Background: Tobacco use is one of the most ubiquitous causes of death and disability worldwide. In sub-Saharan Africa, despite the rising trend the use of tobacco in generally low among adults - less than 10% in men and around 2% in women. As a result the region is viewed as being in the early stages of the four stage tobacco epidemic model. Projections suggest that the tobacco epidemic, if unchecked, can peak in Sub-Saharan Africa in the middle of this century. This offers the public health community an extraordinary opportunity – not only is the epidemic predicted so far in the future, there is knowledge on how to prevent it. The purpose of this study is to (a) research and assess case studies and theoretical frameworks used to guide global collaborative efforts in public health and development; (b) develop, administer, and summarize feedback collected from key stakeholders representing organizations critical in SSA tobacco control efforts; (c) analyze findings and identify gaps in the collective action; recommend opportunities to improve the systematic operations/capacity of all collaborating partners within SSA so that progress and collective impacts are maximized in the future. Methods: Secondary data was first sorted using a comparative, thematic approach to detect themes related to M&E practices at individual (organizational) level and at the group (collective) level. The sorted data was then analyzed using hypothesized content analysis for alignment of individual and group perceptions across the five components necessary for a collaborative effort to achieve a collective impact - shared agenda, shared measurements, mutually reinforcing activities, on-going communications, and support organization. Results: Current practices of M&E are perceived as sub-optimal both at individual and group levels. Even though the secondary data was focused primarily on shared measurements, the mapping of individual and group level perceptions against the five components of collective impact indicates that attributes of the other four components were organically included in the discussion in varied depths. Analysis of perception indicates general willingness to adopt a common monitoring and evaluation framework. Conclusions: A common M&E framework remains a missing component of the collaborative effort striving to prevent the tobacco epidemic in sub-Saharan Africa. It is needed to learn from past successes and challenges and to inform strategy of current and future initiatives so that collaborating organizations are better able seize the unprecedented opportunity of preventing death and suffering from tobacco related illnesses in sub-Saharan Africa. It is important that such an M&E framework be thoughtfully conceptualized within the context of a common agenda, and supported by processes that facilitate mutually reinforcing activities and continuous communication among collaborators.

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BACKGROUND: This study sought to identify factors associated with school personnel’s support for tobacco- free policies in Uganda in 2007 and 2011. METHODS: Data were obtained from the combination of the 2007 (n=515) and 2011 (n=682) Ugandan Global School Personnel Survey (GSPS). Analyses included chi-square statistics and multivariate logistic regression. RESULTS: Of the participants, 92.9% supported the tobacco- free policies and 61.9% (n=727) of the schools had a policy restricting tobacco use within the school premises by personnel and students. However only 52.8% (n=370) of those with school policy reported complete enforcement of the school policy. A greater proportion of non-smokers than smokers were in support of a school policy (94.8% vs. 57.7%; p<0.05). Believing that teacher tobacco use influences student use (OR=8.9; 95% CI= 2.41- 33.47) and supporting increase in price of tobacco products (OR=6.4; 95% CI=1.34- 30.58) were significantly associated with support for policy. Those who supported school tobacco-free policy were also more likely to be of the opinion that tobacco industry should be allowed to sponsor school events (OR=4.4; 95% CI= 1.26- 15.23). CONCLUSIONS: Tobacco control interventions should promote personnel’s enforcement of the policies and raise awareness of Tobacco Industry Advertising Promotion and Sponsorship (TAPS) strategies. / Dissertation (MPH)--University of Pretoria, 2015. / tm2015 / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted

The diploma thesis "Social acceptability of smoking and unintended consequences of tobacco control in the Czech Republic" offers an understanding of the question whether the smokers in the Czech Republic are stigmatized in connection with denormalization strategies, whether and how public policies contribute to them and what their unintended negative consequences on the health of citizens in various forms. Research from a semi-structured in- depth interview with smokers revealed that they perceive that smoking is neither normal nor modern. While there was no stigmatization among respondents, as demonstrated abroad, some elements suggesting stigmatization were present. Some smokers feel that they are negatively perceived by the neighborhood, as manifested by their relatives, as well as negative verbal and nonverbal expressions from the wider environment. The negative consequences of stigmatization in respondents to this research, unlike foreign experiences, did not show up in the social and health spheres and did not imply a significant change in cigarette consumption of a given smoker. The influence of public policies on stigmatization of smokers has also not significantly materialized in this research.

In 2007 Tennessee enacted and implemented the Nonsmoker Protection Act (NSPA) to protect nonsmokers by creating 100% smoke-free restaurants. Several venues were exempted, including age-restricted ones such as bars, and tobacco regulation was preempted. Thus, the NSPA is not equitable smoke free policy (SFP) because it has left vast segments of nonsmokers such as employees and patrons of bars unprotected from second-hand smoke (SHS) exposure and thwarted any local initiative to pursue 100% comprehensive SFPs. While this predisposes these nonsmokers to the health dangers of SHS exposure, it makes the NSPA incompatible with the objectives of the Healthy People 2020 and 2030 as well as goals of the state health plan. In 2021, the American Lung Association graded the NSPA “C,” and the United Health Foundation ranked it 42nd out of 50 states. This project assessed the effects of smoke-free venues across different economic domains through quantitative and qualitative data review to determine the implications for venues exempted by NSPA. By delineating any economic effects of SFP across several economic domains, the quantitative data gleaned from NAICS, Census Bureau, and Tennessee Dept. of Revenue were supplemented with interviews of establishments in Tennessee that voluntarily transitioned to smoke-free environment. A total of 7 such establishments with capacities ranging from 50 to over 69,000 people and number of employees ranging from 6 to over 1300 were interviewed. It was discovered that smoke-free environments have positive economic effects on restaurant establishments in Tennessee. By focusing on the SFP effect on restaurant establishments, the findings can be extrapolated to support the case for 100% smoke-free environments for other hospitality locations such as bars, music venues, and casinos. After analysis of trends for retail sales, number of establishments, employment, and payrolls by size of establishment and Metropolitan Statistical Area, a positive economic effect was identified for majority of these indicators between 2010 and 2019, a 10-year period following restaurants becoming smoke-free. Highlights include: Retail sales in Tennessee eating and drinking establishments increased by 62% The number of restaurant establishments increased by 16% Employment in the restaurant sector increased by 23% The qualitative data from the interviews reinforces these findings, with 100% of respondents supporting smoke-free age-restricted venues in their local communities. Thus, it can be inferred from these Tennessee-specific data with high degree of confidence that other hospitality venues will benefit economically in some way by becoming smoke-free with the following considerations: Provide protections from SHS exposure and health risks to nonsmokers; Do not adversely affect sales or employment in the hospitality, entertainment or sport industries, including bars, hotels and motels, and restaurants; Have strong public support and compliance.

The diploma thesis deals with the ratification process of the WHO Framework Convention on Tobacco Control in the Czech Republic. The proposal of ratification was denied by the Senate of the Parliament of the Czech Republic in 2005 and it was postponed. The debate was renewed in 2011 when the proposal was approved by both chamber of the Parliament of the Czech Republic and subsequently in May 2012 it was signed by the President of the Czech Republic. The thesis investigated different views of Members of Parliament on the ratification of the framework convention. To fulfil the aims of the thesis the Framework analysis method is used. The method reveals the competing frames in 2005 and 2011. Both periods are then compared. The author also tried to understand why the proposal in 2005 was denied and she offered one of the possible interpretations. The thesis is supplemented by chapters which describe the Framework Convention on Tobacco Control and the development of the ratification process. These parts use the interviews made with experts in the research area.

This dissertation consists of three chapters on questions in Environmental Economics, addressing policy and health issues in indoor and outdoor environments. In the first chapter, I explores price and quantity policy solutions to externalities that arise from private decisions made over time, focusing on resource extraction as a specific example. In the U.S., mining causes more pollution than any other single industry. I show how tax policy can optimally address a flow externality associated with resource extraction when the policymaker faces asymmetric information in the short run. Chapter 2 investigates whether ordinary exposure to a common indoor air pollutant—Nitrogen Dioxide (NO₂)—affects respiratory health. About 40 percent of occupied homes in the U.S. use gas stoves for cooking, which produce NO₂ as a byproduct of combustion (US Census, 2006), and peak concentrations in homes may reach above 900 ppb when a gas stove is used for cooking (Dennekamp et al., 2001). Permanent or fatal lung damage occurs at NO₂ concentrations greater than 1000 ppb (Samet and Utell, 1990). Previous studies find mixed evidence of negative effects from indoor NO₂ (Basu and Samet, 1999), but exposure may be endogenous in these analyses. I address this problem by developing a physical model of indoor NO₂ concentrations that depends on ventilation decisions and housing characteristics and estimate it using data from the third wave of the National Health and Nutrition Examination Survey. In every model I consider, I find no significant effects of gas stoves on respiratory outcomes. In the final chapter, I combine data on state and local tobacco control ordinances from Americans for Non-smokers Rights Tobacco US Tobacco Control Laws Database with a sample of 35 million births in the U.S. to examine the impact of smoking bans on birth weight and related outcomes. Using difference-in-difference techniques, I identify the effects of state bans net of local bans, as well as the effects of local bans net of state bans. The results suggest less restrictive bans do more to improve birth outcomes than “100% smokefree” bans do, particularly in urban settings. / text

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p < .001) and between the longer instrument and the single question (Spearman’s rho .65, p < .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas.

<strong>Objective:</strong> This study was designed to inform the development of a web tool to simplify access to and analysis of available evidence for youth tobacco control. This tool will support planning, evaluation and research related to youth tobacco control. Primary objectives were to examine useful functions and characteristics of potential end-users. <br /> <strong>Methods:</strong> A pilot-tested, web-based questionnaire was administered to potential end-users (N=43). A purposeful sample of participants was selected to represent individuals working in youth tobacco control from research, health, and education sectors in Western, Central, and Eastern Regions of Canada. Data were analyzed using frequency calculations and cross-tabulations by sector. Results guided the creation of a prototype. Interviews were conducted with a subset of participants (N=6) to validate the prototype and identify further functions. Data were analyzed using content analysis. <br /> <strong>Results:</strong> Useful functions of the prototype identified varied slightly across sectors. Research participants felt that access to raw data was a useful function. Health sector practitioners were interested in accessing data and creating summary reports of data. Educators were mostly interested in obtaining summary information from data, through reports. Further, health and research participants felt the information resources function was redundant. This research has provided important insights that will guide the development of a functional web tool. <br /> <strong>Implications:</strong> This tool can enable users to identify effective interventions, track the progress of school or health regions relative to benchmarks, and identify high risk schools or communities to target intervention efforts. This tool is an innovative way to maximize the use of available resources to link research, policy, and practice.

Philosophiae Doctor - PhD / Background: Non-communicable diseases (NCDs) continue to rise in South Africa, accounting for 43% of total deaths in 2012. Smoking and a diet high in salt are among the major modifiable risk factors for NCDs that can be addressed through cost-effective policy interventions in the form of regulation or legislation and active multisectoral engagement. Population-based prevalence and mortality data are necessary for monitoring and evaluation such interventions. South Africa has developed a National Strategic Plan for NCDs but there is limited evaluation of NCD policies. Furthermore, there is a need to explore the availability of population-based data and the role that it can play to monitor interventions. Aim: The overall aim of the thesis is to assess the implementation of policies for reducing risk factors for chronic NCDs in South Africa, and to explore the role of population-based data in supporting environmental and policy approaches to prevent NCDs. The thesis will also examine whether there are differences in urban and rural settings in the implementation of tobacco control and salt reduction regulation as well as the barriers to implement the National Strategic Plan for prevention of NCDs. Methods: Multiple methods of data collection were used. A desk review of policies to address NCDs in South Africa was undertaken and semi-structured interviews with the NCD policymakers and managers in two provinces (the Eastern Cape and Western Cape) were undertaken, to explore challenges and successes of implementation of the NSP. The Cross-sectional baseline questionnaire and quantified food frequency data from the PURE study were used to determine the prevalence of smoking and the intakes of sodium and potassium in a selected urban and a rural community. Data collected using a validated community audit tool was used to assess the physical environment related to tobacco as well as questionnaire data from face-to-face interviews about perceptions about tobacco use in the urban and rural communities. Trends in mortality from tobacco related and high salt consumption related conditions together with prevalence data from national health surveys were reviewed to assess the health impact.