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Introduction We found no comprehensive studies on the location of transnational tobacco and leaf company (TTLC) subsidiaries (business entities they control) or the consequences of their presence on health policy. Aims and Methods Here we assess (1) the global reach of TTLCs by mapping their tobacco growing and manufacturing subsidiaries and (2) the relationship between in-country presence of the tobacco industry and their power and interference. Data on subsidiaries were collated through systematic searching for countries' supply chain activities in documents and web pages. Cross-sectional multiple regression analysis was used to assess the association between the number of agricultural and manufacturing TTLCs and the Tobacco Industry Interference score, and the degree to which these were mediated by tobacco control, good governance, and economic importance of tobacco. Results TTLC supply chain activity had global reach. As the number of TTLCs with tobacco growing and manufacturing activities rose, interference increased significantly. Interference was associated with poorer tobacco control. The association with more TTLCs undertaking final product manufacturing was related to higher-value tobacco exports but was not related to tobacco making a bigger contribution to the economy. Conclusions TTLCs continue to control the global tobacco supply chain through their globe-spanning subsidiaries. The presence of TTLCs in a country is associated with political interference. Countries should consider their participation in the tobacco supply chain alongside the understanding that they are likely to cede political power to TTLCs, potentially undermining the health of their populations. Implications Tobacco control research has traditionally concentrated on the demand side of tobacco. Our results lend support to calls for more research on the supply of tobacco. Governments should require tobacco companies to provide detailed, up-to-date information in an easily accessible format on in-country supply chain activities. Policymakers should take the likelihood of political interference in health and environmental policy into account when making decisions about foreign direct investment offered by the tobacco industry. [ABSTRACT FROM AUTHOR]

Background: Many countries have started pursuing tobacco 'endgame' goals of creating a 'tobacco-free' country by a certain date. Researchers have presented models to attain this goal, including shifting the supply of tobacco to a monopoly-oriented endgame model (MOEM), wherein a state-owned entity controls the supply and distribution of tobacco products. Although not designed to end tobacco use, the Regie in Lebanon exhibits some of the key features identified in MOEM and hence can serve as a practical example from which to draw lessons.Methods: We comprehensively review previous literature exploring tobacco endgame proposals featuring a MOEM. We distil these propositions into core themes shared between them to guide a deductive analysis of the operations and actions of the Regie to investigate how it aligns (or does not) with the features of the MOEM.Results: Analysing the endgame proposals featuring MOEM, we generated two main themes: the governance of the organisation; and its operational remit. In line with these themes, the investigation of the Regie led to several reflections on the endgame literature itself, including that it: (i) does not seem to fully appreciate the extent to which the MOEM could end up acting like Transnational Tobacco Companies (TTC); (ii) has only vaguely addressed the implications of political context; and (iii) does not address tobacco growing despite it being an important element of the supply chain.Conclusion: The implementation of tobacco endgame strategies of any type is now closer than ever. Using the Regie as a practical example allows us to effectively revisit both the potential and the pitfalls of endgame strategies aiming to introduce some form of monopoly and requires a focus on: (i) establishing appropriate governance structures for the organisation; and (ii) adjusting the financial incentives to supress any motivation for the organisation to expand its tobacco market. [ABSTRACT FROM AUTHOR]

The article comments on attempts to undermine global public health and cites observations from the World Health Organization (WHO) Framework Convention on Tobacco Control's (FCTC) Conference of Paris (COP) 10. It attributes the tobacco industry's anti-COP stance to risk for profit. It raises concern about the deferral of a decision linked to the regulation of content of tobacco products and tobacco product disclosures. Several organizations have also initiated activities in the run-up to COP.

Background Pictorial health warnings are more effective than text warnings in enhancing motivation to quit and not to start smoking among youth. In Lebanon, packs still have only a very small text warning. The aim of this study was to evaluate the perceived effectiveness of pictorial health warnings on cigarette packs among Lebanese youth. Methods This was a cross-sectional study including school students (n=1412) aged 13-18 years recruited from 28 schools and university students (n=1217) aged 18-25 years recruited from 7 universities. A variety of warnings were adapted from other countries. In all, 4 warnings were tested among school students and 18 among university students. Results All pictorial warnings were considered more effective than the current text warning on messagerelated and impact-related variables, including intentions to quit or not to start smoking among school and university students. Selected examples related to the topranked pictorial warnings are: among male non-smoking school students, 81% agreed that the ‘lung' warning had more impact on their intentions not to start smoking as compared to 57% for the current text warning (p<0.001) with a significant difference compared to the current text warning; among female non-smoking university students, 75% agreed that the ‘economic impact' pictorial had more impact on their intentions not to start smoking with significant difference as compared to 43% for the current text warning (p value=0.001); finally, the ‘heart attack' pictorial resulted in 52% of male university students smokers stating they intended to quit as opposed to 20% for the current text warning (p value=0.019). Conclusions The results of the present study add to the general international literature on the impact of pictorial warnings on youth and young adults. This study is also the first to test a non-health pictorial warning about the negative economic consequences of smoking, and to find that such a warning was effective among specific sociodemographic groups. [ABSTRACT FROM AUTHOR]

The article focuses on the positive response of the Arab youth on the Lancet Commission adolescent health and wellbeing report. The effort of the members of the Arab Youth Health Coalition (AYHC) in taking part of the regional launch of the project at the American University of Beirut in Lebanon, is cited. It also mentions the recognition of the AYHC of the evidences set out by the Commission as an opportunity to prioritize topics for research, intervention and policy in the region.

Objectives: This study measures sociodemographic disparities in perceived effectiveness of pictorial health warnings on cigarette packs. Methods: A cross-sectional study in 2011 tested 20 pictorial warnings among 1517 adults across Lebanon. Participants evaluated the effectiveness of the current text-only warning, and 2 pictorial warnings. Health warnings were thematically grouped. Logistic regression models evaluated associations between the perceived effectiveness of themes and sociodemographic characteristics. Results: Perceived effectiveness of the current warning was 15.0% (95% CI 13.2%-16.9%). All pictorial warnings were perceived to be more effective than the current warning, including those about the long-term consequences of smoking (78.1%, 95% CI 74.9%-81.3%) and second-hand smoke (79.2%, 95% CI 74.3%-84.2%). Men had lower odds of perceiving warnings about dependence and second-hand smoke as being effective (AOR 0.30, 95% 0.14-0.65; AOR 0.22, 95% CI 0.10-0.50, respectively). Older respondents had lower odds of perceiving warnings about reproductive health, but higher odds of perceiving warnings about cessation, as effective (AOR 0.35, 95% CI 0.14-0.88; AOR 3.30 95% CI 1.26-8.64, respectively). Other sociodemographic disparities are described. Conclusions: Pictorial warnings are perceived to be more effective than text-only warnings in Lebanon, and should be implemented considering sociodemographic disparities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco consumption rates in Lebanon are among the highest worldwide. The country ratified the Framework Convention on Tobacco Control in 2005. A law was passed in 2011 which regulates smoking in closed public spaces, bans advertising, and stipulates larger warnings. Despite international evidence confirming that increasing taxation on tobacco products lowers tobacco consumption, no such policy has yet been adopted: a cigarette pack costs on average US$1.50. To date no studies in Lebanon have addressed the welfare and public finance effects of increasing taxes on tobacco products. METHODS: Using the 2005 national survey of household living conditions, we estimate an almost ideal demand system to generate price elasticities of demand for tobacco. Using estimated elasticities and a conservative scenario for expected smuggling, we simulate the consumption and tax revenue effects of a change in the price of tobacco under various tax schemes. RESULTS: Increasing taxes on all tobacco products so as to double the price of imported cigarettes would lower their consumption by 7% and consumption of domestically produced cigarettes by over 90%. Young adults (ages 15-30) are more sensitive: consumption would drop by 9% for imported cigarettes and by 100% for domestic cigarettes. Government revenues would increase by approximately 52%. CONCLUSIONS: The estimated elasticities indicate that an increase in taxes on all tobacco products would lead to a reduction in consumption and an increase in government revenue. Evidence from Lebanon on the effectiveness of increased taxation may help initiate national debate on the need to raise taxes. [ABSTRACT FROM AUTHOR]