Understanding the dynamics of compliance to smoke-free policy regulations: Exploring the perspectives of venue owners and staff in Türkiye.

INTRODUCTION: The study aims to understand the facilitators and barriers associated with enforcing and complying with Türkiye's smoke-free policy from the perspective of hospitality venue owners and employees. METHODS: A qualitative open-ended survey was conducted in Istanbul and Ankara in 2021 with 58 respondents from 3 different districts in each city from four types of venues: restaurants, traditional coffee and waterpipe houses, and European-style cafés. The open-ended survey included questions to understand the knowledge, beliefs, and attitudes of respondents about Türkiye's smoke-free policy and their perceptions of the facilitators and/or barriers to smoke-free policy implementation and changes after COVID-19. The data were analyzed using an inductive approach to identify patterns and categorize the data into themes. RESULTS: The respondents expressed that the smoke-free policy aimed to protect employees and customers from secondhand smoke (SHS), respect human health, and improve air quality. Findings suggest that the positive attitude of venue owners and staff toward the smoke-free policy serves as a facilitator. However, fear of financial impact, customers' negative attitudes, difficulties in meeting physical requirements, and insufficient enforcement were found to be barriers to implementing the smoke-free policy. The effects of the COVID-19 pandemic were reported as an initial increase in compliance and awareness among customers and staff, but some respondents noted negative changes due to the emotional and financial effects of prolonged restrictions. These challenges have led to decreased attention on the smoke-free policy among venue owners, staff and customers. Respondents' suggested improvements were related to building infrastructure, such as the ventilation systems and educating the public on the harmful health effects of smoking. CONCLUSIONS: Despite the general understanding of the dangers of secondhand smoke and the smoke-free policy, this study highlights the challenges in implementing smoke-free policy measures and the continued need to raise awareness about the importance of a 100% smoke-free venue. A comprehensive approach to addressing the tobacco epidemic as a multifaceted public health issue is essential.

Addressing a gap: a qualitative analysis of Scotland's Drowning and Incident Review process.

OBJECTIVES: Drowning is a leading cause of fatalities worldwide and Scotland carries a disproportionate number of drownings compared with its UK neighbours. Drowning data captured in Scotland are often incomplete and the Drowning and Incident Review (DIR) is a new process designed to help improve the capture of data and help inform future preventative measures. The aim of this study was to explore the perspectives and views of key stakeholders on the facilitators and barriers of implementing the DIR as well as areas for its future sustainability. METHODS: A qualitative approach was used with in-depth interviews using key participants. Participants were identified using purposive sampling, through use of a stakeholder analysis. Participants watched a hypothetical DIR and then participated in a semistructured interview. Questions focused on DIR facilitators, barriers and areas for future sustainability. Qualitative data were then analysed using thematic analysis. RESULTS: A total of 14 participants took part in the study. Results found: three facilitator themes (addresses a gap, design of DIR, safe space), four barrier themes (representation, resource, legal concerns, control concerns) and four areas for future sustainability (the voluntary nature, framework agreement, political prioritisation and the human element). These themes were then discussed within this paper in relation to findings from research on similar review processes. CONCLUSION: The research was the first of its kind and the findings are therefore extremely important to provide a first exploration and insight into facilitators and barriers of the DIR as well as areas for its future sustainability.

Are E-Cigarette and Tea Cigarette Gifting Behaviors Associated with Tobacco Use and Failed Quit Attempts in China?

This study aims to investigate e-cigarette and tea cigarette gifting in China and their influencing factors, as well as to explore whether they were associated with tobacco use and cessation. Using a multistage sampling design, 1512 household heads from Guangdong and Shaanxi provinces were recruited for the study and filled out an online questionnaire about smoking status, social participation, e-cigarette, and tea cigarette gifting. Results showed that more than 30% and nearly 3% of participants had been gifted tea cigarettes and e-cigarettes, respectively. Marital status, province of residence, smoking status, and social participation were associated with gifting behaviors. Logistic regressions showed that receiving e-cigarettes (OR = 3.43, p < 0.05) and tea cigarettes (OR = 1.70, p < 0.01) were related to tobacco use. Smokers who have received e-cigarettes (OR = 9.85, p < 0.01) and tea cigarettes (OR = 1.92, p < 0.05) were also less likely to quit smoking.

How independent is the international food information council from the food and beverage industry? A content analysis of internal industry documents.

BACKGROUND: The International Food Information Council (IFIC) and its partner foundation (IFIC Foundation) widely disseminate nutrition information and participate in relevant policymaking processes. Prior research has established a connection between IFIC and large food and beverage companies, representing a potential conflict of interest. The authors reviewed public records documents to investigate the connection between IFIC and industry, and to describe how IFIC communicates policy-relevant information about nutrition science to the public. METHODS: The research team collected communications between IFIC and members of the research and policymaking communities by using state and federal transparency laws. The team analyzed the content of these documents with a commercial determinants of health framework while allowing for new themes to emerge, guided by the broad analytic questions of how and why does IFIC communicate nutrition information to policymakers and the broader public? RESULTS: IFIC employs self-designed research and media outreach to disseminate nutrition information. Communications from IFIC and its affiliates related to nutrition information fell within major themes of manufacturing doubt and preference shaping. CONCLUSIONS: IFIC uses media outlets to preemptively counter information about the negative health impacts of added sugars and ultra-processed foods, and promotes a personal-responsibility narrative about dietary intake and health. IFIC and its affiliates disseminate a narrow subset of nutrition and health information consistent with corporate interests and in opposition to public health policies associated with improved population health.

The political and social contexts of global road safety: challenges for the next decade.

The goal of this Series paper is to show how road safety has evolved as a global public health issue over the past two decades and to discuss the political and economic dynamics that led to this change. Specifically, the key stakeholders, influences, networks, issue framing, actor power, and synergistic interactions that have contributed to how road safety has evolved as a global public health issue will be discussed. In doing so, we capture the important chronology of events and discuss a set of challenges that highlight the complexity of road safety. We posit that the global road safety community needs to re-evaluate its role and strategy for the next decade and focus more on implementation and country action to achieve reductions in road traffic injuries. We call for an open and inclusive process to ensure that such a reflection occurs before the end of the current decade.

Understanding why collective action resulted in greater advances for tobacco control as compared to alcohol control during the Philippines' Sin Tax Reform: a qualitative study.

BACKGROUND AND AIMS: In 2012, the Philippines passed a law popularly known as the 'Sin Tax Reform'. This law increased excise tax on both tobacco and alcohol. While a victory for public health, the total amount of taxes paid by the tobacco and alcohol industries was an uneven 69-31 split. The primary aim of this study is to explore why collective action of Sin Tax proponents resulted in greater advances for tobacco control as compared with alcohol control. METHODS: A case study approach was used. Key informant interviews were carried out with 25 individuals from academic, governmental, non-governmental and international organisations and industry who had first-hand knowledge of the Sin Tax policy process, led an organisation that participated in the process and/or possessed expert knowledge of Sin Taxes in the Philippines. Interviews were subsequently transcribed then analysed using inductive coding. RESULTS: Four factors contributed to the varying tax treatment of the two industries: (1) absence of advocacy-oriented alcohol control groups, (2) the proponents' 'divide and conquer' strategy, which aimed to prevent the alcohol and tobacco industries from joining forces, (3) the perception that moderate drinking is acceptable among some of the Sin Tax proponents, public and medical community and (4) a weaker global push for alcohol control. CONCLUSIONS: Our findings suggest the need to cultivate advocacy-oriented alcohol control civil society organisations, generate consensus at the local and global level regarding the problem definition and policy solutions for alcohol control and consider global instruments to strengthen norms and standards for alcohol control. Given that proponents also negotiated for a lower alcohol tax compared with tobacco due to the concern that the two industries might join forces, it also raises the question of whether or not a health tax bill should tackle more than one health harming product at a time.

Smoker characteristics and trends in tobacco smoking in Rakai, Uganda, 2010-2018.

INTRODUCTION: Tobacco use is a major public health concern, particularly in low- and middle-income countries where 80% of the world's smokers reside. There is limited population-based data from rural Africa on patterns of tobacco smoking and smoker characteristics. We assessed trends in rates of smoking, characteristics of smokers, and factors associated with smoking using repeat population-based cross-sectional surveys in south-central Uganda. METHODS: Data accrued over five survey rounds (2010-2018) of the Rakai Community Cohort Study (RCCS) from consenting individuals aged 15-49 years including sociodemographic and behavioral characteristics and smoking status. Proportions of smokers per survey were compared using χ2 test for trends, and factors associated with smoking were assessed by multivariable logistic regression. RESULTS: The prevalence of tobacco smoking in the general population declined from 7.3% in 2010-2011 to 5.1% in 2016-2018, p<0.001. Smoking rates declined among males (13.9-9.2%) and females (2.2-1.8%) from 2010-2011 to 2016-2018. Smoking prevalence was higher among previously married (11.8-11.7%) compared to currently (8.4-5.3%) and never married persons (3.1-1.8%) from 2010-2011 to 2016-2018. Older age (≥35 years) was associated with higher odds of smoking (AOR=8.72; 95% CI: 5.68-13.39 in 2010-2011 and AOR=9.03; 95% CI: 5.42-15.06 in 2016-2018) compared to those aged <35 years (AOR=4.73; 95% CI: 3.15-7.12 in 2010-2011 and AOR=4.83; 95% CI: 2.95-7.91 in 2016-2018). Primary and secondary/higher education level was significantly associated with lower odds of smoking (AOR=0.20; 95% CI: 0.14-0.29 in 2010-2011 and AOR=0.26; 95% CI: 0.18-0.39 in 2016-2018) compared to no education (AOR=0.43; 95% CI: 0.31-0.59 in 2010-2011 and AOR=0.48; 95% CI: 0.34-0.68 in 2016-2018). Number of sexual partners and HIV status were not associated with smoking. CONCLUSIONS: We observed declining trends in tobacco smoking in the Rakai region of rural Uganda. Smoking was more prevalent in men, older individuals, individuals who were previously married, and individuals with lower education. The decline in smoking may be due to tobacco control efforts, but there is a continued need to target sub-populations with higher smoking prevalence.

The alcohol industry's involvement with road safety NGOs.

BACKGROUND: Road crashes are a major cause of death among all age groups and the leading cause of death among persons 5-29 years, according to the World Health Organization. One key risk factor is drink-driving. While the world's leading beer, wine, and spirit producers have pledged to combat drink-driving, there is increasing evidence showing the alcohol industry's promotion of solutions which minimally impact sales. One strategy is forming partnerships with road safety non-governmental organizations (NGOs). Given this, the primary objective of this study is to understand the extent to which the alcohol industry is involved with road safety NGOs around the world. METHODS: A desk review from July 2020 to March 2021 was conducted to assess the alcohol industry's involvement with various road safety NGOs (n = 256) in 92 countries. Financial documents press releases, annual reports, social media platforms, and other resources were analyzed to uncover relationships between the alcohol industry and NGOs. RESULTS: Out of 256 NGOs, n = 11 (4%) showed direct ties to the alcohol industry, and n = 3 (1%) showed indirect ties. NGOs involved with the alcohol industry were found in five continents and n = 8 of the 11 NGOs (73%) partnered with transnational alcohol manufacturers. Interventions supported by these partnerships were primarily mass media campaigns, free-ride and ride-sharing campaigns, and drink-driving educational events where alcoholic or zero-percent alcoholic beverages were sold or provided. These interventions are largely inconsistent with evidence-based best practice recommendations. Relationships between the alcohol industry and road safety NGOs lacked public transparency on key details such as terms of partnerships and funding amount and terms. CONCLUSIONS: The study showed a clear effort on behalf of the alcohol industry to partner with road safety NGOs around the world. Findings underscore the need for the road safety community to generate consensus on involvement of the alcohol industry and suggest the need for more transparency on details of partnerships involving road safety. Findings also highlight the importance of local and national government support of road safety initiatives and road safety NGOs to avoid dependence on controversial funding from the alcohol industry.

Compliance with smoke-free policies at indoor and outdoor public places: an observational study in Pakistan.

BACKGROUND: In 2002, the Government of Pakistan implemented a national law governing the use of tobacco products. The law included smoke-free policies banning smoking in all public places, and required no-smoking signage to be displayed at all such venues. Compliance with smoke-free policies is imperative, as it protects the health of nonsmokers. Almost two decades later, efforts to assess compliance with smoke-free policies in Karachi have been lacking, with only one study conducted in 2016. AIMS: To investigate smoke-free compliance across public places in Karachi, the most populous city in Pakistan. METHODS: A cross-sectional observational study was conducted in the east and south districts of Karachi between October and December 2019. Data pertaining to evidence of smoking (observed smoking, cigarette butt litter, and display of ashtrays/ similar instruments), the presence of designated smoking areas/rooms (DSAs/DSRs), and the display and location of no-smoking signage were collected via direct observations. Results are reported using descriptive statistics. RESULTS: Observations were conducted at 1704 indoor and outdoor public venues. Among the sample, 972 (57%) were compliant with the composite indicator assessing evidence of smoking. DSAs were observed at 104 (6%) places and DSRs at 16 (1%) places. No-smoking signage was displayed at the main entrance of 104 (6%) places and inside 174 (10%) places. CONCLUSION: Compliance with smoke-free policies is lacking in Karachi. Enhanced efforts by enforcement agencies and venue managers are needed to establish 100% smoke-free public places across Karachi.

Multisectoral action coalitions for road safety in Brazil: An organizational social network analysis in São Paulo and Fortaleza.

OBJECTIVE: This research was conducted to explore the nature of multisectoral action for road safety in Brazil. In an effort to improve the implementation of complex interventions, we sought to characterize the relationships and exchange patterns within a network tied to the Bloomberg Initiative for Global Road Safety (BIGRS) in Fortaleza and São Paulo, Brazil. METHODS: We conducted an organizational social network analysis based on in-person surveys and key informant interviews with 57 individuals across the two cities from August to October 2019. Survey data included network dimensions such as the frequency of interaction, perceived value of interaction, resource sharing, coordination, data/research sharing, practical guidance, and access to decision makers. We coded and analyzed interview transcripts according to network properties of structure, governance, development, and outcomes, as well as in situ codes that emerged from the data. RESULTS: We found differences in all network properties between road safety networks in Fortaleza and São Paulo. Fortaleza was characterized by a centralized, dense, and relatively new network, whereas São Paulo was larger, diffuse, diverse, and established. Government agencies were central in both networks, but an international nongovernmental organization (NGO) was highly central in Fortaleza and a local NGO was highly central in São Paulo. Few actors on the periphery of both networks were connected to one another or decision makers, which revealed sectors to engage for enhancing network connectivity. Finally, politics were understood to be key in facilitating network activity, data (especially their integration and transparency) were considered to be influential for decision making, and strategic planning was acknowledged as a central concern for network expansion and fluidity. CONCLUSIONS: Multisectoral action for road safety can be reinforced by carefully disentangling the social dynamics of implementation. Organizational social network analysis, supplemented with interview data, can provide a deeper explanation for how members behave and understand their work. In this way, research can help build a collective identity and impetus to action on road safety, contributing to a healthier and more equitable world.

Seven-year tobacco tax plan in Ukraine: a case study of the actors, tactics and factors motivating policy passage.

OBJECTIVE: In December 2017, the Ukrainian Rada passed legislation that would increase tobacco taxes for the next 7 years to meet requirements of the European Union-Ukraine Association Agreement (EU-UAA). We analysed factors motivating passage of Ukraine's 7-year tobacco tax plan as well as tactics used by both opponents and proponents to describe how the plan was passed. DESIGN: A case study approach was used. Data were gathered from semistructured interviews (n=12) and document review (n=24) and analysed using inductive and deductive coding. RESULTS: The European Union-Ukraine Association Agreement, a significant budget deficit and a history of tobacco tax success were all contextual factors contributing to policy passage. Proponents of high tobacco taxes capitalised on this opportunity, using media advocacy, generating scientific evidence and collaborating effectively across multiple sectors to support the passage of the plan. Opponents used media advocacy and lobbied to water down several features of the plan, resulting in smaller increases that might not meet EU-UAA requirements. CONCLUSION: Industry interference via lobbying continues to hamper passage of high tobacco taxes and should be addressed via legislation that aligns with Article 5.3 of the Framework Convention on Tobacco Control. Proponents should look for windows of opportunity caused by external events, create a multisectoral coalition, including tax experts and use media advocacy to support tax increases. Further work should continue to document what contextual factors support tobacco control policy change.

Strategies to expand corporate autonomy by the tobacco, alcohol and sugar-sweetened beverage industry: a scoping review of reviews.

BACKGROUND: Noncommunicable diseases contribute to over 70% of global deaths each year. Efforts to address this epidemic are complicated by the presence of powerful corporate actors. Despite this, few attempts have been made to synthesize existing evidence of the strategies used to advance corporate interests across industries. Given this, our study seeks to answer the questions: 1) Is there an emergent taxonomy of strategies used by the tobacco, alcohol and sugar-sweetened beverage (SSB) industries to expand corporate autonomy? 2) How are these strategies similar and how are they different? METHODS: Under the guidance of a framework developed by Arksey and O'Malley, a scoping review was carried out whereby six databases were searched in June 2021 to identify relevant peer-reviewed literature. To be included in this review, studies had to explicitly discuss the strategies used by the tobacco, alcohol, and/or sugar-sweetened beverage multinational corporations and be considered review articles aimed to synthesize existing evidence from at least one of the three industries. Eight hundred and fifty-eight articles were selected for full review and 59 articles were retained for extraction, analysis, and categorization. RESULTS: Results identified six key strategies the industries used: 1) influencing government policy making and implementation, 2) challenging unfavorable science, 3) creating a positive image, 4) manipulating markets, 5) mounting legal challenges, and 6) anticipating future scenarios. Despite these similarities, there are few but important differences. Under the strategy of influencing government policy making and implementation, for example, literature showed that the alcohol and SSB industries have been "privileged with high levels of participation" within international public health organizations. CONCLUSIONS: Understanding how industries resist efforts to control them is important for public health advocates working to reduce consumption of and death and diseases resulting from harmful commodities. Moreover, there is a greater need for the public health community to generate consensus about how to ethically engage or not engage with industries that produce unhealthy commodities. More studies are also needed to build the evidence base of industry tactics to resist regulation, particularly in the case of SSB, and in low-and middle-income countries.

Evidence attack in public health: Diverse actors' experiences with translating controversial or misrepresented evidence in health policy and systems research.

Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.

Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China.

The primary aims of this study are to examine the associations between two key environmental factors-regional cigarette tobacco production and tobacco retail outlet density-and secondhand smoke (SHS) exposure in urban China and to explore the possible mechanisms that explain this association. METHODS: A cross-sectional multistage sampling design was used to collect individual information in 21 cities in China. Environmental variables were retrieved from national databases. Multilevel logistic regression analysis was conducted to examine the associations between regional cigarette tobacco production, tobacco retail outlet density and SHS exposure. Structural equation modelling was employed to determine possible mechanisms. RESULTS: SHS exposure prevalence defined as daily exposure to SHS for at least 15 min/day at the time of the survey was found to be 28.1% among non-smokers (95% CI 27.1 to 29.0) across the 21 cities. The multilevel logistic regressions showed that province-level per capital cigarette production (OR: 2.72 (95% CI 1.56 to 4.76)and per GDP cigarette production(OR:1.69(95% CI 1,42,2.01), and city-level tobacco retail outlet density (OR: 2.66 (95% CI 1.63 to 4.38)) were significantly associated with SHS exposure. Moreover, results showed that these associations may be explained by the level of tobacco advertisement, which influences social norms, including attitudes and behaviours toward SHS exposure. CONCLUSIONS: Findings shed light on the role of cigarette manufacturers and retailers in producing environmental SHS pollution. To address the health and economic burden associated with SHS in China, it will be critical for the Chinese government to enact tobacco control measures consistent with the Framework Convention for Tobacco Control. Efforts should also focus on restricting the permitted density of tobacco retail outlets, and tobacco production in China.

Reflections on benefits and challenges of longitudinal organisational network analysis as a tool for health systems research and practice.

As health systems practitioners and researchers increasingly turn towards systems thinking approaches and work on building interorganisational networks, they have demonstrated increasing interest in network analysis for investigating relationships and interactions between system actors, both at the individual and organisational levels. Despite the potential of network-based approaches to improve health system efficiency, effectiveness and responsiveness, both the theoretical and practical guidance on designing and evaluating network-building strategies is underdeveloped within the field. While there are multiple tools and resources to help users collect, manage and analyse network data, there is much less guidance on the practical applications of this information. One apparent gap is the limited application of longitudinal organisational network analysis, in which data are collected from the same organisational actors repeatedly over multiple time points. This yields insights into the dynamic nature of networks, including how the network structure and interactions change over time. Given that networks are rarely static, the addition of the time dimension has the potential to substantially enhance the analytical value of network analysis and contribute to more nuanced guidance for interested practitioners and policymakers. In this article, the authors draw on their experiences in conducting longitudinal network analysis of interorganisational relationships in the USA and India to comment on the opportunities and challenges of the methodology within the field of health systems research. We also provide suggestions as to how some of these challenges may be addressed or mitigated.

The battle to increase tobacco taxes: Lessons from Philippines and Ukraine.

INTRODUCTION: While increasing taxes on tobacco is one of the most effective tobacco control measures, its adoption has been slow compared to other tobacco control policies. Given this, there is an urgent need to better understand the political and economic dynamics that lead to its adoption despite immense tobacco industry opposition. The primary aim of this study is to explore the process, actors, and determinants that helped lead to the successful passage of the 2012 Sin Tax Reform Law in the Philippines and the 2017 seven-year plan for tobacco tax increases in Ukraine. METHOD: Under the guidance of the Advocacy Coalition Framework, we used a case study approach gathering data from key informant interviews (n = 37) and documents (n = 56). Subsequently, cross-case analysis was undertaken to identify themes across the two cases. RESULTS: We found that external events in the Philippines and Ukraine triggered policy subsystem instability and tipped the scale in the favor of tobacco tax proponents. In the Philippines, elections brought forth a new leader in 2010 who was keen to achieve universal health care and improve tax collection efficiency. In Ukraine, the European Union Association Agreement came into force in 2017 and included the Tobacco Products Directive requiring Ukraine to synchronize its excise taxes to that of the European Union. Exploiting these key entry points, tobacco tax proponents formed a multi-sectoral coalition and used a multi-pronged approach. In both countries, respected economic groups and experts who could generate timely evidence were present and used local as well as international data to counter opponents who also used an array of strategies to water down the tax policies. CONCLUSIONS: Findings are largely consistent with the Advocacy Coalition Framework and suggest the need for tobacco tax proponents to 1) form a multi-sectoral coalition, 2) include respected economic groups and experts who can generate timely evidence, 3) use both local data and international experiences, and 4) undertake a multi-pronged approach.

Enforcement agencies and smoke-free policy compliance: An observational study in Qingdao, China.

INTRODUCTION: In recent years, tobacco control policy initiatives have emerged at the subnational level in China. In 2013, for example, Qingdao enacted a 100% smoke-free policy that gave regulatory authority to multiple enforcement agencies. Given that little is known about the extent of smoke-free policy compliance in smaller Chinese cities, this study assessed compliance with Qingdao's Tobacco Control Regulation and whether compliance differed by enforcement agency. METHODS: A cross-sectional observational study was undertaken between October and November 2018. Venues were selected based on enforcement agency and included restaurants, retail stores, schools, government buildings, hospitals, business offices, and other hospitality venues. Comprehensive lists of venues were identified where they existed, and a random sample of venues were subsequently selected. For venue categories for which there were no comprehensive lists, a walking protocol was used. Observational data included evidence of smoking, the presence of no-smoking signage, and designated smoking areas (DSAs). Descriptive statistics were obtained. Subsequently, logistic regression models were used to determine the association between enforcement agency and policy compliance. RESULTS: A total of 694 venues were observed. For all venue types, 64.7% were compliant with the composite indicator 'evidence of smoking'. Findings also showed that smoke-free compliance varied by enforcement agency (p<0.001). Venues with evidence of smoking and not posting of no-smoking signs at the main entrance were lowest among venues that fall under Public Security Bureau. Compliance with posting no-smoking signs inside was lowest in venues that fall under the Industry and Commercial Administration (I&C). While Qingdao's smoke-free policy prohibits DSAs, our findings showed that 2% of venues that fall under the jurisdiction of I&C had DSAs. CONCLUSIONS: An effective coordination mechanism that can ensure a consistent and standardized approach is urgently needed in Qingdao. With such a concerted effort, it will be possible to achieve the target of 100% smoke-free indoor places in Qingdao.

'It has candy. You need to press on it': young adults' perceptions of flavoured cigarettes in the Philippines.

BACKGROUND: The Philippines has a high smoking prevalence and one of the largest tobacco menthol market shares in the world. Flavour capsule cigarettes were introduced to the Philippines in 2013, most of which are menthol flavoured, and their market share is increasing. We explored perceptions of flavoured cigarette packaging among young adult Filipinos. METHODS: We conducted eight focus groups with 63 young adults ages 18-24 years in Manila in 2019, stratified by gender and smoking status. We conducted a thematic analysis of the transcripts. RESULTS: Most participants assessed relative harm of cigarettes based on strength, mainly determined by colour of the packaging. Menthol cigarettes with primarily blue packaging were considered less harmful than menthol cigarettes with primarily green packaging. Many participants considered flavour capsule packs most attractive, compared with non-flavoured and traditional menthol cigarettes, due to the colouring of the packs and expectations regarding taste. Some participants likened the capsules and the taste of flavour capsule cigarettes to candy, and many participants thought flavour capsule cigarettes would most likely be smoked by teenagers or young adults. CONCLUSIONS: Young adult Filipinos believe that some menthol-flavoured cigarettes are less harmful than other flavoured cigarettes and non-flavoured cigarettes and find flavour capsule cigarettes attractive. A tobacco flavour ban and implementation of plain packaging might help reduce misperceptions of risk and make cigarettes less appealing.

Drink, but don't drive? The alcohol industry's involvement in global road safety.

Drink-driving is a major cause of global road traffic fatalities, yet few countries have laws that meet international best practices. One possible reason is the alcohol industry's opposition to meaningful policies that are perceived to directly threaten sales. Our primary objectives are to document alcohol industry involvement in global road safety policies and programmes and to critically evaluate the responses of public health and road safety communities to this involvement. Under the guidance of the Policy Dystopia Model, we used a mixed methods approach in which data were gathered from expert interviews and a mapping review of 11 databases, 5 watchdog websites and 7 alcohol industry-sponsored initiatives. Triangulation was used to identify points of convergence among data sources. A total of 20 expert interviews and 94 documents were analysed. Our study showed that the alcohol industry acknowledges that drink-driving is an issue but argues for solutions that would limit impact on sales, akin to the message 'drink-but do not drive'. Industry actors have been involved in road safety through: (1) coalition coupling and decoupling, (2) information production and management, (3) direct involvement in policymaking and (4) implementation of interventions. Our study also shed light on the lack of cohesion within and among the public health and road safety communities, particularly with regard to the topics of receiving funding from and partnering with the alcohol industry. These results were subsequently used to adapt the Policy Dystopia Model as a conceptual framework that illustrates the ways in which the alcohol industry has been involved in global road safety. Several implications can be drawn from this study, including the urgent need to increase awareness about the involvement of the alcohol industry in road safety and to build a cohesive transnational alcohol control advocacy alliance to curb injuries and deaths related to drink-driving.