Perceptions of social media harms and potential management strategies: vaping case study.

BACKGROUND: The social media landscape is now ubiquitous in people's everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals' perceptions of social media harms and potential management strategies using vaping as a case study. METHODS: A critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy. RESULTS: Two superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)- that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging). CONCLUSIONS: There was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.

Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives.

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.

E-cigarettes on Instagram: Exploring vape content via an Australian vaping influencer.

INTRODUCTION: Mounting evidence suggests that electronic cigarettes (e-cigarettes) are extensively promoted and marketed using social media, including through user-generated content and social media influencers. This study explores how e-cigarettes are being promoted on Instagram, using a case-study approach, and the extent to which Meta's Restricted Goods and Services Policy (Meta's policy) is being applied and enforced. METHODS: We identified the accounts followed by an Australian Instagram influencer who primarily posts e-cigarette-related content. The main foci of these 855 accounts were coded and 369 vaping-focused accounts were identified. These vaping-focused accounts were then further coded by two trained coders. RESULTS: All (n=369; 100.0%) of the vape content posted by these accounts was positive in sentiment. One-third of the vape accounts (n=127; 34.4%) had a shared focus, indicating that vape content may permeate into other online communities through shared interests. A total of 64 accounts (17.3%) potentially violated Meta's policy by attempting to purchase, sell, raffle or gift e-cigarette products. CONCLUSIONS: The findings of this study suggest that pro-vaping information is available and accessible on Instagram. Much of the content identified in this study promoted the purchase or gifting of e-cigarette products and potentially violates Meta's policy. Greater regulation and/or stronger enforcement of e-cigarette content on social media platforms such as Instagram is necessary to prevent the ongoing promotion of these harmful products.

A roadmap to establishing global oncology as a priority initiative within a National Cancer Institute-designated cancer center.

As the burden of cancers impacting low- and middle-income countries is projected to increase, formation of strategic partnerships between institutions in high-income countries and low- and middle-income country institutions may serve to accelerate cancer research, clinical care, and training. As the US National Cancer Institute and its Center for Global Health continue to encourage cancer centers to join its global mission, academic cancer centers in the United States have increased their global activities. In 2015, the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, responded to the call for international partnership in addressing the global cancer burden through the establishment of the Global Cancer Program as a priority initiative. In developing the Global Cancer Program, we galvanized institutional support to foster sustained, bidirectional, equitable, international partnerships in global cancer control. Our focus and intent in disseminating this commentary is to share experiences and lessons learned from the perspective of a US-based, National Cancer Institute-designated cancer center and to provide a roadmap for other high-income institutions seeking to strategically broaden their missions and address the complex challenges of global cancer control. Herein, we review the formative evaluation, governance, strategic planning, investments in career development, funding sources, program evaluation, and lessons learned. Reflecting on the evolution of our program during the first 5 years, we observed in our partners a powerful shift toward a locally driven priority setting, reduced dependency, and an increased commitment to research as a path to improve cancer outcomes in resource-constrained settings.

Foregrounding women and household dynamics to inform Article 17: a qualitative description analysis of tobacco farming households in Mozambique.

PURPOSE: This paper examines the intrahousehold dynamics between women and men present in tobacco farming households in Mozambique. Attention to the experiences and realities of the smallholder farmers is crucial for understanding approaches to alternative livelihoods. Intrahousehold dynamics can provide important insights into how these households and their members view tobacco production and engage with the political economy of tobacco farming, how they make decisions, and the rationale and values behind these decisions. METHODS: Data were collected through single-gender focus group discussions (n=8) with 108 participants (men=57, women=51). Analysis was informed by a qualitative description methodology. This research presents a gender-based analysis examining the perspectives, roles, decision-making processes and desires of female and male tobacco farmers in four key tobacco-growing districts in Mozambique. FINDINGS: Throughout this paper, women are found to hold leverage and influence in tobacco farming households, and this leverage is in part gained via the necessity of women's unpaid labour in achieving profitability in tobacco farming. Both women and men are also found to strongly desire and pursue the well-being of the household. CONCLUSION: Women hold agency within tobacco-growing households and participate in decision-making processes regarding tobacco agriculture. Women should be included in future tobacco control policies and programmes pertaining to Article 17.

Promotion of E-Cigarettes on TikTok and Regulatory Considerations.

E-cigarettes are promoted extensively on TikTok and other social media platforms. Platform policies to restrict e-cigarette promotion seem insufficient and are poorly enforced. This paper aims to understand how e-cigarettes are being promoted on TikTok and provide insights into the effectiveness of current TikTok policies. Seven popular hashtag-based keywords were used to identify TikTok accounts and associated videos related to e-cigarettes. Posts were independently coded by two trained coders. Collectively, the 264 videos received 2,470,373 views, 166,462 likes and 3426 comments. The overwhelming majority of videos (97.7%) portrayed e-cigarettes positively, and these posts received 98.7% of the total views and 98.2% of the total likes. A total of 69 posts (26.1%) clearly violated TikTok's own content policy. The findings of the current study suggest that a variety of predominantly pro-vaping content is available on TikTok. Current policies and moderation processes appear to be insufficient in restricting the spread of pro-e-cigarette content on TikTok, putting predominantly young users at potential risk of e-cigarette use.

Tactics of the tobacco industry in an Arab nation: a review of tobacco documents in Oman.

BACKGROUND: Few studies have investigated tobacco industry interference in the tobacco control policies of Arab nations. This paper explores the tactics used by the industry to subvert tobacco control policies in Oman and offers lessons on how to prevent such interference in the future. METHODS: We searched the Truth Tobacco Industry Documents Archive using the word 'Oman', names of government institutions, policymakers and local tobacco distributors. Extracted data were noted chronologically by key elements of tobacco control measures. Gulf Cooperation Council (GCC) Health Ministers' Council resolutions on tobacco control were also reviewed. RESULTS: Out of 1020 tobacco documents located, 327 were closely related to policy interference. Documents revealed that the industry met key government officials, offered in-kind services, used local diplomatic missions to influence Omani policymakers, opposed smoking bans, delayed regulations to lower tar and nicotine content of cigarettes, and to require effective health warnings, circumvented a tobacco advertising, promotion and sponsorship ban and provided voluntary codes as an alternative to effective regulations. Additionally, industry representatives lobbied individual countries in the GCC to veto tax increments and defeat consensus on agreed resolutions of the Health Ministers' Council. CONCLUSION: The tobacco industry interfered in all key public health policies aimed to reduce tobacco use in Oman. There is an urgent need for the Omani government to enforce the Civil Code of Conduct and develop guidelines for all policymakers through implementing Article 5.3 of the WHO Framework Convention on Tobacco Control to curb the tobacco epidemic.

Does a human rights-based approach to harm reduction support commercialized harm reduction? Brief research.

In recent years, the tobacco industry has been pushing a narrative that their newer lines of products-including electronic nicotine delivery devices-are offered in part to meet a social responsibility of providing potentially reduced-harm choices to their consumers. While some of the newer tobacco products might potentially be less harmful than combustible tobacco products, there is also significant deviation from the very concept of harm reduction when it is used for such a conspicuously commercialized purpose. The framing of commercialized tobacco harm reduction as a mere consumer preference by the industry is not clearly consistent with the core principles of harm reduction, let alone the human right to health and the highest attainable level of health. A human rights-based approach (HRBA) to harm reduction is a set of principles that frame an effort to respect and promote human rights, including the right to health. Whether the HRBA supports commercialized harm reduction requires study. We review industry materials from 2017 to 2022 to identify themes in the harm reduction narrative of the tobacco industry and analyse those themes using an HRBA to the tobacco harm reduction framework. Using this analysis, the industry's continued marketing of combustible products alongside their "potentially less harmful" products, and preference that their non-combustible products be regulated less strictly than cigarettes and cigars, adulterates the public health principles of harm reduction and undermines the right to health. We conclude that the tobacco industry's commercialized tobacco harm reduction is incompatible with a human rights-based approach to tobacco harm reduction.

Overcoming tobacco industry opposition to standardized packaging in the Americas.

Countries in the Region of the Americas have been slow to adopt standardized packaging of tobacco products. The objectives of this analysis are to report on the progress made in adopting such packaging in countries in the Region, review known tobacco industry strategies for opposing these policies and discuss the resources available to academics, advocates and policy-makers who might be interested in advancing the use of standardized packaging in the Region. Of the 23 countries worldwide that have fully adopted standardized packaging laws, only 2 are in the Region (Canada and Uruguay). Six other countries (Brazil, Chile, Costa Rica, Ecuador, Mexico and Panama) have tried to introduce standardized packaging through draft bills, all of which have been delayed or withdrawn. There are indications that the tobacco industry has used its playbook of arguments to oppose the policy in those countries, including allegations that standardized packaging breaches national laws and international treaties protecting intellectual property, alongside threats of litigation. It is possible that these threats and allegations may have had a greater effect in the Region because of the lengthy (6 years) and costly (legal fees of US$ 10 million) international investment arbitration brought by Philip Morris International against Uruguay's strong tobacco packaging laws. However, all of the industry's arguments have been debunked, and national courts and international legal forums have upheld standardized packaging as a lawful policy. Governments in the Region of the Americas should follow the examples of Canada and Uruguay and reject the industry's false arguments and litigation threats. This analysis discusses some of the financial and technical resources that can assist them.

Los países de la Región de las Américas han tardado en adoptar el empaquetado estandarizado de los productos de tabaco. Los objetivos de este análisis son informar sobre el progreso realizado en la adopción de dicho empaquetado en los países de la Región, revisar las estrategias conocidas de la industria tabacalera para oponerse a estas políticas y abordar los recursos disponibles para la comunidad académica, los defensores de la causa y los responsables de formular las políticas que podrían estar interesados en fomentar el uso del empaquetado estandarizado en la Región. De los 23 países de todo el mundo que han adoptado plenamente leyes sobre el empaquetado estandarizado, solo dos se encuentran en la Región (Canadá y Uruguay). Otros seis países (Brasil, Chile, Costa Rica, Ecuador, México y Panamá) han tratado de introducir empaquetados estandarizados mediante proyectos de ley, los cuales han enfrentado demoras o han sido retirados. En esos países hay indicios de que la industria tabacalera ha recurrido a una cartilla de argumentos para oponerse a esta política, como acusaciones de que los empaquetados estandarizados violan las leyes nacionales y los tratados internacionales que protegen la propiedad intelectual, además de amenazas de litigios. Es posible que estas amenazas y alegatos hayan tenido un mayor efecto en la Región debido al largo (6 años) y costoso (costos legales de US$ 10 millones) arbitraje internacional en el ámbito de las inversiones presentado por Philip Morris International contra las fuertes leyes de empaquetado de tabaco de Uruguay. Sin embargo, todos los argumentos de la industria han sido desacreditados, y los tribunales nacionales y los foros jurídicos internacionales han defendido el empaquetado estandarizado como una política legal. Los gobiernos de la Región de las Américas deben seguir los ejemplos de Canadá y Uruguay y rechazar los argumentos falsos y las amenazas de litigio de la industria. En este análisis se examinan algunos de los recursos financieros y técnicos que pueden ayudarlos.

Os países da Região das Américas têm sido lentos em adotar embalagens padronizadas para produtos de tabaco. Os objetivos desta análise são: informar acerca do progresso feito na adoção de tais embalagens nos países da região; revisar as estratégias conhecidas da indústria do tabaco para se opor a essas políticas; e discutir os recursos disponíveis para acadêmicos, defensores e formuladores de políticas que possam estar interessados em avançar no uso de embalagens padronizadas na região. Dos 23 países do mundo que adotaram leis obrigando o uso de embalagens totalmente padronizadas, apenas 2 estão na região (Canadá e Uruguai). Seis outros países (Brasil, Chile, Costa Rica, Equador, México e Panamá) tentaram introduzir embalagens padronizadas por meio de projetos de lei, os quais foram todos adiados ou retirados. Há indícios de que a indústria do tabaco usou seus argumentos habituais ­ incluindo alegações de que embalagens padronizadas violam leis nacionais e tratados internacionais de proteção à propriedade intelectual, além de ameaças de litígio ­ para se opor às políticas nesses países. É possível que essas ameaças e alegações tenham tido um efeito maior na região devido ao longo (6 anos) e dispendioso (US$ 10 milhões em honorários advocatícios) processo de arbitragem internacional iniciado pela Philip Morris International contra as fortes leis de embalagem de produtos de tabaco do Uruguai. Porém, todos os argumentos da indústria foram desmascarados e tanto os tribunais nacionais como fóruns jurídicos internacionais decidiram em favor da embalagem padronizada como política legal. Os governos da Região das Américas deveriam seguir os exemplos do Canadá e do Uruguai e rejeitar os argumentos falsos e as ameaças de litígio da indústria. Esta análise discute alguns recursos financeiros e técnicos que podem ajudá-los.

Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women.

BACKGROUND: Women with breast cancer in sub-Saharan Africa are commonly diagnosed at advanced stages. In Tanzania, more than 80% of women are diagnosed with stage III or IV disease, and mortality rates are high. This study explored factors contributing to delayed diagnostic evaluation among women with breast cancer in Tanzania. METHODS: A qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Twelve women with symptomatic pathologically proven breast cancer were recruited. In-depth, semi-structured interviews were conducted in Swahili. Interviews explored the women's journey from symptom recognition to diagnosis, including the influence of breast cancer knowledge and pre-conceptions, health seeking behaviors, psychosocial factors, preference for alternative treatments, and the contribution of culture and norms. Audio-recorded interviews were transcribed and translated into English. Thematic analysis was facilitated by a cloud-based qualitative analysis software. RESULTS: All women reported that their first breast symptom was a self-identified lump or swelling. Major themes for factors contributing to delayed diagnostic presentation of breast cancer included lack of basic knowledge and awareness of breast cancer and misconceptions about the disease. Participants faced barriers with their local primary healthcare providers, including symptom mismanagement and delayed referrals for diagnostic evaluation. Other barriers included financial hardships, fear and stigma of cancer, and use of traditional medicine. The advice and influence of family members and friends played key roles in healthcare-seeking behaviors, serving as both facilitators and barriers. CONCLUSION: Lack of basic knowledge and awareness of breast cancer, stigma, financial barriers, and local healthcare system barriers were common factors contributing to delayed diagnostic presentation of breast cancer. The influence of friends and family also played key roles as both facilitators and barriers. This information will inform the development of educational intervention strategies to address these barriers and improve earlier diagnosis of symptomatic breast cancer in Tanzania.

Tobacco industry's human rights makeover: an archival review of British American Tobacco's human rights rhetorical veneer.

BACKGROUND: British American Tobacco (BAT) released an industry-first human rights report in 2020, which extolled the efforts and objectives of the tobacco industry giant for promoting human rights. How BAT came to brand itself as a human rights champion, being a leader in an industry long accused of enabling human rights violations from leaf-to-stub including profiting from a product which inherently violates the right to health, is unknown. Exploring BAT's evolution through reviewing its materials and Tobacco Industry Documents could shed light on their development and what it means in the tobacco control and human rights context. METHODOLOGY: We reviewed publicly available materials from BAT as well as conducted archival research in the Tobacco Industry Documents digital archives at University of California San Francisco. We focused on how and when BAT used terms such as 'human rights', 'right to health', 'sustainable development goal' and 'harm reduction' as well as 'Framework Convention on Tobacco Control'. RESULTS: We reviewed 48 BAT publications and 45 documents from the Tobacco Industry Documents archives. These materials demonstrate both BAT's increasing utilisation of human rights language as well as BAT's reuse of the same language, concepts and general rhetoric. BAT has not engaged significantly or meaningfully on the human right to health. CONCLUSION: BAT's increasing use of human rights rhetoric does not appear to reflect a shift in the company's human rights positions, particularly with respect to the right to health of consumers and BAT's lack of impactful measures to eliminate the harms of its tobacco products.

Tobacco industry presence and practices in Mozambique: a 'chaotic' but worthy market.

BACKGROUND: Mozambique has experienced a series of tobacco industry consolidation both in tobacco leaf buying and processing, and in cigarette manufacturing and marketing. The growth of the tobacco industry presence in Mozambique was followed by an increase in tobacco industry's Corporate Social Responsibility (CSR) activities. This is the first paper to describe the history of tobacco industry activities in Mozambique, a party to the WHO Framework Convention on Tobacco Control (FCTC). METHODS: We reviewed industry documents and associated web-based information. Industry documents (1990-2021) were identified through University of California San Francisco's Truth Tobacco Industry Documents Library. We followed with a search of web-based sources pertaining to the tobacco industry in Mozambique. We complemented our analysis with select media sources to identify statements by government officials in relation to the tobacco industry. We mapped major tobacco industry players, industry partnerships and corresponding CSR activities. RESULTS: Tobacco production increased substantially in Mozambique in the 1990s when tobacco companies began targeting African countries. The increased attention to tobacco production, trade and sales in Mozambique was coupled with greater industry involvement in CSR activities. We identified 10 tobacco industry CSR programmes in Mozambique. Most of the CSR programmes focus on health including HIV/AIDS, social issues and environmental issues. CONCLUSIONS: Similar to other tobacco-growing countries, the industry facilitated an increase in tobacco production and continues efforts to increase the tobacco consumption market while engaging in CSR activities focused on social and environmental issues. As in other countries, CSR initiatives in Mozambique enhance industry's reputation. Importantly, these CSR programmes and partnerships breach national laws and the provisions of the FCTC. The continuation of these programmes suggests limited attention within government to protect public policy from industry interference in compliance with Article 5.3 of the FCTC.

Is It Possible to Solve the Conflicts Over Conflict of Interest? Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Addressing conflicts of interest (COIs) when developing and implementing policies to address commercial determinants of health is pivotal to ensure that these policies are free from commercial and other vested interests of unhealthy commodities industry. As a concept, this is well accepted within the tobacco control community, and supported by the existence of an international treaty, the WHO Framework Convention on Tobacco Control (FCTC). But in nutrition policy the engagement of the food industry appears to remain controversial, as efforts to create partnerships are still underway. There is a need to undertake evaluation of existing COI policies to assess their implementation and outcomes, creating best practice models that can be replicated, and understanding how to change norms within governments. Additionally, a review of existing norms, codes of conduct, and ethics to determine their impact on preventing COI would guide future implementation of these measures. Finally, governments, academics, and advocates should consider how existing tools, guidelines or other instruments could help frame the COI discussion to ensure its political feasibility. There is a need for a discussion on whether the current approach of separate policies for distinct industries is preferable than a broader COI policy that would be applicable to a wide range of unhealthy commodities and across governmental sectors.