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
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 th...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2017-03-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/3/e013817.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832540917123252224 |
|---|---|
| author | Annika Rosengren Li Wei Khalid Yusoff Martin McKee Clara K Chow Rajeev Gupta Koon Teo Sumathy Rangarajan Patricio Lopez-Jaramillo Rafael Diaz Alvaro Avezum Fernando Lanas Noorhassim Ismail Romaina Iqbal Jephat Chifamba Gilles Dagenais Salim Yusuf Anna B Gilmore Scott Lear Wang Yang Omar Rahman Katarzyna Zatonska Prem Mony Rajesh Kumar Afzalhussein Yusufali Daniel J Corsi Ehimario Igumbor V Mohan Annamarie Kruger Krishnapillai Vijayakumar Yuksel Altuntas Ahmad Bahonar |
| author_facet | Annika Rosengren Li Wei Khalid Yusoff Martin McKee Clara K Chow Rajeev Gupta Koon Teo Sumathy Rangarajan Patricio Lopez-Jaramillo Rafael Diaz Alvaro Avezum Fernando Lanas Noorhassim Ismail Romaina Iqbal Jephat Chifamba Gilles Dagenais Salim Yusuf Anna B Gilmore Scott Lear Wang Yang Omar Rahman Katarzyna Zatonska Prem Mony Rajesh Kumar Afzalhussein Yusufali Daniel J Corsi Ehimario Igumbor V Mohan Annamarie Kruger Krishnapillai Vijayakumar Yuksel Altuntas Ahmad Bahonar |
| author_sort | Annika Rosengren |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c4b9630f3d8543e1bb2c9e26f911cf3d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-c4b9630f3d8543e1bb2c9e26f911cf3d2025-02-04T13:10:10ZengBMJ Publishing GroupBMJ Open2044-60552017-03-017310.1136/bmjopen-2016-013817Tobacco 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 countriesAnnika Rosengren0Li Wei1Khalid Yusoff2Martin McKee3Clara K Chow4Rajeev Gupta5Koon Teo6Sumathy Rangarajan7Patricio Lopez-Jaramillo8Rafael Diaz9Alvaro Avezum10Fernando Lanas11Noorhassim Ismail12Romaina Iqbal13Jephat Chifamba14Gilles Dagenais15Salim Yusuf16Anna B Gilmore17Scott Lear18Wang Yang19Omar Rahman20Katarzyna Zatonska21Prem Mony22Rajesh Kumar23Afzalhussein Yusufali24Daniel J Corsi25Ehimario Igumbor26V Mohan27Annamarie Kruger28Krishnapillai Vijayakumar29Yuksel Altuntas30Ahmad Bahonar31Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenCenter for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USAUiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysiaprofessor of European public healthThe University of Sydney, Sydney Medical School, Sydney, New South Wales, AustraliaMedicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, IndiaPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, CanadaPopulation Health Research Institute, McMaster University, Hamilton, Ontario, CanadaMasira Research Institute, Universidad de Santander, Bucaramanga, ColombiaECLA - Academic Research Organization, Rosario, ArgentinaInternational Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil30 Internal Medicine, Universidad de La Frontera, Temuco, Chile18Department of Community Health, University Kebangsaan Malaysia Medical Centre, Bangi, MalaysiaDepartment of Community Health Sciences, The Aga Khan University, Karachi, PakistanDepartment of Physiology, University of Zimbabwe, Harare, ZimbabweInstitut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, CanadaPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada1 Department of Health, University of Bath, Bath, UK8 Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, CanadaDepartment of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, ChinaUniversity of Liberal Arts Bangladesh, Dhaka, BangladeshDepartment of Social Medicine, Wroclaw Medical University, Wroclaw, Poland1 Division of Epidemiology, Biostatistics & Population Health, St John`s Research Institute, St John`s Medical College, Bangalore, Karnataka, IndiaU.O. Rheumatology and Clinical immunology, ASST Spedali Civili of Brescia, Clinical and Experimental Sciences, BRESCIA, ItalyprofessorSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, CanadaPrevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, NigeriaMadras Diabetes Research Foundation, Chennai, India5Faculty of Health Science North, West University Potchefstroom Campus, Potchefstroom, South AfricaCommunity Medicine, Health Action by People, Thiruvananthapuram, Kerala, IndiaprofessorIsfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)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.https://bmjopen.bmj.com/content/7/3/e013817.full |
| spellingShingle | Annika Rosengren Li Wei Khalid Yusoff Martin McKee Clara K Chow Rajeev Gupta Koon Teo Sumathy Rangarajan Patricio Lopez-Jaramillo Rafael Diaz Alvaro Avezum Fernando Lanas Noorhassim Ismail Romaina Iqbal Jephat Chifamba Gilles Dagenais Salim Yusuf Anna B Gilmore Scott Lear Wang Yang Omar Rahman Katarzyna Zatonska Prem Mony Rajesh Kumar Afzalhussein Yusufali Daniel J Corsi Ehimario Igumbor V Mohan Annamarie Kruger Krishnapillai Vijayakumar Yuksel Altuntas Ahmad Bahonar 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 |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/7/3/e013817.full |
| work_keys_str_mv | AT annikarosengren tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT liwei tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT khalidyusoff tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT martinmckee tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT clarakchow tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT rajeevgupta tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT koonteo tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT sumathyrangarajan tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT patriciolopezjaramillo tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT rafaeldiaz tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT alvaroavezum tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT fernandolanas tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT noorhassimismail tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT romainaiqbal tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT jephatchifamba tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT gillesdagenais tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT salimyusuf tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT annabgilmore tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT scottlear tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT wangyang tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT omarrahman tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT katarzynazatonska tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT premmony tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT rajeshkumar tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT afzalhusseinyusufali tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT danieljcorsi tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT ehimarioigumbor tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT vmohan tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT annamariekruger tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT krishnapillaivijayakumar tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT yukselaltuntas tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries AT ahmadbahonar tobaccocontrolenvironmentcrosssectionalsurveyofpolicyimplementationsocialunacceptabilityknowledgeoftobaccohealthharmsandrelationshiptoquitratioin17lowincomemiddleincomeandhighincomecountries |