Naowarut Charoenca

Success Counteracting Tobacco Company Interference in Thailand: An Example of FCTC Implementation for Low- and Middle-income Countries

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face ‘how to’ challenges of implementation. For more than two decades, Thailand’s public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with ‘two faces’, (2) seeking to influence people in high places, (3) ‘buying’ advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

Tobacco control: Lessons learnt in Thailand

This review of legislation, obstacles faced, and challenges to be met, outlines present tobacco control lessons learnt in Thailand. A review of over twenty years of tobacco control experience in Thailand is provided in seven areas including policy formulation and the role of civil society, as well as in essential WHO Framework Convention on Tobacco Control areas. A descriptive, historical review shows how stakeholders, policies and resources were mobilized in Thailand, and what lessons resource-challenged countries might use from the Thai experience.

Determining the burden of secondhand smoke exposure on the respiratory health of Thai children

BackgroundThe impact of secondhand smoke (SHS) on Southeast Asian children’s health has been assessed by a limited number of studies. The purpose of this study was to determine whether in Thailand, pre- and postnatal exposure to SHS is associated with acute lower respiratory conditions in young children.MethodsWe conducted a case control study of 462 children under age five admitted with acute lower respiratory illnesses, including asthma and pneumonia, at a major hospital in Bangkok. We selected 462 comparison controls from the well-child clinic at the hospital and matched them by sex and age. We used a structured questionnaire to collect information about exposure to SHS and other factors. We conducted bivariate and multivariate analyses to identify risk factors for acute lower respiratory conditions.ResultsThe number of cigarettes smoked at home per day by household members was significantly greater among cases. A greater number of household caregivers of cases held and carried children while smoking as compared to controls (26% versus 7%, p <0.05). Cases were more likely to have been exposed to SHS in the household (adjusted OR = 3.82, 95% CI = 2.47-5.9), and outside (adjusted OR = 2.99, 95% CI = 1.45-6.15). Parental lower educational level and low household income were also associated with respiratory illnesses in Thai children under five.ConclusionsThai children who are exposed to SHS are at nearly 4 times greater risk of developing acute lower respiratory conditions. Continued effort is needed in Thailand to eliminate children’s exposure to SHS, especially at home.

Assessment of secondhand smoke in international airports in Thailand, 2013

Objective To assess secondhand smoke (SHS) exposure in Thai international airports using a fine particulate indicator, particulate matter ≤2.5 μm (PM2.5), and to compare with 2012 exposure findings in international airports in the USA. Methods Smoking rooms in the four largest international airports that serve the most travellers and with the most operating designated smoking rooms (DSRs) were monitored using PM2.5 monitoring equipment following an approved research protocol for assessing fine particle pollution from tobacco smoke. Monitoring was conducted inside and just outside DSRs and throughout the airport terminals in all four airports. Altogether 104 samples were taken to assess SHS exposure in four airports. Simultaneous samples were taken multiple times in a total of 11 DSRs available for sampling in the research period. Results Levels of PM2.5 in DSRs were extremely high in all four airports and were more dangerous inside DSRs than in the US airports (overall mean=532.5 vs 188.7 µg/m3), higher outside DSRs than in the US airports (overall mean=50.1 vs 43.7 µg/m3), and at comparable levels with the US airports in the terminals away from DSRs (overall mean=13.8 vs 11.5 µg/m3. Findings show that travellers and employees in or near DSRs in the airports assessed in Thailand are being exposed to even higher levels of SHS than in US airports that still have DSRs. Conclusions Extremely high levels of SHS in and adjacent to DSR show that these rooms are not providing safe air quality for employees and travellers. These high levels of exposure are above those levels reported in US airports and show the need for remedial action to ensure safe air quality in international airports in Thailand.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia

IntroductionIn low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailands comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures.MethodWe used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailands tobacco control community, and an analysis of research productivity.FindingsIn Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support.ConclusionThe evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Three-month effects of Project EX: A smoking intervention pilot program with Thai adolescents

Adolescent smoking is a major public health problem around the world, including Thailand. The current study provides a three-month follow-up evaluation of the Project EX tobacco use cessation program among Thai adolescents. The intervention was tested involving a quasi-experimental trial with 185 smokers, with two program and two control condition schools (within each condition, one school in Bangkok Province and one school in Nakhon Pathom Province). At 3-month follow-up, the intent-to-treat (ITT) quit rate was 23% in the program group and 11% in the standard care control group (p<0.02). The intervention also lowered the level of last 30-day smoking at follow-up among persons who did not quit in the program condition, while no change in level of smoking was reported in the control condition. These results are promising for teen tobacco use cessation programming in Thailand.

Secondhand smoke point-source exposures assessed by particulate matter at two popular public beaches in Thailand

Background Throughout Asia, smoking is commonplace at crowded public beaches. Evidence has clearly shown the dangers of secondhand smoke (SHS) indoors, but no naturalistic studies have determined levels of SHS in outdoor air. Methods We measured SHS exposure at two public beaches in Thailand where families lounge in beach chairs under beach umbrellas. Researchers unobtrusively collected PM2.5 in close proximity to smokers by placing instruments downwind from smokers. We collected 88 samples of second-by-second measurements over 10-min periods. The density of people, smokers and children in each sampling area was also recorded. Results At the two beaches, mean levels were 260 and 504 µg/m3; peak levels reaching up to 716 and 1335 µg/m3. Five of the 88 samples were below the outdoor standard for Thailand of 50 µg/m3. Density counts in sampled zones were up to 4 smokers and 15 children under 12 years of age. Findings show high beach exposures suggesting regulatory protections, especially for children whose exposures can produce multiple health consequences. Conclusions Action should be taken to prohibit smoking on Thai beaches as in other outdoor settings because peak levels of PM2.5 almost always exceeded the outdoor standard in Thailand and pose a danger to health.

Smoking Prevalence Among Monks in Thailand

Previous studies among Buddhist monks in Thailand have reported smoking rates to be as high as 55%. Because 95% of Thais are Buddhist, monks are highly influential in establishing normative behavioral patterns. As the first population-based study on smoking among Buddhist monks in Thailand, this study aims to determine the smoking prevalence in six regions of the country, and to examine smoking knowledge, risk perceptions, behaviors, and associated demographics among full-fledged and novice monks (n = 6,213). Results demonstrated that the overall prevalence for current smoking monks is 24.4% (95% confidence interval [24.453, 24.464]), with regional differences ranging from 14.6% (North) to 40.5% (East). Findings suggest that integrating prevention and cessation programming into religious courses may be one avenue for reaching many incoming monks. Further, involving monks in tobacco control education and setting a nonsmoking standard among them is vital to the success of reducing smoking rates among the general population in Thailand.

Cigarette Waste in Popular Beaches in Thailand: High Densities that Demand Environmental Action

Thailand, like all nations, has a responsibility to initiate environmental actions to preserve marine environments. Low- and middle-income countries face difficulties implementing feasible strategies to fulfill this ambitious goal. To contribute to the revitalization of Thailand’s marine ecosystems, we investigated the level of tobacco product waste (TPW) on Thailand’s public beaches. We conducted a cross-sectional observational survey at two popular public beaches. Research staff collected cigarette butts over two eight-hour days walking over a one-kilometer stretch of beach. We also compiled and analyzed data on butts collected from sieved sand at 11 popular beaches throughout Thailand’s coast, with 10 samples of sieved sand collected per beach. Our survey at two beaches yielded 3067 butts in lounge areas, resulting in a mean butt density of 0.44/m2. At the 11 beaches, sieved sand samples yielded butt densities ranging from 0.25 to 13.3/m2, with a mean butt density of 2.26/m2 (SD = 3.78). These densities show that TPW has become a serious problem along Thailand’s coastline. Our findings are comparable with those in other countries. We report on government and civil society initiatives in Thailand that are beginning to address marine TPW. The solution will only happen when responsible parties, especially and primarily tobacco companies, undertake actions to eliminate TPW.

How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization.

Background Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. Objective In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. Design We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. Results In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. Conclusions Thailands strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.Background Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. Objective In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. Design We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. Results In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. Conclusions Thailands strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.