Waterpipe tobacco smoking legislation and policy enactment: a global analysis

Objective (1) To review how current global tobacco control policies address regulation of waterpipe tobacco smoking (WTS). (2) To identify features associated with enactment and enforcement of WTS legislation. Data Sources (1) Legislations compiled by Tobacco Control Laws (www.tobaccocontrollaws.org). (2) Weekly news articles by ‘Google Alerts’ (www.google.com/alerts) from July 2013 to August 2014. Study Selection (1) Countries containing legislative reviews, written by legal experts, were included. Countries prohibiting tobacco sales were excluded. (2) News articles discussing aspects of the WHO FCTC were included. News articles related to electronic-waterpipe, crime, smuggling, opinion pieces or brief mentions of WTS were excluded. Data Abstraction (1) Two reviewers independently abstracted the definition of “tobacco product” and/or “smoking”. Four tobacco control domains (smokefree law, misleading descriptors, health warning labels and advertising/promotion/sponsorship) were assigned one of four categories based on the degree to which WTS had specific legislation. (2) Two investigators independently assigned at least one theme and associated subtheme to each news article. Data Synthesis (1) Reviewed legislations of 62 countries showed that most do not address WTS regulation but instead rely on generic tobacco/smoking definitions to cover all tobacco products. Where WTS was specifically addressed, no additional legislative guidance accounted for the unique way it is smoked, except for in one country specifying health warnings on waterpipe apparatuses (2) News articles mainly reported on noncompliance with public smoking bans, especially in India, Pakistan and the UK. Conclusions A regulatory framework evaluated for effectiveness and tailored for the specificities of WTS needs to be developed

Smuggling as the “key to a combined market”: British American Tobacco in Lebanon

OBJECTIVES: To understand the strategy of British American Tobacco (BAT) and other transnational tobacco companies (TTCs) to gain access to the Lebanese market, which has remained relatively closed under monopoly ownership and political instability. METHODS: Analysis of internal industry documents, local language secondary sources and industry publications. RESULTS: TTCs have relied on legal and illegal channels to supply the Lebanese market since at least the 1970s. Available documents suggest smuggling has been an important component of BAT's market entry strategy, transported in substantial quantities via middlemen for sale in Lebanon and neighbouring countries. TTCs took advantage of weak and unstable governance, resulting in uncertainty over the Regie's legal status, and continued to supply the contraband trade despite appeals by the government to cease undermining its revenues. Since the end of the civil war in the early 1990s, continued uncertainty about the tobacco monopoly amid political instability has encouraged TTCs to seek a legal presence in the country, while continuing to achieve substantial sales through contraband. CONCLUSION: Evidence of the complicity of TTCs in cigarette smuggling extends to Lebanon and the Middle East where this trade has especially benefited from weak governance and chronic political instability. The regional nature of TTC strategy supports strong international cooperation under the Framework Convention on Tobacco Control to tackle the problem

Energy requirements in multicomponent distillation trains

This thesis is concerned with feasibility of reducing the energy requirement for mtilticomponent distillation processes. Four systems of four component ideal mixtures are considered, using for each system two degrees of recovery (95% and 99.5%) and two configurations I and lI. A mathematical model has been developed to predict the minimum energy sequence for four component mixtures. Because of the difficulties in solving the equations a graphical method is devised to deal with the problem. To develop this method the concept of pseudo-components is invoked, where a 'pseudo-component' is defined as one having predetermined values of the properties required for the design analysis, e.g. K-values, vapour and liquid enthalpies. A prediction design method has been developed for four component ideal systems which enables the optimal sequence to be related for any type of feed, different degree of recoveries and a set of relative volatilities. Energy integration is considered between reboilers and condensers only and then between intermediate heaters and coolers at the pinch points below and above the feed plate, respectively. The concept of non-ideality is introduced. Nonideal systems often occur e.g.industrially significant mixture for such as Ethanol/Water. Their non-ideality makes them energy intensive usually because of the high reflux ratio required. No general solution is possible but two real mixtures are considered, Acetone/Cumene /Phenol and Ethanol/Water. It is shown that the engineering techniques discussed earlier can be used to produce significant savings in energy requirement for the two systems. These techniques are also applied to an industrial system. The first is the separation of light hydrocarbons, in a stabilizer, C3/C4 splitter and Gasoline Splitter. The mixture is nearly ideal in its vapour-liquid equilibrium relationships and again it is shown that considerable energy savings are possible. The conclusions of the work are summarised and suggestions for further studies in this field are provided

The tobacco industry’s thwarting of marketing restrictions and health warnings in Lebanon

AIMS: This article outlines how the tobacco industry has undermined tobacco control efforts in Lebanon since the early 1970s. METHODS: An analysis of online and on-site tobacco industry documents, reviews of newspapers, policy and other documents, and interviews with key policy makers were conducted. RESULTS: Findings reveal how the weakness of tobacco control legislation in Lebanon has been the product of an effective tobacco industry strategy to weaken the content and scope of regulation, and delay adoption and implementation. CONCLUSIONS: The tobacco industry has built and maintained strong alliances that were and are regularly mobilised to effectively oppose regulation. Despite ratification of the World Health Organization Framework Convention on Tobacco Control in 2005, Lebanon's tobacco control track remains weak. Public health professionals and the government should work hard to oppose such tobacco industry tactics

Global health and foreign policy.

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health

Development and evaluation of smoke-free or tobacco-free policies in university settings:A systematic scoping review

We conducted a systematic scoping review to map the available evidence on smoke-free or tobacco-free (SF/TF) university policies globally. We specifically looked at (i) how policies were developed and communicated and (ii) what indicators were used to evaluate their impact. We searched for peer-reviewed literature, published up to January 2020, across 10 multi-disciplinary databases. We followed a duplicate, independent data selection, and charting process. We inductively categorized the studies according to the research design and objective of 'process' and 'impact evaluation'. We identified 75 unique studies across 23 countries conducted between 1993 and 2019. Most studies were conducted in the United States (46/75, 61.3%), were based on quantitative research design and focused on impact evaluations; a third (n ¼ 28) reported both process and impact evaluations (37.3%). Community engagement and multi-channel communication strategies were mostly used to disseminate SF/ TF policies. The impact was determined by a wide range of indicators for knowledge, attitudes and behaviors related to policies. There is a mature, relevant body of literature describing the development and evaluation of SF/TF policies in universities. Future reviews could quantify the impact of the bans and may consider process indicators as moderating factors to explain the potential heterogeneity of results.</p

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Dietary genistein influences function of mouse aorta

Abstract only availableCardiovascular disease is the leading cause of death for men and postmenopausal women in the United States. Estrogen is thought to be cardioprotective. An important action of estrogen is increasing endothelial-dependent vasodilation of coronary arteries. Because of their estrogen-like components and activities, phytoestrogens, especially isoflavones such as genistein found in high concentrations in soy products, are being studied as a potential means to prevent cardiovascular disease and as an alternative to estrogen replacement therapy. In the current study we examined the effects of high dietary genistein on vascular function of mice. Since genistein is considered estrogenic, we hypothesized that genistein also would enhance vasodilation. Mice were divided into three diet groups: standard fed (200 mg genistein), high genistein (600 mg), and genistein-free (0 mg). After being on their respective diets for at least one month, the mice were sacrificed, thoracic aortas were isolated, cleaned of surrounding fat and connective tissue, and then cut into rings to measure contractile capacity. Receptor independent contractility was measured by adding increasing doses of potassium chloride (KCl). Both males and females fed 600 mg genistein showed significantly greater force of contractions at all doses of KCl above 30mM compared to other groups. The 0 mg group exhibited the least amount of tension for all KCl doses. Receptor dependent contractility was measured following increasing concentrations of norepinephrine (NE) in the presence and absence of NG-nitro-L-arginine methyl esther (L-NAME), a nitric oxide synthase (NOS) inhibitor. In the absence of L-NAME contractile responses to NE followed the KCl pattern for diet groups except for the 600 mg male group which was similar to the standard fed males. Therefore, the NE curves were normalized to the maximal KCl force. Normalization of NE to KCl indicated NE responses were similar for all groups except 600 mg males. To evaluate whether endothelial vasodilators alter contractile force mediated by NE, data were collected in the presence of L-NAME. The NE contractile responses with L-NAME were significantly greater than contractility without L-NAME for all groups. NOS contribution to vasodilation was significantly less in males compared to females. In females the contribution of NOS appeared greatest in the 600 mg group compared to other groups. These results show that vasodilation capacity is increased with high genistein (600 mg) diets with females, but not males. Surprisingly genistein significantly increased contractile force to KCl. Possible mechanisms that may underlie genistein effects on KCl contractions include increased L-type calcium currents and/or smooth muscle hypertrophy/hyperplasia.Life Sciences Undergraduate Research Opportunity Progra

Features of the waterpipe tobacco industry: A qualitative study of the third International Hookah Fair [version 1; referees: 1 approved, 1 approved with reservations]

Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structured interviews with representatives of waterpipe companies participating in a trade exhibition in Germany. We used an inductive approach to identify emerging themes. Results: We interviewed 20 representatives and four themes emerged: industry growth, cross-industry overlap, customer-product relationship, and attitude towards policy. The industry was described as transnational, generally decentralized, non-cartelized, with ad hoc relationships between suppliers, distributors and retailers. Ties with the cigarette industry were apparent. The waterpipe industry appeared to be in an early growth phase, encroaching on new markets, and comprising of mainly small family-run businesses. Customer loyalty appears stronger towards the waterpipe apparatus than tobacco. There was a notable absence of trade unionism and evidence of deliberate breaches of tobacco control laws. Conclusion: The waterpipe industry appears fragmented but is slowly growing into a mature, globalized, and customer-focused industry with ties to the cigarette industry. Now is an ideal window of opportunity to strengthen public health policy towards the waterpipe industry, which should include a specific legislative waterpipe framework

Waterpipe tobacco smoking (WTS) control policies:global analysis of available legislation and equity considerations

INTRODUCTION: The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. METHODS: We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation's Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. RESULTS: Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. CONCLUSIONS: Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.</p