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Tobacco kills 5 million people annually. By the mid 2020s, that figure will increase to about 10 million a year, with most of the deaths occurring in developing countries. This review explains how early technological and regulatory developments contributed to the epidemic, reveals the efforts of the tobacco industry to conceal its products' harmfulness, and stresses the role of the globalization of trade and marketing as a means of increasing consumption world-wide. The results of tens of thousands of studies published globally over the past 50 years point to an association between smoking and lung cancer and other adverse health effects, and the non-smoker's rights movement has exposed the wide-spread perils of 'secondhand' smoke. Yet, the tobacco industry continues its global expansion, and consumers in low- and middle-income countries are especially susceptible to its marketing tactics. This review ends by emphasising the need for a global public-health response, and identifies the Framework Convention on Tobacco Control as a significant effort. It stresses the need for accelerated action and innovative tobacco-control efforts, if the projected death toll is to be reduced in this century. [ABSTRACT FROM AUTHOR]

The article informs that the adoption of the Framework Convention on Tobacco Control (FCTC) by World Health Organization in 2003 marked a critical achievement in efforts to stem the global tobacco epidemic. The FCTC negotiations raised the political profile of tobacco as a global public health problem, improved awareness among policy makers, and resulted in an agreed upon agenda for action. In the long run, the FCTC will only be successful in countries that have strong and durable capacity in tobacco control. Countries need the capability to implement the treaty's obligations and to respond to the unintended consequences of increased national and international regulation of tobacco products. National tobacco control capacity refers to the indigenous capability of countries to develop and deliver comprehensive, multi-sectoral action so as to provide the appropriate prevention and control strategies to reduce tobacco use in their countries.

Background: Air pollution is a known risk factor for non-communicable diseases that causes substantial premature death globally. Rapid urban growth, burning of biomass and solid waste, unpaved sections of the road network, rising numbers of vehicles, some with highly polluting engines, contribute to the poor air quality in Kampala., Objective: To provide evidence-based estimates of air pollution attributable mortality in Kampala city, with focus on ambient fine particulate matter (PM 2.5 )., Methods: We utilized a time series design and prospectively collected data on daily ambient PM 2.5 concentration levels in micrograms per cubic meter (μg/m 3 ) using a Beta Attenuation Monitor (BAM-1022) in Kampala city, Uganda. We combined the PM 2.5 data with all-cause mortality data obtained from the Uganda Bureau of Statistics and the Ministry of Health in Kampala. We calculated attributable risk estimates for mortality using the WHO AirQ+ tools., Results: Overall, the annual average concentration for PM 2.5 for the period of 4 years, 2018-2021, was 39 μg/m 3 . There was seasonal variation, with the rainy season months (March-June and October-December) having lower values. PM 2.5 concentrations tend to be highest in the morning (09.00 h) and in the evening (21.00 h.) likely due to increased vehicular emissions as well as the influence of weather patterns (atmospheric temperature, relative humidity and wind). Saturday has the most pollution (daily average over 4 years of 41.2 μg/m 3 ). Regarding attributable risk, we found that of all the deaths in Kampala, 2777 (19.3%), 2136 (17.9%), 1281 (17.9%) and 1063 (19.8%) were attributable to long-term exposure to air pollution (i.e., exposure to PM 2.5 concentrations above the WHO annual guideline of 5 μg/m 3 ) from 2018 to 2021, respectively. For the 4 years and considering the WHO annual guideline as the reference, there were 7257 air pollution-related deaths in Kampala city., Impact: Our study is the first to estimate air pollution attributable deaths in Kampala city considering the target as the WHO annual guideline value for PM 2.5 of 5 μg/m 3 . Our monitoring data show that fine particulate matter air pollution in Kampala is above the WHO Air Quality Guideline value, likely resulting in substantial adverse health effects and premature death. While further monitoring is necessary, there is a clear need for control measures to improve air quality in Kampala city., (© 2024. The Author(s).)

Competing Interests: Competing interests: None declared.

Background: Drowning is a major cause of death in Uganda, especially among young adults with water-based occupations and livelihoods. Information about drowning and other water-related deaths and injuries is limited. To address this gap in knowledge, study partners assessed knowledge, attitudes and beliefs about drowning and drowning prevention interventions in the Mayuge district of eastern Uganda., Methods: This study consisted of a mixed-methods, cross-sectional community health assessment. Research was conducted in 10 landing sites of 6 subcounties within Mayuge district bordering Lake Victoria and focused on 505 head-of-household interviews, 15 key informant interviews, 10 landing site observations and 3 focus group discussions with 10 young adults each., Results: While landing site observations revealed high lake use, households reported limited community drowning prevention knowledge and revealed risky behaviours and attitudes towards water safety. Less than one-third (30.9%) of participants reported that at least one family member can swim. 64.2% of all respondents reported no existing safety measures (eg, signage, fences) around the lake and 95.8% reported no aquatic emergency response system in their community. The majority of households (85.7%) had experienced a drowning incident in their area. Key informants and focus group participants were eager for community-based interventions and offered solutions that reflected international drowning prevention recommendations., Conclusions: The results reveal gaps in services, access and knowledge and highlight a need for water safety services and interventions in lakeside communities in Uganda and throughout the Lake Victoria Basin., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia., Methods: In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment., Discussion: Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits., Trial Registration: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807., (© 2024. The Author(s).)

Purpose: This study evaluated adolescents' mental health their knowledge, attitudes, and beliefs about mental health conditions, and their access to critical mental health services in Lira District, northern Uganda. The political history of the region, the epicenter of the decades-long conflict between the Lord's Resistance Army and the Ugandan government, makes for an interesting case study of the political and social determinants of mental health of those directly impacted by conflict, and on subsequent generations growing up in post-conflict communities., Methods: This paper presents the results of a community-based participatory research study carried out by youth public health ambassadors in Lira District, Uganda. The study consisted of a mixed methods cross-sectional survey of households, schools, and healthcare facilities., Results: The study found 66% of adolescents indicated poor well-being and possible symptoms of depression and 41% of adolescents reported at least 4 childhood trauma events. Over 35% reported feeling extremely sad and 60% reported feeling socially isolated during the COVID lockdowns that lasted from 2020 to 2021. Nearly half of the adolescents aged 14-17 surveyed (N = 306) believed that witchcraft caused mental health problems, while less than 20% believed that traumatic experiences could be a cause. Forty percent of respondents had no idea of where to seek mental health care, and few facilities had mental health services available., Discussion: These findings illustrate the need to study the political and social determinants of mental health, especially on those directly impacted by armed conflict and for the generations growing up in post-conflict communities as they seek to rebuild., (© 2023. The Author(s).)

Despite a growing body of research outlining the harms of thirdhand smoke (THS), the public remains generally unaware of risks and exposure routes. This project built on past tobacco prevention campaigns and the tenants of McGuire's input-output model to implement and evaluate a seven-month Facebook-disseminated campaign seeking to improve THS awareness among California adults ( n = 1087). Multilinear regression showed that THS-related knowledge ( χ 2 [6] = 19.31, p < .01), attitude ( χ 2 [6] = 13.88, p < .05), and efficacy ( χ 2 [6] = 13.81, p < .05) significantly increased by the campaign's end, with messages highlighting children's health ( r = .110, p < .05), pets ( r = .145, p < .01), and dust reservoirs ( r = .144, p < .01) as the most persuasive. Path analysis modeling found campaign recall to be associated with changes in knowledge ( β  = .161, p < .01), which predicated attitude change ( β  = .614, p < .001) and, in turn, behavior change ( β  = .149, p < .05). Findings suggest social media campaigns should continue to educate diverse populations about new tobacco risks and that tobacco control advocates should consider integrating educational THS messages.

Background: Education and training in global health and social justice is crucial to ensuring the next generation of health professionals are poised to tackle the pressing issues of our time., Objectives: To develop and implement an intensive summer course on global health and social justice for high school students at the University of Southern California., Methods: This paper reviews the course aims and curriculum, its implementation both onsite and online, and reports on student course evaluations and long-term student outcomes., Results: Student satisfaction with the program was extremely high, which endured when the course went virtual during the COVID-19 pandemic. The most popular elements of the course included interactive, game-based activities and guest speakers. Many students reported that the course motivated them to pursue higher education and careers in global health or related fields., Conclusions: More universities should consider offering summer programs or other extension programs targeting high school students in order to meet the increasing demand for global health education. Recommendations for implementing global health courses for younger learners include having an interdisciplinary focus with a range of topics and diverse perspectives; provision of scholarships to allow low-income students and students from abroad to participate; prioritizing the integration of active learning and experiential educational opportunities; and incorporating debriefing and reflection as integral parts of learning.

Background: Previous research in high-income countries (HICs) has shown that smokers reduce their cognitive dissonance through two types of justifications over time: risk minimizing and functional beliefs. To date, however, the relationship between these justifications and smoking behaviors over time has limited evidence from low- and middle-income countries. This study examines these of justifications and their relation to quitting behavior and intentions among smoking tobacco users in India., Methods: The data are from the Tobacco Control Policy (TCP) India Survey, a prospective cohort of nationally representative sample of tobacco users. The respondents include smoked tobacco (cigarettes and bidi) users (n = 1112) who participated in both Wave 1 (W1; 2010-2011) and Wave 2 (W2; 2012-2013) surveys. Key measures include questions about psychosocial beliefs such as functional beliefs (e.g., smoking calms you down when you are stressed or upset) and risk-minimizing beliefs (e.g., the medical evidence that smoking is harmful is exaggerated) and quitting behavior and intentions at Wave 2., Findings: Of the 1112 smokers at W1, 78 (7.0%) had quit and 86 (7.8%) had intentions to quit at W2. Compared to W1, there was a significant increase in functional beliefs at W2 among smokers who transitioned to mixed use (using both smoking and smokeless tobacco) and a significant decrease among those who quit. At W2, smokers who quit held significantly lower levels of functional beliefs, than continuing smokers, and mixed users ((M = 2.96, 3.30, and 3.93, respectively, p < .05). In contrast, risk-minimizing beliefs did not change significantly between the two waves. Additionally, higher income and lower functional beliefs were significant predictors of quitting behavior at W2., Conclusion: These results suggest that smokers in India exhibit similar patterns of dissonance reduction as reported in studies from HICs: smokers who quit reduced their smoking justifications in the form of functional beliefs, not risk-minimizing beliefs. Smokers' beliefs change in concordance with their smoking behavior and functional beliefs tend to play a significant role as compared to risk-minimizing beliefs. Tobacco control messaging and interventions can be framed to target these functional beliefs to facilitate quitting., (© 2022. The Author(s).)

Introduction: This study sought to provide essential tobacco control tools by testing the reliability and validity of new self-report scales developed to assess thirdhand smoke (THS) (ie, toxic tobacco residue) related knowledge, attitudes, and behavior (KAB)., Aims and Methods: Items for the KAB scales were adapted from established secondhand smoke (SHS) measures, reviewed to support face validity, and tested in a longitudinal online survey evaluating THS health messages. Participants were California adults at risk of THS exposure. For 7 months, the three KAB scales were completed monthly, and data from the first (n = 1086), third (n = 315), and seventh (n = 301) month surveys were used in these analyses., Results: All three scales demonstrated consistent reliability and single-factor loading at all three timepoints for knowledge (αrange: .87-.90), attitude (αrange: .84-.87), and behavior (αrange: .80-.86). Similarly, analyses supported scale convergent validity (scale correlations rrange: .45-.85; all p values <.001), discriminant validity between smokers and nonsmokers (knowledge Cohen's drange: .57-.61, all p values <.001; attitude Cohen's drange: .78-.82, all p values <.001; behavior Cohen's drange: .90-.99, all p values <.001), and predictive validity (range R2KAB: .41-.48; all p values <.001)., Conclusions: KAB scales about THS provide new opportunities for tobacco control advocates and scholars to identify gaps in knowledge, misperceptions, and obstacles to behavior change in order to guide the design of novel tobacco control policies and interventions., Implications: Numerous scales have been vetted as reliable and valid measures for assessing SHS-related KABs. Currently, standard measures of THS KABs are not available. This study tested three THS scales to fill this gap. The present findings provide tobacco control advocates, scholars, and practitioners tools for assessing KABs related to THS. This information is critical to development, implementation, and evaluation of novel tobacco control strategies., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Externalities, such as air pollution and increased occupational hazards, resulting from global trends in climate change, rapid industrialization, and rapidly increasing populations are raising global concerns about the associated health risks. The Global Environmental and Occupational Health Hub for Eastern Africa was established to address some of these problems at national and regional levels through focused training and applied research that would yield evidence supporting policies and investments to mitigate risks of increasing environmental threats throughout the Eastern African region. Emphasis has been placed on air pollution, a leading risk factor for global mortality, accounting for over 7 million premature deaths or 8.7% of the 2017 global mortality burden. Despite the enormous disease burden that air pollution causes, global investment in air pollution monitoring and research capacity building in low-middle and middle-income countries have been inadequate. This study outlines the activities the Hub has undertaken in planning for and carrying out its initial capacity building and building its primary research programs and identifies central lessons that can inform other large global research partnerships., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2021. The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Introduction: The Asia-Pacific is home to 30% of the world's smokers. Additional efforts are needed to reduce negative health impacts of tobacco, including e-cigarettes. The study objectives were to 1. Investigate Asian-Pacific students' knowledge, attitudes, and use of tobacco products; 2. Determine the level of student support for tobacco control policies; and 3. Examine differences in students' attitudes by the strength of national tobacco control policies based on implementation of WHO's MPOWER package, and e-cigarette regulation in their countries., Methods: A total of 1953 students from members of the Association of Pacific Rim Universities in 13 countries completed the online survey. We compared the results by the Fisher-Freeman-Halton test., Results: While about 83% of students had heard of e-cigarettes; only 14.1% had tried them. Students in countries with e-cigarette bans were the least likely to report having experimented with e-cigarettes (8.1%). While the vast majority of students (87.9%) reported having seen health campaigns targeting combustible cigarettes, far fewer (42.5%) had seen any health campaigns targeting e-cigarettes. About 80% of students supported smoke-free campuses, with the most support coming from those in countries with the weakest adoption of MPOWER policies (88.7%) and no e-cigarette regulations (80.4%). Students in countries with the weakest MPOWER policies were also the most likely to support campus bans and government regulation of e-cigarettes., Conclusions: The adoption of tobacco control polices by government may have an impact on e-cigarette smoking behavior among students, and student support for tobacco control, including noncombustible products, is high. Universities should take action by adopting comprehensive tobacco control measures that include e-cigarette regulations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.

Background: Migration has played, and continues to play, an important role in shaping our global economy. As of 2017, there were 258 million international migrants worldwide, over 100 million of whom came from the Asia-Pacific region. Migration is increasingly recognized as a social determinant of health, as migrants often experience vulnerabilities that make them susceptible to a range of negative health outcomes. Addressing the health and human rights concerns of migrants requires concerted and global efforts from many stakeholders, including universities., Methods: The Global Health Program of the Association of Pacific Rim Universities (APRU), a non-profit network of more than 50 universities in the region, is an example of an avenue to foster research, innovation, collaborative engagement, and large-scale advocacy around migration and health. In 2017, a special half-day workshop was held in Manila, convening 167 participants from 10 economies and 21 disciplines. The goal of the workshop was to delineate the role of universities in promoting migrant health and well-being. The global health experts from a diverse set of backgrounds collaboratively developed a policy statement to be used to better address migrant health and human rights. The objective of this paper is to disseminate the policy statement, highlighted specific action items that universities can take to protect and promote migrant health., Results: The Manila Declaration on Migration and Health highlights that universities must ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families. Universities are also urged to capitalize on their educational and research expertise to generate data on migrant experiences and communicate this research to policymakers., Conclusions: This commentary highlights how institutions of higher education can serve as powerful avenues for promoting migrant health and human rights. Universities can play a vital role in building awareness and sensitivity to migrant challenges and needs, as well as helping to develop policy frameworks appropriate to their diverse contexts to guide, promote, and reinforce commitment to migrant rights and health. Universities should also ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families.

Mexico was the first country in the Americas to sign and ratify the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulnerable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

This paper examines whether country implementation of a public health treaty is influenced by the implementation behaviors of other countries to which they have network ties. We examine implementation of the Framework Convention on Tobacco Control (FCTC) adopted by the World Health Organization in 2003 and ratified by approximately 94% of countries as of 2016. We constructed five networks: (1) geographic distance, (2) general trade, (3) tobacco trade, (4) GLOBALink referrals, and (5) GLOBALink co-subscriptions. Network exposure terms were constructed from these networks based on the implementation scores for six articles of the FCTC treaty. We estimate effects using a lagged Type 1 Tobit model. Results show that network effects were significant: (a) across all networks for article 6 (pricing and taxation), (b) distance, general trade, GL referrals, and GL co-subscriptions for article 8 (second hand smoke), (c) distance, general trade, and GL co-subscriptions for article 11 (packaging and labeling), and (d) distance and GL co-subscription for article 13 (promotion and advertising), (e) tobacco trade and GL co-subscriptions for article 14 (cessation). These results indicate that diffusion effects were more prevalent for pricing and taxation as well as restrictions on smoking in public places and packaging and labeling. These results suggest that network influences are possible in domains that are amenable to control by national governments but unlikely to occur in domains established by existing regulatory systems. Implications for future studies of policy implementation are discussed., (Copyright © 2019. Published by Elsevier Ltd.)

Background: A qualitative study of key informant semi-structured interviews were conducted between March and July 2016 in Mexico and India to achieve the following aims: to explore corporations' and stakeholders' views, attitudes and expectations in relation to health, wellness and cancer prevention in two middle-income countries, and to determine options for health professions to advance their approach to workplace wellness programming globally, including identifying return-on-investment incentives for corporations to implement wellness programming., Results: There is an unmet demand for workplace wellness resources that can be used by corporations in an international context. Corporations in India and Mexico are already implementing a range of health-related wellness programs, most often focused on disease prevention and management. A number of companies indicated interest is collecting return on investment data but lacked the knowledge and tools to carry out return-on-investment analyses. There was widespread interest in partnership with international non-governmental organizations (public health organizations) and a strong desire for follow-up among corporations interviewed, particularly in Mexico., Conclusions: As low-and middle-income countries continue to undergo economic transitions, the workforce and disease burden continue to evolve as well. Evidence suggests a there is a growing need for workplace wellness initiatives in low-and middle-income countries. Results from this study suggest that while corporations in India and Mexico are implementing wellness programming in some capacity, there are three areas where corporations could greatly benefit from assistance in improving wellness programming in the workplace: 1) innovative toolkits for workplace wellness initiatives and technical support for adaptation, 2) assistance with building partnerships to help implement wellness initiatives and build capacity, and 3) tools and training to collect data for surveillance as well as monitoring and evaluation of wellness programs.

GLOBALink, a large online network of tobacco control professionals, was active in the promotion of the World Health Organization's Framework Convention on Tobacco Control treaty, an international treaty aimed at reducing the global burden of tobacco-related death and disease. We examined and compared the roles that different countries served in the GLOBALink community during FCTC negotiation and ratification. Previous studies of FCTC ratification found the process adhered to a diffusion of innovation model (Valente et al., 2015). We followed that work by conducting content analyses of discussion messages posted by GLOBALink members representing different countries. Based on the time when they ratified the FCTC, each country was labeled by one of the four adoption stages of the diffusion model and we investigated the amount of shared word use between the different stages. A goodness-of-fit chi-squared test indicated that content was not shared in an expected manner between stages ( χ 2 = 11,856.45, N = 51,447, p < 0.001). A deeper look at the specific words shared between countries within and between adoption stages provided insight into how interactions between certain countries might have served to support the ratification process.

Background: Most people who lack adequate access to surgical care reside in low- and lower-middle-income countries. Few studies have analyzed the barriers that determine the ability to access surgical treatment. We seek to determine which barriers prevent access to cleft care in a resource-limited country to potentially enable barrier mitigation and improve surgical program design., Methods: A cross-sectional, multi-site study of families accessing care for cleft lip and palate deformities was performed in Vietnam. A survey instrument containing validated demographic, healthcare service accessibility, and medical/surgical components was administered. The main patient outcome of interest was receipt of initial surgical treatment prior to 18 months of age., Results: Among 453 subjects enrolled in the study, 216 (48%) accessed surgical care prior to 18 months of age. In adjusted regression models, education status of the patient's father (OR 1.64; 95% CI 1.1-2.5) and male sex (OR 1.61; 95% CI 1.1-2.4) were both associated with timely access to care. Distance and associated cost of travel, to either the nearest district hospital or to the cleft surgical mission site, were not associated with timing of access. In a sensitivity analysis considering care received prior to 24 months of age, cost to attend the surgical mission was additionally associated with timely access to care., Conclusions: Half of the Vietnamese children in our cohort were not able to access timely surgical cleft care. Barriers to accessing care appear to be socioeconomic as much as geographical or financial. This has implications for policies aimed at reaching vulnerable patients earlier.

Background: Despite health system advances, residents of low- and middle-income countries continue to experience substantial barriers in accessing health care, particularly for specialized care such as plastic and reconstructive surgery., Methods: A cross-sectional household survey of patients seeking surgical care for cleft lip and/or cleft palate was completed at five Operation Smile International mission sites throughout Vietnam (Hanoi, Nghe An, Hue, Ho Chi Minh City, An Giang, and Bac Lieu) in November of 2014., Results: Four hundred fifty-three households were surveyed. Cost, mistrust of medical providers, and lack of supplies and trained physicians were cited as the most significant barriers to obtaining surgery from local hospitals. There was no significant difference in household income or hospital access between those who had and had not obtained cleft surgery in the past. Fewer households that had obtained cleft surgery in the past were enrolled in health insurance (p < 0.001). Of those households/patients who had surgery previously, 83 percent had their surgery performed by a charity. Forty-three percent of participants did not have access to any other surgical cleft care and 41 percent did not have any other access to nonsurgical cleft care., Conclusions: The authors highlight barriers specific to surgery in low- and middle-income countries that have not been previously addressed. Patients rely on charitable care outside the centralized health care system; as a result, surgical treatment of cleft lip and palate is delayed beyond the standard optimal window compared with more developed countries. Using these data, the authors developed a more evidence-based framework designed to understand health behaviors and perceptions regarding reconstructive surgical care.

Online networks can serve as a platform to diffuse policy innovations and enhance global health governance. This study focuses on how shifts in global health governance may influence related online networks. We compare social network metrics (average degree centrality [AVGD], density [D] and clustering coefficient [CC]) of Globalink, an online network of tobacco control advocates, across three eras in global tobacco control governance; pre-Framework Convention on Tobacco Control (FCTC) policy transfer (1992-1998), global regime formation through the FCTC negotiations (1999-2005), and philanthropic funding through the Bloomberg Initiative (2006-2012). Prior to 1999, Globalink was driven by a handful of high-income countries (AVGD=1.908 D=0.030, CC=0.215). The FCTC negotiations (1999-2005) corresponded with a rapid uptick in the number of countries represented within Globalink and new members were most often brought into the network through relationships with regional neighbors (AVGD=2.824, D=0.021, CC=0.253). Between 2006 and 2012, the centrality of the US in the network increases significantly (AVGD=3.414, D=0.023, CC=0.310). The findings suggest that global institutionalization through WHO, as with the FCTC, can lead to the rapid growth of decentralized online networks. Alternatively, private initiatives, such as the Bloomberg Initiative, can lead to clustering in which a single source of information gains increasing influence over an online network.

Background: Finding solutions to global health problems will require a highly-trained, inter-disciplinary workforce. Global health education and research can potentially have long-range impact in addressing the global burden of disease and protecting and improving the health of the global population., Methods: We conducted an online survey of twelve higher education institutions in the Pacific Rim that spanned the period 2005-2011. Program administrators provided data on program concentrations, student enrollment and student funding opportunities for 41 public health programs, including those specific to global health., Results: The Master of Public Health (MPH) was the most common degree offered. A growing demand for global health education was evident. Enrollment in global health programs increased over three-fold between 2005-2011. Very few institutions had specific global health programs or offered training to undergraduates. Funding for student scholarships was also lacking., Conclusions: The growing demand for global health education suggests that universities in the Pacific Rim should increase educational and training opportunities in this field. Schools of medicine may not be fully equipped to teach global health-related courses and to mentor students who are interested in global health. Increasing the number of dedicated global health research and training institutions in the Pacific Rim can contribute to building capacity in the region. Faculty from different departments and disciplines should be engaged to provide multi-disciplinary global health educational opportunities for undergraduate and graduate students. New, innovative ways to collaborate in education, such as distance education, can also help universities offer a wider range of global health-related courses. Additional funding of global health is also required.

The Framework Convention on Tobacco Control (FCTC) stands as a landmark approach to addressing a global health problem. It represents the first time the World Health Organization (WHO) used its constitutional right to negotiate an international law and the first time the Member States of WHO agreed to a collective response to chronic, non-communicable diseases. This paper draws lessons from the FCTC's first decade in force and explores what aspects of the FCTC experience can inform future efforts to address other disease epidemics driven by corporate activity, such as alcohol and food.

Today's global tobacco epidemic may represent one of the first instances of the globalization of a noninfectious cause of disease. This article focuses on the first century of the global tobacco epidemic and its current status, reviewing the current and projected future of the global tobacco epidemic and the steps that are in progress to end it. In the United States and many countries of Western Europe, tobacco consumption peaked during the 1960s and 1970s and declined as tobacco control programs were initiated, motivated by the evidence indicting smoking as a leading cause of disease. Despite this policy advancement and the subsequent reductions in tobacco consumption, the global tobacco epidemic continued to grow exponentially in the later years of the twentieth century, as the multinational companies sought new markets to replace those shrinking in high-income countries. In response, between 2000 and 2004, the World Health Organization developed its first public health treaty, the Framework Convention on Tobacco Control, which entered into force in 2005. An accompanying package of interventions has been implemented. New approaches to tobacco control, including plain packaging and single representation of brands, have been implemented by Australia and Uruguay, respectively, but have been challenged by the tobacco industry.

Problem: An estimated two billion people worldwide lack access to adequate surgical care. Addressing surgical disparities requires both immediate relief efforts and long-term investments to improve access to care and surgical outcomes, train the next generation of surgical professionals, and expand the breadth of formative research in the field. While models exist for establishing short-term surgical missions in low- and middle-income countries, far less focus has been placed on models for multi-institutional partnerships that support the development of sustainable solutions., Approach: In 2011, the Global Surgery Partnership (GSP) was founded by an established children's hospital (Children's Hospital Los Angeles), an academic medical center (University of Southern California), and a nonprofit organization (Operation Smile) to build oral cleft surgical capacity in resource-poor settings through education, research, and service., Outcomes: Leveraging the strengths of each partner, the GSP supports three global health education programs for public health graduate students and surgical residents, including the Tsao Fellowship in Global Health; has initiated two international research projects on cleft lip and palate epidemiology; and has built upon Operation Smile's service provision. As of January 2015, Tsao fellows had operated on over 600 patients during 13 missions in countries including China, Vietnam, Mexico, and India., Next Steps: The GSP plans to conduct a formal evaluation and then to expand its programs. The GSP encourages other global health organizations and academic and medical institutions to engage with each other. The partnership described here provides a basic model for structuring collaborations in the global health arena.

Background: Ethiopia produced its Environmental Health Situational Analysis and Needs Assessment (SANA) report in 2010 as part of the global endeavor to characterize and underscore the importance of connecting health and environment. The assessment methods used in SANA 2010 were updated, replicated and used in this SABNA. with a focus on air pollution, occupational safety and health, and climate change., Objectives: The purpose of the review was to examine national policies and identify gaps in regulations and organizational arrangements that determine Ethiopia's ability to mitigate and eventually prevent the health impacts of air pollution, occupational hazards, and climate change., Methods: The national policy and regulatory documents were reviewed. Literature was identified through electronic searches. Hard copies of past reports and policies were reviewed whenever necessary. A semi-structured guideline was used to conduct in-depth interviews aimed at identifying gaps and needs., Results: The Constitution of Ethiopia has policy provisions related to air pollution, occupational safety and health (OSH), and climate change and health. Proclamation No. 300/2002 on Environmental Pollution Control specifies ambient air quality standards and allowable emissions. However, there were no documents that outlined the national or regional strategies that the ministries and agencies could adopt to translate existing policies, legal provisions, or guidelines for air pollution into practical programs. In the same way, a national OSH policy was lacking at the time this review was made on how occupational safety and health should be handled nationally or at lower governing levels as required by the International Occupation Safety and Health and Working Environment Convention No. 155/1981. Ethiopia is a signatory of this Convention., Conclusions and Recommendations: The results of the situational analysis indicate that there are cross-cutting gaps in the various sectors. Among these, addressing the critical shortage of skilled personnel is an urgent priority. Most stakeholders face acute shortages of professionals and poor retention mechanisms. It is therefore important to design interventions that focus on capacity building in, for example, aligning curricula with specific needs of ministries, andequip professionals with the necessary technical skills.In addition, the results indicate that policies and regulations exist in theory, but in practice, there are inadequate implementation strategies to encourage adherence and enforcement of the regulations and policies.

This study applies diffusion of innovations theory to understand network influences on country ratification of an international health treaty, the Framework Convention for Tobacco Control (FCTC). From 2003 to 2014 approximately 90% of United Nations member countries ratified the FCTC. We hypothesized that communication between tobacco control advocates on GLOBALink, a 7000-member online communication forum in existence from 1992 to 2012, would be associated with the timing of treaty ratification. We further hypothesized dynamic network influences such that external influence decreased over time, internal influence increased over time, and the role of opinion leader countries varied over time. In addition we develop two concepts: Susceptibility and influence that uncover the micro-level dynamics of network influence. Statistical analyses lend support to the influence of co-subscriptions on GLOBALink providing a conduit for inter-country influences on treaty ratification and some support for the dynamic hypotheses. Analyses of susceptibility and infection indicated particularly influential countries. These results have implications for the study of policy diffusion as well as dynamic models of behavior change., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)