Implementation of effective cigarette health warning labels among low and middle income countries: State capacity, path-dependency and tobacco industry activity
Open accessAbstract
We investigates the effects of ratifying the WHO Framework Convention of Tobacco Control (FTCT), state capacity, path-dependency and tobacco industry activity on the implementation of effective health warning labels (HWL) on cigarette packs among low and middle income countries (LMIC). Using logistic regression in separate analyses for FCTC Article 11 compliant HWLs and graphic HWLs (GHWL), we found that the odds of FCTC compliance increased by a factor of 1.31 for each year after FCTC entered into force in the country (p < 0.01). The odds of passing GHWLs increased by a factor of 1.46 (p < 0.05) per year after FCTC entered into force. The weaker the capacity of the states were, the less likely they were to have implemented FCTC compliant HWLs (p < 0.05). The countries with voluntary HWLs in 1992 were less likely (OR = 0.19, p < 0.01) to comply with FCTC 21 years later (in 2013). The FCTC has promoted HWL policies among LMICs. Public health regulations require investments in broader state capacity. As the theory of path-dependency predicts voluntary agreements have long lasting influence on the direction of tobacco control in a country. Adopting voluntary HWL policies reduced likelihood of having FCTC compliant HWLs decades later. The fact that voluntary agreements delayed effective tobacco regulations suggests that policymakers must be careful of accepting industry efforts for voluntary agreements in other areas of public health as well, such as alcohol and junk food.
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Properly implemented FCTC policies significantly reduce tobacco consumption.
“Properly implemented FCTC policies significantly reduce tobacco consumption.7–10”
From Role of stakeholders in Nigeria’s tobacco control journey after the FCTC: lessons for tobacco control advocacy in low-income and middle-income countries (2019) · cites this paper as [7]
The Introduction describes health warning labels as an effective policy for decreasing tobacco consumption. But the Methods and Results assess whether countries implemented FCTC-compliant warning labels, not whether implementation significantly reduced consumption. The source therefore supports the claim for warning labels in general, but not its broader assertion about FCTC policies or a measured significant reduction. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe united front between local and international health organisations demonstrates the value of the transnational tobacco control network in combating tobacco industry interference and supporting FCTC implementation, especially in low-income and middle-income countries.
“The united front between local and international health organisations demonstrates the value of the transnational tobacco control network in combating tobacco industry interference and supporting FCTC implementation,139495 especially in low-income and middle-income countries.192057”
From Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International (2018) · cites this paper as [20]
The Introduction links participation in global tobacco control networks to adoption of FCTC-promoted policies, and the Discussion says industry efforts to undermine warning labels can be overcome. The paper studies FCTC-compliant warning labels in low- and middle-income countries, but it does not describe a united front between local and international health organisations or establish that such cooperation countered industry interference. (LLM, conf=0.81)
Experimental — accuracy not yet measuredThe transnational tobacco control network supported the creation of the WHO FCTC and assisted governments in implementing it, which has accelerated the adoption of tobacco control regulations, including pictorial health warning labels on cigarette packages.
“This network supported the creation of the WHO Framework Convention on Tobacco Control (FCTC)15 and assisted governments in implementing it,16–19 which has accelerated the adoption of tobacco control regulations,20–23 including pictorial health warning labels (HWLs) on cigarette packages.24”
From Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International (2018) · cites this paper as [20]
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- Authors
- Hiilamo, H., & Glantz, S. A.
- Affiliations
- University of Helsinki (FI)
- University of California, San Francisco (US)
- Corresponding author
- Glantz, Stanton A.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 124
- Pages
- 241-245
- ISSN
- 0277-9536 (ISSN-L)
- PMC
- PMC4276461
- OpenAlex
- W2036269910
- Cited by
- 58
- References
- 28
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 8 · 2021: 4 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 4
- FWCI
- 11.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Cancer Institute (CA-087472)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- Framework Convention on Tobacco Control, state capacity, path dependence, tobacco industry, low- and middle-income countries, graphic health warnings, voluntary agreements, tobacco control, public health regulation
- MeSH terms
- Smoking Prevention, Developing Countries, Humans, Product Labeling, Global Health, World Health Organization, Tobacco Industry, Tobacco Products
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