RESUMEN
OBJECTIVE: To assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile. DESIGN: Longitudinal cross-sectional study. SETTING: National level. PARTICIPANTS: Data from the National Survey of Drug Consumption (Service of Prevention and Rehabilitation for Drug and Alcohol Consumption). A pseudo-cohort of smokers born between 1982 and 1991 (N=17 905) was tracked from 2002 to 2016. PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary outcome was the tendency to cease smoking conceptualised as the report of using cigarettes 1 month or more ago relative to using cigarettes in the last 30 days. The main exposure variable was the Tobacco Policy Index-tracking tobacco policy changes over time. Logistic regression, controlling for various factors, was applied. RESULTS: Models suggested a 14% increase in the smoking cessation tendency of individuals using cigarettes 1 month or more ago relative to those using cigarettes in the last 30 days (OR 1.14, CI 95% CI 1.10 to 1.19) for each point increment in the Tobacco Policy index. CONCLUSIONS: Our study contributes to documenting a positive impact of the implementation of interventions considered in the MPOWER strategy in the progression of smoking cessation tendencies in smokers born between 1982 and 1991 in Chile.
Asunto(s)
Cese del Hábito de Fumar , Humanos , Chile/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Estudios Transversales , Masculino , Estudios Longitudinales , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Adolescente , Fumar Cigarrillos/epidemiología , Política de Salud , Modelos Logísticos , Productos de Tabaco/legislación & jurisprudencia , Control del TabacoRESUMEN
INTRODUCTION: To document the adoption of a comprehensive tobacco control law in Bolivia, a low-income country in South America. AIMS AND METHODS: Analysis of the Bolivian case study by reviewing news sources, tobacco control legislation, industry websites, and advocacy reports. Application of the Policy Dystopia Model to analyze tobacco industry and health advocacy arguments and action-based strategies. RESULTS: For decades tobacco control progress in Bolivia remained relatively stagnant due to industry interference. In the 2000s and 2010s, Bolivia ratified the WHO Framework Convention on Tobacco Control (FCTC) and implemented a couple of laws that began restricting smoking in public places and tobacco advertising. In 2015, tobacco control civil society emerged with the creation of Fundación InterAmericana del Corazón (FIC) Bolivia, which began coordinating efforts to counter industry interference. Between 2016 and 2020, FIC Bolivia with financial and technical support from international health groups proactively coordinated interministerial meetings, identified and met with key policymakers, and held public educational socialization events to introduce and support a FCTC-based tobacco control bill. Tobacco companies argued to policymakers and the media the bill would result in lost sales/jobs, increase illicit trade and help smugglers profit but only secured minimal changes. In February 2020, Bolivia passed Law 1280, which established 100% smoke-free environments, banned tobacco advertising (except at the point-of-sale), required 60% pictorial health warnings, among others. CONCLUSIONS: International financial and technical support combined with proactive advocacy strategies, including identifying and engaging key policymakers, coordinating interministerial meetings, and educating the public can help pass strong tobacco control laws, especially in low-income countries. IMPLICATIONS: Low- and middle-income countries struggle to adopt comprehensive tobacco control legislation due to weak state capacity, limited resources, and aggressive tobacco industry interference. This is one of a handful of studies to examine the adoption of a comprehensive tobacco control law in a low-income country, Bolivia. Proactive health advocacy strategies, including identifying and engaging key political allies, helping coordinate interministerial meetings, and aggressively educating and engaging the public can help pass strong tobacco control laws, especially in low-income countries.
Asunto(s)
Industria del Tabaco , Productos de Tabaco , Bolivia , Humanos , Prevención del Hábito de Fumar , Productos de Tabaco/legislación & jurisprudenciaRESUMEN
The article analyzes some dilemmas related to the implementation of the Framework Convention on Tobacco Control, underscoring the States parties' difficulties in adopting public policies with proven cost-benefit and aimed at reducing tobacco's supply and demand. Specifically, the article examines the recommendation to adopt policies for plain cigarette packaging, as provided in the guidelines for implementation of the Convention's Articles 11 and 13. Based on case analysis, we identified political and legal factors that hinder the Convention's implementation, including the regulatory chill produced by legal claims filed by the tobacco industry, which uses investor-State arbitration clauses from bilateral investment agreements. The article concludes that despite the costs imposed on States and the delays in the adoption of such policies, in the medium and long term the rulings handed down by the arbitration courts and the World Trade Organization's Dispute Settlement Body can consolidate the understanding of the legality and effectiveness of policies that adopt the model.
O artigo analisa alguns dilemas relacionados à implementação da Convenção-Quadro para o Controle do Tabaco, destacando as dificuldades dos Estados participantes para adotar políticas públicas, com custo-benefício comprovado, que visam à redução da oferta e demanda do tabaco. Especificamente, o artigo examina a recomendação para a adoção de políticas de padronização das embalagens de cigarro, presente nas diretrizes para a implementação dos Artigos 11 e 13 da Convenção. Por meio da análise de casos, identificamos fatores políticos e jurídicos que dificultam a implementação da Convenção, incluindo a inibição regulatória produzida pela abertura de litígios por parte da indústria do tabaco, que utiliza-se das cláusulas de arbitragem investidor-Estado existentes em acordos bilaterais de investimentos. Conclui-se que, apesar dos custos impostos aos Estados e dos atrasos na adoção dessas políticas, no médio ou longo prazo, as decisões proferidas pelos tribunais arbitrais e pelo Órgão de Solução de Controvérsias da Organização Mundial do Comércio podem consolidar o entendimento acerca da legalidade e efetividade de políticas que adotam o referido modelo.
El artículo analiza algunos dilemas relacionados con la implementación del Convenio Marco para el Control del Tabaco, destacando las dificultades de los Estados participantes para adoptar políticas públicas, con coste-beneficio comprobado, que tienen como objetivo la reducción de la oferta y demanda del tabaco. Específicamente, el artículo examina la recomendación para la adopción de políticas de estandarización de los paquetes de cigarrillos, presente en las directrices para la implementación de los Artículos 11 y 13 del Convenio. Mediante el análisis de casos, identificamos factores políticos y jurídicos que dificultan la implementación del Convenio, incluyendo la inhibición regulatoria, producida por la apertura de litigios por parte de la industria del tabaco, que recurre a cláusulas de arbitraje inversor-Estado, existentes en acuerdos bilaterales de inversión. Se concluye que, a pesar de los costes impuestos a los Estados, y de los atrasos en la adopción de esas políticas, en el medio o largo plazo, las decisiones proferidas por los tribunales arbitrales y por el Órgano de Solución de Diferencias de la Organización Mundial del Comercio pueden consolidar el entendimiento acerca de la legalidad y efectividad de políticas que adoptan el referido modelo.
Asunto(s)
Prevención del Hábito de Fumar/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Brasil , Organización Mundial de la SaludRESUMEN
Smoking is a public health problem and an important source of exposure to toxic metals. This work describes an efficient analytical method comparable to the ones based on atomic emission techniques for the determination of chromium in different constituent parts of cigarette samples (tobacco, filters and ashes) using electrothermal vaporization-atomic absorption spectrometry. The method was evaluated using 12 samples, and the results showed recovery values between 83 and 107%. The accuracy was also evaluated using a reference sample of tomato leaves (NIST SRM 1573a), which proved the efficiency of the method. The limits of detection of the developed method were 20.4, 75.8 and 80.7 ng g-1 for tobacco, filter and cigarette ash samples, respectively. The average chromium values found for the analyzed samples were in the range of 0.96 to 3.85 and from 0.32 to 0.80 µg/cigarette for tobacco and ashes, respectively. For most pre-burn and post-burn filter samples, the values of chromium concentration remained below limits of detection. The developed method presented adequate results about precision and accuracy, demonstrating its applicability in the determination of chromium in cigarette samples.
Asunto(s)
Cromo/análisis , Productos de Tabaco/análisis , Brasil , Humanos , Fumar , Nicotiana/química , Productos de Tabaco/legislación & jurisprudenciaRESUMEN
OBJECTIVE: To examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design. DESIGN: Monthly longitudinal (panel) ecological study from January 2000 to December 2016. SETTING: All Brazilian municipalities (n=5565). PARTICIPANTS: Infant populations. INTERVENTION: Smoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes. STATISTICAL ANALYSES: Municipal-level linear fixed-effects regression models. MAIN OUTCOMES MEASURES: Infant and neonatal mortality. RESULTS: Implementation of partial smoke-free legislation was associated with a -3.3 % (95% CI -6.2% to -0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with -5.2 % (95% CI -8.3% to -2.1%) and -3.4 % (95% CI -6.7% to -0.1%) step reductions in infant and neonatal mortality, respectively, and a -0.36 (95% CI -0.66 to-0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted. CONCLUSIONS: Strengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes-particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation's Sustainable Development Goal three.
Asunto(s)
Muerte del Lactante/etiología , Mortalidad Infantil , Muerte Perinatal/etiología , Política para Fumadores/legislación & jurisprudencia , Prevención del Hábito de Fumar/métodos , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Brasil/epidemiología , Femenino , Humanos , Lactante , Salud del Lactante , Recién Nacido , Modelos Lineales , Masculino , Persona de Mediana Edad , Embarazo , Humo/efectos adversos , Cese del Hábito de Fumar , Prevención del Hábito de Fumar/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/efectos adversosRESUMEN
OBJECTIVE: To estimate with a rigorous statistical methodology and independent from the tobacco industry the prevalence and consumption of illicit cigarettes in Metropolitan Santiago de Chile, in addition to identifying the variables statistically associated with choosing to smoke illicit cigarettes. METHODS: Surveys of 851 smokers who reside in the Metropolitan Santiago were collected using a sampling design that combined a randomisation of high-traffic points and a quota sampling to approximate the smoking population. Photographs of packs along with questions on where they were bought were used to define whether cigarettes were licit or illicit. After this identification, the statistical association between the decision to smoke illicit cigarettes and sociodemographic variables and smoking habits was estimated using probit models. RESULTS: The proportion of smokers smoking illicit cigarettes in Metropolitan Santiago was 10.9%. Adjusted by smoking intensity, 16.3% of cigarettes smoked in a month were illicit. Models show that the probability of smoking illicit cigarettes is inversely associated with employment status (ie, employed/inactive/unemployed), and smokers with lower levels of education are more likely to smoke illicit cigarettes. Though smokers' incomes are not directly measured, both employment status and educational levels are indicative that illicit cigarette consumption is more prevalent among low-income groups. CONCLUSIONS: The proportion of smokers consuming illicit cigarettes estimated in this research is less than half of the widely publicised claims of the tobacco industry. Furthermore, past and present pricing strategies by the tobacco industry indicate that, contrary to public statements, the tobacco industry is not concerned by illicit trade.
Asunto(s)
Fumar Cigarrillos/epidemiología , Fumadores/estadística & datos numéricos , Productos de Tabaco/economía , Productos de Tabaco/legislación & jurisprudencia , Adolescente , Adulto , Chile , Ciudades , Escolaridad , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Productos de Tabaco/provisión & distribución , Población UrbanaRESUMEN
Chile has experienced rapid epidemiological transitions characterized by decreasing infant mortality, population aging, and a shift towards obesity with an increase in noncommunicable diseases (NCDs). Today, tobacco, alcohol, and ultraprocessed foods are the main risk factors for these diseases. Based on Chile's experience in tobacco control, we discuss paths to make progress in population evidence-based strategies to improve overall community health.
Asunto(s)
Bebidas Alcohólicas , Enfermedad Crónica , Alimentos , Política de Salud , Legislación como Asunto , Enfermedades no Transmisibles , Salud Pública , Productos de Tabaco , Bebidas Alcohólicas/legislación & jurisprudencia , Bebidas Alcohólicas/normas , Chile , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Alimentos/normas , Política de Salud/legislación & jurisprudencia , Humanos , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/prevención & control , Salud Pública/legislación & jurisprudencia , Salud Pública/normas , Ciencia , Productos de Tabaco/legislación & jurisprudencia , Productos de Tabaco/normasRESUMEN
O artigo analisa alguns dilemas relacionados à implementação da Convenção-Quadro para o Controle do Tabaco, destacando as dificuldades dos Estados participantes para adotar políticas públicas, com custo-benefício comprovado, que visam à redução da oferta e demanda do tabaco. Especificamente, o artigo examina a recomendação para a adoção de políticas de padronização das embalagens de cigarro, presente nas diretrizes para a implementação dos Artigos 11 e 13 da Convenção. Por meio da análise de casos, identificamos fatores políticos e jurídicos que dificultam a implementação da Convenção, incluindo a inibição regulatória produzida pela abertura de litígios por parte da indústria do tabaco, que utiliza-se das cláusulas de arbitragem investidor-Estado existentes em acordos bilaterais de investimentos. Conclui-se que, apesar dos custos impostos aos Estados e dos atrasos na adoção dessas políticas, no médio ou longo prazo, as decisões proferidas pelos tribunais arbitrais e pelo Órgão de Solução de Controvérsias da Organização Mundial do Comércio podem consolidar o entendimento acerca da legalidade e efetividade de políticas que adotam o referido modelo.
El artículo analiza algunos dilemas relacionados con la implementación del Convenio Marco para el Control del Tabaco, destacando las dificultades de los Estados participantes para adoptar políticas públicas, con coste-beneficio comprobado, que tienen como objetivo la reducción de la oferta y demanda del tabaco. Específicamente, el artículo examina la recomendación para la adopción de políticas de estandarización de los paquetes de cigarrillos, presente en las directrices para la implementación de los Artículos 11 y 13 del Convenio. Mediante el análisis de casos, identificamos factores políticos y jurídicos que dificultan la implementación del Convenio, incluyendo la inhibición regulatoria, producida por la apertura de litigios por parte de la industria del tabaco, que recurre a cláusulas de arbitraje inversor-Estado, existentes en acuerdos bilaterales de inversión. Se concluye que, a pesar de los costes impuestos a los Estados, y de los atrasos en la adopción de esas políticas, en el medio o largo plazo, las decisiones proferidas por los tribunales arbitrales y por el Órgano de Solución de Diferencias de la Organización Mundial del Comercio pueden consolidar el entendimiento acerca de la legalidad y efectividad de políticas que adoptan el referido modelo.
The article analyzes some dilemmas related to the implementation of the Framework Convention on Tobacco Control, underscoring the States parties' difficulties in adopting public policies with proven cost-benefit and aimed at reducing tobacco's supply and demand. Specifically, the article examines the recommendation to adopt policies for plain cigarette packaging, as provided in the guidelines for implementation of the Convention's Articles 11 and 13. Based on case analysis, we identified political and legal factors that hinder the Convention's implementation, including the regulatory chill produced by legal claims filed by the tobacco industry, which uses investor-State arbitration clauses from bilateral investment agreements. The article concludes that despite the costs imposed on States and the delays in the adoption of such policies, in the medium and long term the rulings handed down by the arbitration courts and the World Trade Organization's Dispute Settlement Body can consolidate the understanding of the legality and effectiveness of policies that adopt the model.
Asunto(s)
Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Prevención del Hábito de Fumar/legislación & jurisprudencia , Organización Mundial de la Salud , BrasilRESUMEN
INTRODUCTION: The Food and Drug Administration may set a maximum nicotine content in cigarettes to minimize smoking's addictiveness. Our recent research may indirectly support setting levels applicable to the population of dependent smokers below 1 mg/g (mg nicotine/g of tobacco filler). METHODS: Using a within-subjects design in laboratory-based studies totaling 61 nontreatment seeking adult dependent smokers, Spectrum research cigarettes with nicotine contents ranging from 1.3 to 17 mg/g (just one per session) were compared with the lowest content available, 0.4 mg/g. Identified for each participant was the smallest difference in nicotine content, or "threshold," between cigarettes that still supported behavioral discrimination (ie, ability to objectively distinguish their difference). The next lower nicotine content cigarette, not discriminated (by definition), was labeled their "subthreshold." Subjective perceptions and choice behavior were also assessed. RESULTS: Thresholds varied widely among all 61 smokers but, importantly, fewer than 7% of smokers could discriminate the two lowest, 1.3 versus 0.4 mg/g nicotine, meaning more than 90% could not do so. Moreover, we found a consistent association between their nicotine discrimination threshold and their subjective perceptions and subsequent reinforcement behavior later in the session. Specifically, a participant's discrimination threshold cigarette was also more highly rated and preferred (ie, self-administered), whereas their subthreshold cigarette was rated similarly to the 0.4 mg/g and not preferred. CONCLUSIONS: Cigarette nicotine content below the threshold for perceiving nicotine's effects (ie, its discriminability) in nearly all smokers from a no nicotine comparison is likely below 1.0 mg/g, or less than or equal to 10% of that in typical commercial cigarettes. IMPLICATIONS: Cigarettes with nicotine contents able to be discriminated (threshold) are also reinforcing, and those unable to be discriminated are not reinforcing, as anticipated. Yet, research explicitly comparing cigarettes with contents below 1.0 mg/g versus no nicotine (ie, a "placebo") is needed with larger samples. Results may confirm what nicotine content lower than 1.0 mg/g is below the threshold for discrimination (and self-administration) in the vast majority (>95%) of adult dependent smokers as well as teens beginning to smoke. Identifying that content would strongly support the Food and Drug Administration policy to establish a maximum nicotine content in cigarettes that will not maintain dependence.
Asunto(s)
Nicotina , Fumadores , Fumar , Productos de Tabaco , Adulto , Humanos , Nicotina/análisis , Nicotina/normas , Fumadores/psicología , Fumadores/estadística & datos numéricos , Fumar/epidemiología , Fumar/psicología , Productos de Tabaco/legislación & jurisprudencia , Productos de Tabaco/normas , Estados Unidos , United States Food and Drug AdministrationAsunto(s)
Prevención del Hábito de Fumar/economía , Impuestos/economía , Industria del Tabaco/economía , Productos de Tabaco/economía , Brasil , Costos y Análisis de Costo , Conducta Criminal , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Humanos , Política Pública , Prevención del Hábito de Fumar/legislación & jurisprudencia , Impuestos/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudenciaRESUMEN
OBJECTIVE: To review the implementation of the WHO Framework Convention onTobacco Control in theAmericas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. MATERIALS AND METHODS: Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. RESULTS: Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. CONCLUSIONS: There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.
OBJETIVO: Revisar la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas, describir dos estudios de caso nacionales y analizar la evidencia sobre los cigarrillos electrónicos desde la perspectiva de salud pública. MATERIAL Y MÉTODOS: Revisión de la legislación de control de tabaco y la evidencia científica sobre los cigarrillos electrónicos. RESULTADOS: La aplicación de políticas no es homogénea, con avances importantes en ambientes libres de humo, advertencias sanitarias gráficas y vigilancia epidemiológica, pero desafíos pendientes en la prohibición total de la publicidad, incremento de impuestos y cesación tabáquica.La interferencia de la industria tabacalera es uno de los principales obstáculos para avanzar y los nuevos productos crean incertidumbre sobre su regulación. CONCLUSIONES: Se necesita revitalizar la voluntad política para aplicar integralmente el Convenio, tomando decisiones basadas en evidencia ante los nuevos desafíos y defendiendo los logros de la interferencia de la industria.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Prevención del Hábito de Fumar/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Publicidad , Práctica Clínica Basada en la Evidencia , Implementación de Plan de Salud , Promoción de la Salud/métodos , Humanos , Cooperación Internacional , Maniobras Políticas , México , Panamá , Política para Fumadores , Prevención del Hábito de Fumar/tendencias , Impuestos , Industria del Tabaco/economía , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/provisión & distribución , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Organización Mundial de la SaludRESUMEN
Resumen: Objetivos: Revisar la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas, describir dos estudios de caso nacionales y analizar la evidencia sobre los cigarrillos electrónicos desde la perspectiva de salud pública. Material y métodos: Revisión de la legislación de control de tabaco y la evidencia científica sobre los cigarrillos electrónicos. Resultados: La aplicación de políticas no es homogénea, con avances importantes en ambientes libres de humo, advertencias sanitarias gráficas y vigilancia epidemiológica, pero desafíos pendientes en la prohibición total de la publicidad, incremento de impuestos y cesación tabáquica. La interferencia de la industria tabacalera es uno de los principales obstáculos para avanzar y los nuevos productos crean incertidumbre sobre su regulación. Conclusiones: Se necesita revitalizar la voluntad política para aplicar integralmente el Convenio, tomando decisiones basadas en evidencia ante los nuevos desafíos y defendiendo los logros de la interferencia de la industria.
Abstract: Objectives: To review the implementation of the WHO Framework Convention on Tobacco Control in the Americas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. Materials and methods: Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. Results: Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. Conclusion: There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.
Asunto(s)
Humanos , Productos de Tabaco/legislación & jurisprudencia , Sistemas Electrónicos de Liberación de Nicotina , Prevención del Hábito de Fumar/legislación & jurisprudencia , Panamá , Impuestos , Contaminación por Humo de Tabaco/prevención & control , Organización Mundial de la Salud , Publicidad , Práctica Clínica Basada en la Evidencia , Política para Fumadores , Prevención del Hábito de Fumar/tendencias , Implementación de Plan de Salud , Promoción de la Salud/métodos , Cooperación Internacional , Maniobras Políticas , MéxicoRESUMEN
BACKGROUND: The tobacco industry (TI) uses several strategies to attract new consumers, including using additives in tobacco products, which makes tobacco especially attractive to youth. Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control, the Brazilian Health Regulatory Agency (ANVISA, for the name in Portuguese), published the Collegiate Board Resolution (RDC, for the name in Portuguese) 14/2012 in 2012, prohibiting the addition of substances that enhance the flavour and taste of tobacco products in order to make them more attractive. In response, the TI used various strategies to prevent RDC 14/2012 from entering into force. At the time, the Brazilian additive ban was the most comprehensive in the world as it included a ban on menthol. OBJECTIVES: This paper analyses the arguments and strategies used by the TI to prevent the implementation of the additives ban. METHODS: Review of published articles, reports, legislation and legislative activity, internal TI documents, media stories and other documents to describe TI's reaction to the ban. RESULTS: The results show that the TI used some well-known strategies to delay or cancel the entering into force of the resolution. For example, the TI attempted political interference, used litigation and commissioned studies with findings that questioned the resolution's rationale. The TI strategies used in Brazil are similar to those used at the global level to oppose other tobacco control measures. CONCLUSIONS: TI successfully delayed the most comprehensive additive ban in the world using its usual tactics, despite the fact that none of the arguments presented by the TI had an acceptable scientific basis or evidence.
Asunto(s)
Aromatizantes/química , Gusto , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Adolescente , Brasil , HumanosRESUMEN
INTRODUCTION: Because of its nature, it is very hard to measure illicit tobacco trade in any product. In the case of Latin American countries, there is scant information on the magnitude and characteristics of this cigarette trade. The goal of this article is to provide estimates on the evolution of the illicit cigarette trade in five South American countries: Argentina, Brazil, Chile, Colombia, and Peru. METHODS: Gap analysis estimates for cigarette tax evasion/avoidance (a comparison on the evolution of the difference between registered cigarette sales and measured population consumption) are developed for Argentina, Brazil, Chile, Colombia, and Peru. Nationally representative surveys, conducted regularly, are used to measure population consumption. Confidence intervals constructed by bootstrapping sample estimates are generated to statistically evaluate the evolution of the gap. RESULTS: Illicit cigarette trade has increased as a percentage of total sales in Brazil in recent years. In the case of Argentina, after a relative decrease between 2005 and 2009, it seems to have stabilized. There is no statistical evidence to argue that there has been an increase of illicit cigarette trade in Chile, Colombia, and Peru, despite substantial price increases in Chile and tax increase in both Colombia and Peru. CONCLUSIONS: Using simple statistical methods, it is possible to assess the trend in illicit tobacco trade over time to better inform policy makers. Getting reliable and regular population consumption surveys can also help to track illicit tobacco trade. Claims by tobacco industry of a positive association between price/tax changes and illicit trade are unsubstantiated. IMPLICATIONS: Evolution of illicit cigarette trade in five Latin American countries shows different trajectories, not in line with tobacco industry estimates, which highlight the importance of producing solid, independent estimates. There are inexpensive methodologies that can provide estimates of the evolution of the relative importance of illicit trade and can be used to inform policy makers.
Asunto(s)
Impuestos/economía , Impuestos/legislación & jurisprudencia , Industria del Tabaco/economía , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/economía , Productos de Tabaco/legislación & jurisprudencia , Argentina , Brasil , Chile , Colombia , Comercio/economía , Comercio/legislación & jurisprudencia , Conducta Criminal , Humanos , PerúRESUMEN
The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.
Asunto(s)
Derecho a la Salud , Productos de Tabaco/legislación & jurisprudencia , Derechos de la Mujer/legislación & jurisprudencia , Argentina , Femenino , Humanos , Política , Cambio Social , Naciones UnidasRESUMEN
BACKGROUND: In Uruguay, real tobacco taxes increased significantly during 2005-2010 and 2014-2017 and decreased during 2010-2014. The effects of these tax changes on illegal and legal cigarette usage differed significantly when we compared cities in the middle and south of the country with cities on the border. OBJECTIVE: This paper analyses whether supply side factors such as geographical location, distribution networks and the effectiveness of tobacco control play a significant role in sales and use of illegal cigarettes when tobacco taxes change, particularly given the price gap between legal and lower-priced illegal cigarettes. METHODS: Using the International Tobacco Control Evaluation Project Uruguay Survey data (2008, 2010, 2012 and 2014), choices among illegal, legal and roll-your-own cigarettes are estimated as a function of smokers' geographical location, an indicator of illegal cigarette supply, and controlling for socioeconomic and demographic variables. Smoking behaviours in Montevideo, Durazno and Maldonado were compared with those in two border cities, Salto and Rivera, where illegal cigarette prevalence may differ. FINDINGS: An increase in taxes on manufactured legal and roll-your-own cigarettes increased the odds that smokers in cities near the borders and women switched down to illegal cigarettes. City geographical location, controls effectiveness and distribution networks may play a significant role in accessibility of illegal cigarettes. To improve the effectiveness of increased taxes and prices in reducing smoking, policy-makers may consider specific policies intended to reduce access to illegal cigarettes, such as ratification and effective implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products of WHO.
Asunto(s)
Comercio/tendencias , Tráfico de Drogas/estadística & datos numéricos , Impuestos/tendencias , Productos de Tabaco/economía , Productos de Tabaco/provisión & distribución , Adolescente , Adulto , Anciano , Comercio/estadística & datos numéricos , Femenino , Geografía , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Política Pública , Fumar/epidemiología , Factores Socioeconómicos , Impuestos/estadística & datos numéricos , Productos de Tabaco/legislación & jurisprudencia , Uruguay/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Paraguay has reportedly been a major transit hub for illicit tobacco products since the 1960s, initially to supply markets in Argentina and Brazil and, more recently, other regional markets and beyond. However, to date there has been no systematic analysis, notably independent of the tobacco industry, of this trade including the roles of domestic production and transnational tobacco companies (TTCs). This article fills that gap by detailing the history of Paraguay's illicit cigarette trade to Brazil and Argentina of TTC products and Paraguayan production between 1960 and 2003. The effective control of illicit cigarette flows, under Article 15 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate the Illicit Trade in Tobacco Products, requires fuller understanding of the changing nature of the illicit trade. METHODS: We systematically searched internal industry documents to understand the activities and strategies of leading TTCs in Paraguay and subregion over time. We also mapped illicit trade volume and patterns using US government and UN data on the cigarette trade involving Paraguay. We then estimated Paraguay's cigarette production from 1989 to 2003 using tobacco leaf flows from the United Nations Commodity Trade Statistics Database (UN Comtrade). RESULTS: We identify four phases in the illicit tobacco trade involving Paraguay: 1) Paraguay as a transit hub to smuggle BAT and PMI cigarettes from the U.S. into Argentina and Brazil (from the 1960s to the mid-1970s); 2) BAT and PMI competing in north-east Argentina (1989-1994); 3) BAT and PMI competing in southern and southern-east Brazil (mid to late 1990s); and 4) the growth in the illicit trade of Paraguayan manufactured cigarettes (from the mid- 1990s onwards). These phases suggest the illicit trade was seeded by TTCs, and that the system of supply and demand on lower priced brands they developed in the 1990s created a business opportunity for manufacturing in Paraguay. Brazil's efforts to fight this trade, with a 150% tax on exports to Latin American countries in 1999, further prompted supply of the illicit trade to shift from TTCs to Paraguayan manufacturers. CONCLUSION: This paper extends evidence of the longstanding complicity of TTCs in the illicit trade to this region and the consequent growth of Paraguayan production in the 1990s. Our findings confirm the need to better understand the factors influencing how the illicit tobacco trade has changed over time, in specific regional contexts, and amid tobacco industry globalization. In Paraguay, the changing roles of TTC and domestic production have been central to shifting patterns of illicit supply and distribution since the 1960s. Important questions are raised, in turn, about TTCs efforts to participate as legitimate partners in global efforts to combat the problem, including a leading role in data gathering and analysis.
Asunto(s)
Comercio/legislación & jurisprudencia , Cooperación Internacional , Industria del Tabaco/organización & administración , Productos de Tabaco/legislación & jurisprudencia , Argentina , Brasil , Humanos , ParaguayRESUMEN
BACKGROUND: Leading transnational tobacco companies (TTCs) began to expand their operations in Latin America in the 1960s. This included legally exporting their cigarettes to Paraguay during the 1960s which, in turn, were illegally re-exported to Argentina and Brazil. By the 1990s, competition between BAT and PMI for this lucrative illicit market, focusing on low-priced brands, prompted manufacturing in Paraguay. Paraguayan manufacturing rapidly grew after the introduction of a new cigarette export tax in Brazil in 1999. METHODS: We systematically searched Truth Tobacco Industry Documents (TTID) to understand the activities and strategies of leading TTCs in Paraguay and subregion over time. We applied the analytical framework of Lee and Eckhardt (2017) to understand Tabesa's global business strategy. We searched the websites of TTCs and Tabesa for activities since the mid 2000s to understand how the companies publicly describe these strategies. We used the United Nations Commodity Trade Statistics Database (UN Comtrade) as an independent source to crosscheck statements by Tabesa executives about export markets. We contextualized and triangulated our findings with 42 key informant interviews. RESULTS: Tabesa became the largest cigarette manufacturer in Paraguay, and one of the largest companies in the country, through complicity in the illicit trade. Enabled by market conditions created by leading TTCs, and a permissive regulatory environment in Paraguay, evidence suggests Tabesa had become a major source of illicit cigarettes across Latin America and beyond by the late 2000s. Although Brazil continues to account for the bulk of Tabesa's revenues, findings suggest that the company is aspiring to compete with TTCs in markets worldwide through legal and illegal sales. CONCLUSION: There is a need for fuller understanding of the risks to global tobacco control from local companies aspiring to compete with TTCs. The rise of Tabesa is part of the changing nature of the illicit trade in tobacco products which must be taken into account in implementing the Framework Convention on Tobacco Control (FCTC) and its Protocol to Eliminate Illicit Trade in Tobacco Products. Potential conflicts of interest concerning Tabesa illustrate the importance of FCTC Article 5.3 on industry interference. There is also an urgent need to address the lack of independent and rigorous data on the illicit tobacco trade in the region.
Asunto(s)
Comercio/legislación & jurisprudencia , Cooperación Internacional , Industria del Tabaco/organización & administración , Productos de Tabaco/legislación & jurisprudencia , Humanos , ParaguayRESUMEN
BACKGROUND: Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers. METHODS: Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests. RESULTS: Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p < 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p < 0.001), and N-nitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations. CONCLUSION: Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry.
Asunto(s)
Higroscópicos/análisis , Nicotina/análisis , Agonistas Nicotínicos/análisis , Nitrosaminas/análisis , Productos de Tabaco/análisis , Comercio/legislación & jurisprudencia , Crimen , México , Productos de Tabaco/legislación & jurisprudenciaRESUMEN
OBJECTIVE: To draw up an up-to-date scenario of compliance with the law prohibiting the sale of cigarettes to minors. METHODS: We used data about youth access to cigarette purchase that were obtained through a nationwide survey conducted in 2015 among students aged 13-17 years. We estimated simple proportions of attempts to buy cigarettes, success of attempts, purchase of cigarettes on a regular basis, and purchase of cigarettes on a regular basis in a store or bar. All estimates were stratified by gender, age group, and Brazilian macro-region. Crude absolute difference and adjusted absolute difference in the proportion of smokers in each category by variable of interest were analyzed by a generalized linear model with binomial distribution and identity link function. RESULTS: Approximately 7 in every 10 adolescent smokers attempted to buy cigarettes at least once in the 30 days prior to the survey. Of those, approximately 9 in every 10 were successful, and individuals aged 16-17 years (vs. those aged 13-15 years) were less often prevented from buying cigarettes (adjusted absolute difference, 8.1%; p ≤ 0.05). Approximately 45% of all smokers aged 13-17 years in Brazil reported buying their own cigarettes on a regular basis without being prevented from doing so, and, of those, 80% reported buying them in a store or bar (vs. from a street vendor). CONCLUSIONS: Our findings raise an important public health concern and may contribute to supporting educational and surveillance measures to enforce compliance with existing anti-tobacco laws in Brazil, which have been disregarded.