World Health Organization, Regional Office for South-East Asia .
Indian J Public Health. 2011 Jul-Sep;55(3):161-8. doi: 10.4103/0019-557X.89944.
This paper examines the social, cultural, economic and legal dimensions of tobacco control in the South-East Asia Region in a holistic view through the review of findings from various studies on prevalence, tobacco economics, poverty alleviation, women and tobacco and tobacco control laws and regulations. Methods were Literature review of peer reviewed publications, country reports, WHO publications, and reports of national and international meetings on tobacco and findings from national level surveys and studies. Tobacco use has been a social and cultural part of the people of South-East Asia Region. Survey findings show that 30% to 60% of men and 1.8% to 15.6% of women in the Region use one or the other forms of tobacco products. The complex nature of tobacco use with both smoking and smokeless forms is a major challenge for implementing tobacco control measures. Prevalence of tobacco use is high among the poor and the illiterate. It is higher among males than females but studies show a rising trend among girls and women due to intensive marketing of tobacco products by the tobacco industry. Tobacco users spend a huge percent of their income on tobacco which deprives them and their families of proper nutrition, good education and health care. Some studies of the Region show that cost of treatment of diseases attributable to tobacco use was more than double the revenue that governments received from tobacco taxation. Another challenge the Region faces is the application of uniform tax to all forms of tobacco, which will reduce not only the availability of tobacco products in the market but also control people switching over to cheaper tobacco products. Ten out of eleven countries are Parties to the WHO Framework Convention on Tobacco Control and nine countries have tobacco control legislation. Enforcement of control measures is weak, particularly in areas such as smoke-free environments, advertisement at the point of sale and sale of tobacco to minors. Socio-cultural acceptance of tobacco use is still a major challenge in tobacco control efforts for the governments and stakeholders in the South-East Asia Region. The myth that chewing tobacco is less harmful than smoking tobacco needs to be addressed with public awareness campaigns. Advocacy on the integration of tobacco control with poverty alleviation campaigns and development programs is urgently required. Law enforcement is a critical area to be strengthened and supported by WHO and the civil society organizations working in the area of tobacco control.
本文从社会、文化、经济和法律等方面综合考察了东南亚地区的烟草控制情况，通过审查各种研究的发现，包括流行率、烟草经济学、扶贫、妇女与烟草以及烟草控制法规和条例。方法是对同行评议出版物、国家报告、世卫组织出版物、关于烟草的国家和国际会议报告以及国家一级调查和研究的结果进行文献回顾。烟草使用一直是东南亚地区人民的社会和文化的一部分。调查结果显示，该地区 30%至 60%的男性和 1.8%至 15.6%的女性使用一种或多种形式的烟草制品。吸烟和无烟烟草形式并存的复杂性质是实施烟草控制措施的主要挑战。贫困和文盲人群中烟草使用的流行率较高。男性高于女性，但研究表明，由于烟草业对烟草产品的密集营销，女孩和妇女的吸烟率呈上升趋势。烟草使用者将其收入的很大一部分用于购买烟草，这使他们及其家庭无法获得适当的营养、良好的教育和医疗保健。该地区的一些研究表明，与烟草使用有关的疾病治疗费用超过了政府从烟草税收中获得的收入的两倍。该地区面临的另一个挑战是对所有形式的烟草适用统一税收，这不仅将减少市场上烟草产品的供应，还将控制人们转向更便宜的烟草产品。该地区的 11 个国家中有 10 个是世卫组织《烟草控制框架公约》的缔约方，9 个国家制定了烟草控制立法。控制措施的执行力度较弱，特别是在无烟环境、销售点广告和向未成年人销售烟草等领域。社会文化上对烟草使用的接受仍然是东南亚各国政府和利益攸关方在烟草控制工作中面临的主要挑战。需要通过开展公众宣传运动来消除咀嚼烟草比吸烟危害小的神话。迫切需要倡导将烟草控制纳入扶贫运动和发展计划。执法是一个关键领域，需要世卫组织和从事烟草控制工作的民间社会组织提供支持和加强。
