Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Hadii M. Mamudu, PhD, MPA

No relationships to disclose

Implementation of the WHO FCTC in Africa: Article 8

–”Protection from Exposure to Tobacco Smoke”

Mamudu HM, Ph.D.; Veeranki SP, DrPH; Ouma EO, PhD.

American Public Health Association Annual Meeting

Tuesday, October 30, 2012

BackgroundO Health Effects of Tobacco use

O Leading preventable cause of NCDs O CancersO Cardiovascular diseasesO Chronic lung diseasesO Diabetes

O 36 million deaths/year

O 6 million smoking-attributable deaths

O 8 million deaths by 2030O 80% in low- and middle-income countries

O 1 billion deaths by the end of 21st century.

O Socioeconomic/environmental effects

Source: U.S. Surgeon General Report, 2010

Background

BackgroundO Secondhand smoke (SHS)

O >250 carcinogensO No safe level of exposure

O EffectsO Deaths

O 600,000 people worldwideO Negative health effects on never smokers

O ChildrenO Developmental effects (e.g., low birth weight, SIDS, pre-term

delivery)O Respiratory effects (e.g., decreased pulmonary function, cough,

asthma)O Adults

O Reproduction (e.g. male and female reproductive toxicity)O Respiratory effectsO Cancer

Tobacco ControlO Smoke-free Policies (SPFs)O Origin

O Began in the 1970s in the U.S. and diffused worldwideO Health benefits

O Protection for nonsmokersO Improvement in healthO Facilitation of smoking cessation

O Economic benefitsO Saves health care costsO Good for business

O SFPs is part of the WHO Framework Convention on Tobacco Control (FCTC)

The FCTCO International tobacco control

treatyO 175 Members

O Not including United StatesO Key provisions

O Demand-sideO Advertising banO Health warningsO Tax increasesO Smoke-free environmentsO Health campaigns

O Supply-sideO Ban on sale to minorsO Control of illicit tradeO Alternative sources of livelihood

The FCTC: Art. 8

O Implementation: MPOWER 2009

The FCTC: Art. 8

GoalsO Assess the adoption of components of smoke-free

policies in Africa

O Delineate key determinants of smoke-free policy adoption

Methodology

Methodology cont.O Policy Analysis

O Smoke-free workplacesO Smoke-free indoor placesO Smoke-free public transportation

O Data SourceO WHO MPOWER reports (2008, 2009, and 2011)O Tobacco control profiles (2000 and 2003)O Tobacco Atlas (2006, 2009, and 2012)O FCTC Implementation database (2-year & 5-year reports)O Tobaccocontrollaws.org

O MeasurementsO Policy status (0=no, 1=partial, 2=full)

O AnalysisO Descriptive statisticsO Regional comparisons over time.

Preliminary ResultsO African countries and the FCTC

O 46 countriesO 89% has ratified the FCTC

O November 12, 2003: First by SeychellesO August 12, 2010: Latest by Cote d’Ivoire

O Non-ratified countries (Eritrea, Ethiopia, Malawi, Mozambique, and Zimbabwe)

O Countries with national smoke-free policyO Comprehensive smoke-free legislation

O Kenya, South Africa

O Pending in the policy processO Ghana, Nigeria and Rwanda

Preliminary Results

O Central Africa

• No clear trend or pattern

Preliminary ResultsO Eastern Africa

• Increasing full adoption for indoor workplaces and public transportation

• Partial adoption for indoor public places

Preliminary ResultsO Southern Africa

• Increasing full adoption for indoor workplaces and public transportation

• No policies for indoor public places

Preliminary ResultsO Western Africa

• Increasing full adoption for indoor workplaces and public transportation

• Partial adoption for indoor public places

DiscussionO Identification of venues that need policy attentionO The use of different legal mechanisms for SFPsO Countries with partial and full policies have

increased since 2003O Likely an FCTC effect

O Indoor public places are least covered with policyO High-level of exposure to SHS

O Countries in Central Africa merit attentionO Fewer reported policiesO Poorer data quality

Future ResearchO Analysis the FCTC implementation reportsO Cross-sectional to Identify key determinantsCountry-level Determinants of Smoke-free Places

Indoor Workplaces

Public Transportation

Indoor Public places

Compositional Factors (Population density, age, Gender, Socioeconomics)Contextual factors (Smoking prevalence, tobacco industry, policy networks, urbanization, mortality rate, morbidity)Health system factors (Type of health system, health expenditure)

AcknowledgementRafie Boghozian-Khoygani, MBA Research Data ManagerCollege of NursingEast Tennessee State University

David M. KiokoDepartment of Health Services Management & PolicyCollege of Public HealthEast Tennessee State University

Yi He, DrPHDepartment of Biostatistics and EpidemiologyCollege of Public HealthEast Tennessee State University

Yang Chen, MS Department of Biostatistics and EpidemiologyCollege of Public HealthEast Tennessee State University

Thank you!!