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2 Tobacco Control Research: Local Priority Setting and a Global Vision  Confronting the Epidemic: A Global Agenda for Tobacco Control Research  RITC Focused Research Priority Topics  Integrating Research into a Global Vision: What Have We Learned in Tobacco Control?  Example from South Africa

3 Confronting the Epidemic: A Global Agenda for Tobacco Control Research ( ons/general/en/) ons/general/en/  Published by RITC-WHO in 1999  Based on RITC-sponsored agenda-setting meetings in Africa, Latin America and the Caribbean, and South and Southeast Asia; review of previous agendas

4 Research Themes Country-Specific Research  Lack of standardized and comparable data; need for county and regional data on:  Prevalence and consumption  Knowledge of health risks  Attitudes and behaviours with respect to tobacco use especially in specific population sub-groups  Pricing and tax policies

5 Research Themes Policy Interventions  Economic policy research:  Elasticity of demand studies to determine optimal levels of taxation according to social class, age and geographic conditions  The determinants, process and impact of illegal trafficking and the influence of smuggling on tobacco use  Opportunities and barriers for harmonization of prices at the regional level

6 Research Themes Policy Interventions  Legislative research:  Effect of international trade agreements on the production, trade and marketing of tobacco products  Empirical and theoretical research to assist in drafting, implementing and evaluating policies (including those outlined in the FCTC)

7 Research Themes Programme Interventions  Opportunities/barriers to tobacco control  Optimal components (programs and policies) for a comprehensive tobacco control strategy  Development of effective messages to counter tobacco industry promotions  Behavioural research to test prevention and treatment programmes for specific age/ethnic/cultural groups  Strategies for high risk groups

8 Research Themes Treatment of Tobacco Dependence  Development of a range of approaches to increase cessation in specific populations  Evaluation of pharmaceutical interventions and delivery mechanisms, their cost- effectiveness, and their impact in diverse socio-cultural subgroups.

9 Research Themes Tobacco Product Design and Regulation  The biology of tobacco addiction  Characterization of additives of tobacco products  Examination of alternative labelling for tobacco products  Examination of public expectations and behaviour with respect to existing and new tobacco products  A research base for regulation of tobacco products

10 Research Themes Tobacco Industry Analysis  Overview of ownership, corporate structure, and regulation of the tobacco industry at local and international level  Tobacco production as an international and regional trade issue in terms of foreign exchange, employment, imports and exports, trafficking  Tobacco industry relationships with government (including lobbying)  Tobacco industry involvement in illegal trade

11 Research Themes Tobacco Industry Analysis  Tobacco industry advertising, marketing and promotion activities (particularly with respect to women, children and other high risk groups)  The impact of changes in advertising on consumption and public perceptions  Industry representation of the health consequences of tobacco use and addiction (including their influence on the content and direction of research.)

12 Research Themes Tobacco Farming  Relationship of tobacco production to destruction of the ecosystem  Attitudes and beliefs of tobacco farmers and the underlying historical/cultural context  Economic impact of tobacco control in countries that grow and manufacture tobacco or tobacco products for domestic or foreign markets  Opportunities for alternative crops and livelihoods; information on crop options employment for all family members

13 Research Themes Tobacco Farming  Cultivation and curing practices at the country and local level  Occupational hazards related to cultivating, curing and handling tobacco  Impact of tobacco cultivation on women and children  The feasibility of diversification in countries heavily dependent on tobacco farming and manufacturing and the mechanisms for supporting these countries in their diversification efforts

14 Research Themes The FCTC  Research to support specific provisions of the FCTC  Monitoring mechanisms to evaluate the implementation and effectiveness of the FCTC and related protocols

15 Cross-cutting Themes  High risk populations  Country readiness  Dissemination  Capacity Development  Mobilization of Human and Financial Resources

16 RITC Focused Research Priority Topics  Poverty and Tobacco  Tobacco Farming: Health, Livelihoods, Economics and the Environment  Health Systems Interventions  Globalization, Trade and Tobacco  Alternate Forms of Tobacco Use

What have we learned from tobacco? Lesson # 1 There is no “magic bullet”

18 Lesson #1  A comprehensive strategy is needed to change social norms and support individual behaviour change  This consists of:  Programming  Policy  Mass media  Research  Community development  Industry “denormalization”

What have we learned from tobacco? Lesson # 2 All sectors must work together

20 Coordination of All Sectors  Researchers  Policy-makers  Advocates  Practitioners  The media  Private sector  Public

The Media Public Opinion Main Policy Sectors VOLUNTARYPRIVATE Policy Sectors in Tobacco Control PUBLIC Source: Waverley Brigden, L. (1997) after Spicker, P. (1995) & Kingdon, J.W. (1995)

What have we learned from tobacco? Lesson # 3 Understand the politics

23 Politics  Multinational industries have enormous resources and the ability to influence policy-makers  They can argue on economic grounds as well as from a health standpoint (e.g., loss of jobs)  Ability to provide jobs and manufacturing  A problem “solved” in the developed world may emerge in developing countries  They are always several steps ahead of us (e.g., waterpipe, harm-reduction tobacco products)  Industries will often challenge “health” research

24 South Africa  A “policy window”  A “champion” in the Minister of Health  Strong advocacy  A sound research base  “Framing” as both a health and economic issue

25 Cigarette prices and consumption South Africa

26 Cigarette excise taxes and government revenue – South Africa

27 Trends in Cigarette Consumption and Smoking Prevalence Year Cigarette consumption (millions of packs) 1,8021,333 Per capita consumption (packs p.a. aged 15+) Smoking prevalence percentage (15+) Avg. consumption per smoker (packs p.a.)

28 Changes in Smoking Prevalence by Gender and Age Group Change Male Female Aged 16– Aged 25– Aged 35– Aged

29 Lessons Learned: 6 Case Studies  Legislative successes won in the face of vigorous opposition from an industry striving to protect its profits and market  Key role played by NGOs and charismatic individuals with commitment and dedication  Coalitions brought new skills and perspectives  Effective advocacy has to be learned  Lack of an organizational home and minimal level of funding make it hard to operate effectively

30 Lessons Learned: 6 Case Studies (cont’d)  Strong political support and political champions are crucial to success  Significant transformations in social norms can occur  The media can have a powerful role in influencing popular opinion  Understand the political framework and legislative timetable of the country  Legislation must be coupled with attention to implementation and enforcement

31 Lessons Learned: 6 Case Studies (cont’d)  Sound research is needed for good policy decisions  Policies and strategies must be comprehensive  It may be necessary to bring together diverse interest groups (e.g., Ministries of Health and Finance)  Even when the situation has seemed hopeless, progress has been made  Persistence is essential

32 Thank You Linda Waverley