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

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dc.contributor.authorChow, Clara K.
dc.contributor.authorCorsi, Daniel J.
dc.contributor.authorGilmore, Anna B.
dc.contributor.authorKruger, Annamarie
dc.contributor.authorIgumbor, Ehimario
dc.date.accessioned2018-10-19T07:05:19Z
dc.date.available2018-10-19T07:05:19Z
dc.date.issued2017
dc.description.abstractOBJECTIVES: 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.en_US
dc.description.accreditationISI
dc.identifier.citationChow, C.K. et al. (2017). 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, middleincome and high-income countries. BMJ Open, 7: e013817.en_US
dc.identifier.issn2044-6055
dc.identifier.urihttp://dx.doi.org/10.1136/ bmjopen-2016-013817
dc.identifier.urihttp://hdl.handle.net/10566/4140
dc.language.isoenen_US
dc.privacy.showsubmitterFALSE
dc.publisherBMJ Publishing Groupen_US
dc.rightsThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/
dc.status.ispeerreviewedTRUE
dc.subjectThe tobacco control environmenten_US
dc.subjectTobacco policy implementationen_US
dc.subjectQuit ratioen_US
dc.titleTobacco 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 countriesen_US
dc.typeArticleen_US

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