Index of tobacco control sustainability (ITCS): a tool to measure the sustainability of national tobacco control programmes.

OBJECTIVE: To produce a tool to assess and guide sustainability of national tobacco control programmes. METHOD: A two-stage process adapting the Delphi and Nominal group techniques. A series of indicators of tobacco control sustainability were identified in grantee/country advisor reports to The International Union Against Tuberculosis and Lung Disease under the Bloomberg Initiative to Reduce Tobacco Control (2007-2015). Focus groups and key informant interviews in seven low and middle-income countries (52 government and civil society participants) provided consensus ratings of the indicators' relative importance. Data were reviewed and the indicators were accorded relative weightings to produce the 'Index of Tobacco Control Sustainability' (ITCS). RESULTS: All 31 indicators were considered 'Critical' or 'Important' by the great majority of participants. There was consensus that a tool to measure progress towards tobacco control sustainability was important. The most critical indicators related to financial policies and allocations, a national law, a dedicated national tobacco control unit and civil society tobacco control network, a national policy against tobacco industry 'Corporate Social Responsibility' (CSR), national mortality and morbidity data, and national policy evaluation mechanisms. CONCLUSIONS: The 31 indicators were agreed to be 'critical' or 'important' factors for tobacco control sustainability. The Index comprises the weighted indicators as a tool to identify aspects of national tobacco control programmes requiring further development to augment their sustainability and to measure and compare progress over time. The next step is to apply the ITCS and produce tobacco control sustainability assessments.

Electronic cigarettes. A position statement of the forum of international respiratory societies.

BACKGROUND: Awareness and usage of electronic cigarettes has exponentially increased during the last few years, especially among young people and women in some countries. The rapid acceptance of electronic cigarettes may be attributed in part to the perception created by marketing and the popular press that they are safer than combustible cigarettes. GOALS: To alert and advise policy makers about electronic cigarettes and their potential hazards. METHODS: Using The Union's position paper on electronic cigarettes as the starting template, the document was written using an iterative process. Portions of the manuscript have been taken directly from the position papers of participating societies. RESULTS: Because electronic cigarettes generate less tar and carcinogens than combustible cigarettes, use of electronic cigarettes may reduce disease caused by those components. However, the health risks of electronic cigarettes have not been adequately studied. Studies looking at whether electronic cigarettes can aid smoking cessation have had inconsistent results. Moreover, the availability of electronic cigarettes may have an overall adverse health impact by increasing initiation and reducing cessation of combustible nicotine delivery products. CONCLUSIONS: The health and safety claims regarding electronic nicotine delivery devices should be subject to evidentiary review. The potential benefits of electronic cigarettes to an individual smoker should be weighed against potential harm to the population of increased social acceptability of smoking and use of nicotine, the latter of which has addictive power and untoward effects. As a precaution, electronic nicotine delivery devices should be restricted or banned until more information about their safety is available. If they are allowed, they should be closely regulated as medicines or tobacco products.

The impact of macroeconomic conditions on obesity in Canada.

The paper used longitudinal Canadian data from the National Population Health Survey to estimate the impact of macroeconomic conditions measured by provincial unemployment rate on individual obesity and BMI. To control for individual-specific unobserved heterogeneity, the study utilized the conditional fixed effect logit and fixed effects models. The study found that unemployment rate had a significant positive impact on the probability of being severely obese. The study also found that unemployment rate significantly increased BMI. However, the study did not find any significant impact of unemployment rate on the probability of being overweight or obese.

The impact of retirement on mental health in Canada.

BACKGROUND: Like most of other developed countries, Canada experienced baby boom in the 20 years after World War II. With the eldest baby turned 65 in 2011, it is expected that a considerable number of people will retire in coming years and consequently, retired people will soon constitute a significant part of Canadian population. In this context, an interesting question would be how retirement impacts mental health. This question is related to the well-being of the retired population as well as to over all health care expenditures. AIMS: The major objective of this study is to examine the impact of retirement on mental health as measured by the Short Form Depression Scale. This study further conducts separate analyses to examine whether the impact of retirement on mental health differs between males and females, and among different education and income groups. METHODS: This study uses large scale Canadian National Population Heath Survey (Longitudinal Component) data and adopts fixed effect method and fixed effect instrumental variable method to deal with possible endogeneity problem. RESULTS: After controlling for unobserved individual specific heterogeneity, the study found that retirement has an insignificant impact on depression. As a robustness check, the study utilizes logit, conditional fixed effect logit, and fixed effect instrumental variable regression on a dichotomous variable representing depression and found that retirement has an insignificant impact on depression. The study further examined this issue using different subgroups based on gender, education and marital status, and again found that impacts of retirement on depression are not statistically significant. IMPLICATIONS FOR POLICY: Though the coefficients are statistically insignificant, however, most of the results are economically meaningful since the magnitudes are relatively large, implying very large effects. The effects of retirement on mental health appear to be complex and multidimensional; however, based on the FE-IV models, most of the effects seem to suggest that there may be some increase in depression symptoms. The findings of this study will have important policy implications. If retirement worsens mental health, then policy encouraging retirement may actually increase health care expenditures. On the other hand, if retirement improves mental health, then such policy will likely to decrease health care expenditure. Studies based on data from Canada and other OECD countries suggest that the provisions of social security programs themselves often provide strong incentive to leave the labor force early. The finding of this study that retirement has negative impact on mental health in Canada will imply that current Canadian policy of encouraging early retirement is likely to increase mental health care expenditure. IMPLICATIONS FOR FURTHER RESEARCH: There are a number of ways to extend this study. Depending on the availability of data, future studies can focus on sub populations: voluntary retiree/ involuntary retirement, early retiree/ late retiree and complete retiree/ partial retiree. Future study can also conduct more detailed analysis by including variables such as previous job characteristics, voluntary activity during retirement and family characteristics.

The impact of retirement on health in Canada.

This study estimates the impact of retirement on subsequent health outcomes as measured by self-reported health status. The empirical study is based on seven longitudinal waves of the Canadian National Population Health Survey, spanning 1994 through 2006. To account for biases due to unobserved individual-specific heterogeneity, this study uses a fixed-effects method. The results indicate that retirement has a positive but insignificant impact on self-reported health status. The study further examined this issue using different subgroups based on gender and income and again found that retirement has no significant impact on health status.

Recent immigrants and the use of cervical cancer screening test in Canada.

Using data from Canadian National Population Health Survey (1998-1999), this paper examined the factors that cause gap in Pap test utilization rate between recent immigrants and other Canadians. The Fairlie non linear decomposition analysis suggests that group differences in the mean values of the variables representing race, language, having regular physician, insurance ownership, and income level are the major factors behind the gap between other Canadians and recent immigrants. The results of the study also show that the Pap test utilization gap between other Canadians and recent immigrants narrows down over time though the process is quite slow.

The impact of diabetes on employment in Canada.

This paper examines the impact of diabetes on the employment of Canadian males and females ages 15-64. Using data from the National Population Health Survey (1998), it utilizes a recursive bivariate probit approach to take into account the potential endogeneity of diabetes in employment outcomes. The results suggest that treating diabetes as exogenous yields an over-estimation of its impact on male employment. The study finds that diabetes has a significant negative impact on female employment probability, but has no significant impact on that of non-white Canadians. An implication thus is that policy-makers should take endogeneity into account in estimating labor market costs of chronic diseases such as diabetes.

Tobacco control: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

Reliance on revenue generated from tobacco is one of the fundamental barriers to effective tobacco control in Pakistan. The tobacco control component of the National Action Plan for Non-Communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) deems it critical to address this issue. A range of policy and environmental strategies are part of this comprehensive effort; these involve regulating access and limiting demand through restrictions on advertising, marketing, promotion and through price and taxation. The NAP-NCD also encompasses community and school interventions, enforcement of tobacco control policies, cessation programmes, mass media counter-marketing campaigns for both prevention and cessation, and surveillance and evaluation of efforts. As part of NAP-NCD, surveillance of tobacco use has been integrated with a population-based NCD surveillance system. Featuring tobacco prominently as part of an NCD behavioural change strategy and providing wide-ranging information relevant to all aspects of tobacco prevention and control and smoking cessation have been identified as priority area in NAP-NCD. Other priority areas include the gradual phasing out of all types of advertising and eventually a complete ban on advertising; allocation of resources for policy and operational research around tobacco and building capacity in the health system in support of tobacco control. NAP-NCD also stresses on the need to develop and enforce legislation on smuggling contrabands and counterfeiting and legislation to subject tobacco to stringent regulations governing pharmaceutical products. The adoption of measures to discourage tobacco cultivation and assist with crop diversification; integration of guidance on tobacco use cessation into health services and insuring the availability and access to nicotine replacement therapy are also part of NAP-NCD.