Role of World Health Organization Framework Convention on Tobacco Control Global Knowledge Hub on Smokeless Tobacco

Smokeless tobacco (SLT) is a recognized public health challenge, having over 350 million users globally, concentrated particularly in South-East Asia. A need for research on curbing major challenges in regulating SLT use has been long felt and subsequently highlighted in several sessions of the Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC). The sixth session of COP established a knowledge hub on SLT at the Indian Council of Medical Research- National Institute of Cancer Prevention and Research India, with a mandate to (i) generate and share expertise, information and knowledge; (ii) promote and facilitate communication among Parties, organizations and stakeholders; and (iii) support the Convention Secretariat in contributing to technical aspects of SLT control. The hub disseminates scientific evidence through an interactive website and publications and supports national and international partners in SLT research. The hub is a contributor to many events/conferences and has conducted several workshops on SLT control, including an inter-country meeting on SLT policy implementation status, which brought together representatives from across the globe, and framed recommendations for policy reform. The hub is dedicated to interaction and collaboration with relevant tobacco control organizations to generate evidence, support and policy orientation in line with its mandates and recommendations under the World Health Organization FCTC.

Implementation of Article 20 of the World Health Organization Framework Convention on Tobacco Control

Background & objectives: Article 20 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) deals with surveillance and research on all tobacco products including smokeless tobacco (SLT). Here we describe the availability of indicators related to SLT among 180 Parties to the convention (countries ratifying the WHO FCTC are referred as Parties to the Convention). Methods: Data on SLT use among adults and adolescents and SLT-related economic and health indicators among Parties were obtained through rigorous literature search. Data analysis for high-burden parties was done using SPSS. Results: Nearly 92 per cent (166) of the Parties reported SLT use prevalence among adults or adolescents at national or subnational level, of these nearly one-fifth of the Parties (20.5%) were high-burden Parties. Comparable SLT tax incidence rate was available for 19.4 per cent (n=35) Parties, and SLT attributable morbidity and mortality risks of major diseases were available for only five per cent (n=10) of Parties. Interpretation & conclusions: SLT use is a global epidemic widespread among Parties to the Convention. There are a data gap and dearth of research on SLT-related issues. Parties need to monitor SLT use and related health and economic indicators regularly at periodic intervals.

La Argentina y la ratificación del CMCT - OMS / Ratification fundaments of the Who Framework Convention on Tobacco Control (WHO-FCTC)

Se fundamenta la necesidad que tiene la Argentina en ratificar el Convenio Marco para el Control del Tabaquismo (CMCT-OMS), permitiéndo le proteger la salud de la población de las enfermedades relacionadas con el consumo del tabaco tanto activo como pasivo.

It is based in the need for Argentina to ratify the Who Framework Convention on Tobacco Control (WHO FCTC), allowing improve the protection of public health in diseases related to the consumption of tobacco.

Día Mundial sin Tabaco 2016: prepárate para el empaquetado neutro, 31 de mayo de 2016 / World No Tobacco Day 2016: get ready for the neutral packaging, May 31, 2016

En este artículo se destaca que el empaquetado neutro y el Convenio Marco para el Control del Tabaco (CMCT - OMS) son parte de la campaña antitabaco 2016. Distintas estrategias se vienen realizando todos los años a favor de la salud pública.

This article emphasizes that the neutral packaging and the Who Framework Convention on Tobacco Control (WHO FCTC). Different strategies are being made every year for improving public health.

Tobacco: Culture and legislature worldwide.

Oral cancer affects as many as 274000, people worldwide annually. Tobacco use is one of the major preventable cause of premature death and disease in the world. TSNAs are considered the most potent classes of carcinogens with N-nitrosonornicotine (NNN) and 4- (methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Risk Factors for Smoking includes family factors, school factors, peer factors, community factors, stress and domestic violence. Tobacco is an integral part of the culture and tradition in many countries of the South-East Asia Region. Tobacco use resulting in 5.4 million deaths every year. A new term, "thirdhand" smoke, has been proposed to describe the particulate residual toxins deposited in layers all over the home furniture after a cigarette has been extinguished. Many countries are putting ban for smoking in public places. Half measures are not enough, when one form of advertising is banned; the tobacco industry simply shifts its vast resources to another channel. Governments are urged to impose a complete ban to break the tobacco marketing net. An effort is made to comprehend articles on tobacco by searched from journals through Google and Ebscohost.

A global health perspective on the future of tobacco control / Una perspectiva de salud global sobre el futuro del control del tabaco

In this age of globalization, the outcome of tobacco control in one country is connected to events on the global stage. Tobacco control has become an increasingly consolidated global movement, catalyzed by the global tobacco control treaty, the World Health Organization's Framework Convention on Tobacco Control (FCTC) as well as the Bloomberg Initiative. This global collective effort is necessary in the face of an increasingly aggressive tobacco industry that has consolidated into a small number of very large multinational corporations, operating globally to expand their markets. Looming issues for tobacco control include the success with which the FCTC is implemented within individual nations, finding the proper role of harm reduction approaches, and using "lessons learned" from experience in the United States with tobacco product regulation.

Con el desarrollo de la globalización, el resultado del control del tabaco en un país está conectado con eventos mundiales. El control del tabaco se ha convertido en un movimiento mundial cada vez más consolidado, catalizado por el Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco así como de la Iniciativa Bloomberg. Este esfuerzo colectivo global es necesario, ya que la industria del tabaco ha consolidado una serie de grandes corporaciones multinacionales que trabajan globalmente para hacer crecer sus mercados. Algunos problemas pendientes siguen limitando el éxito del control del tabaco. Los problemas incluyen el relativo éxito de cada país al implementar el Convenio Marco, encontrar el papel del enfoque de reducción de daños, y utilizar experiencias y éxitos de los Estados Unidos en la regulación de productos de tabaco.

WHO framework convention on tobacco control and its implementation in South-East Asia region.

The birth of the WHO Framework Convention on Tobacco Control (WHO FCTC) took place in response to the global tobacco epidemic and it became the most important global tobacco control instrument. Duly recognizing tobacco use as an important public health problem and in the wake of rising prevalence of and mortality related to tobacco use, almost all Member States of the South-East Asia Region signed and ratified the WHO FCTC. Following the ratification, Member countries have enacted comprehensive national tobacco control laws and regulations. Most countries have covered some important provisions, such as tax and price measures, smoke-free places, health warnings, a ban on tobacco advertising and promotion, and a ban on tobacco sales to minors. In spite of innumerable constraints and challenges, particularly human, infrastructural and financial resources, Member countries have been doing their best to enforce those legislations and regulations as effectively as possible. In order to educate the general public on the harmful effects of tobacco, mass health campaigns have been organized which are being continued and sustained. However, some of the important areas that need attention in due course of time are tax raises, illicit trade, tobacco industry interference and alternate cropping systems. All Member States in the Region are striving harder to achieving the goals and provisions of the Framework Convention through actively engaging all relevant sectors and addressing the tobacco issue holistically, and thus protecting the present and future generations from the devastating health, social, economic and environmental consequences of tobacco consumption and exposure to tobacco smoke.

Social, economic and legal dimensions of tobacco and its control in South-East Asia region.

This paper examines the social, cultural, economic and legal dimensions of tobacco control in the South-East Asia Region in a holistic view through the review of findings from various studies on prevalence, tobacco economics, poverty alleviation, women and tobacco and tobacco control laws and regulations. Methods were Literature review of peer reviewed publications, country reports, WHO publications, and reports of national and international meetings on tobacco and findings from national level surveys and studies. Tobacco use has been a social and cultural part of the people of South-East Asia Region. Survey findings show that 30% to 60% of men and 1.8% to 15.6% of women in the Region use one or the other forms of tobacco products. The complex nature of tobacco use with both smoking and smokeless forms is a major challenge for implementing tobacco control measures. Prevalence of tobacco use is high among the poor and the illiterate. It is higher among males than females but studies show a rising trend among girls and women due to intensive marketing of tobacco products by the tobacco industry. Tobacco users spend a huge percent of their income on tobacco which deprives them and their families of proper nutrition, good education and health care. Some studies of the Region show that cost of treatment of diseases attributable to tobacco use was more than double the revenue that governments received from tobacco taxation. Another challenge the Region faces is the application of uniform tax to all forms of tobacco, which will reduce not only the availability of tobacco products in the market but also control people switching over to cheaper tobacco products. Ten out of eleven countries are Parties to the WHO Framework Convention on Tobacco Control and nine countries have tobacco control legislation. Enforcement of control measures is weak, particularly in areas such as smoke-free environments, advertisement at the point of sale and sale of tobacco to minors. Socio-cultural acceptance of tobacco use is still a major challenge in tobacco control efforts for the governments and stakeholders in the South-East Asia Region. The myth that chewing tobacco is less harmful than smoking tobacco needs to be addressed with public awareness campaigns. Advocacy on the integration of tobacco control with poverty alleviation campaigns and development programs is urgently required. Law enforcement is a critical area to be strengthened and supported by WHO and the civil society organizations working in the area of tobacco control.

Reflexiones sobre oportunidades de intervención en tabaquismo en Latinoamérica / Reflections on smoking intervention opportunities In Latin America

El tabaquismo es un grave problema de salud pública en Latinoamérica, cuyos países aún muestran en su estructura poblacional una amplia base piramidal formada por grupos etarios de jóvenes que han sido el blanco primordial de la industria tabacalera. Latinoamérica requiere urgentemente de estrategias de prevención y acciones sanitarias para modificar las consecuencias de fumar sobre la salud de la población a través de la cesación del tabaquismo. El tratamiento de la adicción a la nicotina requiere estrategias de intervención eficaces para disminuir la prevalencia de fumadores y evitar su recaída, brindándoles herramientas para el mantenimiento de la abstinencia. En la actualidad, poblaciones pobres y vulnerables (44 por ciento de la población latinoaméricana) están condenadas a sufrir las consecuencias sanitarias de esta enfermedad, ya que son las que presentan un mayor consumo de tabaco y las que pueden acceder menos a las intervenciones sanitarias. El Convenio Marco para el Control del Tabaco (CMCT) y el MPOWER, ambos estrategias de la Organización Mundial de la Salud para la lucha contra el tabaco, definen claras líneas de acción pero sus limitaciones están definidas por los recursos que se asignan para las mismas en cada país. La comunidad científica y técnica abocada a la lucha contra este flagelo debe considerar y poner en marcha nuevas perspectivas para lograr colocar en la agenda política la necesidad de obtener y asignar más recursos económicos y humanos para disminuir el consumo del tabaco en todos los grupos de la población. En la lucha contra el tabaco, este es el momento indicado para considerar primordialmente aspectos de equidad y justicia social en salud.

The tobacco epidemic is a huge public health problem affecting all Latin American countries. These countries have the characteristic of a wide base of the pyramidal population structure, with many young people who have been natural targets for the tobacco industry. Therefore in this region there is an urgent need to establish prevention and treatment strategies capable to reduce incidence and prevalence of tobacco smoking in the population and as a consequence modify the health effects of tobacco consumption. Treating nicotine addiction requires intervention strategies really effective to reduce the number of current smokers as well as giving them tools to avoid relapse and maintain abstinence. Currently poor and vulnerable groups, which represent 44 percent of the total population in Latin America, are the most susceptible to suffer the health consequences of smoking since they show the highest prevalence rates and have little or no access to health services. The Framework Convention on Tobacco Control (FCTC) and MPOWER, both strategies proposed by the World Health Organization against tobacco, define clear goals to achieve their purposes, nevertheless they are limited by the economic and human resources assigned by each country. The scientific community involved in the fight against tobacco must think about new ways to place this issue in the political agenda so there will be more opportunities to increase the resources and therefore to reduce tobacco consumption in all the groups of the population. In the fight against tobacco, this is the right time to consider primarily issues related to equity and social justice.

Avances y puntos pendientes en la agenda latinoamericana para el control del tabaco / Progress and pending issues in the Latin American agenda for tobacco control

El estudio de la Carga Mundial de la Enfermedad proyecta que el incremento en la prevalencia de fumadores en países de ingresos medios y bajos contribuirá a incrementar las muertes cardiovasculares, por enfermedad pulmonar obstructiva crónica y algunos cánceres. Para reducir estas consecuencias del tabaquismo, la Organización Mundial de la Salud (OMS) recomienda un conjunto de acciones reunidas en el Convenio Marco para el Control del Tabaco (CMCT) y los informes MPOWER. En este artículo se revisó el más reciente de estos informes y sintetizamos las principales intervenciones que estaban vigentes en los países latinoamericanos y también revisamos algunas medidas implementadas durante 2009 y 2010. En los últimos años se ha avanzado considerablemente en materia de control del tabaco. Sin embargo, todavía queda por avanzar para acercarnos a lo sugerido por la OMS. De mantenerse el nivel de consumo entre los adolescentes de la región actualmente, observaremos en las décadas futuras un incremento en el número de muertes prematuras y evitables causadas por el tabaco.

Projections based on the most recent report on the Global Burden of Disease show that the observed increase in smoking prevalence in middle and low income countries will contribute to the increase of the number of deaths due to cardiovascular diseases, chronic obstructive pulmonary diseases, and some cancers. The World Health Organization (WHO) Framework Convention on Tobacco Control recommends a group of actions to curb the tobacco epidemic. This is a review paper based on the most recent MPOWER report and also included in this review are some of the most recent tobacco control measures implemented during 2009 and 2010. We conclude that most Latin American countries have achieved significant progress in tobacco control in recent years. However, when comparing the current situation against the WHO recommendations we realized that for most countries there is still work to be done. If current smoking prevalence among teenagers remains unchanged, there will be a significant increase in the number of premature deaths attributable to tobacco consumption in future decades.

Smoking-related Characteristics in Korean Adult Smokers: Findings from the 2005 International Tobacco Control Policy Evaluation Survey-Korea

BACKGROUND: This study reports findings from the ITC Korea Survey, which was conducted to evaluate the characteristics in Korean adult smokers as part of the ITC Project. METHODS: Adult male and female smokers were randomly selected using telephone survey from November to December 2005. The ITC Korea Survey contained a wide range of questions on smoking behavior and smoking history. The data reported are weighted on the basis of age and gender, and they are nationally representative of smokers in Korea. RESULTS: A total of 1,002 smokers among the selected 1,402 subjects (71.5%) were interviewed; 96.2% were males. Daily smokers comprised 94.5% of the sample. The mean of cigarettes per day was 17.9. The average minutes after waking before the first cigarette was smoked was lower (50.6 minutes) than it was in other countries of the ITC Project. Over 90% considered themselves addicted to cigarettes and 86.5% expressed regret over smoking. Smokers reported that the norms against smoking in Korea were very strong both personal norms (89.4%) and perceived norms in Korean society (86.3%). Among the smokers, 80.8% had tried to quit smoking, and 76.1% were planning to quit. Only 5.8% of the Korean smokers indicated that the warning labels made them a lot more likely to quit smoking. When the price of cigarettes increased by 500 won (25%) in December 2004, 34.3% reported trying to quit smoking. Only 17.7% supported a complete workplace ban and 15.8% supported a complete ban in restaurants. Although knowledge of the harms of smoking was high, nearly 80% of the Koreans wrongly believed that "nicotine causes most of the cancer in smokers." Finally, the great majority (85.2%) of smokers in Korea believed that "the government should do more to tackle the harm done by smoking" and 62.5% believed that "tobacco products should be more tightly regulated." CONCLUSION: The results from the baseline wave of the ITC Korea Survey have identified where tobacco control in Korea has been done. Future waves of the ITC Korea Survey will be able to evaluate the impact of important tobacco control policies that Korea will be required to implement over the next few years, as a party to the FCTC.