EXAMINING TOBACCO CONTROL POLICIES IN THE GULF COOPERATION COUNCIL COUNTRIES

Abstract

Tobacco use remains a significant issue in the Gulf Cooperation Council countries (GCC), a political and economic union consisting of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Tobacco is responsible for 11.6% and 5.3% of mortalities among men and women, respectively, and causes US$ 34.5 billion financial loss. Tobacco use is expected to slightly decline in GCC countries by 2025, except in Oman, where tobacco use is expected to increase. In GCC countries, tobacco use is influenced by similar socio-cultural and environmental factors acting independently or interacting with other factors. In 2006, the six GCC countries ratified the Framework Convention on Tobacco Control (FCTC) treaty, which was developed by the World Health Organization. The FCTC is composed of evidence-based policies that address environmental and behavioral factors. While FCTC policies have shown a positive effect in many countries, little is known about the impact of the FCTC in GCC countries. Given the past influence of the tobacco industry in culturally and politically connected countries, it becomes necessary to examine tobacco use in the GCC region to prevent the initiation of use and reduce the economic burden associated with tobacco use. The goal of this study was to examine the impact of tobacco control policies on preventing tobacco use among youth in the GCC countries. The study used a mixed-method approach to investigate tobacco control policies. The specific aims of the study were: 1) evaluate the implementation of FCTC measures in the six GCC countries at the national level; 2) examine the relationship between youth susceptibility to initiate tobacco use and key FCTC provisions in five GCC countries; and 3) investigate the occurrence of tobacco use in Arabic media to assess compliance with the FCTC provision on banning tobacco advertisement, promotion, and sponsorship in the GCC region. The longitudinal review of tobacco control measures in the six GCC countries between 2008 and 2020 showed progress in implementing measures related to tobacco packaging, smoking cessation, and tobacco sale to minors in most GCC countries while much less progress in implementing measures related to tobacco prices and taxes and eliminating illicit tobacco trade. Examining the self-reported intention to initiate tobacco use by youth indicated that a person’s susceptibility to begin tobacco use statistically declined over time from the pre- to post-FCTC ratification in Bahrain (15.6% in 2002 to 8.9% in 2015) and Qatar (11.3% in 2004 to 7.3% in 2018), while it increased in the UAE (4.9% in 2002 to 9.3% 2013). Consistent with previous literature, exposure to smoking in public places and tobacco marketing activities increased susceptibility to initiate tobacco use among youth at a statistically significant level. In contrast, exposure to anti-tobacco education in media statistically reduced susceptibility. Finally, the in-depth examination of incidents of tobacco use in Arabic media showed a total of 32,084 incidents of tobacco use in 92 TV series broadcasted between January 2017 and December 2019, suggesting that on-screen tobacco use has not been completely banned in Arabic media. The findings of this study should lead to more collective action in the region. Policymakers should dedicate more efforts to address environmental factors that influence tobacco use, and anti-tobacco advocacy groups should enhance youth engagement in tobacco control activities. Policy surveillance remains the ultimate solution to assess the impact of legal intervention in health outcomes and amend interventions when unintended consequences occur. Future research should continue tracking tobacco control measures at the national and local levels and share policy surveillance data across countries to better assist with the decision-making process. Researchers should examine the implementation process and enforcement activities related to tobacco control policies. Moreover, it is critical to understand the history of the influence of the tobacco industry in the GCC region and examine the current activities of the tobacco industry in order to counter them effectively. Mixed methods research may be an optimal option for researchers to examine the cause-effect relationships and uncover gaps that hinder tobacco control policies from addressing the issue.