Journal Article

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

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

2017

Overview

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

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Adults / Aged / behavior / Cancer / cigarette / Cigarettes / control program / Cross-Sectional Studies / Developed Countries / Developing Countries / Environment / european countries / Female / Folkhälsovetenskap, global hälsa och socialmedicin / General & Internal Medicine / Health Knowledge, Attitudes, Practice / Health Policy / High income / Humans / impact / industry / Knowledge / Knowledge of tobacco harms / LDCs / Logistic Models / Low income groups / Male / Marketing / Middle Aged / Nicotine / Odds Ratio / Patient Acceptance of Health Care / prices / proximity / Public health / Public Health, Global Health and Social Medicine / smokers / Smoking / Smoking - adverse effects / Smoking - therapy / Smoking and Tobacco / Smoking Cessation / Social unacceptability / societal influences / Surveys and Questionnaires / Tobacco / Tobacco control policy / Tobacco environment / Tobacco Products / Tobacco Smoking - adverse effects / Tobacco Smoking - therapy / Variables / Women