, providing a total of 120 completed questionnaires. The study investigated a range of measures including the image and text of GHW, their ratio and colour use, and prescribed rotation.FindingsWarning labels for 3312 tobacco items were assessed. In April 2016, 75% of tobacco products surveyed did not have GHWs. In November 2016, 19% were still found to not have the prescribed warnings. Even among products which did include GHW, there was significant non-compliance with the full range of requirements, in both survey periods. Compliance was highest for cigarette packets and lowest among smokeless tobacco products. In addition, awareness among tobacco retailers about the range of GHW requirements was low.ConclusionEffective implementation of GHW labels in low-income and middle-income countries requires awareness-raising among key stakeholders, combined with focused monitoring and compliance strategies. This should take into account different product categories and manufacturers, as well as measures targeted at retailers.

scholarly journals Cigarette Pack Structure Elements in Low- and Middle-Income Countries

2021 ◽  
Vol 7 (1) ◽  
pp. 76-86
Author(s):  
Olufemi Erinoso ◽  
Kevin Welding ◽  
Joanna E. Cohen ◽  
Katherine Smith
Keyword(s):  
Tobacco Industry ◽  
Total Sample ◽  
Descriptive Statistics ◽  
Soft Or ◽  
Tobacco Products ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cigarette Pack ◽  
Packaging Structure ◽  
Low And Middle Income

Objectives: The tobacco industry can attract consumers using appealing packaging, including pack structure. We assessed the variety of pack structure elements across select low- and middle-income countries (LMICs). Methods: Between 2013 and 2017, we systematically collected 3542 packs from 14 LMICs. The selected countries represented LMICs with the greatest number of smokers. We assessed packs for 4 packaging structure elements: pack-type (hard, soft, or box), pack-shape, pack-edge, and opening-style. We used descriptive statistics to analyze the packag- ing structure elements by country and tobacco company. Results: All 14 countries assessed had predominantly hard packs (88.3% of the total sample). We identified 5 pack-shape variants; the most common pack-shape in all countries was the rectangular non-slim pack-shape (79.2%). Straight right-angled edge packs were the most common in 11 of the 14 countries assessed, but rounded edge packs were the most common in Turkey (58.5%). We found 9 broad categories of pack-opening styles, with the most common being the flip-top (94.5%). Conclusion: Although we found common packaging structure elements across the 14 LMICs, we also noted diverse packaging structures. Restrictions on pack structure elements are important as these elements can contribute to the attractiveness of tobacco products.

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

scholarly journals Impact of common tobacco products on human health and environmental pollution in Bangladesh

2021 ◽  
Vol 31 (3) ◽  
pp. 130-143
Author(s):  
MA Mondol ◽  
AMM Hosain ◽  
S Sultana ◽  
S Marzia ◽  
MA Islam ◽  
...  
Keyword(s):  
Environmental Pollution ◽  
Human Health ◽  
Smokeless Tobacco ◽  
Tobacco Product ◽  
Tobacco Products ◽  
Face To Face ◽  
Adverse Health Effects ◽  
Survey Results ◽  
Young Smokers ◽  
Structured Questionnaire

Worldwide, tobacco is one of the leading causes of disability and death. Over a million of pounds of toxic chemicals are released by tobacco products. This study aims to explore the effects of tobacco toxicants on human health and environmental pollution. Four districts (Dhaka, Kushtia, Chattogram and Rangpur) were selected where most of the tobacco product grown. Total 468 respondents were interviewed face-to-face using structured questionnaire to assess the knowledge about toxicant content in tobacco and health and environmental hazards of tobacco use. Survey results revealed that about 44.4% respondents used smoking tobacco products and 38.5% used smokeless tobacco, while only 17.1% used both. About two third (74.3%) of smoking tobacco users started smoking when they were between 15 to 24 years old and majority (61.6%) of smokeless tobacco users started tobacco when they were between 30 to 35 years above. Tobacco product has large impacts on health of young smokers. Smokers are suffering from various acute and chronic diseases. Among the respondents, 38% indicated that they were suffering from hypertension. The second most affected disease was COPD/Asthma (31.6%), while cancer was the least suffering disease (0.4%). Majority of the respondents were not aware about the presence of toxicants (i.e. nicotine, tar and metals) in tobacco products. However, 85.1% tobacco users had an idea about environmental pollution. There is a lack of knowledge among the survey respondents about toxicants in tobacco products that are linked to health hazards and environmental pollution. These results are important in strengthening existing policy considering adverse health effects of toxicants examined. Progressive Agriculture 31 (3): 130-143, 2020

Smartphone-based DIY home microsurgical training with 3D printed microvascular clamps and Japanese noodles

2021 ◽  
Author(s):  
Zhi Yang Ng ◽  
Calum Honeyman ◽  
Alexandre G Lellouch ◽  
Ankur Pandya ◽  
Theodora Papavasiliou
Keyword(s):  
Back Wall ◽  
Internal Validation ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Video Recordings ◽  
Low Middle Income Countries ◽  
Konjac Flour ◽  
3D Printed ◽  
Set Up

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least 3.5-5x magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approx. 0.83 mm) without an overly thick and unrealistic “vessel” wall. The current set-up however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels) and video recordings were submitted for internal validation by senior surgeons. A “wet” operative field where the knojac noodle lumen can be distended or collapsed, unlike other non-living models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course, and potentially, be extended to low-middle income countries (LMICs) without routine access to microsurgical training for capacity development. That it can be utilised remotely also bodes well with the current limitations on face to-face training due to COVID restrictions and lockdowns.

Strengthening Noncommunicable Disease Research Capacity and Chronic Disease Outcomes in Low- and Middle-Income Countries in South Asia: Implementation and Evaluation of the ASCEND Program

2019 ◽  
Vol 31 (6) ◽  
pp. 536-547
Author(s):  
Allison Byrnes ◽  
Tilahun Nigatu Haregu ◽  
Naanki Pasricha ◽  
Kavita Singh ◽  
Sathish Thirunavukkarasu ◽  
...  
Keyword(s):  
Online Learning ◽  
Communicable Disease ◽  
Research Capacity ◽  
Lessons Learned ◽  
Early Career ◽  
Noncommunicable Disease ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Low And Middle Income

This article describes the design, outcomes, challenges, and lessons learned from the ASian Collaboration for Excellence in Non-Communicable Disease (ASCEND) program, implemented between 2011 and 2015 in India, Sri Lanka, and Malaysia. The program involved a blended-delivery model, incorporating online and face-to-face training, mentoring, and supervision of trainees’ research projects. Evaluation data were collected at baseline, 6, 12, 18, and 24 months. Intended outcomes, lessons, and challenges were summarized using a logic model. During the program period, 48 participants were trained over 2 cohorts in June 2011 and 2012. The trainees published 83 peer-reviewed articles between 2011 and 2015. Additionally, 154 presentations were given by trainees at national and international conferences. Underutilization of the online learning management system was an important challenge. Utilizing a combination of intensive face-to-face and online learning and mentoring of early career researchers in low- and middle-income countries has great potential to enhance the research capacity, performance, and outputs.

scholarly journals Defending Comprehensive Tobacco Control Policy Implementation in Nepal From Tobacco Industry Interference (2011–2018)

2020 ◽  
Vol 22 (12) ◽  
pp. 2203-2212 ◽  
Author(s):  
Dharma N Bhatta ◽  
Eric Crosbie ◽  
Stella A Bialous ◽  
Stanton Glantz
Keyword(s):  
Tobacco Control ◽  
Tobacco Industry ◽  
Public Awareness ◽  
Control Policy ◽  
Control Law ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
The Law ◽  
Low And Middle Income

Abstract Introduction Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law. Aims and Methods Policy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM). Results The TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition. Conclusions Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it. Implications The PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.

scholarly journals Price, Income, and Affordability as the Determinants of Tobacco Consumption: A Practitioner’s Guide to Tobacco Taxation

2020 ◽  
Author(s):  
Nigar Nargis ◽  
Michal Stoklosa ◽  
Ce Shang ◽  
Jeffrey Drope
Keyword(s):  
Price Elasticity ◽  
Tobacco Consumption ◽  
High Income ◽  
Cigarette Consumption ◽  
Tobacco Products ◽  
Middle Income ◽  
Middle Income Countries ◽  
Price Increases ◽  
Tobacco Tax ◽  
Tobacco Taxation

Abstract Introduction Tobacco product prices and consumers’ income are the two major economic determinants of tobacco demand. The affordability of tobacco products is dependent on the price of tobacco products relative to consumer income. Increase in tobacco tax is expected to lead to higher price, lower affordability, and reduced consumption. Price elasticity and affordability elasticity are used in analyzing the effect of tobacco tax increases on tobacco consumption and public health. The availability of both parameters raises the question of which one to apply in policy discussions. Aims and Methods Using global data on cigarette consumption, price, income, and tobacco control measures for 169 countries over 2007–2016, this study estimated the price elasticity and affordability elasticity of cigarette consumption by country income classification using country-specific fixed effects model for panel data. Results The estimates show that the restriction of equal strength of the effects of price and income changes on tobacco consumption maintained in affordability elasticity estimation is valid for low- and middle-income countries, while it is rejected for high-income countries. Conclusions Affordability elasticity may prove to be a useful parameter to explain and predict the sensitivity of consumers to tobacco tax and price policy changes under conditions of robust economic growth, which are more likely to be observed in countries with initial low- or middle-income setting. It can provide a reasonable benchmark for tobacco tax and price increase necessary to effectively reduce affordability and consumption of tobacco, which can form a basis for building systematic tax and price increases into the tobacco tax policy mechanism. Implications Price elasticity measures the sensitivity of consumers to changes in real prices, holding real income constant. Affordability elasticity measures the sensitivity of consumers to price changes adjusted for inflation and income changes. Existing scientific literature on tobacco demand abounds in both price and affordability elasticity estimates, without providing a clear explanation of the theoretical and policy implications of using one parameter over the other. By estimating and comparing price and affordability elasticities for high-income and low-and-middle-income countries separately, this article offers a guide to the practitioners in tobacco taxation for evaluating the effectiveness of tax-induced price increases on tobacco consumption.

Evaluating tobacco retailer experience and compliance with a flavoured tobacco product restriction in Boston, Massachusetts: impact on product availability, advertisement and consumer demand

2019 ◽  
pp. tobaccocontrol-2019-055124 ◽  
Author(s):  
Lindsay Kephart ◽  
Claude Setodji ◽  
Joseph Pane ◽  
William Shadel ◽  
Glory Song ◽  
...  
Keyword(s):  
Policy Implementation ◽  
Smokeless Tobacco ◽  
Consumer Demand ◽  
Tobacco Product ◽  
Tobacco Products ◽  
Process Measures ◽  
Product Availability ◽  
The Impact ◽  
The City

BackgroundFlavoured tobacco products are widely available in youth-accessible retailers and are associated with increased youth initiation and use. The city of Boston, Massachusetts restricted the sale of flavoured tobacco products, including cigars, smokeless tobacco and e-cigarettes, to adult-only retailers. This paper describes the impact of the restriction on product availability, advertisement and consumer demand.MethodsBetween January and December 2016, data were collected in 488 retailers in Boston at baseline and 469 retailers at 8-month follow-up, measuring the type, brand and flavour of tobacco products being sold. Process measures detailing the educational enforcement process, and retailer experience were also captured. McNemar tests and t-tests were used to assess the impact of the restriction on product availability.ResultsAfter policy implementation, only 14.4% of youth-accessible retailers sold flavoured products compared with 100% of retailers at baseline (p<0.001). Flavoured tobacco product advertisements decreased from being present at 58.9% of retailers to 28.0% at follow-up (p<0.001). Postimplementation, retailers sold fewer total flavoured products, with remaining products often considered as concept flavours (eg, jazz, blue). At follow-up, 64.0% of retailers reported that customers only asked for flavoured products a few times a week or did not ask at all. Retailers reported that educational visits and the flavoured product guidance list aided with compliance.ConclusionTobacco retailers across Boston were largely in compliance with the regulation. Availability of flavoured tobacco products in youth-accessible retailers declined city-wide after policy implementation. Strong educational and enforcement infrastructure may greatly enhance retailer compliance.

scholarly journals Heated tobacco products likely appeal to adolescents and young adults

2018 ◽  
Vol 27 (Suppl 1) ◽  
pp. s41-s47 ◽  
Author(s):  
Karma McKelvey ◽  
Lucy Popova ◽  
Minji Kim ◽  
Benjamin W Chaffee ◽  
Maya Vijayaraghavan ◽  
...  
Keyword(s):  
Health Risks ◽  
Tobacco Industry ◽  
Tobacco Product ◽  
Adolescent And Young Adult ◽  
Tobacco Products ◽  
Design And Implementation ◽  
Philip Morris ◽  
The Us ◽  
The Usa ◽  
The 1960S

BackgroundBeginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured ‘HeatSticks’ in the USA as a modified-risk tobacco product (MRTP).MethodsWe systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI’s IQOS product meets the US Tobacco Control Act’s standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS.ResultsPMI’s own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims.ConclusionPMI’s own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products.

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