03745nas a2200493   4500000000100000008004100001100001700042700001500059700001700074700001700091700002100108700002100129700002000150700001400170700001100184700001800195700001400213700001700227700003000244700001200274700001700286700001600303700001800319700002200337700002300359700002000382700002100402700001800423700002600441700002000467700001500487700001600502700001800518700002900536700001900565700002300584700001300607700001600620245023000636300001200866490000600878520235300884022001403237       2017                            d1 aMcKee Martin1 aChow Clara1 aCorsi Daniel1 aGilmore Anna1 aKruger Annamarie1 aIgumbor Ehimario1 aChifamba Jephat1 aYang Wang1 aWei Li1 aIqbal Romaina1 aMony Prem1 aGupta Rajeev1 aVijayakumar Krishnapillai1 aMohan V1 aKumar Rajesh1 aRahman Omar1 aYusoff Khalid1 aIsmail Noorhassim1 aZatonska Katarzyna1 aAltuntas Yuksel1 aRosengren Annika1 aBahonar Ahmad1 aYusufali AfzalHussein1 aDagenais Gilles1 aLear Scott1 aDiaz Rafael1 aAvezum Alvaro1 aLopez-Jaramillo Patricio1 aLanas Fernando1 aRangarajan Sumathy1 aTeo Koon1 aYusuf Salim00aTobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries.  ae0138170 v73 a<p>
<b>OBJECTIVES: </b>This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio.
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<b>SETTING: </b>545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.
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<b>PARTICIPANTS: </b>Community audits and surveys of adults (35-70 years, n=12 953).
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<b>PRIMARY AND SECONDARY OUTCOME MEASURES: </b>Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models.
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<b>RESULTS: </b>Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had &gt;2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (&lt;5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, &gt;80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was &gt;80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1).
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<b>CONCLUSIONS: </b>This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.
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