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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 Publisher Pubmed



Chow CK1, 2 ; Corsi DJ1, 3 ; Gilmore AB4 ; Kruger A5 ; Igumbor E6 ; Chifamba J7 ; Yang W8 ; Wei L9 ; Iqbal R10 ; Mony P11 ; Gupta R12 ; Vijayakumar K13 ; Mohan V14 ; Kumar R15 Show All Authors
Authors
  1. Chow CK1, 2
  2. Corsi DJ1, 3
  3. Gilmore AB4
  4. Kruger A5
  5. Igumbor E6
  6. Chifamba J7
  7. Yang W8
  8. Wei L9
  9. Iqbal R10
  10. Mony P11
  11. Gupta R12
  12. Vijayakumar K13
  13. Mohan V14
  14. Kumar R15
  15. Rahman O16
  16. Yusoff K17
  17. Ismail N18
  18. Zatonska K19
  19. Altuntas Y20
  20. Rosengren A21
  21. Bahonar A22
  22. Yusufali A23
  23. Dagenais G24
  24. Lear S25
  25. Diaz R26
  26. Avezum A27
  27. Lopezjaramillo P28
  28. Lanas F29
  29. Rangarajan S2
  30. Teo K2
  31. Mckee M30
  32. Yusuf S2

Source: BMJ Open Published:2017


Abstract

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). 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. © 2017 Chow CK, et al. BMJ Open.
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