Alaouie Hala, Krishnamurthy Reddiar Sumithra, Tleis Malak, El Kadi Lama, A Afifi Rima, Nakkash Rima
Department of Social and Policy Sciences, University of Bath, Bath, UK.
Independent Researcher, Texcoco, Mexico.
Tob Control. 2022 Mar;31(2):187-197. doi: 10.1136/tobaccocontrol-2021-056550.
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.
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.
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.
Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.
《烟草控制框架公约》（FCTC）为基于证据的减少烟草消费及其疾病负担的政策提供了指导。最近，它为水烟等替代烟草产品提供了指导。水烟吸食在全球普遍存在，应对水烟吸食的政策需要考虑到其作为一种吸烟方式的特殊性。与此同时，越来越多的文献指出，基于证据的烟草控制政策有可能加剧健康不平等。本文更新了之前对水烟烟草政策的全球综述，并增加了一个公平视角来评估其对健康不平等的影响。
我们审查了90个国家中针对水烟吸食的政策，其中包括10个有国有烟草公司的国家；最终分析纳入了47个国家。我们主要依赖无烟儿童组织的烟草控制法律网站，该网站提供全球烟草控制法律的访问。我们根据各国烟草政策对水烟烟草在与FCTC的九项条款相关方面的定义和处理的明确程度进行分类。我们使用PROGRESS（居住地、种族/族裔/文化/语言、职业、性别、宗教、教育、社会经济地位和社会资本）框架进行公平性分析，通过审查每个国家政策中提及的公平性考虑因素，并纳入按公平轴和国家分类的患病率数据（如可获取）。
我们的结果显示，总体上对水烟政策以及此类政策中的公平性关注非常有限，并突出了规范水烟吸食的复杂性。我们建议将公平作为水烟吸食政策和监测的目标。
我们的建议可为全球政策提供参考，以公平地减少水烟吸食及其对健康的影响，涵盖所有人群。
