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BackgroundThe tobacco industry works to block, delay, and weaken national tobacco control legislation to implement the WHO Framework Convention on Tobacco Control (FCTC). This article reviews how Nepal overcame industry opposition and to a comprehensive tobacco control law implementing the FCTC.MethodsWe triangulated newspaper articles and policy documents with key informant interviews.ResultsWith the support of international health groups, local tobacco control advocates worked with policymakers in Nepal to pass a comprehensive tobacco control law that exceeded FCTC obligations. The tobacco industry exploited a time of political transition to block consideration by Parliament, arranged and sponsored foreign tours for legislators, made death threats to tobacco control advocates and their families, and argued for the economic importance of tobacco farms. Despite strong interference from Health, and Law and Justice ministers, a 2009 Supreme Court ruling helped tobacco control advocates secure a comprehensive tobacco control law in 2011 that included rotating pictorial health warning labels covering 75% of both sides of cigarette packages, 100% smoke free public places and workplaces, private homes and vehicles, and a tobacco advertising, promotion, and sponsorship ban.ConclusionsAdvocates in developing countries should utilize Nepal's experience to reject tobacco industry offers of compromise and continue educating politicians and legislators to generate political support to pass a comprehensive tobacco control law. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak (the abstract in Nepali is available as a Supplementary Material).ImplicationsThe tobacco industry exploited a time of political transition in Nepal in its effort to block comprehensive tobacco control policy in Parliament by sponsoring foreign tours of legislatures, making death threats to tobacco control advocates and their families, and arguing for the economic importance of tobacco farms. Tobacco control advocates used litigation to raise awareness and educate legislators and promote strong legislation with the involvement of international health groups. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak.

IntroductionNepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law.Aims and methodsPolicy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM).ResultsThe TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition.ConclusionsBoth tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it.ImplicationsThe PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.

Active and secondhand tobacco exposures are major causes of cancer. Cancer prevention efforts are particularly relevant in resource-constrained settings in which significant barriers to early detection and cancer treatments contribute to poor outcomes. We assess the associations between exposure to household tobacco smoke and cancer morbidity and mortality. We used household data from Afghanistan Demographic and Health Survey, which was a national cross-sectional survey that applied a two-stage stratified random sampling technique in 2015 and 2016. We performed regression analysis to estimate associations between exposure to household tobacco smoke and cancer morbidity and mortality at the household level. Exposure to household tobacco smoke was significantly associated with household reports of a history of any cancer (Adjusted Odds Ratio (AOR): 1.90; 95% Confidence Interval (CI): 1.44, 2.51), breast cancer (1.59; 1.00, 2.55), lung cancer (2.88; 1.58, 5.27), and liver cancer (2.56; 1.10, 5.96), compared to households with no tobacco smoke exposure. These associations persisted after controlling for household location, wealth index, type of cooking fuel used in house, and location of food preparation. Households in a rural location experienced significantly higher mortality of any cancer (4.40; 95% CI: 1.57, 12.38), breast cancer (2.91; 1.02, 8.25), and liver cancer (3.91; 1.29, 11.89) vs. those in an urban location. Exposure to household tobacco smoke is a risk factor for cancer morbidity in Afghanistan. Strategies to implement comprehensive smoking cessation and smoke free housing policies are urgently needed as primary cancer prevention strategy in Afghanistan and comparable resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Child mortality is a public health challenge in developing countries, and exposure to second-hand smoke and prenatal exposure to smokeless tobacco are risk factors for child death. We determined the associations between parental tobacco use and child death under the age of five in eight South and South East Asian countries.Methods: We analysed cross-sectional demographic and health survey data collected between 2005 and 2016, using multiple logistic regressions to estimate the unadjusted and adjusted associations between parental tobacco use and child death, accounting for demographic and economic covariates.Results: Overall prevalence of tobacco smoking was 46.8% for fathers and 2.7% for mothers, smokeless tobacco use was 32.6% for fathers and 7.8% for mothers and any tobacco use was 67.1% for fathers and 10.1% for mothers. Adjusted for demographic and economic covariates, child death was significantly associated with fathers' [odds ratio: 1.10; 95% confidence interval (CI): 1.03, 1.17] and mothers' (1.44; 1.23, 1.70) smoking tobacco, fathers' (1.25; 1.17, 1.34) and mothers' (1.11; 1.00, 1.23) use of smokeless tobacco and fathers' (1.21; 1.13, 1.29) and mothers' (1.24; 1.12, 1.36) use of any tobacco.Conclusions: Both smoked tobacco and smokeless tobacco policies should be aggressively implemented in public places and workplaces in developing countries, because they stimulate voluntary smoke and smokeless tobacco-free policies in homes. [ABSTRACT FROM AUTHOR]