The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries.

The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

Correlates of compliance with national comprehensive smoke-free laws.

OBJECTIVE: To explore correlates of high compliance with smoking bans in a cross-sectional data set from the 41 countries with national comprehensive smoke-free laws in 2014 and complete data on compliance and enforcement. METHODS: Outcome variable: compliance with a national comprehensive smoke-free law in each country was obtained for 2014 from the WHO global report on the global tobacco epidemic. Explanatory variables: legal enforcement requirements, penalties, infrastructure and strategy were obtained through a separate survey of governments. Also, country socioeconomic and demographic characteristics including the level of corruption control were included. ANALYSIS: an initial bivariate analysis determined the significance of each potentially relevant explanatory variable of high compliance. Differences in compliance were tested using the exact logistic regression. RESULTS: High compliance with the national comprehensive smoke-free law was associated with the involvement of the local jurisdictions in providing training and/or guidance for inspections (OR=10.3, 95% CI 1.7 to 117.7) and a perception of high corruption control efforts in the country (OR=7.2, 95% CI 1.1 to 85.8). DISCUSSION: The results show the importance of the depth of the enforcement infrastructure and effort represented by the degree to which the local government is involved in enforcement. They also show the significance of fighting corruption in the enforcement process, including the attempts of the tobacco industry to undermine the process, to achieve high levels of compliance with the law. The results point out to the need to invest minimal but essential enforcement resources given that national comprehensive smoke-free laws are self-enforcing in many but not all countries and sectors.

Global youth tobacco surveillance, 2000-2007.

PROBLEM: Tobacco use is a major contributor to deaths from chronic diseases. The findings from the Global Youth Tobacco Survey (GYTS) suggest that the estimate of a doubling of deaths from smoking (from 5 million per year to approximately 10 million per year by 2020) might be an underestimate because of the increase in smoking among young girls compared with adult females, the high susceptibility of smoking among never smokers, high levels of exposure to secondhand smoke, and protobacco indirect advertising. REPORTING PERIOD COVERED: This report includes GYTS data collected during 2000-2007 from 140 World Health Organization (WHO) member states, six territories (American Samoa, British Virgin Islands, Guam, Montserrat, Puerto Rico, and the U.S. Virgin Islands), two geographic regions (Gaza Strip and West Bank), one United Nations administered province (Kosovo), one special administrative region (Macau), and one Commonwealth (Northern Mariana Islands). For countries that have repeated GYTS, only the most recent data are included. For countries with multiple survey sites, only data from the capital or largest city are presented. DESCRIPTION OF SYSTEM: GYTS is a school-based survey of a defined geographic site that can be a country, a province, a city, or any other geographic entity. GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, conducting field procedures, and processing data. GYTS standard sampling methodology uses a two-stage cluster sample design that produces samples of students in grades associated with students aged 13-15 years. Each sampling frame includes all schools (usually public and private) in a geographically defined area containing any of the identified grades. In the first stage, the probability of schools being selected is proportional to the number of students enrolled in the specified grades. In the second sampling stage, classes within the selected schools are selected randomly. All students in selected classes attending school the day the survey is administered are eligible to participate. Student participation is voluntary and anonymous using self-administered data collection procedures. The GYTS sample design produces independent, cross-sectional estimates that are representative of each site. RESULTS: The findings in this report indicate that the level of cigarette smoking between boys and girls is similar in many sites; the prevalence of cigarette smoking and use of other tobacco products is similar; and susceptibility to initiate smoking among never smokers is similar among boys and girls and is higher than cigarette smoking in the majority of sites. Approximately half of the students reported that they were exposed to secondhand smoke in public places during the week preceding the survey. Approximately eight in 10 favor a ban on smoking in public places. Approximately two in 10 students own an object with a cigarette brand logo on it, and one in 10 students have been offered free cigarettes by a tobacco company representative. Approximately seven in 10 students who smoke reported that they wanted to stop smoking. Approximately seven in 10 students who smoked were not refused purchase of cigarettes from a store during the month preceding the survey. Finally, approximately six in 10 students reported having been taught in school about the harmful effects of smoking during the year preceding the survey. INTERPRETATION: The findings in this report suggest that interventions that decrease tobacco use among youth (e.g., increasing excise taxes, media campaigns, school programs in conjunction with community interventions, and community interventions that decrease minors' access to tobacco) must be broad-based, focused on boys and girls, and have components directed toward prevention and cessation. If effective programs are not developed and implemented soon, future morbidity and mortality attributed to tobacco probably will increase. PUBLIC HEALTH ACTION: The synergy between countries in passing tobacco-control laws, regulations, or decrees; ratifying the WHO Framework Convention on Tobacco Control; and conducting GYTS offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco-control policy that can be helpful to each country. The challenge for each country is to develop, implement, and evaluate a tobacco-control program and make changes where necessary.