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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.

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]

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]

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]

Introduction: Waterpipe tobacco smoking is increasing globally particularly among youth. In Lebanon, the high prevalence of waterpipe tobacco smoking among younger age groups calls for immediate intervention particularly given its negative health effects. To date, such interventions have rarely been implemented or evaluated., Methods: This manuscript describes the process evaluation of a school-based intervention to prevent/delay waterpipe tobacco smoking among 6th and 7th graders (n=844) in Lebanon. Process evaluation documents whether an intervention is implemented as planned, and guides understanding of the relationship between the intervention activities and outcomes. The intervention was carried out over 5 months during 2011-2012 on school premises and during school hours, using a participatory approach. The ten intervention sessions included knowledge, skills and a social promise. The process evaluation assessed fidelity, dose delivered, dose received, reach, satisfaction, and the influence of context. Tools included observation and satisfaction forms, attendance log sheets, focus group discussions, and daily journal entries., Results: The majority of participants (87.2%) attended at least 75% of the sessions. Results indicate high fidelity of implementation; 72.3% of the activities were rated by facilitators to be fully implemented - with high participant satisfaction; 89.5% of children chose a happy face to express their rating of the session. Facilitators rated children's participation as 'positive and active' in 77.9% of the sessions., Conclusions: Main challenges to implementation were contextual at the country and school level, and related to local pro social norms around waterpipe tobacco smoking. The experience of this intervention confirms the critical importance of context in program implementation., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported., (© 2017 Bteddini D.)